传染病护理学重点（Key points of infectious disease nursing）.doc

传染病护理学重点（Key points of infectious disease nursing）2. pathogenicity of pathogens during infection:(1) invasiveness: the ability of pathogens to invade the body and spread in vivo. Such as: invasive ability, soluble tissue capacity, penetration and so on.(2): including virulence exotoxin, endotoxin and virulence factors.(3) number: the same pathogen, the number of invasion is often proportional to its pathogenic ability; in different infectious diseases, the number of pathogens causing a certain infectious disease varies greatly.(4) variationImmune response during 3. infection: nonspecific immunity and specific immunity(1) nonspecific immunity: the mechanism of the bodys elimination of foreign body into the body. It is obtained by heredity without antigen specificity, also known as innate immunity.Three main natural barriers skin, blood, cerebrospinal fluid, placenta; phagocytosis; humoral factors. Phagocytosis: mononuclear phagocyte system has nonspecific phagocytic function.Humoral factors, including fluid infusion, lysozyme and various cytokines, such as interleukin, tumor necrosis factor, interferon gamma, etc.(2) specific immunity: the specific immune response produced by the anti recognition of the antigen is an acquired active immunity. It includes humoral immunity mediated by B lymphocytes and cell-mediated immunity mediated by T lymphocytes.7. the route of transmission of viral hepatitis(1) fecal oral transmission: the main route of transmission of hepatitis A and e;(2) the spread of blood and body fluids: mainly spread hepatitis B, hepatitis C, d way(3) mother to child transmission: mainly through the placenta, birth canal delivery, breast-feeding and feeding and other means of transmission, is also an important route of transmission of HBV infection.8. Detection of hepatitis virus etiology (markers)The hepatitis A: Anti -HAV-IgG serum: recent infection index, is a marker for diagnosis of hepatitis A in the main. Serum anti HAV-IgG: protective antibodies are seen in patients who have been vaccinated with hepatitis A or those who have previously been infected with HAV. HAV RNAThe hepatitis b:Surface antigen (HBsAg) and surface antibody (anti -HBs): HBsAg positive in HBV infected patients, HBV infection 3 weeks after the first occurrence of HBsAg. Anti -HBs positivity is mainly seen in patients who have been vaccinated against hepatitis B vaccine or who have been infected with HBV and who have developed immunity.E antigen (HBeAg) and e antibody (anti -HBe): HBeAg only appeared in HBsAg positive serum, HBeAg positive indicated that HBV replication was active and infectivity was stronger; anti -HBe appeared after HBeAg disappeared.Core antigen (HBcAg) and its antibody (anti -HBc): HBcAg mainly existed in the nucleus of infected liver; anti -HBc appeared in the 35 week after HBsAg appeared. Type IgM anti -HBc exists in acute or chronic hepatitis B, and type IgG anti -HBc is a marker of past infection.Hepatitis B virus HBV (HBV DNA) and DNAP are the most direct, specific and sensitive indicators of HBV infection. Both positive suggest the existence and replication of HBV, infectivity is strong.The hepatitis c:Hepatitis C virus RNA (HCV RNA);Hepatitis C virus antibody (anti -HCV) is a marker of HCV infection, not a protective antibody.The HDAg and HDV RNA: hepatitis DThe hepatitis E: Anti -HEV-IgM and anti -HEV-IgG9. antiviral drugs for chronic hepatitis:1) interferon: indications of chronic hepatitis: (1) HBV is in active replication; (2) hepatitis is in active phase.Interferon is generally used in 1065 year old patients with severe heart and kidney dysfunction, and decompensated cirrhosis.2) nucleoside drugs: HBV DNA replication has strong inhibitory effect, no obvious adverse reactions.Lamivudine was first used in clinic. Other: adefovir, entecavir.3) Chinese herbal medicine: Shandougen agents such as Ganyanlin injection etc.Common nursing diagnosis / measures for viral hepatitisThe activity intolerance and impaired liver function and energy metabolism disorders.Rest and activities: acute hepatitis, chronic hepatitis, active hepatitis, severe hepatitis should be in bed rest, liver function is normal, 13 months later can resume daily activities and work, but should avoid excessive exertion and heavy physical labor.The life care: serious illness need to assist patients for dining, bathing, toilet and other life care.Psychological counseling.The nutritional disorders: less than body requirements and loss of appetite, vomiting, diarrhea, digestion and absorption dysfunction.1) introduce the importance of a reasonable diet;2) eating principle:The acute phase of hepatitis should be light, digestible and rich in vitamins, and can be supplemented with glucose, fat emulsion and vitamins according to the doctors advice.Jaundice subsided period: gradually increase the diet, eat less, eat more, avoid overeating. Diet principle of chronic stage patients: energy intake of bed rest or rest should be 84 105kJ/ (kg? D), moderate activity (work) should be 126 147kJ/ (kg? D). The protein of 1.5 2.0g/ (kg? D), with high quality protein, such as milk, lean pork, fish and other carbohydrates; 300 400g/d; fat tolerance limit of about 50 60g/d, with vegetable oil; eat more fruits, vegetables and other foods rich in vitamin.(3) posthepatitic cirrhosis and severe hepatitis: light and low salt4. Dietary contraindication of patients with various types of hepatitis: it is not suitable for long-term intake of high sugar and high calorie diet, abdominal distension can reduce the intake of gas producing foods (milk, soy products). All types of hepatitis patients should be prohibited from drinking alcohol.3) observe gastrointestinal symptoms: To observe the appetite, nausea, vomiting, acid and other symptoms.4) assess the patients nutritional status: weight measurement every week and daily intake.The potential complications of bleeding1) observe the condition: pay attention to observe the bleeding position, development and regression of the patient.2) general nursing: rest and diet guidance; encourage patients to eat high protein, high vitamin, digestible diet or semi liquid, fast and excellent, too rough food; maintain defecate unobstructed.Bleeding and nursing of common site:3) skin bleeding: to avoid artificial injury or aggravate bleeding; high fever patients prohibited alcohol bath cooling.4) epistaxis: (1) to prevent the nasal mucosa from bleeding and keep the relative humidity between 50% and 60%;Avoid artificial induced bleeding: dont dig the nose forcefully;3. A small amount of bleeding can be filled with cotton ball or gelatin sponge; after serious bleeding, vaseline gauze is used to fill the nasal cavity.5), oral gingival bleeding: with a soft toothbrush, do not use a toothpick, avoid eating fried, prickly, food containing bone, shelled nuts, eating slowly.The potential complications of adverse reactions: interferon treatment1) pre medication instruction;2) nursing during medication: common adverse reactions and treatment:Febrile reactions: usually in the first 35 times of interferon injection, ranging from low fever to high fever, accompanied by headache, muscle, skeletal pain, fatigue, weakness, etc. Patients should be asked to drink more water, rest in bed, symptomatic treatment if necessary;Gastrointestinal reactions: nausea, vomiting, anorexia, diarrhea and so on. Generally symptomatic treatment, severe withdrawal.Alopecia: after withdrawal, can be restored.4. Liver function damage: jaundice, increased ALT, etc. Continue treatment or withdrawal as appropriate.Neuropsychiatric symptoms: depression, anxiety and so on. Severe cases should be reduced or discontinued.The change of peripheral blood white blood cell count decreased more common, if the white blood cells in more than 3 * 109/L should adhere to treatment, the doctors advice to give leukogenic drugs; if the white cell is less than 3 * 109/L or neutrophil <1.5 * 109/L, <40 * 109/L or platelets can reduce the dose of interferon and withdrawal.3) periodic reviewMain points of treatment for epidemic encephalitis b:The symptomatic treatment:1) high fever: physical cooling is the main, continuous high fever with repeated convulsions can be Ya Dong sleep therapy, chlorpromazine and promethazine each 0.5 1mg/d intramuscular injection.2) convulsions or convulsions: treatment measures include the removal of the cause and the onset of convulsion in the town (the preferred diazepam (diazepam).3) according to the cause of respiratory failure: given the therapy of brain edema caused by dehydrating agent treatment; central respiratory failure by respiratory stimulant, such as lobeline (Toban) and Nikethamide; respiratory tract obstruction, attention suctioning, postural drainage, inhalation of phlegm drugs; also can use vasodilator agents such as anisodamine and scopolamine.4) increased intracranial pressure: early adequate dehydration treatment, commonly used 20% mannitol or sorbitol, furosemide, glucocorticoid.The Chinese medicine treatment: White Tiger Decoction, qingwenbaidu drink etc. The medicine can be used as an Niuhuang Niuhuang pill.The recovery and sequelae of treatment: pay attention to functional training, including language, swallowing and limb function, physical therapy, acupuncture, physical therapy, feasible hyperbaric oxygen therapy.