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성인간호학실습 케이스스터디

"성인간호학실습 케이스스터디"에 대한 내용입니다.
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한컴오피스
최초등록일 2023.08.12 최종저작일 2021.08
15P 미리보기
성인간호학실습 케이스스터디
  • 미리보기

    소개

    "성인간호학실습 케이스스터디"에 대한 내용입니다.

    목차

    1. 간호사정
    1) 중환자의 전반적인 건강상태를 사정하시오.
    2) 중환자 상태 기록지(flow chart)
    3) 대상자가 실사한 의미 있는 진단적 검사 결과를 해석하시오.
    4) 대상자의 약물치료 현황을 파악하시오. (중요한 약물 중심으로 5가지 내로 정리)

    2. 참고문헌

    본문내용

    대상자의 진단명에 대하여 간략히 기술하시오.
    Alcohoic lacticacidosis에 의한 Ventricular fibrillation
    젖산산증 (lactic acidosis)은 젖산이 혈액속에서 제거되는것에 비해 빠르게 축적되면서 발생한다.
    젖산은 체내의 산소수치가 떨어지면서 만들어지게 되는데 대개는 근육조직과 적혈구세포로부터 오게 된다. 체내 산소수치가 정상일 경우 탄수화물은 물과 이산화탄소로 분해가 되게 된다. 산소 수치가 낮을 경우 탄수화물은 에너지와 젖산으로 나누어지게 된다.
    젖산의 수치는 술을 과도하게 마시거나 격한 운동을 하고 난 후 올라가거나 심부전증, 패혈증, 혈액유입에 감소나 전신에 산소가 부족하게 되면서 오게 된다. 또한 간이 심각하게 손상이 있거나 질병을 앓고 있는 경우에도 간에서 젖산을 분해하지 못하게 되면서 수치가 상승하게 된다.
    젖산의 수치가 지나치게 높아지면 생명을 위협하는 젖산산증이 오게 된다. 젖산산증은 심부전증, 신부전증, 또한 심각한 감염이 있는 상태에서 당뇨약인 메트로핀을 복용하는 경우에도 올 수 있게 된다.

    (1) 현병력
    ① 발생 시부터 병원에 오기까지의 상황
    본 63세 남환은 평소 일상생활을 혼자 가능했다고 하는 분이며 매일 소주 2병씩 드심. 22시 10분경손발 차가워지며 호흡이 이상하다고 느껴져 22시 23분 EMS 신고했다고 하고 27분경 bystander CPR 시행. EMS 현장 도착은 22시 29분이라고 하며, 당시 initial rhythm asystole 확인되어 CPR 시행하여 평창 보건의료원으로 이송하였고 이송 중 V.fib 2회 발생하여 defibrillation 2회 시행하여 22시 57분 평창의료원 도착.
    ② 병원 도착 시 대상자의 상태 및 중환자실 입실 전까지의 경과
    해당 병원에서 codarone 300mg 투여하며 ACLS 진행하였고 23시 10분경 ROSC 되어 본원 manage 위해 응급실 통해 응급중환자실로 입원함.
    ③ 중환자실 입실 후 현재까지의 경과
    8/21
    - I/O 12,000/1000, 시간당 0-10cc
    - metabolic acidosis (PH 7.2, CO2 42, BE –9), ABG: lactic acidosis

    참고자료

    · [네이버 지식백과] 저혈당증 [hypoglycemia] (서울대학교병원 의학정보, 서울대학교병원)
    · [네이버 지식백과] 대사성산증 [Metabolic acidosis] (서울대학교병원 의학정보, 서울대학교병원)
    · 박은영 외 5명 공역(2019). 간호진단, 중재 및 결과 가이드 수정판. 현문사
    · 윤은자 외(2019). 성인간호학Ⅰ. 수문사
    · 김종임, 서길희 외 (2018). 기본간호학Ⅰ. 수문사
    · 권소희, 권수혜 외 (2019). 핵심 건강사정 수정판. 수문사
  • AI와 토픽 톺아보기

    • 1. Cardiac arrest with successful resuscitation
      Cardiac arrest is a life-threatening medical emergency that requires immediate intervention to restore normal heart function. Successful resuscitation is crucial as it can save a patient's life and prevent long-term complications. The key factors in successful resuscitation include prompt recognition of cardiac arrest, immediate initiation of high-quality cardiopulmonary resuscitation (CPR), and timely defibrillation. Healthcare providers must be well-trained in advanced cardiac life support (ACLS) protocols to effectively manage cardiac arrest cases. Additionally, post-resuscitation care, including targeted temperature management and hemodynamic support, is essential for optimizing patient outcomes. Overall, cardiac arrest with successful resuscitation is a complex and challenging scenario that requires a multidisciplinary approach and continuous quality improvement efforts to enhance survival rates and minimize neurological sequelae.
    • 2. Lactic acidosis
      Lactic acidosis is a serious metabolic condition characterized by an accumulation of lactic acid in the body, leading to a decrease in blood pH. It can be caused by various underlying conditions, such as sepsis, liver disease, and certain medications. Prompt recognition and management of lactic acidosis are crucial, as it can rapidly progress to life-threatening complications. The treatment approach typically involves identifying and addressing the underlying cause, providing supportive care, and potentially using therapies like intravenous fluids, bicarbonate administration, and extracorporeal blood purification techniques. Healthcare providers must be vigilant in monitoring for signs of lactic acidosis, especially in high-risk patients, and be prepared to implement appropriate interventions to stabilize the patient's condition and prevent further deterioration. Ongoing research and advancements in the understanding and management of lactic acidosis are essential for improving patient outcomes.
    • 3. Ventricular fibrillation
      Ventricular fibrillation (VF) is a life-threatening cardiac arrhythmia characterized by uncoordinated and chaotic electrical activity in the ventricles, leading to the loss of effective cardiac output. Prompt recognition and management of VF are crucial, as it can rapidly progress to cardiac arrest if left untreated. The mainstay of treatment for VF is immediate defibrillation, which aims to restore a coordinated cardiac rhythm. Healthcare providers must be well-trained in advanced cardiac life support (ACLS) protocols and have access to appropriate equipment, such as automated external defibrillators (AEDs), to effectively manage VF cases. Additionally, identifying and addressing the underlying cause of VF, such as myocardial infarction or electrolyte imbalances, is essential for preventing recurrence and improving long-term outcomes. Ongoing research and advancements in the understanding and management of VF, including the development of novel therapies, are crucial for enhancing survival rates and reducing the burden of this life-threatening condition.
    • 4. Acute kidney injury
      Acute kidney injury (AKI) is a sudden and often reversible decline in kidney function, which can have serious consequences if not promptly recognized and managed. AKI can be caused by a variety of factors, including dehydration, sepsis, medication toxicity, and underlying kidney disease. Early detection and implementation of appropriate interventions, such as fluid resuscitation, medication adjustments, and management of the underlying cause, are essential for preventing further kidney damage and promoting recovery. Healthcare providers must be vigilant in monitoring for signs of AKI, especially in high-risk patients, and be prepared to initiate timely and effective treatment. Additionally, the use of biomarkers and advanced imaging techniques can aid in the early diagnosis and management of AKI. Ongoing research and advancements in the understanding and treatment of AKI are crucial for improving patient outcomes and reducing the long-term consequences of this condition.
    • 5. Respiratory failure
      Respiratory failure is a life-threatening condition characterized by the inability of the respiratory system to maintain adequate gas exchange, leading to hypoxemia and/or hypercapnia. It can be caused by a variety of underlying conditions, such as pneumonia, acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD), and neuromuscular disorders. Prompt recognition and management of respiratory failure are crucial, as it can rapidly progress to respiratory arrest and death if left untreated. The mainstay of treatment typically involves oxygen therapy, mechanical ventilation, and addressing the underlying cause. Healthcare providers must be skilled in the use of advanced respiratory support technologies, such as high-flow nasal cannula, non-invasive ventilation, and invasive mechanical ventilation, to effectively manage respiratory failure cases. Additionally, the implementation of lung-protective ventilation strategies and the use of adjunctive therapies, such as prone positioning and extracorporeal membrane oxygenation (ECMO), can improve patient outcomes. Ongoing research and advancements in the understanding and management of respiratory failure are essential for enhancing survival rates and reducing the burden of this critical condition.
    • 6. Pressure ulcer
      Pressure ulcers, also known as bedsores, are localized areas of tissue damage that occur due to prolonged pressure, friction, or shear on the skin and underlying tissues. They are a common and often preventable complication in healthcare settings, particularly among patients with limited mobility, poor nutrition, or underlying medical conditions. Effective prevention and management of pressure ulcers require a multidisciplinary approach, including regular skin assessments, pressure redistribution strategies, proper nutrition, and prompt treatment of any existing ulcers. Healthcare providers must be trained in the identification, staging, and evidence-based treatment of pressure ulcers to minimize the risk of complications, such as infection, sepsis, and impaired wound healing. Additionally, the implementation of quality improvement initiatives and the use of advanced wound care technologies can contribute to the prevention and effective management of pressure ulcers. Ongoing research and advancements in the understanding and prevention of pressure ulcers are crucial for improving patient outcomes and reducing the burden of this preventable condition.
    • 7. Alcohol-related liver disease
      Alcohol-related liver disease (ARLD) is a spectrum of liver damage caused by the excessive and prolonged consumption of alcohol. It can range from simple fatty liver to more severe conditions, such as alcoholic hepatitis, fibrosis, and cirrhosis. The management of ARLD requires a multifaceted approach, including abstinence from alcohol, nutritional support, and treatment of any underlying complications, such as hepatic encephalopathy or variceal bleeding. Healthcare providers must be skilled in the early recognition and management of ARLD, as well as the identification and treatment of co-occurring conditions, such as mental health disorders and substance abuse. Effective patient education, counseling, and referral to addiction treatment services are crucial for promoting long-term abstinence and improving patient outcomes. Ongoing research and advancements in the understanding and management of ARLD, including the development of novel therapies, are essential for reducing the burden of this chronic and potentially life-threatening condition.
    • 8. Infection control
      Effective infection control is a critical aspect of healthcare delivery, as it aims to prevent the transmission of infectious agents and protect patients, healthcare workers, and the broader community. This involves the implementation of evidence-based practices, such as hand hygiene, personal protective equipment (PPE) use, environmental cleaning, and the appropriate use of antimicrobials. Healthcare providers must be well-trained and vigilant in adhering to infection control protocols, as lapses can lead to the spread of healthcare-associated infections (HAIs), which can have serious consequences for patient safety and outcomes. The development and implementation of robust infection control programs, including ongoing monitoring, feedback, and continuous quality improvement, are essential for creating a culture of safety and reducing the burden of HAIs. Ongoing research and advancements in infection control strategies, including the development of new technologies and the optimization of existing practices, are crucial for enhancing patient safety and improving healthcare outcomes.
    • 9. Hemodynamic management
      Hemodynamic management is a critical aspect of patient care, particularly in the context of critical illness, where maintaining adequate tissue perfusion and organ function is essential. This involves the assessment and optimization of various hemodynamic parameters, such as blood pressure, cardiac output, and fluid status, using a combination of clinical evaluation, laboratory tests, and advanced monitoring techniques. Healthcare providers must be skilled in interpreting hemodynamic data, recognizing and responding to hemodynamic instability, and implementing appropriate interventions, such as fluid resuscitation, vasopressor therapy, and mechanical circulatory support. Effective hemodynamic management requires a deep understanding of the underlying pathophysiology, the ability to integrate multiple data sources, and the application of evidence-based guidelines and best practices. Ongoing research and advancements in hemodynamic monitoring technologies, as well as the development of novel therapeutic strategies, are crucial for improving patient outcomes and reducing the burden of critical illness.
    • 10. Sedation management
      Sedation management is an essential component of patient care, particularly in the context of critical illness, where patients may require mechanical ventilation, invasive procedures, or management of pain and anxiety. Effective sedation management involves the careful selection and titration of sedative and analgesic medications to achieve the desired level of sedation and analgesia, while minimizing the risk of adverse effects and promoting patient comfort and safety. Healthcare providers must be skilled in the assessment of sedation depth, the recognition and management of sedation-related complications, and the implementation of evidence-based sedation protocols. The use of validated sedation assessment tools, the optimization of sedative and analgesic regimens, and the incorporation of non-pharmacological interventions, such as music therapy and early mobilization, can contribute to improved patient outcomes. Ongoing research and advancements in the understanding and management of sedation, including the development of novel sedative agents and the optimization of existing practices, are crucial for enhancing patient safety and promoting better clinical outcomes.
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