목차
1. 용어 및 약어
1) 용어 및 약어 ·························································································· 3
2. 주요 학습내용
1) 중환자실에서 주로 시행하는 검사와 전, 후간호(A-line, CVP, PAP/PCWP monitoring 등) ···················································································· 5
2) 인공 환기요법과 간호 ·············································································· 6
3) 무의식 환자 간호 ···················································································· 7
4) CRRT(Continuous renal replacement therapy)적용 환자 간호 ··············· 10
5) 장기 이식 환자 간호 ·············································································· 11
6) 배액관 관리(흉부 배액관, EVD, Hemovac, Barovac 등) ·························· 11
3. 주요 질환
1) 심장판막질환(MR, AS, AR, TS 등) ························································· 13
2) 뇌출혈(EDH, ICH, SDH, SAH) ······························································· 14
3) 폐렴(Pnuemonia) ·················································································· 16
4) 성인호흡곤란증후군(ARDS) ····································································· 16
5) 장기이식(간, 신장 등) ············································································ 17
4. 주요 수술
1) CABG ·································································································· 18
2) Craniotomy ························································································· 19
3) Organ transplantation ········································································· 20
5. 참고문헌
1) 참고문헌 ································································································ 21
본문내용
2. 주요 학습내용
1) 중환자실에서 주로 시행하는 검사와 전, 후 간호
(1) A-line (Arterial line)
* 목적 : 동맥압을 정확히 측정하기 위해 말초동맥에 카테터를 삽입해 동맥압을 측정하고 동맥혈가스분석(ABGA)을 위한 혈액을 채취하기 위함.
* 절차
① Allen test.
② 18-20G의 Teflon catheter를 환자의 동맥(주로 요골동맥)내에 삽입
③ Teflon catheter와 변환기를 연결
④ 다른 한 끝은 EKG에 연결되어 oscilloscope의 검출판에 과시광선에 의한 혈압파형이 계속 투시됨으로써 SBP, ABP, MAP(수축기압, 이완기압, 평균혈압)을 알 수 있음.
⑤ 동맥내압 측정치는 전압기에 연결된 압력측정기를 통해 나타남.
– 동맥 수축 시 : EKG의 QRS complex와 관련해 상부에 충격파가 나타남.
– 동맥 이완 시 : 하부에 충격파가 나타남.
– 계속적으로 충격파가 하부로 떨어질 경우 이는 이완 시 계속 압력이 떨어짐을 의미
– 만약 전압기가 없을 경우에는 CVP와 비슷한 장치로 동맥압을 측정할 수 있음.
(2) CVP(Central venous pressure)
* 정의 : 전신순환으로부터 우심방으로 귀환하는 혈액의 압력으로 전부하와 우심장의 기능상태를 직접 반영하며 수액과다 또는 수액부족 등을 알 수 있게 하므로 수액공급의 지침으로 이용됨.
* 목적
– 우심방 내 혹은 대정맥내의 압력을 측정하기 위해
– 울혈성 심부전을 조기에 인지하기 위해
– 수액보충의 기준을 얻기 위해
– 순환 혈액량을 측정하기 위해
– 중심정맥혈을 채취하기 위해
– 수액대치를 위한 가이드를 제공하기 위해
– 말초 정맥 부위가 부적절할 때 정맥접근법 사정을 위해
– 수혈 및 총 비경구 영양과 말초 공급의 금기된 투약 치료를 위해
– 일시적 심장 박동기를 삽입하기 위해
* 정상범위: 2~8mmHg(5~10cmH20)
① 정상 중심 정맥압 ↑ 간호 : 이뇨제
– Cardiac insufficiency
– CHF, Pul.Edema
– Rt. Heart failure
– Increased intravascular volume due to Iv overload
② 정심 중심 정맥압 ↓ 간호 : 수액공급
– 순환 혈류량의 감소 (Hypervolemia, Shock)
– Rt.Ventricular empty(End diastolic volume ↑)
출처 : 해피캠퍼스
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