Rabies is also called aquaphobia, is dominated by rabies virus caused by the invasion of the central nervous system of acute zoonotic diseases. According to the survey, about 55 thousand people died of rabies in Asia and around the world every year, every 15min has 1 people died of rabies [1]. along with the acceleration of the development of social economy and the process of city, people's way of living and consumption change gradually, more and more families have pets, but the lack of strict management, our rabies deaths increased gradually and among the legal infectious diseases in China in third, the second highest in the world, after India [2]. effective nursing measures for the study of rabies, relieve the pain of patients in our department, the implementation of evidence-based nursing for rabies patients, using evidence-based methods to develop and implement nursing measures are summarized as follows.
1, data and methods.
1.1 general information.
30 cases of January 2013 -2014 year in December in our hospital were rabies patients, male 26 cases, female 4 cases; age 11 ~73 years old, the average age of 43.7 years; 18 years of age in 3 cases, aged 18 and above in 27 cases; 26 cases were farmers, 2 students, 2 cases had clear history of workers; dog bites. The latency of 15d to 10 years.
29 cases did not do any treatment after injury, did not receive anti rabies vaccine; in the case of 1 cases of rabies vaccine was not injected.
30 patients with varying degrees of hydrophobia, fear of wind, throat muscle spasm, fever, and other symptoms of dysphagia. From the onset to the longest 8D, the shortest 1D.
1.2 evidence based approach.
1.2.1 questions.
In this study, we focused on the effective nursing measures for patients with rabies, and focused on identifying and correcting the existing and potential nursing problems. Malnutrition: less than body requirements; there is the risk of cross infection; risk of damage to the skin; self injury or injury of his danger; inefficient breathing patterns; fear.
1.2.2 evidence based retrieval.
Looking for reliable evidence to support these nursing problems. The main database CNKI, Wan Fang, CI-NAHL, Cochrane, Library PubMed and other randomized controlled clinical trials and other clinical evidence, the authenticity and reliability evaluation of clinical evidence, to find out the best research evidence.
1.2.3 evidence based nursing practice.
1.2.3.1 general nursing.
A single room will be placed in the patient quiet, warm, air circulation and hanging in dark curtains, absolute bed rest, avoid interference and light stimulation, Caution!, use the bed stalls, the need for restraint, avoid placing indoor hard objects; do not use electric fan or air conditioning dedicated bathrooms.
1.2.3.2 dystrophy.
Patients with hydrophobia, choking and swallowing difficulties, not recommended by eating [3], so it should be early nasogastric tube, given the high calorie liquid diet in the intermittent period of seizures or sedatives after treated by nasal feeding, small meals, to supplement nutrition. Fasting should be given intravenous infusion, to ensure that the daily intake and maintain water and electrolyte balance, accurately record the amount of access.
1.2.3.3 cross infection risk.
The implementation of close contact isolation, patients arranged in a single ward, by hand care. The medical staff or family members should enhance their awareness of protection, wear protective clothing, wearing masks, hats, shoes, gloves, wear protective glasses when necessary; strict hand hygiene; as far as possible the use of disposable items, residual food and the use of patients after the use of material should be burned; patient's saliva, urine, blood and other body fluids or with secretions containing available chlorine 5 000mg/L disinfectant mixing, placing 2H dumping; bedside table, doors and windows, with effective chlorine content of 1 000mg/L disinfectant wipe, 2 floor mopping the floor with the disinfectant containing available chlorine 1 000mg/L per day; the door placed disinfecting pad and regularly spraying disinfectant containing available chlorine 1 000mg/L maintain wet, ward disinfected 2 times a day with ultraviolet radiation, the patient from the hospital, ward of terminal disinfection strictly.
1.2.3.4 has a risk of skin damage.
The excitement phase occurs in patients with high fever, body temperature up to 40.7 DEG [4], at the same time due to sympathetic hyperactivity, showed a large number of salivation, sweating, fever, restlessness, wet skin, malnutrition patients are at risk of pressure ulcers, therefore, nurses should observe the patient timing of skin conditions, changing clothes, bedding timely. Keep clean and dry bed unit.
1.2.3.5 has hurt his self harm or danger.
Uneasy about irritability, pay attention to whether seizures, in order to prevent patient self injury or injury to others, should be extra protection bar, when necessary, families consent given after constraint; constraint during the relaxation time, observe the binding site of the blood supply. Explain the excitement, manic to the family, asked the boiling water should avoid the stimulation of the patient, should avoid drinking water, see, hear the water or talk about water, do not place the indoor water container, do not take a bath, appropriate shelter infusion device. Try to reduce unnecessary irritation. To plan and simplify the medical, nursing operation, focused on the use of sedatives, the action should be light, fast, so as not to cause unnecessary stimulation induced spasm. At the same time, the side of the bed is ready to open the mouth, tongue forceps and other objects, the patient appears twitch, immediately use, so as to avoid a tongue bite.
1.2.3.6 potential nursing problems: inefficient breathing patterns.
Close observation of patients' consciousness, complexion, vital signs, especially should pay attention to the change of respiratory frequency, rhythm, give care, timely removal of oxygen inhalation, oral cavity and respiratory tract secretions, maintain airway patency, prevent suffocation. Ready for emergency materials and drugs, such as sedative, respiratory stimulant, tracheal intubation and tracheotomy, respirator, if severe respiratory failure, can not breathe independently, should cooperate with the doctor for endotracheal intubation, tracheotomy or the use of a respirator.
1.2.3.7 psychological nursing.
The patients in the prodromal and exciting period consciousness are clear, because of rapid progression, seizures, and hydrophobia caused pain and fear, should be given more care and more care, multi comfort patients, strict language and try to reduce the patient alone, according to the needs of patients with psychosomatic aspects of the society, to provide the necessary help. In order to alleviate the anxiety and fear. Family members can be invited into the ward, in order to alleviate the fear of patients.
2, discussion.
Rabies has become a serious threat to people's life of the disease, there is no effective treatment, can not cure the anti rabies is a deadly infectious disease. Evidence-based nursing is the best evidence for application of nurse carefully, can get accurate and clear, professional skills and clinical experience combined with nurses, and consideration of the patient's value and intention of the three integrated, developed for the actual situation of patients, nursing plan complete. Therefore, the implementation of evidence-based nursing in the nursing process of rabies patients, although the patient life irreparable, but effective nursing measures can improve the quality of life of patients dying.
Reference
[1] Liu Xiaodong, Liu Xin,, et al. Analysis of epidemiology and clinical characteristics of.215 patients with rabies and nursing [J]. Chinese Journal of experimental and clinical infectious diseases, 2013,7 (3): 97-99.
[2] Ouyang Yanhao, Liu Fuqiang, Li Zhanzhan, et al. Trends of rabies in China and the grey prediction model of the establishment and evaluation of [J]. practical preventive medicine, 2015,22 (3): 368-369.
[3] Liu Ruiqing, Li Jing. Nursing and hospice care for patients with rabies [J]. Chinese Journal of practical medicine, 2012,7 (5): 199-200.
[4] Zhang Chunpei, Lin parsley and nursing [J]. Zhang maple.34 cases of rabies preventive medicine in Zhejiang, 2008,20 (6): 86-88.