1、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
2、,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%
3、-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 Body Mechanics mechanics: how forces act on bodies in motion.center of gravity: the point arournd which all weigh
4、t is evenly balanced.,USE YOUR LEG MUSCLES,Your back is easily injured. Whether,lifting, pulling, or pushing, bend your knees - not your back. This will put pressure on the powerful leg muscles which can better absorb it. Always keep your back straight.,HOLD OBJECTS CLOSE TO YOUR BODY,The closer the
5、 objects weight is to your own center of gravity (between your hips when you are standing up straight)the easier it will be to maintain balance and transfer pressure to leg muscles. Leaning倾斜 or reaching拉伸 will strain扭伤 back and other muscles. 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。,KEEP H
6、IPS AND SHOULDERS SQUARE（直）,Face the object with hips and shoulders squared, whether lifting, pushing,or pulling.When you turn, pivot转动 your feet instead of twisting at the waist. This will help you keep your balance and distribute the weight of the object evenly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
7、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。,The condition of the patients bed is an important element in his or her experience of hospital care. Bedrest is a part of many treatments and all patients spend a large amount of time in bed, even if only to sleep.,A neat, clean, and we
8、ll-made bed providescomfort and prevents a number of problems. The condition of the bed can have physical and psychological effects upon a patient. A poorly made bed can irritate a patients skin and lead to bedsores. A bed contaminated by body fluids can help spread contagious disease. Sloppy or soi
9、led bed linens can also embarrass patients, especially when they have visitors.,You will make both unoccupied and occupied beds. It is much easier to make an unoccupied bed than one with a patient in it (occupied). However, making an occupied bed is often necessary for health and safety reasons. Whe
10、n doing so, you must be especially sensitive to the patients privacy and will have to make sure the patient is protected from falling out of bed.,铺床法（bed making),1、备用床(closed bed)目的：保持病室整洁，准备接受新病人。,、暂空床（unoccupied bed) 保持病室整洁、美观，供新入院病人或暂离床病人使用。,Unoccupied bed(Open bed),To make an open bed,one method
11、 is to fan-fold back the top linens to the foot of the bed.The wide hem of top fold is showing.,3、麻醉床（anesthetic bed) 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。,Surgical bed,A surgical bed is a type of open bed in which the top linens are not tucked but are fan folded to the side or foot
12、 of the bed.,、卧有患者床(occupied bed) 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。,You will make an occupied bed when a patient is confined限制 to bed. The patient is covered with a bath blanket and turned to the far side while you remove the soiled bottom linens and make that side of the bed.,You then roll th
13、e patient over the fan-folded bottom linens onto his or her other side and complete making the other side of the bed.The side rail by the patient is always kept up.,You will have to handle soiled and potentially infectious bed linens.Patients suffering incontinence may soil their bedlinens because t
14、hey are unable to control bladder orbowel elimination, Wound drainage, vomitus, andvarious body secretions are also sources ofcontamination.,Making an Unoccupied Bed（Closed bed),To perform the procedure,you will need:mattress, bottom sheet, plastic draw sheet,cotton draw sheet,blanket, pillowcases,W
15、hen making an unoccupied bed,one side of the bed is made at a time for efficiency and ease.The linens are tucked in tightly and smoothly using mitered corners. When finished,the bed is left either open or closed.Draw sheets may be used to protect against soiling the mattress with urine or other body
16、 fluids,Procedure Collect the linens Remove the desk and chair,Turn over the mattressApply bottom linensUnfold the bottom sheetIts center fold should be at the center of the mattressMake mitered cornersTightly tuck the top ofthe sheet under the head of mattress,Grasp the edge of the sheetabout 30cm
17、from the cornerForming a triangleTuck the hanging corner of the sheet under the mattress,Lower the side of the sheet and tuck it tightly under the side of mattressMove to the other side of the bed and repeat steps.,Apply quilt coverThe top of the quilt is placed atthe top edge of the mattress.Tuck t
18、he end of quilt under the foot of the mattress.,Put the pillow in the pillowcasePlace the pillow on the bed with the openend away from the door to the room.,The desk and the chair beside the bed must be returned.,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
19、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
20、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，以及年老体弱、慢性病不宜多活动者、幼儿等。,三级护理：病人病情较轻，生活能基本自理。如一般慢性病，疾病恢复期及选择手术前的准备阶段等。,出院护理,一、出院前护理1、出院前通知患者和亲属、注意患者情绪变化、健康教育、出院指导、征求意见。,2、出院当日护理1）执行出院医嘱（红笔竖写出院时间于体温单4042之间2）填写出院护理记录3）协助患者清理用物,4）护送患者出院,3、出院后处理 1）处理床单位（1）撤去病床上污被服，放入污衣袋
21、。（2）床垫、床褥、棉胎、枕芯等放在日光下曝晒或 紫外线照射或臭氧消毒。,（3）床及床旁桌用消毒液擦拭（4）病室开窗通风。,（5）铺好备用床，准备迎接新病人。 （6）患传染性疾病病人离院后，需按传染病终末消毒法进行处理。 2）按要求整理病历。,第三节 运送病人法（Transferring Patients）,You will regularly assist patients out of beds and chairs and in walking or moving about.This is called transferring patients.Many patients need
22、this type of assistance.,It is important to keep patients from falling when transferring them,Patients who require assistance to move are at serious risk of falling and becoming injured.They must be carefully observed for signs of dizziness or instability.,Pay special attention to safety precautions
23、.,A falling patient can receive serious injury and can cause you to fall as well.Always use caution and be alert for hazards when transferring patients.,Patient cooperation is important.,Patients can often help,making the move safer and easier.More importantly,they can tell you when they are feeling
24、 faint无力,dizzy眩晕,uncomfortable,or in pain.This will help you to avoid accidents or injury.,（一）轮椅运送法 护送不能行走但能坐起的病人入院、出院、检查、治疗或室外活动。 帮助病人下床活动，促进血液循环和体力恢复。,评估：计划：实施：将轮椅推至病人床旁与床尾平齐，面向床头。Position wheelchair parallel to bed.,翻起脚踏板Remove footrest将闸制动。Lock brakes,护士站在轮椅背后，用两手臂压住椅背，一只脚踏住椅背下面的横挡，以固定轮椅。,翻下脚踏板，
25、让病人双脚置于其上。 天冷需用毛毯(blanket)保暖,在推送过程中注意观察病人情况，下坡应减速 过门槛时，翘起前轮，避免过大的震动。,（二）平车运送法（flatcar transportation)评估： 病人的体重、病情与躯体活动能力。 病人的病损部位与理解合作程度。 平车性能是否良好。计划：,实施：挪动法： 协助病人将上半身、臀部、下肢依次向平车挪动。,一人搬运法：适用于病情允许，体重较轻者。搬运者一臂自病人腋下伸入对侧肩部，一臂在同侧伸入病人股下。,甲一手抬起病人头、颈、肩部，一手抬起腰部；乙一手抬起病人臀部，一手抬起病人膝部（腘窝处）。二人同时抬起，使病人身体稍向护士倾斜。,三人搬运法：甲托住病人的头、颈、肩及胸部；乙托住病人的背、腰、臀部；丙托住病人的膝及脚部。,四人搬运法：适用于颈椎、腰椎骨折病人或病情较重的病人。搬运者甲、乙分别站于病床首、尾端，分别抬起病人的头、颈肩及双腿；搬运者丙、丁分别站于病床及平车两侧，紧紧抓住帆布兜或中单四角，四人同时抬起,平车运送注意：1、车速适宜。2、上下坡时，患者头部位于高处。3、进出门时，不能用车撞门。,
