先天性高肩胛症.ppt

1、Postoperative nursing for sprengle deformity: a case report,Manhui. HE2016-8-16Trauma and hand microsugery,Contents,1 Sprengle deformity2 Case report3 Nursing process4 Nirsing experience,Sprengle deformity,The disease is genetic, and more women than menMost are unilateral and bilateral incidence was

2、 10%-20%,Sprengle deformity,Definition: It is a rare congenital deformity one or both scapulate that apears at birth.Characterize by one side shoulder joint is 2cm-10cm higher than normal one . And it causes restricted mobility of the shoulder and cervical spine,Sprengle deformity,ClassificationI de

3、grees: deformity is very light, on both sides of the shoulder joint in the same level, appearance is not obvious degrees: on both sides of the shoulder joint is almost the same level, the dress can be seen when the deformity degrees: shoulder joint is higher than the contralateral 2 5 cm, deformity.

4、IV: is very serious, shoulder blades can be ascended the occipital,Diagnosis: X-ray examination,Sprengle deformity,Operative treament Appropriate age: 3-6 years old； I degrees does not consider surgery, IV degrees demand through surgery under 5 years old,detiod nuscle,subclavian artery and vein,pect

5、ialismajor,pectoralis minor,brachial plexus,Common complications,bleeding,hematoma,wound,surgery,Endotracheal intubation,Laryngeal edema,Oppression of the trachea,Difficulty in breathing,infection,Brachial plexus injury,The most serious complications,Case report,Huang XX female, 3 y, by finding the

6、left shoulder blade deformity, 3 years , generally in good condition, no shortness of breath, chest tightness and other discomforts; Children with smooth mood, good appetite, sleep good, normal to the toilet. Cultural degree: children kindergarten, social psychological reaction is good, acompamy wit

7、h parents in the hospital,Case report,Specialized examination,Bone tissue pathological examination,Blood biochemical test,hospital examination,Electrocardiogram (ecg),Chest Radiography,X-ray:The shoulder blade positive side,Diagnosis:sprengle deformity,Case report-Specialized examination and surgery

8、, degree of deformity,On the left shoulder blade Angle place is relatively higher than that of the right shoulder blade ca. 4 cm,Limited lift on the left upper limb, outreach activities, left arm adduction, rotation,Forward bends after stretch no obvious limitations, fingers feel normal.,Operation:

9、4/8 in endotracheal hemp on her left shoulder blade edge,Muscle release + check point down around the excision reconstruction + bone bridge,Case description - postoperative condition,Left shoulder a wound drainage tube, drainage of the dark red hemorrhagic fluid 10 ml, shoulder wound dressings dry c

10、lean,Left upper limb activity limited mild, good blood supply,5%GS100ml bid.muscosolvan15mg+0.9%NS10mlbid oxygen inhalation lansoprazole 15mg+0.9%NS100ml bid,Often cried, emotional instability, family felt nervous.,Continue to ecg monitoring and oxygen 2 l/min, stable vital signs, pain scores six po

11、ints,Nursing process,assess,plan,evalaute,diagnosis,do,assess,Postoperative evaluation of children with pain,Vital signs, especially respiratory and blood oxygen saturation,Admission assessment and evaluation of preoperative limb situation,术后评估患侧肢体的活动、血运 患儿引流管 及伤口局部情况,评估患儿与家属心理情况，及家属对术后注意事项掌握度,Posto

12、perative evaluation of limb activity, blood supply drainage tube and wound local situation,psychological situation, and Master degree of families of postoperative consideratios,diagnosis,Potential complications: brachial plexus injury, acromegaly bloodLoop obstacle, bleeding, infection, hematoma,Lac

13、k of knowledge: families lack of postoperative nursing knowledge,Anxiety: and the child is not adapt to the environment,pain :associated with postoperative wound,Ease the painPsychological careObservationPostoperative guidance,ObservationTo prevent infection,Guide function exercise,Plan,near term（1-

14、3d）,medium term（4-10d）,late period（10d后）,painnursing,Do,Listen to the chief complaintAssessment of pain location, time, nature;With smiling face pain assessment scale,Body position nursing care: avoid lateral position, recommended the hypothesis or right side a little bit high (on the left side of t

15、he pad 10 , 15 ) in children with place sandbags fixed head on both sides of the head,Guide the non-drug pain relief methodPrescribed drugs, drug effect and adverse reactions.,Postoperative pain scores,observation,Do,Vital signs, especially pay attention to the childs temperature, breathing, complex

16、ion, blood oxygen saturation.,Limb blood circulation: color, swelling, skin temperature, the radial pulse.observe Limb activity, muscle strength through induction and the finger grasping,and compared with preoperative.,Wound observation: wound dressings ;Wound drainage s quantity, color, character;

17、inflamed or hematoma,nursing,Do,Continue to ecg monitoring and give oxygen for 24hWrite the nursing record,Prevent infection nursing:dressing wound temperature monitoring,Avoid shoulder joint activities within 2 weeks. start a limited range of active and passive joint training after 2 weeks.,psychol

18、ogical nursing,Do,Explain to the family about treatment and nursingGiving more concern and sympathy, to obtain the trust and cooperation,keep an comfortable environment The same age childrens encouragement and supportDistraction: toys, anime,Listen to children complained, understand the cause of the

19、 crying,Psychological change,Children and family tensions ease, smooth mood,health education (to the family),Do,postoperative position requirements, turn and drainage tube care considerations,observation points：kids complexion and abnormal crying ,abnormal limb avtivity,high protein, high quantity o

20、f heat, high vitamin diet; Guide function exercise, such as the recent massage distal limb, wrist, elbow flexion exercise;The late: monkey climbing training, weight training,the awareness of familly before and after health education,evaluate,No complications occurred,Families can be the first day af

21、ter surgery with postoperative considerations,Before discharge can grasp the functional exercise,Postoperative pain relief on the first day,Family members grasp the method of non-drug pain relief,and use the smiling face pain assessment scale correctly,children, family members emotional stable two days after,nursing experience,psychological nursing.jiont the familyto nurse the child,Do a good job of explaining to thefamily members To obtain the trust and cooperation,undestand operation methodcommunicate with doctors about nursing emphsisin advance,obervation,Thank you,