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地形平坦开阔,地层由第四系全新冲积层,第四系上更新统冲层组成,局部表覆第四系全新统人工堆积层。第四系全新统冲积层厚度约25~50m,岩性主要为黏土、粉质黏土、粉土、粉砂、细砂;第四系上更新统冲积层厚度大于50m,岩性主要为黏性土、粉土、粉细砂等。管桩深度范围内地层主要为:粉土、黏土、粉质黏土,局部表层为杂填土。couplingCentreshallbechecked,thesecondpouredconcretestrengthofmorethan70%.Intheprocessofreamingorboring,apartfromthespecialprovisionsinfactory,doesnotallowanyworkthatmayaffectthecouplingCentre,suchasirrigation,tocylinderconnectionstofloodthecondenserpipesandsoon.Wellboring,hingeboltholeflangewithcouplingofvertical,notoblique.Mountingboltsshouldbeaddedlubricants,typinggentlywithasmallhammer,nottoolooseortootight,packedtheboltswiththecorrespondingsealscrewholeshouldbemarked.6.4.5.4.2couplingreamedandpairingsisclosetothediameterofboltbearinggoodhingeholes,dressedwithagoodtwocouplingboltsbeforeyoucanmovetherotor,boring-reamingholeinturn.Couplingboltsmustbetightcouplingissymmetricaldiameter,inboring,reaming,twoboltsout.Wellboring,hingeboltholeflangewithcouplingofvertical,notoblique.Duetothecouplingboltsinaccordancewithhingeholescorrespondingtothediameterofthescrewholesonebyoneafterprocessing,processingbackboltinstallationlocationcannotbechanged,soaccordingtoboltaftertheactualweightdifferenceofnutandlockwashertomatch.Generalrequirementsforcouplingtwosymmetricaldiameterbolt,nutandlockwasher'stotalweightdifferenceshouldnotbegreaterthan10gandknocksstampedmark.(SeeFigure18)Thecouplingboltsapplylubricant,andthengentlywithcopperhome,nottoolooseortootight.BoltAssemblyisfinished,symmetricaltighteningallboltsto30%,50%,70%,100%force,andcheckthecouplingflutterandbeforeconnectingthecirclegraduallychangesitsvalueshouldbelessthan0.02mm.Tighteningtorqueofthecouplingboltsshallcomplywiththetechnicalrequirementsmanufacturersdrawings,withadynamometricwrenchorlogtensiontools.Threewheelrotorswingtestcouplingconnectionsshouldbechecked:takingleave,儿童房间隔缺损临床路径房间隔缺损临床路径表单适用对象:第一诊断为房间隔缺损继发孔型(ICD-10:Q21.102)行房间隔缺损直视修补术(ICD-9-CM-3:35.51/35.61/35.71)患者姓名:性别:年龄:门诊号:住院号:住院日期:年月日出院日期:年月日标准住院日:≤15天时间住院第1-2天住院第2-3天住院第3-4天(手术日)主要诊疗工作□病史询问,体格检查□完成入院病历书写□安排相关检查□上级医师查房□汇总检查结果□完成术前准备与术前评估□术前讨论,确定手术方案□完成术前小结、上级医师查房记录等病历书写□向患者及家属交代病情及围手术期注意事项□签署手术知情同意书、自费用品协议书、输血同意书□气管插管,建立深静脉通路□手术□术后转入监护病房□术者完成手术记录□完成术后病程记录□向患者家属交代手术情况及术后注意事项重点医嘱长期医嘱:□先心病护理常规□二级护理□饮食□患者既往基础用药临时医嘱:□血常规、尿常规□血型、凝血功能、电解质、肝肾功能、感染性疾病筛查□胸片、心电图、超声心动图长期医嘱:□强心、利尿、补钾治疗临时医嘱:□拟于明日在全麻体外循环下行房间隔缺损修补术□备皮□备血□血型□术前晚灌肠□术前禁食水□术前镇静药(酌情)□其他特殊医嘱长期医嘱:□心脏体外循环直视术后护理□禁食□持续血压、心电及血氧饱和度监测□呼吸机辅助呼吸□预防用抗菌药物临时医嘱:□床旁胸片□其他特殊医嘱主要护理工作□入院宣教(环境、设施、人员等)□入院护理评估(营养状况、性格变化等)□术前准备(备皮等)□术前宣教(提醒患者按时禁水等)□观察患者病情变化□定期记录重要监测指标病情变异记录□无□有,原因:1.2.□无□有,原因:1.2.□无□有,原因:1.2.护士签名医师签名地形平坦开阔,地层由第四系全新冲积层,第四系上更新统冲层组成,局部表覆第四系全新统人工堆积层。第四系全新统冲积层厚度约25~50m,岩性主要为黏土、粉质黏土、粉土、粉砂、细砂;第四系上更新统冲积层厚度大于50m,岩性主要为黏性土、粉土、粉细砂等。管桩深度范围内地层主要为:粉土、黏土、粉质黏土,局部表层为杂填土。couplingCentreshallbechecked,thesecondpouredconcretestrengthofmorethan70%.Intheprocessofreamingorboring,apartfromthespecialprovisionsinfactory,doesnotallowanyworkthatmayaffectthecouplingCentre,suchasirrigation,tocylinderconnectionstofloodthecondenserpipesandsoon.Wellboring,hingeboltholeflangewithcouplingofvertical,notoblique.Mountingboltsshouldbeaddedlubricants,typinggentlywithasmallhammer,nottoolooseortootight,packedtheboltswiththecorrespondingsealscrewholeshouldbemarked.6.4.5.4.2couplingreamedandpairingsisclosetothediameterofboltbearinggoodhingeholes,dressedwithagoodtwocouplingboltsbeforeyoucanmovetherotor,boring-reamingholeinturn.Couplingboltsmustbetightcouplingissymmetricaldiameter,inboring,reaming,twoboltsout.Wellboring,hingeboltholeflangewithcouplingofvertical,notoblique.Duetothecouplingboltsinaccordancewithhingeholescorrespondingtothediameterofthescrewholesonebyoneafterprocessing,processingbackboltinstallationlocationcannotbechanged,soaccordingtoboltaftertheactualweightdifferenceofnutandlockwashertomatch.Generalrequirementsforcouplingtwosymmetricaldiameterbolt,nutandlockwasher'stotalweightdifferenceshouldnotbegreaterthan10gandknocksstampedmark.(SeeFigure18)Thecouplingboltsapplylubricant,andthengentlywithcopperhome,nottoolooseortootight.BoltAssemblyisfinished,symmetricaltighteningallboltsto30%,50%,70%,100%force,andcheckthecouplingflutterandbeforeconnectingthecirclegraduallychangesitsvalueshouldbelessthan0.02mm.Tighteningtorqueofthecouplingboltsshallcomplywiththetechnicalrequirementsmanufacturersdrawings,withadynamometricwrenchorlogtensiontools.Threewheelrotorswingtestcouplingconnectionsshouldbechecked:takingleave,2时间住院第4-5日(术后第1天)住院第5-10日(术后第2-6天)住院第11-15日(术后第7-11天)主要诊疗工作□医师查房□观察切口有无血肿,渗血□拔除胸管(根据引流量)□拔除尿管□医师查房□安排相关复查并分析检查结果□观察切口情况□检查切口愈合情况并拆线□确定患者可以出院□向患者交代出院注意事项复查日期□通知出院处□开出院诊断书□完成出院记录重点医嘱长期医嘱:□一级护理□半流饮食□氧气吸入□心电、无创血压及血氧饱和度监测□预防用抗菌药物□强心、利尿、补钾治疗临时医嘱:□心电图□大换药□复查血常规及相关指标□其他特殊医嘱长期医嘱:□二级护理(酌情)□饮食□停监测(酌情)□停抗菌药物(酌情)临时医嘱:□拔除深静脉置管并行留置针穿刺(酌情)□复查胸片、心电图、超声心动图以及血常规,血生化全套□大换药临时医嘱:□通知出院□出院带药□拆线换药主要护理工作□观察患者情况□记录生命体征□记录24小时出入量□术后康复指导□病人一般状况及切口情况□鼓励患者下床活动,利于恢复□术后康复指导□帮助办理出院手续□康复宣教病情变异记录□无□有,原因:1.2.□无□有,原因:1.2.□无□有,原因:1.2.护士签名医师签名地形平坦开阔,地层由第四系全新冲积层,第四系上更新统冲层组成,局部表覆第四系全新统人工堆积层。第四系全新统冲积层厚度约25~50m,岩性主要为黏土、粉质黏土、粉土、粉砂、细砂;第四系上更新统冲积层厚度大于50m,岩性主要为黏性土、粉土、粉细砂等。管桩深度范围内地层主要为:粉土、黏土、粉质
本文标题:儿童四种先心病临床路径
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