【正文】 disfunction of Cholinergic Nerve. It manifestates excitement at first and then inhibition . 護(hù)理評(píng)估 Nursing assessment 袁清紅 ? 臨床表現(xiàn) ? 膽堿能危象 急性有機(jī)磷農(nóng)藥中毒的典型表現(xiàn) ? Clinical Situation ? Cholinergic crisis Typical performance of AOPP . 護(hù)理評(píng)估 Nursing assessment ? 毒蕈堿樣癥狀 ? 主要是副交感神經(jīng)興奮所致 , 臨床表現(xiàn)有惡心 ,嘔吐 ,腹痛 ,多汗 ,流涎 ,瞳孔 縮小 ,支氣管痙攣 ,分泌物增多 ,心率減慢 ,氣急 ,嚴(yán)重者出現(xiàn)肺水腫 ? Muscarinic symptoms ? Mainly causedby the parasympathetic nervous excitement, Clinical manifestations have nausea,vomiting, abdominal pain, sweating,salivation, miosis, bronchospasm and Increased secretions heart rate decreased, dyspnea, the serious cases appear pulmonary edema. 護(hù)理評(píng)估 Nursing assessment ? 煙堿樣癥狀 ? 患者常有肌束顫動(dòng) ,肌肉強(qiáng)直性痙攣 ,心率加快 ,甚至全身抽搐 ,最后出現(xiàn)肌麻痹 ,呼吸肌麻痹引起周圍性呼吸衰竭 ? Nicotinelike symptoms ? Patients often have muscle bundle of trembling, tetanic spasm ,heart rate increased , Even the whole body twitching, finally, myoplegia happen,breath myoparalysis cause peripheral respiratory failure 護(hù)理評(píng)估 Nursing assessment ? 中樞神經(jīng)系統(tǒng)癥狀 ? 表現(xiàn)為頭暈 ,頭痛 ,疲乏無力 ,共濟(jì)失調(diào) ,煩躁不安 ,意識(shí)模糊 ,抽搐及昏迷 ? Central nervous system symptoms ? Manifested as dizziness, headache, fatigue, ataxia, irritability, confusion, convulsions and a 護(hù)理評(píng)估 Nursing assessment 莫思慧 ? 急性有機(jī)磷中毒分為輕、中、重三級(jí)： ? 輕度中毒：頭暈、頭痛、惡心、嘔吐、多汗、流涎、視力模糊、瞳孔縮小、全血膽堿脂酶活力一般在 70％－ 50％。全血膽堿脂酶活力降至 50％－ 30％ 。全血膽堿脂酶活力降至 30％以下。 ? Organophosphorus pesticide poisoning were the first aid clinical symptom, can be in a few days to get better within a week, even happen again suddenly a pulmonary edema or sudden death, says bounce phenomenon . 護(hù)理評(píng)估 Nursing assessment ? 這與殘留在皮膚 、 毛發(fā)和胃腸道的有機(jī)磷農(nóng)藥重吸收或解毒藥 停用過早或減量過快等原因有關(guān) 。 ? In patients with acute poisoning symptoms after the lateoccurred neuropathy, generally in the poisoning before 24 to 96 hours after happen suddenly by respiratory muscular paralysis primarily the symptoms, says middle type syndrome. 護(hù)理評(píng)估 Nursing assessment ? 發(fā)病機(jī)制可能與膽堿酯酶長期受到抑制，影響神經(jīng)肌肉接頭突觸后功能有關(guān)。另外，導(dǎo)瀉也是一個(gè)好辦法。 ? Secondly, promoting discharge poison is necessary, we used blood perfusion for her. 治療原則 ?第三，特殊解毒劑的應(yīng)用，如阿托品、碘解磷定 ，這取得不錯(cuò)的效果。 ? 抗感染，促進(jìn)炎癥消散 ； ? 護(hù)胃，保護(hù)胃黏膜 ； ? 護(hù)心，治療中毒性心肌炎 ； ? The last but not least , Symptomatic support treatment including Fighting infection to promote inflammation dissolve 。 we should better calm down her emotion and take care of tenderly . As quickly as possible to correct acidosis and electrolytes disturbance to stable inner condition . 護(hù)理診斷 Nursing diagnosis 彭瑜 ? 氣體交換受損 與肺水腫有關(guān) ? 清理呼吸道無效 與呼吸道炎癥、氣道分泌物增多有關(guān) ? 急性神志改變 與膽堿能神經(jīng)功能紊亂有關(guān) ? Impaired gas exchange Relating to pulmonaryedema ? Acute consciousness changing Relating to cholinergic disturbances ? Ineffective airway clearance Relating to airways inflammation and airway secretions increasing. 護(hù)理診斷 Nursing diagnosis ? 有效血容量不足 與大量嘔吐、感染等有關(guān) ? 體溫過高 與肺部感染、應(yīng)用阿托品等有關(guān) ? 有受傷的危險(xiǎn) 與躁動(dòng)不安有關(guān) ? 有猝死的危險(xiǎn) 與毒物的重吸收和阿托品使用不當(dāng)有關(guān) ? Risk for Sudden Death Relating to poison absorbing and the wrongly using of atropine ? Hyperthermia Relating to Lung Infection and application atropine etc ? Risk for injury Relating to restlessness ? Insufficient of blood decrease Relating to profuse vomiting,infection and so on. 護(hù)理措施 劉 萍 ? 迅速清除毒物 ? 清除胃內(nèi)毒物 ? 催吐：神志清楚、能合作的服毒者，可行催吐。 ? Quickly remove toxic ? removal of the undigested poisons ? Emetic: This only applies to the pations who can cooperate with, Let the patient drink warm water 300 to 500 ml, and then with a spatula or finger stimulate patients, posterior pharyngeal wall or the base of the tongue caused vomiting, 護(hù)理措施 ? 洗胃：一般在服藥后 6小時(shí)內(nèi)洗胃有效，但如果超過 6小時(shí)，仍有洗胃的必要。 ? 清除皮膚上的毒物 脫去污染的衣服，用肥皂水或大量清水沖洗皮膚和毛發(fā) 。 ? Application of atropine observation and nursing ? The rescue of the principle of treatment using atropine: early, enough, fast, repeated dose, until the atropine again after reducing gradually or extend the time interval . 護(hù)理措施 ? 阿托品化和阿托品中毒的劑量接近，后者可引起抽搐、昏迷等。 ? The cause atropine and atropine toxic dosage is close, the latter can cause convulsions, a, etc. Therefore when using atropine we should monitor the condition changes, and pay attention to the distinction between the atropine and atropine poisoning. 護(hù)理措施 ? 阿托品化的表現(xiàn)包括： ? ①意識(shí)清楚或模糊 ? ②顏面潮紅、干燥 ? ③瞳孔由小擴(kuò)大后不再縮小 ? ④體溫正?；蜉p度升高 ? ⑤心率 ≦ 120次／分，脈搏快而有力。 ? The performance of atropine include: ? (1) clear consciousness or fuzzy ? (2) red and dry face ? (3)the pupil bee big and not small any more ? (4) and the temperature is normal or little raise ? (5) the heart rate is more than 120 times every minute, and the pulse fast and powerful 護(hù)理措施 ? 阿托品中毒的表現(xiàn)包括： ? ① 譫妄 、 躁動(dòng) 、 幻覺 、 雙手抓空 、 抽搐 、 昏迷 ? ② 皮膚紫紅 、 干燥 ? ③ 瞳孔極度散大 ? ④ 高熱 ， T＞ 40℃ ? ⑤ 心動(dòng)過速 ， 甚至有室顫發(fā)生 ? Atropine poisoning performance including: ? (1) the delirium, agitated, illusion, convulsions, a ? (2) amaranthine and dry skin ? (3)the pupils extremely enlarge ? (4)high fever, the temperature 40 centigrade ? (5) tachycardia and even a ventricular fibrillation happen . 護(hù)理措施 王潔 ? 應(yīng)用膽堿酯酶復(fù)能藥的觀察和護(hù)理 ? 首先 ,你必須盡早用藥。 ? The clinical observation and nursing of the application of acetyl choline