环境（environment)

环境（environment)学习目标1．熟悉环境的定义、范围及影响健康的常见环境因素。2．了解环境与护理的关系。3．掌握医院环境中物理环境因素的内容和调节方法，熟悉社会环境因素的内容。4.熟悉人体力学在护理操作中的运用原则。5．掌握各种床单位准备的方法及注意事项：备用床、暂空床、麻醉床和危重病人更换床单位。环境与健康一、环境的含义与范围1、环境的含义围绕着人群的空间及其中可以直接、间接影响人类生活和发展的各种自然因素。2、环境的范围人类的环境分为内环境和外环境。1）内环境人的生理、心理等方面。2）外环境物理环境和社会环境组成。二、环境中影响健康的常见因素（一）物理因素（二）社会因素环境中影响健康的常见因素物理因素社会因素大气吸烟水温度土壤辐射噪声废料室内空气社会经济社会阶层生活方式社会关系卫生服务环境与护理的关系护理的基本任务：减轻痛苦、预防疾病、恢复健康、促进健康南丁格尔曾说过：“症状和痛苦一般认为是不可避免的，并且发生疾病常常不是疾病本身的症状而是其它的症状全部或部分需要空气、光线、温暖、安静、清洁、合适的饮食等”。医疗环境一、医院的物理环境安全性、舒适性、整洁性、安静性1.空间(space)病床间距不少于1米。2．温度(Temperature)病室：18-22℃。新生儿室等：22-24℃。3.湿度(Humidity)50%-60%4．通风(ventilation)5．噪声(Sound)35-45dB（白天）“四轻”：说话轻、走路轻操作轻、关门轻。6.光线(light)日光照射、夜间照明6.装饰(decorate)简洁美观医院的社会环境1、护患关系语言、行为、情绪、工作态度2、患患关系3、医院规则第三节提供舒适安全的环境一、病人床单位及设备患者运送法一、人体力学BodyMechanicsmechanics:howforcesactonbodiesinmotion.centerofgravity:thepointarourndwhichallweightisevenlybalanced.USEYOURLEGMUSCLESYourbackiseasilyinjured.Whether,lifting,pulling,orpushing,bendyourknees--notyourback.Thiswillputpressureonthepowerfullegmuscleswhichcanbetterabsorbit.Alwayskeepyourbackstraight.HOLDOBJECTSCLOSETOYOURBODYTheclosertheobject’sweightistoyourowncenterofgravity(betweenyourhipswhenyouarestandingupstraight)theeasieritwillbetomaintainbalanceandtransferpressuretolegmuscles.Leaning倾斜orreaching拉伸willstrain扭伤backandothermuscles.护士操作时应靠近操作物护士在操作中，应该根据实际需要两脚前后或左右分开，以扩大支撑面。降低重心。KEEPHIPSANDSHOULDERSSQUARE（直）Facetheobjectwithhipsandshoulderssquared,whetherlifting,pushing,orpulling.Whenyouturn,pivot转动yourfeetinsteadoftwistingatthewaist.Thiswillhelpyoukeepyourbalanceanddistributetheweightoftheobjectevenly均匀.三、患者床单位的准备（一）患者床单位的设备患者床单位的准备为了给病人提供安全舒适的环境，铺床法是重要的方法之一。由于病人大多数时间均在病人单位内活动，因此必须注意病人单位的整洁与安全。Theconditionofthepatient'sbedisanimportantelementinhisorherexperienceofhospitalcare.Bedrestisapartofmanytreatmentsandallpatientsspendalargeamountoftimeinbed,evenifonlytosleep.Aneat,clean,andwell-madebedprovidescomfortandpreventsanumberofproblems.Theconditionofthebedcanhavephysicalandpsychologicaleffectsuponapatient.Apoorlymadebedcanirritateapatient'sskinandleadtobedsores.Abedcontaminatedbybodyfluidscanhelpspreadcontagiousdisease.Sloppyorsoiledbedlinenscanalsoembarrasspatients,especiallywhentheyhavevisitors.Youwillmakebothunoccupiedandoccupiedbeds.Itismucheasiertomakeanunoccupiedbedthanonewithapatientinit(occupied).However,makinganoccupiedbedisoftennecessaryforhealthandsafetyreasons.Whendoingso,youmustbeespeciallysensitivetothepatient'sprivacyandwillhavetomakesurethepatientisprotectedfromfallingoutofbed.铺床法（bedmaking)1、备用床(closedbed)目的：保持病室整洁，准备接受新病人。２、暂空床（unoccupiedbed)保持病室整洁、美观，供新入院病人或暂离床病人使用。Unoccupiedbed(Openbed)Tomakeanopenbed,onemethodistofan-foldbackthetoplinenstothefootofthebed.Thewidehemoftopfoldisshowing.3、麻醉床（anestheticbed)便于接受和护理麻醉手术后的病人。避免床铺被血液或呕吐物污染，保持床单清洁。使病人安全、舒适，预防并发症。SurgicalbedAsurgicalbedisatypeofopenbedinwhichthetoplinensarenottuckedbutarefanfoldedtothesideorfootofthebed.４、卧有患者床(occupiedbed)保持床单位舒适、美观。保持病人的清洁卫生。防止皮肤压疮及其他合并症的发生。Youwillmakeanoccupiedbedwhenapatientisconfined限制tobed.Thepatientiscoveredwithabathblanketandturnedtothefarsidewhileyouremovethesoiledbottomlinensandmakethatsideofthebed.Youthenrollthepatientoverthefan-foldedbottomlinensontohisorherothersideandcompletemakingtheothersideofthebed.Thesiderailbythepatientisalwayskeptup.Youwillhavetohandlesoiledandpotentiallyinfectiousbedlinens.Patientssufferingincontinencemaysoiltheirbedlinensbecausetheyareunabletocontrolbladderorbowelelimination,Wounddrainage,vomitus,andvariousbodysecretionsarealsosourcesofcontamination.MakinganUnoccupiedBed（Closedbed)Toperformtheprocedure,youwillneed:mattress,bottomsheet,plasticdrawsheet,cottondrawsheet,blanket,pillowcasesWhenmakinganunoccupiedbed,onesideofthebedismadeatatimeforefficiencyandease.Thelinensaretuckedintightlyandsmoothlyusingmiteredcorners.Whenfinished,thebedislefteitheropenorclosed.DrawsheetsmaybeusedtoprotectagainstsoilingthemattresswithurineorotherbodyfluidsProcedureCollectthelinensRemovethedeskandchairTurnoverthemattressApplybottomlinensUnfoldthebottomsheetItscenterfoldshouldbeatthecenterofthemattressMakemiteredcornersTightlytuckthetopofthesheetundertheheadofmattressGrasptheedgeofthesheetabout30cmfromthecornerFormingatriangleTuckthehangingcornerofthesheetunderthemattressLowerthesideofthesheetandtuckittightlyunderthesideofmattressMovetotheothersideofthebedandrepeatsteps.ApplyquiltcoverThetopofthequiltisplacedatthetopedgeofthemattress.Tucktheendofquiltunderthefootofthemattress.PutthepillowinthepillowcasePlacethepillowonthebedwiththeopenendawayfromthedoortotheroom.Thedeskandthechairbesidethebedmustbereturned.入院和出院护理学习目标1、熟悉入院、出院护理的程内容。2、掌握分级护理的概念、适用对象和护理内容。3、掌握轮椅、平车以及担架运送病人的方法及适用对象。入院护理一、入院程序1、办理入院手续持住院证办理住院手续。2、进行卫生处置理发、沐浴、更衣等。传染病人送隔离室处置。3、护送入病区步行、轮椅、平车或担架护送。二、患者入病区后的初步护理（一）一般患者入院后的护理准备床单位、迎接新患者通知主管医师、测量T、P、R、BP等填写住院病历和有关护理表格介绍与指导通知营养室准备膳食、进行入院护理评估。2．急诊患者入院后的初步护理：准备床单位、备好急救器材及药品、通知医生做好抢救准备、密切观察病情变化等。三、分级护理特级护理：病人病情危重，需随时观察，以便进行抢救。如严重创伤、复杂疑难的大手术后、器官移植、大面积灼伤，以及某些严重的内科疾患等。一级护理：病人病情危重，需绝对卧床休息。如各种大手术后、休克、昏迷、瘫痪、高热、大出血、肝肾功能衰竭和早产婴等。二级护理：病人病情较重，生活不能自理。如大手术后病情稳定者