I. Mawu
Mu mankhwala amakono, pampu yopanga imayimira chipangizo chofunikira komanso champhamvu, ndikugwira ntchito yofunika kwambiri pakuwonetsetsa kuti muwonetsetse mankhwala ndi madzi. Iwo wasinthitsa anthu azaumoyo amapereka chithandizo, kulimbikitsa chitetezo choleza mtima komanso kuchita bwino kwa kulowererapo kachipatala. Nkhaniyi imakhudzanso kugwiritsa ntchito mapapu a jakisoni, kuwunikira chifukwa chotsatira kwambiri macinidwe azachipatala osiyanasiyana.
Ii. Pampu yam'manja ndi chiyani?
A. Tanthauzo ndi Malangizo
Pampu ya jekeseni ndi chipangizo chopangidwa kuti chiphe madzidzi, makamaka mankhwala, molondola komanso molondola. Imagwira ntchito moyenerera kwa akatswiri azachipatala, kuonetsetsa kuti odwala amalandira mlingo woyenera wa mankhwala osokoneza bongo. Pachiyambikere, kampu ya jakisoni imagwira ntchito panjira yogwiritsa ntchito makina kapena magetsi kuti muyendetse syrenger, potero kukankhira mankhwala olumikizidwa ndi thupi la wodwalayo. Njirayi imakhazikitsidwa modzisintha modzipangitsa kuti ipereke mphamvu zowonjezera m'madzi ambiri amadzimadzi owoneka bwino, nthawi zambiri kumalumikizana ndi miliriti miliritiri pa ola limodzi. Kulondola kumakwaniritsidwa kudzera munthawi yapamwamba yomwe imatanthauzira zizindikiro zamagetsi kukhala kuyenda kwa syaringete komanso kuyenda kapisiri kamene kakuyenda bwino koma kudalirika.
B. Zigawo zazikulu ndi ntchito zawo
1. Chowalemba : Chigawo ichi chimatsuka mosatekeseka, kuonetsetsa kuti ili pamalo okhazikika m'njira yonse yosiyanasiyana. Amapangidwa kuti azikhala ndi syringe yosiyanasiyana, kuyambira yaying'ono, yolunjika yamagetsi yomwe imagwiritsidwa ntchito mankhwala okwanira kwa owonjezera mafayilo ambiri. Wogwirayo amaperekanso gawo lolumikizana ndi tubing omwe amatsogolera kwa wodwalayo, kutsimikizira njira yopanda tanthauzo.
1. Makina oyendetsa : kuphatikizira mota, omwe nthawi zambiri amakhala wocheperako, komanso dongosolo lotumiza monga chododometsa kapena njira yoyendetsa pamputo ya jekeseni. Moyalo zimazungulira mu zowonjezera zenizeni, kutanthauzira kusunthira kwake mu mzere mzere wa synger. Kusuntha koyendetsedwa kumeneku kumanenetsa momwe zimakhalira ndi mankhwalawa, kulola kusintha kwa liwiro ndi kuchuluka kwa kutumiza ndi chiwonetsero chabwino kwambiri.
1. Dongosolo Lamphamvu : Ubongo wa pampu ya jekesekani, kachitidwe kaziwongolera, kumangiriza microprocesser ndikumagwirizanitsa madera. Imatanthauzira zolowetsa za ogwiritsa, zomwe zingaphatikizepo gawo lokoka, voliyumu yonseyo kuti ipangidwe, ndipo iliyonse yapadera dosing. Kutengera malamulo awa, imatumiza zizindikilo pamakina oyendetsa kuti athe kupereka mawu olondola. Kuphatikiza apo, makina owongolera amayang'anira ntchito ya pampu, ndikuonetsetsa kuti mtengo womwe umayenda bwino ndi magawo otsogola ndi kusintha kwa nthawi ngati kupatuka kumachitika.
1. Sonyezani ndi mawonekedwe ogwiritsira ntchito : Panel yowonetsera yowoneka bwino komanso yodziwika bwino kwa wogwiritsa ntchito, monga kuchuluka kwa kulowetsedwa, voliyumu yomwe ilipo idzakumanirana, komanso zizindikiritso zilizonse. Mawonekedwe ogwiritsa ntchito, nthawi zambiri amakhala ndi mabatani kapena kukhudzana, kumapangitsa othandizira azaumoyo kuti alowetse pampu, kuyamba kapena kuletsa kulowa, ndikupeza zosintha zapamwamba. Kusaphzeredwa kumeneku ndikofunikira mu malo opsinjika ndi opsinjika kwambiri a makonda azaumoyo, kuchepetsa mwayi wa zolakwika mukamatsatira.
1. Makina a Alamu ndi Chitetezo : Kuti muteteze odwala omwe angathe kuvulaza chifukwa cholakwika kapena zida zolakwika, mapampu a jekeseni ali ndi alamu ndi chitetezo. Izi zimaphatikizapo makina omwe amazindikira zowunikira mu tube, zokongoletsera zamtundu wa mpweya kuti zilepheretse mpweya wabwino, komanso machenjezo otsika kwambiri. Pakachitika alamu, pampuyo ija imalowerera kulowetsa ndikuchenjeza ogwira ntchito zamankhwala, kuwalimbikitsa kuti athe kukonza mwachangu.
Iii. Zochitika zamankhwala zamankhwala
A. Mu unive Surfic (ICU)
1. Kuyang'anira mankhwala osokoneza bongo
M'malo okwera kwambiri a ICU, pomwe moyo wa odwala umangokhala chete, mapampu jakisoni amatuluka ngati kachilombo ka mankhwala. Mankhwala a Vasopessor, monga Dopamine ndi Nopinephrine, amakhumudwitsidwa pogwiritsa ntchito mapampu a jakisoni kuti asunge magazi okhazikika kapena a hemodynamic. Mankhwalawa, okhala ndi mawindo awo ochepera, akufuna dosing moyenera; Ngakhale kupatuka pang'ono komwe kumatha kuthamangitsa zotsatira zoyipa kapena kuletsa zotsatira za wodwala. Momwemonso, zoseweretsa ndi analgesics ngati propofol ndi fentanyl zimaperekedwa ndi kulondola kwa zithunzi kuti zikhale zodekha komanso bata. Kutha kwa pulusa kuthekera kopereka microdication pamphindi kumatsimikizira kuti wodwalayo akukhalabe m'malo omwe mukufuna kapena kusokonekera, komwe kumatha kubweretsa zovuta ngati mpweya wabwino.
2. Thandizo launtha la odwala odwala kwambiri
Kwa odwala omwe sangathe kutenga zakudya pakamwa, zakudya zonse (TPN) imakhala njira yofunika. Mapampu jakisoni amatenga mbali yofunikira kwambiri pa gawo ili ndikuwongolera kulowetsedwa kwa mitundu yosakanikirana. Mayankho a TPN, omwe ali ndi mawonekedwe owoneka bwino a amino acid, shuga, mapids, mapiraminda, ndi michere, ayenera kuthandizidwa pang'onopang'ono kuti ateteze Hyperrolyceridemia, kapena ma eleboralyte. Mawonekedwe ampikisano ampikisano ampikisano amalola othandizira azaumoyo kuti alowetse matenda opatsirana potengera zofunikira za mankhwalawa, kunenepa thupi, komanso matenda. Mulingo woyenera kungoyang'ana zopatsa mphamvu komanso kuchepetsa chiopsezo cha kusokoneza ka metabolic, komwe kungakwezenso matenda odwala.
B. Pa opaleshoni
1. Kutumiza kwa mankhwala oletsa
M'bwato lamasewera, popu ya jekeseta ndi chida chofunikira kwambiri kwa olerera. Imatsimikizira kusawoneka bwino komanso kuwongolera kutumiza mankhwala opangira mankhwala opangira opaleshoni. Kaya ndi gawo lolowera, pomwe pakukonza mopitirirabe mankhwala monga prosofol amafunikira kuti musadziwe msanga kupewa kupewa matenda otetezeka. Kuthamanga kwa kampu kumapereka mwayi woyankha pazenera nthawi yomweyo kuti asinthe magawo a thupi, monga kusinthasintha magazi kapena kuchuluka kwa mitima yawo, ndikuwonetsetsa kuti mukuchita bwino. Mwa kukhalabe ndi vuto losasintha m'magazi, mapampu apakati amathandiza kupewa kuzindikira kwakukulu ndikupereka ndege yotsekera, ndikuchepetsa chidwi cha wodwalayo komanso zovuta zina postoperative.
2. Kuyang'anira maantibayotiki ndi Bostamstatics
Matenda opaleshoni yamatenda amasokoneza kwambiri kuchira, ndikupanga antibiotiction yoyang'anira panthawi yake komanso yolondola. Mapampu a jekeseni amathandizira maantibayotiki a prophylactic ndikuwonetsetsa kuti mankhwalawa amafika nthawi yochiritsa mu minofu isanachitike ndikutsatira mogwira mtima mogwira mtima mogwira mtima nthawi yonseyi. Njira yolosera ili imakulitsa bwino maantibayotiyi pamene mukuchepetsa chiopsezo cha chitukuko cha antibiotiking. Kuphatikiza apo, pakuchita magazi komwe magazi ndiofunika, mapampu a jekeseka amagwiritsidwa ntchito popereka hepatactic. Mankhwalawa, omwe amalimbikitsa magazi, ayenera kuthiridwa panthawi yoyenera komanso kuchuluka kwa magazi mosavuta popanda kuyambitsa mavuto osafunikira. Kuwongolera kwapaku kumatsimikizira kuti hergattic wothandizira amaperekedwa ndendende ndipo pakufunika kutero, kukulitsa chitetezo chochita opaleshoni ndikuchepetsa kufunika kwa kuikidwa magazi.
C. Mu ad Pediatric ndi Neonatal Care
1. Mankhwala olondola a matupi ang'onoang'ono
Odwala a ana komanso neonatal amakhala ndi mavuto apadera chifukwa cha kukula kwawo kwa thupi, njira zosakhwima, komanso chidwi ndi mankhwala. Mapampu jakisoni ndi boon pazinthu izi monga momwe angatherere molondola mankhwala ochepetsa miyeso. Mwachitsanzo, ndili ndi zitsime zobadwa nazo zokhala ndi zitsime zokhala ndi mtima wofuna kuthana ndi vuto la mtima kuti zisamalire, malire olakwika mu dosing ndiwopapa kwambiri. Kulakwika kambiri kumatha kubweretsa kuwopsa kwa moyo kapena mankhwala osakwanira. Pompo mapampi, ndi kuthekera kwawo kufalitsa mafayilo ochepa ngati miliri pa ola limodzi, onetsetsani kuti kuchuluka kwa mankhwala ngati digoxin kapena ma itotrops amafika pakhungu lawo lofooka. Dokotala wotsimikiza uku amathandizanso mankhwala omwe amagwiritsidwa ntchito pochiza kukoka kwa neonatal, pomwe mlingo wolakwika ungakhale ndi zotsatirapo zoopsa.
2. Kusachedwa komanso kusunthika kwa neonates
Makanda osabadwa nawo nthawi zambiri amafunikira kulowetsa kwamankhwala ochirikiza zomwe akutukuka. Mapampu a jekeseni amagwiritsidwa ntchito popereka zinthu zothandizirana ndi zopindika m'matumba osakhazikika kapena madzi amchere kuti azikhala ndi ma hydiration. Kulowetsedwa pang'onopang'ono komanso kosasunthika komwe kumaperekedwa ndi njira zachilengedwe, pang'onopang'ono machitidwe ochiritsira thupi, kupewa kusungunuka mwadzidzidzi kapena kuchuluka kwa mankhwala omwe amatha kuwononga homestasis. Izi ndizofunikira kwambiri mu United Sukulu Yosamala (Nicus), pomwe odwala ochepa kwambiri amadalira zomwe mwapanga mwatsatanetsatane za zinthu zosangalatsa izi zikule ndikukula.
D. Mu mankhwala Oncology
1. Chemotherapy kulowetsedwa
Cancy Cheritherapy imafuna kulongosoka koyenera pakubala mankhwala. Chemothetherapy, ndi zotsatira zawo za cytotoxic, zimafuna kupasuka mosamala kuti tipeze maselo a khansa pomwe mukusaka minofu yathanzi momwe tingathere. Mapampu jakisoni ndi muyezo wagolide kuti apereke mankhwala a chemotherapy, kuonetsetsa kuti mlingo woperekedwa umakhala wokhazikika komanso wolamulidwa. Kulowetsa kosasunthika kumeneku kumathandiza kusunga kuchuluka kwa mankhwalawa mkati mwa zenera lochizira, kukulitsa mphamvu yake motsutsana ndi maselo a khansa. Mwachitsanzo, mankhwalawa khansa ya m'mawere ndi doxorubitin, pompu ya jekesani imatsimikizira kuti pa njira yothetsera vutoli (yomwe ingakweze zotsatira zoyipa). Kuphatikiza apo, kwa odwala omwe akukumana ndi nthawi yayitali, kudalirika kwa kampu komanso kulondola kwa pampu ndi kulondola kumateteza zolakwa zazitali kwa nthawi yayitali, kukonza chithandizo chonse cha khansa.
2. Zizindikiro zothandizira
Odwala khansa nthawi zambiri amapirira zovuta zofooketsa kuchokera ku chemotherapy, monga nseru, kusanza, ndi zowawa. Mapampu jakisoni amagwiritsidwa ntchito kuti apereke mpumulo mosalekeza popereka antiemetictics, analgesic, ndi mankhwala ena othandizira. Popereka mankhwalawa mosalekeza, pampu imathandiza kuti odwala akhale omasuka, kuwalola kuti azitha kulekerera zovuta za chithandizo cha khansa. Mwachitsanzo, odwala omwe akukumana ndi mseru wowoneka bwino wa mankhwala osokoneza bongo kapena osasunthika, kupewa mafunde a squartion omwe angayambitse kuchepa kwa moyo. Pankhani ya kasamalidwe ka khansa, mapioids monga morphine amatha kuphatikizidwa ndendende kugwiritsa ntchito kampweya pakati ndikupereka chitsime chogwiritsira ntchito mankhwalawa, ndikuonetsetsa kuti odwala amatha kuyang'ana pa ululu wosakhazikika m'malo mopweteketsa mtima.
E. Mu kasamalidwe kopweteka
1. Kutumiza kwa analgesics
M'malo mwa kasamalidwe chopweteka, mapampu a jekeseni amapereka njira zodalirika zoperekera zowawa. Odwala post-opaleshoni, mwachitsanzo, nthawi zambiri amamva kupweteka kwambiri panthawi yotumizira pambuyo pake. Mapampu jakisoni amatha kupangidwa kuti abweretse analgesics ngati fentanyl kapena bupivacaine nthawi zonse, kusunga mankhwala othandizira kupweteka. Izi sizimangokhala ndi mavuto a wodwala komanso amalimbikitsa kuchira mwachangu powalimbikitsa kuti achite masewera olimbitsa thupi komanso kupuma kwakukulu, zomwe ndizofunikira popewa zovuta monga chibayo. Mu kasamalidwe kakang'ono kwambiri kambiri, kwa odwala omwe ali ndi vuto la neuropathic kapena kupweteka kwamideramo, pampu imatha kuwongolera analgesics ataliatali, kuchepetsa kufunika kwa ma jakisoni pafupipafupi komanso kukonza moyo wonse.
2. Analgesia (PCA)
PCA ndi njira yosinthira mu kayendetsedwe ka ululu womwe umayatsa odwala kuti azichita bwino. Kugwiritsa ntchito pompopompu yokhala ndi ntchito ya PCA, odwala amatha kudzipereka pang'ono Mlingo wa analgesics, popioid, mkati mwa malire. Izi zimawathandiza kuti azichita bwino kuti akhumudwitse kupweteka, kupereka chizolowezi chowongolera komanso kuchepetsa nkhawa zomwe zimakhudzana ndi ululu. Mawonekedwe a pompu ya jakisoni amateteza bongo poletsa pafupipafupi komanso mlingo wodzipereka. Mwachitsanzo, wodwala akuchira ku opaleshoni yayikulu amatha kukanikiza batani kuti alandire mlingo wa morphine pomwe ululu umakhala wosagwirizana, kuchuluka kwa mankhwala omwe aperekedwa m'malo otetezeka. Kuthekera pakati pa oldempi baji komanso chitetezo chapangitsa PCA njira yopezeredwa komanso yopweteka kwambiri yazaumoyo wamakono.
Iv. Ubwino wa jakisoni pompopompo
A. Kulondola kwambiri komanso kulondola
Poyerekeza ndi njira zachikhalidwe kulowetsedwa njira, mapampu jakisoni amaperekanso malire. Kulowetsedwa pamanja, kumadalira mphamvu yokoka ndi kuwongolera kwamagetsi kwa mitengo ya Drip, imakonda zolakwika chifukwa cha zinthu zomwe zimakhala zodwala, tubeni makilogalamu, kapena vuto la anthu pakuwerengera madontho. Pampu ya jekele, gwiritsani ntchito molimbika magalimoto ndi maenje owoneka bwino kuti awonetsetse kuti mankhwalawa amaperekedwa ndi kulondola kwa zithunzi. Kulondola kumeneku ndi kofunika kwambiri kuchitika komwe ngakhale kupatuka pang'ono muyezo kumatha kukhala ndi zotsatirapo zazikulu. Mwachitsanzo, ku chemotherapy, mililili yochepa kwambiri kapena kuchuluka kwambiri kwa mankhwala osokoneza bongo a Crototoxic kumatanthauza kusiyana pakati pa chotupa champhamvu komanso zoopsa kwambiri kukhala ndi minyewa yathanzi. Mu chisamaliro cha neonatal, komwe matupi a makanda amasamala kwambiri mankhwala, kuthekera kogwiritsa ntchito ma microgram a pakamwa pa ola limodzi ndi osaunikira kumateteza matupi awo osagawika. Kulondola kwa pompoyo sikungokhala ndi zotsatira za chithandizo chokha komanso kuchepetsa chiopsezo cha mankhwala osokoneza bongo, kukulitsa chitetezo choleza mtima.
B. mitengo yosinthika yosinthika
Kusinthasintha kwa kusintha kwa mpweya wa jekesani pakufunikira ndi mwayi wina wabwino. Ophunzira azaumoyo amatha kugwiritsa ntchito mankhwala osokoneza bongo otengera odwala enieni. Pokhala mosavuta, ngati matenda a wodwala mwadzidzidzi amatsitsidwa, mankhwala a Vosopressor amatha kuphatikizidwa mwachangu powonjezera mpweya wa jakisoni kuti mubwezeretse hemodynamic kukhazikika. Mosiyananso, ngati wodwala akuwonetsa zizindikiro zopitilira muyeso pakuchita opatsirana, kuchuluka kwa kulowetsedwa kumatha kutsika mwachangu. Kutengera kumeneku kumayambira zochitika zosiyanasiyana, kuti asinthe kuchuluka kwa wodwala matenda a shuga chifukwa cha kuchuluka kwa ma shuga kuti athe kusintha mankhwala a anti-antictuc mudzidzidzi. Kutha kwa pfupa kwa pracele kuyankha nthawi yomweyo kusintha miction miction kumalimbikitsa ogwira ntchito zamankhwala kuti apereke umunthu ndi kusamalira mwa utoto, kuwongolera chithandizo chamankhwala pazinthu zapadera zilizonse.
C. mawonekedwe achitetezo
Chitetezo ndi chachikulu mu kapangidwe ka chipangizo cha zamankhwala, ndipo mapampu amtundu wa jakisoni amakhala ndi chitetezo chokwanira cha kuteteza. Mabungwe oopsa ndi gawo loyamba kudzitchinjiriza, onjezerani antchito pazomwe angathe kuchita. Ma ARM milm nthawi yomweyo adziwitsa pomwe ma tuber atsekedwa, kupewa kupanikizika kwambiri komwe kumatha kufooka mtsempha kapena kuwononga tsamba lodzalowetsedwa. Zojambula zamtundu wa mpweya zimamveka ngati mafupa amlengalenga amalowa kubululu, ndikutha kuwopsa kwa moyo wa embolism ya mpweya. Machenjezo otsika a batire amaonetsetsa kuti pampu saletsa mosayembekezereka pakulowetsedwa. Kuphatikiza apo, pompopompompi yambiri yamapulogalamu yopanda mphamvu kuti musatenge mankhwala osokoneza bongo ngati syringe yasokonekera mwangozi. Mitundu ina imakhalanso ndi chinsinsi cha password kapena zokongoletsera kuti zilepheretse kusokonekera kosaloledwa ndi kulowetsedwa. Zinthu zotetezekazi zimagwira ntchito ku Tandem kuti ipange chitchino cholakwira zolakwika ndi zolakwika, zomwe zimapangitsa kuti zikhale zodalirika zaumoyo komanso kuteteza odwala kuti asavutike.
V. Pomaliza
Pomaliza, mapampu a jakisoni adafika mbali iliyonse ya mankhwala aliwonse azachipatala, akutuluka ngati chida chofunikira kwa omwe amapereka matenda. Kutha kwawo kupulumutsa mankhwala osokoneza bongo osagwirizana, mitengo yosiyanasiyana yosiyanasiyana, komanso mawonekedwe otetezeka, onjezerani zotsatira za kuleza mtima, zomwe zimapangitsa kuti zitheke.
