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목차

1. 용어 및 약어
1) 용어 및 약어 ····························································································· 1

2. 주요 학습내용
1) 소화기계 병동에서 주로 시행하는 검사 전·후 간호 ··············································· 3
– GFS(위내시경, Gastrofiberscope)
– CFS(대장내시경, Colonofiberscope)
– ERCP(내시경역행췌담관조영술, Endoscopic retrograde cholangio pancreatography)
– TACE(간동맥 화학색전술, Transcatheter arterial chemoembolization)
– EVL(내시경 정맥류 결찰술, Endoscopic variceal ligation)
– 간 생검(Liver biopsy)
– 복수 천자(Paracentesis, Peritoneal tapping)
2) 위 장관 점막 절제술 환자 관리 ······································································· 6
3) 각종 배액관 삽입환자 관리(PTBD, ENBD, ERBD) ················································ 7
4) 간성혼수간호 ······························································································· 7

3. 주요 질환
1) 위염(Gastritis), 궤양(Ulcer), 위암(Stomach cancer) ··········································· 8
2) 염증성 장질환(Intestinal inflammation), 국소장염(Regional enteritis), 대장암(CRC, Colon cancer), 궤양성 대장염(Ulcerative colitis), 과민대장증후군(Irritable bowel syndrome), 장폐색(Intestinal obstruction) ····················································· 11
3) 직장암(Rectal cancer) ················································································· 15
4) 간염(Hepatitis), 간경화증(Liver cirrhosis), 간암(Hepatoma), 정맥류 출혈(Varix bleeding), 간세포암(HCC, Hepatocellular carcinoma) ······································ 16
5) 담석증(Cholelithiasis), 담낭염(Cholecystitis), 담낭암(Gallbladder cancer), 담관암(Cholangiocarcinoma) ··············································································· 19
6) 췌장염(Pancreatitis), 췌장암(Pancreatic cancer) ·············································· 22

3. 주요 수술 및 시술
1) GFS (위내시경) ·························································································· 24
2) EMR (내시경적 점막 절제술) ········································································· 24
3) ESD (내시경적 점막하 절제술) ······································································· 25
4) PTBD (피부간경유쓸개관배액술) ····································································· 26
5) EST (내시경적유두괄약근절개술) ···································································· 26
6) 내시경적역행성췌담관조영술(ERCP) ································································· 27
7) 경피적간담도조영술(PTCA) ············································································ 28

4. 참고문헌
1) 참고문헌 ··········································································································· 28

본문내용

2. 주요 학습내용

1) 소화기계 병동에서 주로 시행하는 특수 검사 전 · 후 간호

1-1) GFS (위내시경, Gastrofiberscope)
√ 간호
– 검사에 대해 설명하고, 서명한 동의서를 확인한다.
– 검사 8~12시간 이전부터 금식한다.
– 검사 후 운전을 할 수 없으므로 동반한 가족이나 지인의 이름을 기록한다.
– ID팔찌를 손목에 부착한다.
– 액세서리, 의치, 안경을 제거한다.
– 검사 전 배뇨했는지 확인한다.
– 활력징후를 측정하고 진정제를 투여한다.
– 구강·인두 분비물 감소를 위해 항콜린제를 투여한다.
– 검사 관련 질문에 대해 대답한다.
– 내시경이 위 내에 삽입되면 압박감이 있을 수 있으며, 시야 확보를 위해 위에 공기를 주입하면 팽창감을 느낄 수 있음을 설명한다.
– 구강 마취제를 5분 정도 머금게 한 후 서서히 삼키도록 하여 삽관 시 불편감과 구개 반사를 방지한다.
– 마취 후에는 침을 삼키지 말고 옆으로 흘러내리게 하라고 설명한다.
– 수면 내시경을 하는 경유 검사 동안 산소포화도와 맥박수 등을 관찰한다.
– 활력징후와 구개 반사를 자주 체크한다.
– 구개 반사가 회복될 때까지 금식하고 고개를 옆으로 돌린다.
– 출혈이나 발열, 호흡곤란, 연하곤란 같은 천공의 징후를 관찰한다. (비빔소리, 목·가슴·어깨 등의 통증, 청색증, 호흡곤란, 심계항진, 경부의 피하기종, 늑막삼출증, 요통 등)
– 검사 후 적어도 12시간 동안 운전하지 말라고 설명한다.
– 검사 후 목의 자극이나 쉰목소리를 예방하기 위해 함당점제나 생리식염수로 함수한다.

1-2) CFS (대장내시경, Colonofiberscope)
√ 간호
– 아스피린, 항응고제와 같이 출혈을 일으키는 약물의 경우 주치의에게 알려 대장 내시경 전 중단하거나 용량을 줄인다. (& 당뇨, 고혈압, 항경련제 복용도 의료진과 상의 후 복용 유무 확인 필요함)
– 복부 수술 경험, 전립선 비대증, 자궁근종, 신장 질환, 과거 약물 알레르기 확인한다.

출처 : 해피캠퍼스

목차

1. 용어 및 약어
1) 용어 및 약어 ·························································································· 3

2. 주요 학습내용
1) 재활의학과 병동에서 주로 시행하는 특수 검사 전 · 후 간호 ························· 5
2) 재활환자 체위 유지 ················································································· 8
3) 재활환자 치료적 운동, 일상생활 동작 훈련 ················································ 9
4) 휠체어 및 목발 등의 보조기구 사용법 ····················································· 11
5) 재활 간호(일상생활 보조) ······································································· 16
6) 재활환자 욕창간호 ················································································· 16

3. 주요 질환
1) 외상성뇌질환 ························································································ 18
2) 염증성 장애 ···························································································· 20
3) 연부조직 질환 ······················································································· 22
4) 퇴행성 질환 ·························································································· 23
5) 마비성 질환 ·························································································· 26
6) 각종 관절염 ·························································································· 28

4. 참고문헌
1) 참고문헌 ······························································································· 30

본문내용

2. 주요 학습내용

1) 재활의학과 병동에서 주로 시행하는 특수 검사 전 · 후 간호

1-1) EMG(근전도 검사, electromyography) : 신경과 근육 등에 발생하는 전기적인 신호를 분석하여 말초신경, 신경근접합부 및 근육에 이상이 있는지를 알기 위해서 시행하는 특수 검사 방법
– 신경 및 근육의 손상에 대해 정확히 진단하고 손상 병변에 대한 정확한 위치를 결정하여 치료 및 예후에 대한 정보를 제공
√ 방법
1) 검사를 시작하기전 환자의 증상 및 병력을 확인
2) 침대에 누워서 신경전도 검사부터 먼저 시행
– 전기로 자극 주는 검사
3) 신경전도 검사가 끝난 후 근육을 바늘로 찌르는 침 근전도 검사를 통해 시행
– 검사 중 통증 유발 가능
4) 처방에 따라 침 근전도 검사를 시행하지 않을 수 있음
√ 검사 전 간호
1) 검사 전, 평소와 같은 식사, 약을 평소와 같이 복용
2) 검사 당일, 혈액 응고에 영향을 주는 약 복용, 인공심장박동기 삽입 환자의 경우 검사 전 고지
3) 검사 당일, 손과 발을 따뜻하게 유지 후 내원 (장갑 및 양말 착용)
4) 검사 당일, 간편한 복장을 착용 (목폴라, 스타킹 금지)
5) 검사 당일, 안면 검사 환자는 화장금지
√ 검사 후 간호
1) 바늘을 근육내 삽입하는 검사이기 때문에 찔린 부위에 통증 지속 가능
2) 검사 당일, 사우나 및 수영장은 금기 (감염 위험)

1-2) 보행분석검사 : – 환자의 보행 시 관절별 각도, 힘, 보행관련 근육의 움직임 정도를 측정하여 평소 보행의 문제점이 무엇인지 평가하는 검사
√ 목적 : 발의 통증, 변형, 걸음걸이 이상에서 나타나는 발에 부하되는 압력을 검사 및 분석하여 이를 통해 적절한 치료 방법 및 효과를 판정
– 평발을 비롯한 선천적 족부 변형
– 관절염, 당뇨병, 말초 혈관 질환으로 인한 발의 변형이 있는 경우
– 각종 스포츠로 인해 과도하게 사용하거나, 잘못된 신발의 착용 등에 의한 발의 변형이 있는 경우
– 정형외과적 수술을 전, 후 평가하는 경우
– 척추손상, 뇌졸중, 뇌성마비 등 중추신경계 질환 또는 하지 골격계 이상으로 · 보행 시 통증이 있거나 걸음걸이에 이상이 있는 경우
– 근 경직에 의한 보행 기능의 이상이 있는 경우
– 보조기 또는 의수족의 기능을 평가하는 경우

출처 : 해피캠퍼스

목차

1. 용어 및 약어
1) 용어 및 약어 ······································································································· 3

2. 주요 학습내용
1) 신경계 병동에서 주로 시행하는 특수 검사 전후 간호 ··············································· 5
1-1) Cerebral angiography(뇌혈관 조영술) ····························································· 5
1-2) MRI(자기공명영상) ··························································································· 5
1-3) DTR (Deep Tendon Reflex, 심부건 반사) ························································ 6
1-4) Lumbar puncture (요추천자) ·········································································· 6
1-5) EEG (electroencephalogram, electroencephalography, 뇌파검사) ···················· 6
1-6) 경두개 초음파 도플러(Transcranial Doppler, TCD) ·········································· 6
1-7) Glasgow coma scale ; GCS ··········································································· 6
2) 무의식 환자 간호 ································································································· 7
3) 두개내압 상승 환자 간호 ······················································································· 9
4) 두개수술 후 간호 ································································································ 11
5) 경련환자 간호 ···································································································· 14
6) 마비환자 간호 ···································································································· 15

3. 주요 질환
1) 감염성 질환 ······································································································· 16
2) 뇌혈관성 질환 ···································································································· 21
3) 신경계 종양 ······································································································· 26
4) 신경계 외상 ······································································································· 29
5) 퇴행성 질환 ······································································································· 32
6) 경련성 질환 ······································································································· 40
7) 말초신경질환 ······································································································ 42

4. 주요 수술
1) 동정맥 기형 절제술 ····························································································· 46
2) 뇌종양 절제술 ···································································································· 46
3) 경동맥 내막절제술 ······························································································ 47
4) 개두술 ··············································································································· 48
5) 추간판 절제술, 척수궁 절제술, 후방 요추간 융합술 ················································ 49

5. 참고문헌
1) 참고문헌 ·········································································································· 50

본문내용

2. 주요 학습내용

1) 신경계 병동에서 주로 시행하는 특수 검사 전·후 간호

1-1) 뇌혈관 조영술(Cerebral angiography) : 뇌혈관 속에 조영제를 주입하고 X선 촬영을 하여 뇌혈관 이상 유무를 진단하는 검사
√ 검사 전 간호
– 검사 동의서를 받음
– 8~12시간 금식하고 요오드와 해조류의 알레르기 확인하고 알레르기 반응을 예방하기 위해 항히스타민제나 스테로이드를 투여
– X-ray 테이블 위에 앙와위로 눕히고 정맥주입로를 확보함
– 검사절차와 조영제 주입 시 홍조감이 있음을 설명
√ 검사 후 간호
– 카테터 삽입 부위 압박 드레싱과 얼음주머니 적용
– 활력징후, 출혈징후, 말초맥박, 신경학적 징후를 사정
– 목의 내부 출혈을 나타낼 수 있는 삼킴곤란 및 호흡곤란을 사정
– 활동은 24시간 동안 제한

1-2) MRI(자가공명영상)
√ 검사 전 간호
– 통증이나 위험이 없음을 설명
– 조영제를 사용할 경우 동의서와 6시간 동안 금식이 필요함
– 검사 2시간 전에 알코올, 카페인, 흡연 및 철분함유 약물을 금함
– 인공보철물, 동맥류클립, 인공심장박동기 착용한 경우 금기
– 검사 전 눈화장과 가발을 제거
– 검사 동안 움직이지 않도록 설명
– 소음이 많은 원통형 기계에서 촬영하여 폐쇄공포감이 올 수 있고 촬영기사와 의사소통이 가능함을 설명
√ 검사 후 간호
– 조영제를 사용하였을 경우 몸에 남아있는 조영제를 배출하기 위해 충분한 수분 섭취를 해야 함
– 조영제를 사용하고 나서 드물게 조영제 과민 반응이 나타날 수 있음을 설명. (과민 반응에는 가벼운 구토증, 두드러기, 얼굴이 붉어짐, 기침, 쉰 목소리, 콧물, 반점, 일시적 호흡곤란 등) 대개는 아무런 조치 없이 증상이 사라짐

1-3) DTR (Deep Tendon Reflex, 심부건반사)
√ 검사 전 간호
– 해머 및 도구에 관해 설명한다.
– 검사 부위가 이완되어야 검사가 원활히 이루어지니 힘을 빼라고 설명한다.

출처 : 해피캠퍼스

목차

Ⅰ. 용어 및 약어 1

Ⅱ. 주요 학습내용 2
1. 정형외과 병동에서 주로 시행하는 특수 검사 전·후 간호 RA factor, CT, MRI, DEXA, Myelography, Arthroscopy, Arthrocentesis, EMG, Bone scan) 1
2. 근골격계 수술 전 · 후 환자 간호 4
3. 근골격계 장치 적용 환자 간호(석고붕대, 견인 환자 간호) 4
4. 정형외과 보조기 종류 5
5. 재활 간호(휠체어 및 목발사용법, 체위유지, 치료적 운동 등) 6

Ⅲ. 주요 질환 8
1. 외상간호(Contusion, Strain, Sprain, Dislocation, Fracture) 8
2. 염증성 장애(Osteomyelitis, Tuberculosis of bone & joint) 9
3. 류마티스 질환(Rheumatoid arthritis) 10
4. 퇴행성 질환(Osteoarthritis, Spinal stenosis) 11
5. 골대사 장애(Osteoporosis, Osteomalacia) 12
6. 골종양 13
7. 요통, 수근터널 증후군 14

Ⅳ. 주요 수술 16
1. 관절성형술(Arthroplasty) 16
2. 관절경 반원연골 절제술(Arthroscopic meniscectomy) 17
3. 십자인대 재건술(Cruciate ligament repair) 17
4. 개방적 견봉성형술 및 회전근개 수복술(Open acromioplasty & rotator cuff repair) 18
5. 개방성 수근터널 해리술(Open Carpal tunnel ligament relaease, OCTR) 19
6. 활액막 절개술(Synovectomy) 20
7. 고관절 치환술(Total hip replacement) 20
8. 슬관절 전 치환술(Total knee replacement) 21

본문내용

Ⅱ – 주요학습내용

1. 정형외과 병동에서 주로 시행하는 특수 검사 전후 간호
(RA factor, CT, MRI, DEXA, Myelography, Arthroscopy, Arthrocentesis, EMG, Bone scan)

1) 류마티스 인자 검사(RA factor)
: 류마티스 관절염, 전신홍반루프스(SLE), 만성 간염, 간암, 간경변, 다발 근육염 등에 의해 상승된다. 류마티스 관절염의 약 80%에서 양성반응을 나타낸다. 정상인의 약 4%에서 낮은 양성반응을 나타낼 수 있으며 연령이 증가할수록 양성률이 높다.
-검사 전후 간호
검사전후 : 관절운동범위, 등척성 운동을 시행해주고 관절의 과도한 긴장은 금지하며 관절 보호를 위해 크고 작은 근육을 사용하도록 한다. 기상 후 더운 물로 목욕하도록 하며 급성기 때는 절대 안정으로 관절의 휴식 및 보호를 격려해주어야 한다. 열 치료나 전기 치료 등으로 물리치료를 시행해준다.

2) 컴퓨터 단층 촬영(computer tomography; CT)
: X선을 인체에 투과시켜 흡수 차이를 컴퓨터로 재구성하여 인체에 관한 정상 해부학적 또는 비정상 해부학적 정보를 영상 정보고 나타내주는 진단 방법으로 조직의 밀도 차이를 구별하고 작은 병소도 진단이 가능하며 인체의 어느 부위에나 검사의 적용이 가능하다.
-검사 전후 간호
검사 전: 대상자에게 검사에 대한 목적과 방법, 과정을 설명하여 불안감을 감소시킨다. 조영제의 부작용에 대해 설명하고 조영제에 대한 과민반응 여부를 파악한다. 조영제가 투여될 경우 4시간 이상 금식하도록 한다. 귀금속같은 방사선 비투과성인 물질을 제거하고 검사용 가운으로 갈아입도록 한다. 필요 시 조영제를 주입하기 위한 정맥용 주사를 확보한다.
검사 후: 조영제 배출을 돕기 위해 수분섭취를 격려해야 한다.

3) 자기공명촬영(Magnetic Resonance Imaging; MRI)
: 자석으로 구성된 장치에서 인체에 고주파를 쏘아 신체부위에 있는 수소원자핵을 공명시켜 각 조직에서 나오는 신호의 차이를 디지털 정보로 변환하여 영상화하는 것이다. 대상자는 테이블 위에 누운 채 도넛 모양의 자석이 포함된 장비 속으로 들어가서 30~90분 동안 검사를 시행한다.

출처 : 해피캠퍼스

목차

. 용어 및 약어
1) 용어 및 약어 ··························································································· 3

2. 주요 학습내용
1) 콩팥 요로계 병동에서 주로 시행하는 특수 검사 전후 간호 ··························· 5
2) 방광 적출술과 요로전환술 수술 전후 간호 ················································· 12
3) CIC 환자 간호 ······················································································· 14
4) 투석 환자 간호 ······················································································· 14
5) 신장 이식 ······························································································ 15
6) 수분 전해질 불균형 ················································································· 16

3. 주요 질환
1) 배뇨장애 ································································································ 18
2) 결석 ······································································································ 24
3) 양성 전립선 비대증 ················································································· 27
4) 신생물 ··································································································· 31
5) 신부전 ··································································································· 37
6) 염증성 질환 ··························································································· 42

4. 주요 수술
1) 경요도 전립샘 절제술 ·············································································· 47
2) 경요도적 방광종양 절제술 ······································································· 49

5. 참고문헌
1) 참고문헌 ································································································ 50

본문내용

2. 주요 학습내용

1) 콩팥 요로계 병동에서 주로 시행하는 특수 검사 전·후 간호

(1) U/A (요검사)
: 요로계검사 중 가장 기본적이고 중요한 검사

√소변 검사물 수집 방법
– 무작위 검사물 수집 (random specimen) : 밤 동안 방광 내에 머물러 가장 농축된 상태이므로 아침 첫 소변을 받는 것이 좋지만, 필요시 언제라도 수집 가능(식후 즉시 채취된 소변은 알칼리화되어 검사 결과가 정확하지 않을 수 있음)
– 중간뇨 검사물 수집 (clean-catch specimen) : 요도 입구와 요도 분비물에 의한 오염을 줄이기 위해 여성은 음순을 벌린 후, 남성은 포피를 젖힌 후 중간 소변을 받도록 교육 (배뇨 전 손, 요도 주변 씻도록 교육)
– 도뇨관을 통한 검사물 수집 (catheterizing specimen) : 단순도뇨관, 유치도뇨관
– 24시간 소변 수집
* 수집 절차 *
– 수집을 시작할 때 첫 소변은 버림.
– foley catheter가 삽입된 경우, 수집을 시작할 때 배뇨관과 배액 주머니를 비워 소변을 버림.
– 그 후 24시간 동안 모든 소변을 수집
– 시작한 지 24시간이 지나면, 대상자에게 방광을 비우게 하고 마지막 소변은 포함
– 다른 검사를 하기 위해 수집 용기에서 소변을 덜어내지 않음.

① 일반 요분석검사
– 소변의 산도(pH)·색·비중을 측정하고, 소변 내 포도당 · 단백질 · 혈액 · 케톤의 유무, 세포·원주체·세균·결정체 등의 소변침전물에 대한 현미경 검사를 포함
– 소변 검사물은 아침 첫 소변을 받도록 하며, 배뇨 후 1시간 이내에 검사를 시행
√ 소변 산도 : pH 4.6~8 (평균 6)

출처 : 해피캠퍼스