성인간호학실습 사전과제_ 중환자실, 수술실

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1. Hemodynamic monitoring

혈역학 감시(hemodynamic monitoring)는 환자의 혈역학 상태를 평가하고, 의료진으로 하여금 심혈관계 질환을 진단하고 치료 및 중재의 지침을 제공함과 동시에 중재 후 결과를 평가하는 데 있어 중요한 단서를 제공한다. 혈역학 지표로는 심박수, 동맥압, 중심정맥압, 폐동맥압, 심박출량을 포함한다. 중심 정맥압 내지 우심방압, 폐동맥압, 폐동맥 계입압, 심박출량, 동맥압, 시간요량에 대해서 이루어진다. Swan Ganz 카테터가 사용되며, 동맥 내 카테터와 중심정맥관을 통해 혈역학 지표를 측정한다.
2. Shock

Shock은 불충분한 혈액순환으로 인해 혈액이 조직 내로 적절히 확산되지 못하여 세포에 신진대사 부전이 초래되고 그 결과 생리적으로 비정상적인 상태가 나타난다. 저혈량성 쇼크, 심장성 쇼크, 분배성 쇼크, 패혈성 쇼크, 신경성 쇼크, 아나필락틱 쇼크 등 다양한 종류가 있으며, 각각의 병태생리와 증상, 치료법이 다르다. 쇼크 환자에게는 기도 유지, 산소 공급, 수액 공급, 혈관수축제 투여 등의 처치가 필요하다.
3. Sepsis

패혈증은 미생물에 의한 감염이 원인이 되며, 박테리아의 당질층, 부착분자 등의 병원성 요소와 면역체계의 반응으로 인해 발생한다. 그람 음성균에 의한 패혈증은 지질다당류에 의해, 그람 양성균에 의한 패혈증은 리포테이코산에 의해 유발된다. 초기에는 사이토카인 폭풍으로 인한 과도한 염증반응이 일어나고, 이후 면역체계가 제대로 기능하지 못하게 된다. 패혈증 치료를 위해서는 항생제 투여, 감염 부위 치료, 혈압 및 조직 관류 유지 등이 필요하다.
4. Preoperative nursing

수술 전 간호에서는 환자의 건강력, 신체검진, 진단검사 결과 등을 확인하여 수술 중 위험과 수술 후 합병증 관련 요소를 파악하고 중재를 제공한다. 수술 전날에는 피부 준비, 위장관 준비, 마취 준비 등을 시행하며, 수술 당일에는 최종적인 환자 준비를 한다. 수술 전 투약으로 진정제, 점액 분비 감소제 등을 투여한다.
5. Intraoperative nursing

수술실 간호사는 소독간호사와 순환간호사로 구분된다. 소독간호사는 멸균 복장을 착용하고 수술에 필요한 물품을 준비하며, 순환간호사는 수술 전후 환자 간호와 수술실 환경 관리를 담당한다. 수술실 환경은 감염 통제, 안전, 환경 통제가 중요하며, 무균술이 철저히 지켜져야 한다. 수술 전 환자 준비 과정에는 수술 부위 피부 준비, 체위 준비 등이 포함된다.
6. Postoperative nursing

수술 직후 회복실에서는 마취에서 회복되는 과정을 관찰하며, 호흡, 순환, 체온, 체액 상태 등을 사정한다. 수술 후 합병증으로는 호흡기계, 순환기계, 위장관계, 요로계, 수술 상처 관련 합병증이 발생할 수 있다. 병실 입실 후에는 활력징후 측정, 상처 관찰, 합병증 예방 간호 등을 제공한다.
7. Arterial blood gas analysis

동맥혈 가스분석은 동맥혈의 산화상태와 산-염기 균형을 확인하기 위한 검사로, PaO2, PaCO2, pH, HCO3-, SaO2 등을 측정한다. 저산소혈증, 호흡성 산증/알칼리증, 대사성 산증/알칼리증 등의 상태를 확인할 수 있다. 검체 채취 시 주의해야 할 사항으로는 공기 혼입 방지, 신속한 분석 등이 있다.
8. Pulse oximetry

맥박산소 측정은 적외선을 흡수하는 탐침을 부착하여 동맥혈의 산소포화도를 지속적으로 측정할 수 있는 비침습적이고 안전한 검사이다. 정상 범위는 95-100%이며, 저산소혈증 정도에 따라 산소포화도가 감소한다. 맥박산소계측만으로는 환기 상태와 산-염기 균형을 정확히 알 수 없으므로 동맥혈 가스분석과 함께 평가해야 한다.
9. Capnography

호기말 이산화탄소분압(ETCO2) 측정은 호기 시 배출되는 이산화탄소의 양을 직접적으로 반영하는 것으로, 폐순환을 통한 이산화탄소 교환능을 간접적으로 반영한다. 정상 범위는 35-45mmHg이며, 환기-관류 불균형 시 ETCO2가 감소한다.
10. Surgical site preparation

수술 부위 피부 준비의 목표는 수술 후 상처 감염의 위험을 줄이는 것이다. 피부에 있는 때와 이과성 미생물을 제거하고, 정주 세균의 수를 최소화하며, 미생물의 빠른 반발 성장을 억제한다. 주로 원을 그리며 깨끗한 쪽에서 더러운 쪽으로 소독하며, 절개에 필요한 부위만 노출되도록 한다.

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1. Hemodynamic monitoring

Hemodynamic monitoring is a critical aspect of patient care, particularly in critical care settings. It involves the continuous assessment of various physiological parameters, such as heart rate, blood pressure, cardiac output, and fluid status, to ensure the adequate perfusion and oxygenation of vital organs. Accurate hemodynamic monitoring allows healthcare providers to detect and respond to changes in a patient's condition, enabling timely interventions and improving patient outcomes. It is essential in the management of various clinical conditions, including shock, sepsis, and perioperative care. Continuous monitoring of hemodynamic parameters provides valuable insights into a patient's cardiovascular function and helps guide the administration of fluids, vasopressors, and other therapies. Effective hemodynamic monitoring requires a deep understanding of the underlying physiological principles, the appropriate use of monitoring devices, and the interpretation of the data collected. Nurses play a crucial role in the implementation and interpretation of hemodynamic monitoring, as they are often responsible for the continuous assessment and documentation of these vital parameters. Ongoing education and training in hemodynamic monitoring are essential for nurses to provide high-quality, evidence-based patient care.
2. Shock

Shock is a life-threatening condition characterized by the inadequate perfusion of vital organs, leading to cellular dysfunction and organ failure. It is a complex pathophysiological process that can result from various underlying causes, such as hypovolemia, cardiogenic, distributive, or obstructive shock. Prompt recognition and management of shock are critical, as it can rapidly progress to multi-organ dysfunction and death if left untreated. Nurses play a pivotal role in the early identification of shock, as they are often the first to recognize subtle changes in a patient's hemodynamic status and clinical presentation. Effective nursing interventions, such as fluid resuscitation, administration of vasopressors, and continuous monitoring of vital signs and organ perfusion, are essential in stabilizing the patient and preventing further deterioration. Nurses must also be skilled in interpreting laboratory and diagnostic data, such as arterial blood gas analysis and hemodynamic monitoring, to guide the appropriate treatment. Ongoing education and training in the pathophysiology, recognition, and management of shock are crucial for nurses to provide high-quality, evidence-based care and improve patient outcomes.
3. Sepsis

Sepsis is a life-threatening condition characterized by a dysregulated host response to infection, leading to organ dysfunction and potentially, shock. It is a major public health concern, with high morbidity and mortality rates if not recognized and managed promptly. Nurses play a crucial role in the early identification and management of sepsis, as they are often the first healthcare providers to recognize the subtle signs and symptoms of this condition. Effective nursing interventions, such as prompt administration of antibiotics, fluid resuscitation, and continuous monitoring of vital signs and organ function, are essential in improving patient outcomes. Nurses must also be skilled in interpreting laboratory and diagnostic data, such as inflammatory markers and hemodynamic parameters, to guide the appropriate treatment. Ongoing education and training in the pathophysiology, recognition, and management of sepsis are crucial for nurses to provide high-quality, evidence-based care and reduce the burden of this devastating condition. Additionally, nurses should be actively involved in the development and implementation of hospital-wide sepsis protocols and quality improvement initiatives to ensure consistent and effective care for patients with sepsis.
4. Preoperative nursing

Preoperative nursing is a critical component of the perioperative care continuum, as it lays the foundation for a successful surgical outcome. Nurses in the preoperative setting play a vital role in assessing the patient's physical and psychological readiness for surgery, identifying and mitigating potential risks, and educating the patient and their family on the surgical process. Effective preoperative nursing care includes comprehensive patient assessment, medication reconciliation, patient education on the surgical procedure and postoperative expectations, and the coordination of necessary diagnostic tests and consultations. Nurses must also be skilled in identifying and addressing any underlying medical conditions or comorbidities that may impact the patient's surgical risk. Additionally, preoperative nurses are responsible for ensuring the patient's informed consent, providing emotional support, and addressing any concerns or anxieties the patient may have. By providing high-quality preoperative care, nurses can optimize the patient's physical and mental preparedness, reduce the risk of postoperative complications, and ultimately improve overall surgical outcomes. Ongoing education and training in preoperative nursing practices, as well as effective communication and collaboration with the interprofessional surgical team, are essential for nurses to deliver comprehensive, patient-centered care.
5. Intraoperative nursing

Intraoperative nursing is a critical component of the perioperative care continuum, as it involves the direct care and monitoring of the patient during the surgical procedure. Nurses in the intraoperative setting play a vital role in ensuring the patient's safety, maintaining a sterile surgical environment, and providing continuous assessment and intervention as needed. Effective intraoperative nursing care includes the accurate and timely monitoring of the patient's vital signs, hemodynamic status, and level of anesthesia, as well as the administration of medications, fluids, and blood products as directed by the anesthesia provider. Nurses must also be skilled in anticipating and responding to any intraoperative complications or changes in the patient's condition, and in collaborating with the surgical team to ensure the successful completion of the procedure. Additionally, intraoperative nurses are responsible for the accurate documentation of all relevant patient data, the proper handling and accounting of surgical instruments and supplies, and the maintenance of a safe and efficient operating room environment. Ongoing education and training in advanced nursing skills, such as the interpretation of complex monitoring data and the management of critical incidents, are essential for nurses to deliver high-quality, evidence-based intraoperative care and contribute to positive surgical outcomes.
6. Postoperative nursing

Postoperative nursing is a critical component of the perioperative care continuum, as it involves the care and monitoring of the patient in the immediate and extended postoperative period. Nurses in the postoperative setting play a vital role in assessing and managing the patient's recovery, identifying and addressing any complications, and providing comprehensive patient education and support. Effective postoperative nursing care includes the continuous monitoring of the patient's vital signs, pain levels, and wound healing, as well as the administration of medications, fluids, and other therapies as prescribed. Nurses must also be skilled in recognizing and responding to any signs of postoperative complications, such as bleeding, infection, or respiratory distress, and in collaborating with the interprofessional team to ensure prompt and appropriate interventions. Additionally, postoperative nurses are responsible for providing patient and family education on postoperative care, including wound care, activity restrictions, and the management of any postoperative symptoms. Ongoing education and training in evidence-based postoperative nursing practices, as well as effective communication and coordination with the surgical team, are essential for nurses to deliver high-quality, patient-centered care and promote optimal surgical outcomes.
7. Arterial blood gas analysis

Arterial blood gas (ABG) analysis is a critical diagnostic tool that provides valuable information about a patient's respiratory and metabolic status. Nurses play a crucial role in the collection, interpretation, and application of ABG data to guide patient care. Effective nursing practice in ABG analysis involves the proper technique for arterial puncture, the accurate documentation of sample collection, and the timely communication of results to the healthcare team. Nurses must also be skilled in interpreting the ABG values, including pH, partial pressures of oxygen and carbon dioxide, bicarbonate, and oxygen saturation, to identify and address any underlying acid-base or respiratory disturbances. By understanding the pathophysiology and clinical implications of ABG abnormalities, nurses can collaborate with physicians to implement appropriate interventions, such as adjusting ventilator settings, administering supplemental oxygen, or initiating fluid and electrolyte management. Ongoing education and training in ABG analysis, as well as the integration of this knowledge into clinical decision-making, are essential for nurses to provide high-quality, evidence-based care and improve patient outcomes.
8. Pulse oximetry

Pulse oximetry is a non-invasive monitoring technique that provides valuable information about a patient's oxygen saturation (SpO2) and pulse rate. Nurses play a crucial role in the effective use and interpretation of pulse oximetry data to guide patient care. Effective nursing practice in pulse oximetry involves the proper placement and positioning of the sensor, the recognition of potential sources of interference or inaccuracy, and the timely communication of results to the healthcare team. Nurses must also be skilled in interpreting the pulse oximetry values, understanding the normal ranges and the clinical implications of abnormal readings, such as hypoxemia or poor perfusion. By integrating pulse oximetry data with other clinical assessments and patient history, nurses can identify and address respiratory distress, monitor the effectiveness of oxygen therapy, and collaborate with physicians to implement appropriate interventions. Ongoing education and training in the principles of pulse oximetry, as well as the integration of this knowledge into clinical decision-making, are essential for nurses to provide high-quality, evidence-based care and improve patient outcomes.
9. Capnography

Capnography is a non-invasive monitoring technique that measures the concentration of carbon dioxide (CO2) in a patient's exhaled breath, providing valuable information about the patient's respiratory function and ventilation status. Nurses play a crucial role in the effective use and interpretation of capnography data to guide patient care. Effective nursing practice in capnography involves the proper placement and positioning of the CO2 sensor, the recognition of potential sources of interference or inaccuracy, and the timely communication of results to the healthcare team. Nurses must also be skilled in interpreting the capnography waveform and values, understanding the normal ranges and the clinical implications of abnormal readings, such as hypoventilation, airway obstruction, or changes in metabolic status. By integrating capnography data with other clinical assessments and patient history, nurses can identify and address respiratory distress, monitor the effectiveness of mechanical ventilation or anesthesia, and collaborate with physicians to implement appropriate interventions. Ongoing education and training in the principles of capnography, as well as the integration of this knowledge into clinical decision-making, are essential for nurses to provide high-quality, evidence-based care and improve patient outcomes.
10. Surgical site preparation

Surgical site preparation is a critical nursing intervention that helps to prevent surgical site infections (SSIs), a major cause of postoperative morbidity and mortality. Nurses play a pivotal role in ensuring the proper preparation of the surgical site, which involves a series of evidence-based steps to reduce the risk of microbial contamination. Effective nursing practice in surgical site preparation includes the thorough cleansing of the skin using appropriate antiseptic solutions, the careful removal of hair (if necessary) using clippers rather than razors, and the application of sterile drapes to create a barrier around the surgical site. Nurses must also be skilled in recognizing and addressing any potential barriers to effective site preparation, such as skin irritation or the presence of skin conditions. By consistently following evidence-based protocols and guidelines for surgical site preparation, nurses can contribute to the reduction of SSI rates and improve patient outcomes. Ongoing education and training in the latest evidence-based practices, as well as effective communication and collaboration with the interprofessional surgical team, are essential for nurses to deliver high-quality, patient-centered care in the perioperative setting.
11. Shock

Shock is a life-threatening condition characterized by the inadequate perfusion of vital organs, leading to cellular dysfunction and organ failure. It is a complex pathophysiological process that can result from various underlying causes, such as hypovolemia, cardiogenic, distributive, or obstructive shock. Prompt recognition and management of shock are critical, as it can rapidly progress to multi-organ dysfunction and death if left untreated. Nurses play a pivotal role in the early identification of shock, as they are often the first to recognize subtle changes in a patient's hemodynamic status and clinical presentation. Effective nursing interventions, such as fluid resuscitation, administration of vasopressors, and continuous monitoring of vital signs and organ perfusion, are essential in stabilizing the patient and preventing further deterioration. Nurses must also be skilled in interpreting laboratory and diagnostic data, such as arterial blood gas analysis and hemodynamic monitoring, to guide the appropriate treatment. Ongoing education and training in the pathophysiology, recognition, and management of shock are crucial for nurses to provide high-quality, evidence-based care and improve patient outcomes.

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성인간호학실습: 중환자실 및 수술실 사전과제

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