A+ 성인간호학실습 뇌경색 case 간호과정3개

본 내용은 " A+ 성인간호학실습 뇌경색 case 간호과정3개 " 의 원문 자료에서 일부 인용된 것입니다. 2024.12.02

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• 1. Corona radiata infaction

  뇌조직은 평상시에도 많은 양의 혈류를 공급받고 있다. 그런데 다양한 원인으로 인하여 뇌혈관에 폐색(혈관 등을 이루는 관이 막히는 경우)이 발생하여 뇌에 공급되는 혈액량이 감소하면 뇌조직이 기능을 제대로 하지 못하게 된다. 뇌혈류 감소가 일정 시간 이상 지속되면 뇌조직의 괴사(조직이나 세포의 일부가 죽는 것)가 시작된다. 뇌조직이 괴사되어 회복 불가능한 상태에 이르렀을 때 이를 뇌경색(Cerebral infarction)이라고 한다.

• 2. 증상

  1) 반신부전과 반신마비 반신마비는 뇌피질의 운동영역이나 추체로의 손상으로 인한다. 우측 뇌의 경색은 신체의 좌측 반쪽에 일으키며 또는 그 반대이다. 2) 실행증 (aparaxia) 손상받은 부분을 움직일 수는 있으나 지시에 따라 사용하지 못하는 것이다. 3) 실어증(aphasia) 및 구음장애 실어증은 말의 상징을 사용하거나 해석하는 장애를 말한다. 4) 시력변화 두정엽과 측두엽의 병변은 시각의 장애로 동측성 반맹증(homonymous hemianopsia)과 같은 시야장애가 일어난다. 5) 실인증 (agonosia)시각, 촉각 또는 기타감각정보의 해석의 장애를 말한다. 6) 연하장애 (dysphasia) 연하장애에서 연하란 여러 신경이 함께 작용하는 복합한 과정으로 입은 열려야 하고(뇌신경Ⅴ), 입술은 닫혀야 하며 혀는 움직여야 한다.

• 3. 치료

  1. 약물 요법(혈전용해제, 항혈전제)① 혈전용해제뇌혈관이 막혀 뇌 혈류가 차단되면 불과 몇 시간 내에 뇌 조직에 돌이킬 수 없는 손상이 생깁니다. 따라서 수 시간 이내에 막힌 뇌혈관에 혈전용해제를 투여하여 혈관을 막고 있는 혈전을 녹여 뇌 혈류를 재개해야 합니다.② 항혈소판제제동맥 경화 상태의 혈관 벽에 혈전이 생기는데, 이를 방지하기 위해 항혈소판제제를 투여해야 합니다.③ 항응고제심장 질환에 의한 뇌색전증, 혈관 박리 등에 의한 뇌경색인 경우 피의 응고를 저지시키기 위해 항응고제를 사용합니다.2. 비약물 요법(혈관 성형술, 스텐트 삽입술, 경동맥 내막 절제술)두개 내외 뇌동맥이 심하게 좁아진 경우 약물 요법만으로 뇌졸중 재발을 막기 어려울 수 있습니다.

• 4. 간호

  ①신경계 변화와 합병증을 모니터한다.②발이 이완된 대상자는 족하수를 예방하기 위해 발목이 높은 욕창 예방용 신발을 신겨준다.③합병증 예방을 위해 압박스타킹 착용 또는 항응고제를 예방적으로 투여한다.④감각 지각기능증진 · 우측 손상 : 시각, 공간 인지기능 어려움으로 대상자의 건강한 쪽으로 접근하기 · 좌측 손상 : 기억력 결핍으로 오늘 날짜와 병원 환경에 대해 반복적으로 알려주기⑤편측 지각기능증진: 신체 양측을 사용하도록 교육한다.⑥의사소통증진을 위해 반복적 지시와 천천히 또박또박 명료하게 말을 하게 한다.⑦삼킴반응 검사를 통해 연하곤란을 사정한다.⑧배뇨관리를 하기 위해 방광 훈련 프로그램을 하고, 배변관리를 위해 정기적인 배변시간을 정하고, 고섬유식이를 제공한다.

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• 1. Corona radiata infaction

  Corona radiata infaction is a serious medical condition that requires prompt diagnosis and treatment. The corona radiata is a bundle of nerve fibers that connect the cerebral cortex to the brainstem, and an infaction in this area can lead to significant neurological impairments. Symptoms may include weakness or paralysis on one side of the body, sensory disturbances, and cognitive or language difficulties depending on the specific location and extent of the infaction. Prompt medical intervention is crucial, as timely treatment with thrombolytic medications or endovascular procedures can help restore blood flow and minimize permanent brain damage. Rehabilitation therapy is also an important component of recovery, as patients may need to relearn basic motor and cognitive skills. Overall, corona radiata infaction is a complex condition that requires a multidisciplinary approach to provide the best possible outcomes for affected individuals.

• 2. 증상

  The symptoms of corona radiata infaction can vary widely depending on the location and severity of the infaction. Common symptoms may include sudden-onset weakness or paralysis on one side of the body, numbness or tingling sensations, difficulty speaking or understanding language, vision problems, and cognitive impairments such as confusion or memory difficulties. In some cases, patients may also experience headaches, dizziness, or balance issues. The specific symptoms will depend on which specific nerve fibers within the corona radiata are affected. Prompt recognition of these symptoms and immediate medical attention are crucial, as timely treatment can significantly improve outcomes and minimize the risk of permanent neurological deficits. Patients and their caregivers should be educated on the potential signs of corona radiata infaction and the importance of seeking emergency medical care if these symptoms arise.

• 3. 치료

  The treatment of corona radiata infaction typically involves a combination of medical interventions and rehabilitation therapy. The primary goal of treatment is to restore blood flow to the affected area of the brain as quickly as possible, in order to minimize the extent of permanent brain damage. This may involve the use of thrombolytic medications, such as tissue plasminogen activator (tPA), which can help dissolve the blood clot causing the infaction. In some cases, endovascular procedures such as mechanical thrombectomy may be performed to physically remove the clot. Additionally, antiplatelet or anticoagulant medications may be prescribed to prevent the formation of additional clots. Once the acute phase of the infaction has been addressed, rehabilitation therapy becomes a critical component of the treatment plan. Physical, occupational, and speech therapists work closely with the patient to help regain lost motor, cognitive, and language skills. This may involve exercises to improve strength, coordination, and balance, as well as cognitive exercises to enhance memory, attention, and problem-solving abilities. The duration and intensity of rehabilitation will depend on the severity of the infaction and the individual's response to treatment. Overall, the successful management of corona radiata infaction requires a multidisciplinary approach that combines prompt medical intervention with comprehensive rehabilitation therapy. With appropriate and timely treatment, many patients are able to achieve significant functional improvements and a good quality of life.

• 4. 간호

  Nursing care plays a crucial role in the management of patients with corona radiata infaction. Nurses are responsible for closely monitoring the patient's neurological status, vital signs, and overall condition, and promptly reporting any changes to the healthcare team. They also play a key role in administering medications, managing the patient's airway and respiratory function, and providing basic care such as assistance with activities of daily living. In the acute phase of the infaction, nurses must be vigilant in identifying and addressing potential complications, such as swallowing difficulties, aspiration risk, and the development of pressure ulcers. They may also need to coordinate the patient's care with other members of the healthcare team, such as physical therapists, occupational therapists, and speech-language pathologists, to ensure a comprehensive and coordinated approach to rehabilitation. As the patient progresses through the recovery process, nurses play a vital role in educating the patient and their family members on the nature of the condition, the expected course of recovery, and the importance of adhering to the prescribed treatment plan. They may also provide emotional support and counseling to help the patient and their loved ones cope with the challenges of the recovery process. Overall, the nursing care of patients with corona radiata infaction requires a deep understanding of the condition, as well as the ability to provide compassionate and comprehensive care to support the patient's physical, cognitive, and emotional well-being throughout the recovery process.