医、技学院(华盛顿医疗手册培训-课程总论).ppt

The Washingtong Manual of Medical Therapeutics Patient Care in Internal Medicine
Jianan Wang MD PhD
Second Affiliated Hospital Zhejiang University School Of Medicine
General Care of the Hospitalized PatientGENERAL PRINCIPLES
Individualization based on Evidence Medicine
Careful Explanation( benefits, risks and alternative)
Basic measures minimizing risks
Use of standardized abbreviations and dose designations
munication between physicians and other caregivers
Institution of appropriate prophylactic precautions
Prevention of ial infections, including attention to hygiene and discontinuation of unnecessary catheters
Medicine reconciliation at all transfers of care
Hospital Orders
Admission Order following ADC VANDALISM

Admitting service, location, and physician responsible for the patient
Diagnoses
Condition of the patient
Vital signs with frequency
Activity limitations
Nursing instructions (., Foley catheter to gravity drainage, wound care, daily weights)
Diet. Remember that “npo” may preclude oral medications unless specified
Allergies, sensitivities, and previous drug reactions
Laboratory tests and radiographic studies
IV fluids, position and rate
Sedatives, analgesics, and other PRN medications
Medications, including dose, frequency, route, and indication. State “First dose now” when appropriate
Prophylactic Measures
Venous Thromboembolism Prophylaxis
Most preventable cause of death in Hosp.
Drugs for prevention of DVT
Heparine
LMWH
10a antagonist: fondaparinux, rivaroxaban (拜瑞妥)
Mechanical prophylaxis with intermittent pression or pression stockings
Aspirin is not indicatied
外科病人静脉血栓危险分层
ACCP 共识会议对外科手术病人静脉血栓的危险分层
低危: 年龄< 40 岁小手术无其他危险因素
中危: 年龄> 40 岁大手术无其他危险因素
高危: 年龄> 40 岁大手术合并一个其他危险因素
(MIs 或 VTE 过去史肿瘤高凝状态)
极高危: 年龄> 40岁大或小手术合并多个其他危险因素
(VTE 或 IS 过去史肿瘤高凝状态)
全髋或全膝关节置换术髋部骨折
严重创伤脊柱损伤
DVT Risk Classification for Surgery Patients
Low risk: <40ys, minor surgery, no other risk factors for DVT
Moerate risk : >40yrs , big surgery, no other ri