先天性高肩胛癥

1、Postoperative nursing for sprengle deformity: a case report,Manhui. HE2016-8-16Trauma and hand microsugery,Contents,1 Sprengle deformity2 Case report3 Nursing process4 Nirsing experience,Sprengle deformity,,The

2、disease is genetic, and more women than menMost are unilateral and bilateral incidence was 10%-20%,Sprengle deformity,Definition: It is a rare congenital deformity one or both scapulate that apears at birth.Charact

3、erize by one side shoulder joint is 2cm-10cm higher than normal one . And it causes restricted mobility of the shoulder and cervical spine,Sprengle deformity,ClassificationI degrees: deformity is very light, on bot

4、h sides of the shoulder joint in the same level, appearance is not obviousⅡ degrees: on both sides of the shoulder joint is almost the same level, the dress can be seen when the deformity Ⅲ degrees: shoulder join

5、t is higher than the contralateral 2 ~ 5 cm, deformity.IV: is very serious, shoulder blades can be ascended the occipital,Diagnosis: X-ray examination,Sprengle deformity,Operative treament Appropriate age: 3-6 y

6、ears old； I Ⅱ degrees does not consider surgery, Ⅲ IV degrees demand through surgery under 5 years old,detiod nuscle,subclavian artery and vein,pectialismajor,pectoralis minor,brachial plexus,Common complications,,ble

7、eding,hematoma,wound,surgery,Endotracheal intubation,Laryngeal edema,Oppression of the trachea,Difficulty in breathing,infection,Brachial plexus injury,,,,,,,,,,,The most serious complications,Case report,Huang XX fe

8、male, 3 y, by finding the left shoulder blade deformity, 3 years , generally in good condition, no shortness of breath, chest tightness and other discomforts; Children with smooth mood, good appetite, sleep good, n

9、ormal to the toilet. Cultural degree: children kindergarten, social psychological reaction is good, acompamy with parents in the hospital,Case report,Specialized examination,Bone tissue pathological examination,

10、Blood biochemical test,hospital examination,,,,,,,Electrocardiogram (ecg),Chest Radiography,X-ray:The shoulder blade positive side,Diagnosis:sprengle deformity,Case report-Specialized examination and surgery,,Ⅲ degree

11、of deformity,On the left shoulder blade Angle place is relatively higher than that of the right shoulder blade ca. 4 cm,Limited lift on the left upper limb, outreach activities, left arm adduction, rotation,Forward b

12、ends after stretch no obvious limitations, fingers feel normal.,Operation: 4/8 in endotracheal hemp on her left shoulder blade edge,Muscle release + check point down around the excision reconstruction + bone bridge,,C

13、ase description - postoperative condition,Left shoulder a wound drainage tube, drainage of the dark red hemorrhagic fluid 10 ml, shoulder wound dressings dry clean,Left upper limb activity limited mild, good blood supply

14、,,5%GS100ml bid.muscosolvan15mg+0.9%NS10mlbid oxygen inhalation lansoprazole 15mg+0.9%NS100ml bid,Often cried, emotional instability, family felt nervous.,Continue to ecg monitoring and oxygen 2 l/min, stable

15、 vital signs, pain scores six points,Nursing process,,assess,plan,evalaute,diagnosis,do,,,,,,,,assess,Postoperative evaluation of children with pain,Vital signs, especially respiratory and blood oxygen saturation,Admis

16、sion assessment and evaluation of preoperative limb situation,術(shù)后評(píng)估患側(cè)肢體的活動(dòng)、血運(yùn) 患兒引流管 及傷口局部情況,評(píng)估患兒與家屬心理情況，及家屬對(duì)術(shù)后注意事項(xiàng)掌握度,Postoperative evaluation of limb activity, blood supply drainage tube and wound local situation,ps

17、ychological situation, and Master degree of families of postoperative consideratios,,,diagnosis,Potential complications: brachial plexus injury, acromegaly bloodLoop obstacle, bleeding, infection, hematoma,Lack of kno

18、wledge: families lack of postoperative nursing knowledge,Anxiety: and the child is not adapt to the environment,pain :associated with postoperative wound,,,Ease the painPsychological careObservationPostoperative guida

19、nce,ObservationTo prevent infection,Guide function exercise,Plan,near term（1-3d）,medium term（4-10d）,late period（10d后）,,painnursing,Do,Listen to the chief complaintAssessment of pain location, time, nature;With smi

20、ling face pain assessment scale,Body position nursing care: avoid lateral position, recommended the hypothesis or right side a little bit high (on the left side of the pad 10 °, 15 °) in children with place san

21、dbags fixed head on both sides of the head,Guide the non-drug pain relief methodPrescribed drugs, drug effect and adverse reactions.,Postoperative pain scores,,observation,Do,Vital signs, especially pay attention to the

22、 child's temperature, breathing, complexion, blood oxygen saturation.,Limb blood circulation: color, swelling, skin temperature, the radial pulse.observe Limb activity, muscle strength through induction and the f

23、inger grasping,and compared with preoperative.,Wound observation: wound dressings ;Wound drainage 's quantity, color, character; inflamed or hematoma,,nursing,Do,Continue to ecg monitoring and give oxygen for 24hW

24、rite the nursing record,Prevent infection nursing:dressing wound temperature monitoring,Avoid shoulder joint activities within 2 weeks. start a limited range of active and passive joint training after 2 weeks.,,psycho

25、logical nursing,Do,Explain to the family about treatment and nursingGiving more concern and sympathy, to obtain the trust and cooperation,keep an comfortable environment The same age children's encouragement and s

26、upportDistraction: toys, anime,,Listen to children complained, understand the cause of the crying,Psychological change,,,,Children and family tensions ease, smooth mood,,health education (to the family),Do,postoperati

27、ve position requirements, turn and drainage tube care considerations,observation points：kid's complexion and abnormal crying ,abnormal limb avtivity,high protein, high quantity of heat, high vitamin diet; Guide fun

28、ction exercise, such as the recent massage distal limb, wrist, elbow flexion exercise;The late: monkey climbing training, weight training,the awareness of familly before and after health education,,,evaluate,No complicat

29、ions occurred,Families can be the first day after surgery with postoperative considerations,Before discharge can grasp the functional exercise,Postoperative pain relief on the first day,Family members grasp the method

30、 of non-drug pain relief,and use the smiling face pain assessment scale correctly,children, family members emotional stable two days after,nursing experience,,psychological nursing.jiont the familyto nurse the child,