解放軍文職招聘考試First Inaugural Address(Excerpts) 就職演講-解放軍文職人員招聘-軍隊(duì)文職考試-紅師教育
解放軍文職招聘考試First Inaugural Address(Excerpts) 就職演講發(fā)布時(shí)間:2017-12-20 22:19:41First Inaugural AddressWe observe today not a victory of party, but a celebration of freedom, symbolizing an end, as well as a beginning; signifying renewal, as well as change. For I have sworn before you and Almighty God the same solemn oath our forebears prescribed nearly a century and three quarters ago.in your hands, my fellow citizens, more than in mine, will rest the final success or failure of our course. Since this country was founded, each generation of Americans has been summoned to give testimony to its national loyalty. The graves of young Americans who answered the call to service surround the globe.Now the trumpet summons us again, not as a call to bear arms, though arms we need; not as a call to battle, though embattled we are; but a call to bear the burden of a long twilight struggle, year in and year out, rejoicing in hope; patient in tribulation , a struggle against the common enemies of man: tyranny, poverty, disease, and war itself.Can we forge against these enemies a grand and global alliance, North and South, East and West, that can assure a more fruitful life for all mankind? Will you join in that historic effort?In the long history of the world, only a few generations have been granted the role of defending freedom in its hour of maximum danger. I do not shrink from this responsibility. I welcome it. I do not believe that any of us would exchange places with any other people or any other generation. The energy, the faith, the devotion which we bring to this endeavor will light our country and all who serve it. And the glow from that fire can truly light the world.And so, my fellow Americans, ask not what your country can do for you, ask what you can do for your country.My fellow citizens of the world, ask not what America will do for you, but what together we can do for the freedom of man.Finally, whether you are citizens of America or citizens of the world, ask of us here the same high standards of strength and sacrifice which we ask of you. With a good conscience our only sure reward, with history the final judge of our deeds, let us go forth to lead the land we love, asking His blessing and His help, but knowing that here on earth, God s work must truly be our own.
昏迷患者護(hù)理常規(guī)-解放軍文職人員招聘-軍隊(duì)文職考試-紅師教育
發(fā)布時(shí)間:2017-08-13 22:01:37㈠觀察要點(diǎn)⒈嚴(yán)密觀察生命體征(T、P、R、BP)、瞳孔大小、對(duì)光反應(yīng)。⒉評(píng)估GLS意識(shí)障礙指數(shù)及反應(yīng)程度,了解昏迷程度,發(fā)現(xiàn)變化立即報(bào)告醫(yī)生。⒊觀察患者水、電解質(zhì)的平衡,記錄24h出入量,為指導(dǎo)補(bǔ)液提供依據(jù)。⒋注意檢查患者糞便,觀察有無(wú)潛反應(yīng)。㈡護(hù)理要點(diǎn)⒈呼喚患者:操作時(shí),首先要呼喚其姓名,解釋操作的目的及注意事項(xiàng)。⒉建立并保持呼吸道通暢:取側(cè)臥位頭偏向一側(cè),隨時(shí)清除氣管內(nèi)分泌物,備好吸痰用物,隨時(shí)吸痰。⒊保持靜脈輸液通暢:嚴(yán)格記錄所用藥物及量。⒋保持肢體功能位,定期給予肢體被動(dòng)活動(dòng)與按摩,預(yù)防手足攣縮、變形及神經(jīng)麻痹。⒌促進(jìn)腦功能恢復(fù):抬高床頭30~45度或給予半臥位姿勢(shì),遵醫(yī)囑給予藥物治療和氧氣吸入。⒍維持正常排泄功能:定時(shí)檢查患者膀胱有無(wú)尿潴留,按時(shí)給予床上便器,協(xié)助按摩下腹部促進(jìn)排尿,導(dǎo)尿者或更換尿袋時(shí)應(yīng)注意無(wú)菌技術(shù)。⒎維持清潔與舒適:取出義齒、發(fā)卡,修剪指(趾)甲;每日進(jìn)行口腔護(hù)理兩次,保持口腔清潔濕潤(rùn),可涂石蠟油(唇膏)防止唇裂;定時(shí)進(jìn)行床上檫浴和會(huì)陰沖洗,更換清潔衣服。⒏注意安全:躁動(dòng)者應(yīng)加床檔,若出現(xiàn)極度躁動(dòng)不安者,適當(dāng)給予約束;意識(shí)障礙伴高熱抽搐、腦膜刺激征時(shí),應(yīng)給予有效降溫并放置牙墊,防止咬傷舌頰部;固定各種管路,避免滑脫。⒐預(yù)防肺部感染:定時(shí)翻身拍背,刺激患者咳嗽,及時(shí)吸痰;注意保暖,避免受涼,使用熱水袋時(shí)水溫不易超過50度,不能直接接觸皮膚,防止?fàn)C傷。⒑預(yù)防壓瘡:使用氣墊床,骨突出部分加用海綿墊,保持床單位整潔、平整。每1~2h翻身一次。⒒眼部護(hù)理:摘除隱形眼鏡交家屬保管?;颊哐鄄€不能閉合時(shí),定時(shí)用生理鹽水檫洗眼部,用眼藥膏或凡士林油紗保護(hù)角膜,預(yù)防角膜干燥及炎癥。㈢健康教育⒈取得家屬配合,指導(dǎo)家屬對(duì)患者進(jìn)行相應(yīng)的意識(shí)恢復(fù)訓(xùn)練,幫助患者肢體被動(dòng)活動(dòng)與按摩。⒉心理護(hù)理:關(guān)心鼓勵(lì)患者,使患者認(rèn)識(shí)到自己在家庭和社會(huì)中存在價(jià)值,以增加戰(zhàn)勝疾病信心。
休克患者護(hù)理常規(guī)-解放軍文職人員招聘-軍隊(duì)文職考試-紅師教育
發(fā)布時(shí)間:2017-08-13 22:01:50㈠觀察要點(diǎn)⒈嚴(yán)密觀察生命體征(T、P、R、BP)、心率、氧飽和度的變化,觀察有無(wú)呼吸淺快、脈搏細(xì)速、心率增快、脈壓減小〈20mmHg、SBP降至〈90mmHg以下或較前下降20~30mmHg、氧飽和度下降等表現(xiàn)。⒉嚴(yán)密觀察患者意識(shí)狀態(tài)(意識(shí)狀態(tài)反映大腦組織血液灌注情況),瞳孔大小和對(duì)光反射,是否有興奮、煩躁不安或神志淡漠、反應(yīng)遲鈍、昏迷等表現(xiàn)。⒊密切觀察患者皮膚顏色、色澤,有無(wú)出汗、蒼白、皮膚濕冷、花斑、紫紺等表現(xiàn)。⒋觀察中心靜脈壓(CVP)的變化。⒌嚴(yán)密觀察每小時(shí)尿量,是否 30 ml/h;同時(shí)注意尿比重的變化,⒍注意觀察電解質(zhì)、血常規(guī)、血?dú)狻⒛δ芗案文I功能等檢查結(jié)果的變化,以了解患者其他重要臟器的功能。⒎密切觀察用藥治療后的效果及是否存在藥物的不良反應(yīng)。㈡護(hù)理要點(diǎn)⒈取平臥位或休克臥位,保持病房安靜。⒉迅速建立靜脈通道,保證及時(shí)用藥。根據(jù)血壓情況隨時(shí)調(diào)整輸液速度,給予擴(kuò)容及血管活性藥物后血壓不升時(shí)作好配血、輸血準(zhǔn)備。⒊做好一切搶救準(zhǔn)備,嚴(yán)密觀察病情變化,行心電、呼吸、血壓、血氧等監(jiān)護(hù)。⒋需要時(shí)配合醫(yī)生盡可能行深靜脈穿刺術(shù),以便搶救用藥,隨時(shí)監(jiān)測(cè)CVP。若無(wú)條件做深靜脈穿刺,應(yīng)注意大劑量的血管活性藥物對(duì)患者血管的影響,避免皮膚壞死。⒌保持呼吸道通暢,采用面罩或麻醉機(jī)給予較高流量的氧氣吸入,以改善組織器官的缺氧、缺血及細(xì)胞代謝障礙。當(dāng)呼吸衰竭發(fā)生時(shí),應(yīng)立即準(zhǔn)備行氣管插管,給予呼吸機(jī)輔助呼吸。 對(duì)實(shí)施機(jī)械輔助治療的,按相關(guān)術(shù)后護(hù)理常規(guī)護(hù)理。⒍留置導(dǎo)尿,嚴(yán)密測(cè)量每小時(shí)尿量,準(zhǔn)確記錄24h出入量,注意電解質(zhì)情況,做好護(hù)理記錄。⒎保持床單位清潔、干燥,注意保暖,做好口腔護(hù)理,加強(qiáng)皮膚護(hù)理,預(yù)防壓瘡。⒏做好各種管道的管理與護(hù)理,預(yù)防各種感染。⒐病因護(hù)理:積極配合醫(yī)生治療原發(fā)病,按其不同病因進(jìn)行護(hù)理。⒑做好患者及家屬的心理疏導(dǎo)。⒒嚴(yán)格交接班制度:交接班時(shí)要將患者的基礎(chǔ)疾病、診治經(jīng)過、藥物準(zhǔn)備情況、患者目前情況、特殊醫(yī)囑和注意事項(xiàng)等詳細(xì)進(jìn)行交接班,每班要詳細(xì)記錄護(hù)理記錄。㈢指導(dǎo)要點(diǎn)⒈進(jìn)行心理指導(dǎo),使患者及家屬克服對(duì)疾病的恐懼感。⒉指導(dǎo)患者及家屬對(duì)誘發(fā)休克出現(xiàn)的疾病進(jìn)行預(yù)防。⒊指導(dǎo)患者按時(shí)服藥,定期隨診。
氣管插管患者護(hù)理常規(guī)-解放軍文職人員招聘-軍隊(duì)文職考試-紅師教育
發(fā)布時(shí)間:2017-08-13 22:02:27㈠觀察要點(diǎn)⒈嚴(yán)密觀察患者生命體征、神志、瞳孔、SpO2變化。⒉注意觀察導(dǎo)管插入的深度。⒊觀察氣管分泌物的性質(zhì)、顏色。⒋拔管后的觀察:⑴嚴(yán)密觀察病情變化,監(jiān)測(cè)心率、血壓、血氧飽和度,觀察呼吸道是否通暢,呼吸交換量是否足夠,皮膚黏膜色澤是否紅潤(rùn),同時(shí)遵醫(yī)囑行血?dú)夥治?;⑵觀察有無(wú)喉頭水腫、黏膜損傷等情況,發(fā)現(xiàn)異常及時(shí)通知醫(yī)生處理。㈡護(hù)理要點(diǎn)⒈環(huán)境要求:病室空氣新鮮,定時(shí)通風(fēng),保持室溫22~24度左右,相對(duì)濕度60%。⒉儀表要求:工作人員在護(hù)理患者時(shí)要嚴(yán)格無(wú)菌操作,洗手,帶口罩、戴手套。⒊無(wú)論是經(jīng)鼻腔或口腔插管均應(yīng)注意固定牢固,做好標(biāo)記;防止口腔插管時(shí)牙墊脫落;注意導(dǎo)管插入的深度及插管與頭頸部的角度。⒋氣囊管理:定時(shí)監(jiān)測(cè)氣囊壓力,在給氣囊放氣前或拔除導(dǎo)管前,必須清除氣囊上滯留物。⒌保持氣管插管通暢,及時(shí)有效的進(jìn)行氣管內(nèi)吸痰:吸痰管吸一次換一根,順序?yàn)闅獾馈⒖谇?、鼻腔;吸痰前后?yīng)充分給氧:一次吸痰時(shí)間不超過15秒,吸痰過程中出現(xiàn)氣管痙攣、紫紺、躁動(dòng)不安等情況應(yīng)停止吸痰,立即通知醫(yī)生處理。⒍根據(jù)患者的病情,遵醫(yī)囑給予適量的止疼藥或鎮(zhèn)靜藥。⒎氣道濕化:人工氣道建立后,上氣道的濕化、溫化功能缺失,易導(dǎo)致痰液潴留、結(jié)痂等并發(fā)癥應(yīng)加強(qiáng)氣道濕化(遵醫(yī)囑配置氣道濕化液,每24小時(shí)更換一次,氣管內(nèi)滴入水份約200ml/日左右,平均每小時(shí)約10ml,可在每次吸痰前后給予)。⒏保持氣管插管局部清潔,固定氣管插管的膠布如被污染應(yīng)立即更換,每天做口腔護(hù)理兩次。⒐經(jīng)鼻或經(jīng)口插管拔管方法:⑴原發(fā)病治愈應(yīng)適時(shí)拔管,并向患者做好解釋,取得患者合作;⑵如無(wú)禁忌癥,以床頭抬高30度以上為宜,以減少返流和誤吸;⑶吸引氣管插管以上及經(jīng)口腔排出堆積在套囊以上的分泌物,因其在套囊放氣后可被吸入到下呼吸道;⑷吸入高濃度氧數(shù)分鐘(每分4~6L),將套管內(nèi)氣體放出;⑸將吸痰管放入氣管插管略超過其長(zhǎng)度,邊吸痰邊拔管,以防積存在氣管內(nèi)套管周圍的分泌物被誤吸;⑹拔管時(shí)在呼氣相將導(dǎo)管拔除,以便拔管后第一次呼吸是呼出氣體,以免咽部分泌物吸入;⑺一旦導(dǎo)管拔除后,將患者頭轉(zhuǎn)向一側(cè),防止口腔內(nèi)分泌物誤吸入氣道;⑻拔管應(yīng)盡量在白天進(jìn)行,以便觀察病情與及時(shí)處理拔管后發(fā)生的合并癥。⒑拔管后的護(hù)理:⑴以口鼻(面)罩吸氧,以保證安全;⑵4小時(shí)內(nèi)禁食,因?yàn)榇藭r(shí)聲門關(guān)閉功能及氣道反射功能不健全;⑶禁止使用鎮(zhèn)靜劑,因在拔管后如有煩躁可能是缺氧的表現(xiàn);⑷予定時(shí)翻身、排背,鼓勵(lì)患者咳嗽、咯痰。㈢指導(dǎo)要點(diǎn)⒈做好患者及家屬的心理護(hù)理,消除焦慮恐懼感。⒉吸痰前應(yīng)與患者做好有效的溝通交流,減少患者的焦慮和緊張。⒊為減少氣囊對(duì)氣管壁的壓力,在充氣時(shí)可采用兩種方法:最小漏氣技術(shù)(MLT)*或最小閉合容積技術(shù)(MOV)*。⒋拔除導(dǎo)管前必須使用氣囊上滯留物清除技術(shù)。⒌拔管后鼓勵(lì)患者主動(dòng)咳嗽、咯痰。*最小漏氣技術(shù) :套囊充氣后吸氣時(shí)容許不超過50毫升的氣體從套囊與氣管壁間的空隙漏出。先把套囊注氣至吸氣時(shí)無(wú)氣體漏出,然后以0.1毫升/次進(jìn)行套囊放氣,直到吸氣時(shí)有少量氣體漏出為止。*最小閉合容積技術(shù):套囊充氣后剛好吸氣時(shí)無(wú)氣體漏出。先把套囊注氣至吸氣時(shí)無(wú)氣體漏出,然后以0.1毫升/次進(jìn)行套囊放氣,聽到漏氣聲后向套囊內(nèi)注氣0.1毫升/次,無(wú)漏氣即可。