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Jingdong book

精神科护理手册(第2版)

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所有编写人员都努力使《精神科护理手册第2版》符合现代临床护理需求,立足临床、服务临床、指导临床,力求成为精神专科护理人员及临床综合科室的专业护士常备的实用手册。
Content Description

《精神科护理手册第2版》为《临床护理指南丛书》之一,共分为两篇,第一篇介绍精神科护理基础知识,第二篇主要介绍精神科常见疾病的临床护理。
《精神科护理手册第2版》在结构体系上以疾病概述、常见护理评估、临床常见症状评估、临床常见风险评估、主要护理问题、护理目标、护理措施、临床风险防范、专科特殊护理为主线进行编写。
Catalogue

第一篇精神科护理基础知识
第一章精神科护理评估及分级护理1
第一节精神科护理评估1
第二节精神科护理级别6
第二章精神疾病常见临床综合征及症状群10
第一节幻觉?妄想综合征10
第二节思维联想障碍症状群17
第三节紧张综合征23
第四节抑郁综合征25
第五节躁狂综合征29
第六节焦虑综合征32
第七节强迫综合征36
第八节疑病综合征39
第九节意识障碍42
第十节痴呆综合征45
第十一节戒断综合征48
第三章精神科常见治疗与护理52
第一节药物治疗52
第二节电痉挛治疗与护理63
第三节精神康复与社区护理69
第四节心理护理96
第五节精神障碍患者的基础护理107
第四章精神科常见安全事件的处理114
第一节概述114
第二节精神科护理安全119
第三节精神科常见安全事件的处理124
第五章精神疾病的相关法律问题174
第一节我国精神卫生立法概况174
第二节精神疾病护理常见法律问题187
第三节精神病患者的权利与义务199
第四节临床护理工作中的注意义务207
第五节精神科护理工作中常涉及的法律问题及处理213
第六章精神科护理工作中的职业防护224
第一节概述224
第二节工作场所暴力防护措施226
第三节职业暴露处理措施229
第二篇精神疾病的临床护理
第七章精神分裂症的护理235
第一节概述235
第二节病因与发病机制235
第三节临床表现237
第四节分型240
第五节诊断242
第六节治疗及预后244
第七节护理245
第八章心境障碍的护理254
第一节概述254
第二节躁狂发作的护理257
第三节抑郁发作的护理269
第四节双相情感障碍的护理284
第九章焦虑障碍及强迫障碍的护理305
第一节概述305
第二节惊恐障碍309
第三节广泛性焦虑327
第四节强迫症338
第十章躯体形式障碍与解离障碍的护理351
第一节概述351
第二节躯体化障碍的护理352
第三节疑病症的护理362
第四节解离性障碍的护理369
第十一章创伤和应激相关障碍的护理390
第一节概述390
第二节对应激事件的反应391
第三节急性应激反应和急性应激障碍的护理393
第四节创伤后应激障碍的护理399
第十二章进食障碍的护理410
第一节概述410
第二节神经性厌食的护理411
第三节神经性贪食的护理426
第四节神经性呕吐的护理430
第十三章常见儿童少年精神障碍的护理434
第一节概述434
第二节精神发育迟滞的护理435
第三节注意缺陷多动障碍的护理448
第四节儿童孤独症的护理461
第五节抽动障碍的护理473
第十四章神经认知障碍的护理486
第一节概述486
第二节阿尔茨海默病的护理487
第三节谵妄的护理512
第四节颅脑损伤所致精神障碍的护理525
第五节颅内感染所致精神障碍的护理545
第六节癫痫性精神障碍的护理561
第十五章精神活性物质相关精神和行为障碍的护理576
第一节概述576
第二节酒精相关的精神和行为障碍583
第三节阿片类药物相关障碍597
第四节苯丙胺类药物相关障碍607
第五节护理619
Book Abstract

第一篇精神科护理基础知识
第一章精神科护理评估及分级护理
第一节精神科护理评估
一建立治疗性护患关系
护理评估应从护士与患者的初次见面开始,并同时建立治疗性关系在评估时应遵循例如“保密原则”之类基本的法律和职业道德要求,以便获得患者的信任,使患者感觉安全和舒适在评估中应避免受到自身价值观与偏见的影响,从而影响病史采集的准确性
护患关系是护士与患者在健康与疾病的问题上建立起来的亲密的人际关系精神科的护患关系不同于一般的护患关系,护士与患者的关系可以直接影响患者治疗和护理方贻儒等提出的精神科医患关系原则很值得我们借鉴
1)医生应持这样的态度,患者是我们服务的对象,值得我们礼遇尊敬接纳和花费时间
2)医患关系是指向患者和围绕着疾病的诊治而建立起来的,医生在医患关系中作为一个社会角色
3)充分理解和尊重患者的人格文化取向生活态度世界观和人生价值观
4)极大程度地相信患者是安全可以面谈交流和协商的
5)医患关系的建立应限于围绕对疾病的正确诊断治疗,以及对患者的医学关怀与帮助,而非其他
6)在医疗活动中,医患关系并非一成不变,而是动态发展的,需要不断维护反思医学关系有无偏离伦理和专业的界限
7)相信患者能从这种良好的关系中获益,即使患者无法“治愈”,一种良好医患关系至少可以帮助改善其功能生活情趣与质量躯体情况
8)建立良好的医患关系需要时间与耐心,而且患者可能并不了解这种关系的重要性
二访谈技巧
1. 观察的重要性首次评估往往都从访谈开始不过护士在访谈中,除了言语信息外,还可以通过敏锐的感知细致的观察来获得信息患者的眼神表情姿势说话的方式穿着一般状态意识等都是有临床意义的,有些症状或疾病具有典型的观察印象,有些观察结果对诊断预后判断治疗性关系的建立具有很好的指导意义
2. 提问的方式开放式问题一般用于会谈之初,因为这可以帮助护士观察到更多的患者言语和行为的信息,当护士需要准确的信息的时候,则选择封闭式提问类似于“你今天怎么来医院的”这样的问题可以让患者以自己的方式和理解进行回答例如,患者可以回答“我今天坐出租车来的”“我母亲送我来的,她觉得我应该住院”“我今天早晨醒来我洗了一个澡,然后穿衣然后,我犹豫了很久”等,这些不同的回答都可以帮助护士了解患者的思维过程和反应
3. 代述和澄清有些想法患者不好意思说出来,或者不便说明,护士可以对其进行代述有些问题患者表达不清楚,或者有歧义,护士需要对其回答进行澄清如患者说“孩子离开后,我的生活改变了”,护士可以问“是的,很多人在孩子离家之后都会感觉生活有改变,不过,你能告诉我你的改变是哪方面吗”
4. 总结包括阶段性的总结和结束性总结两种适当进行总结归纳不仅可以让患者感到护士理解了他的问题,也有利于双方达成共识,还有利于检查者本人理清思路例如,“非常好,你给我讲了你患病以来的一些重要信息,这将对我们的治疗和护理很有帮助,现在,我将你刚才给我谈到的情况重复一下,你看有没有和你讲到不一致的或者需要补充的部分”
5. 家属的提供家属或其他与患者关系较近的人提供的信息对精神科护理评估也很重要,特别在病人缺乏自知力的情况下但护士向家属及患者身边的人收集信息时,要注意不要引起患者的抵触情绪,认为护士不相信自己,从而破坏治疗性护患关系
三生理心理和社会的综合评估
护理评估是根据护士的专业评估,针对性地收集患者生理心理社会方面的各项数据,来对患者的精神状态做出一个综合评定(图1-1)精神护理评估不仅包括心理方面的评估,还包括生理和社会方面的表现具体评估表见表1-1
图1-1精神状态的综合评定
表1-1精神科护理评估表
第二节精神科护理级别
随着医学模式的改变,整体护理这一新的护理模式取代了传统的功能制护理,为病人提供了包括生理心理社会文化等全方位的护理服务精神疾病是以认知情绪意志行为改变为基础,发病原因往往综合生理心理社会等各方面因素因此,患者具有比躯体疾病更加突出的心理需求和社会适应障碍,更需要护士在护理活动中实施以病人为中心的整体护理
另外,卫生部为了加强医院临床护理工作,规范临床分级护理及护理服务内涵,保证护理质量,保障患者安全,于2009年颁布了《综合医院分级护理指导原则(试行)》,对各级护理病人做了详细规定,要求各个医疗机构严格根据患者病情和生活自理能力,确定并实施不同级别的护理护理级别包括特级护理一级护理二级护理和三级护理共四类,但遗憾的是其内容没有专门针对精神疾病的护理,有鉴于此,我们在参照卫计委《综合医院分级护理指导原则(试行)》的基础上,针对于精神疾病的疾病特点,将精神科护理分级护理内涵界定如下
一特级护理
(一)护理对象
1)精神疾病的基础上伴有严重躯体疾病,病情危重,如伴有严重的震颤谵妄心力衰竭高血压危险或严重外伤等,生活完全不能自理者;
2)有极严重的自伤和自杀危险者;
3)自杀未遂或严重自伤,生命体征欠稳定者;

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Jingdong book