護(hù)理英語(yǔ)基礎(chǔ):ICU指南(1)

This introductory guide to the critical care environment describes the ICU and the caregivers who staff it; the patients and how they are admitted, monitored, and treated; and some of the common life-support equipment. It includes a strategy for presenting your patient to your team and prepares you for the ethical issues that might confront you in the ICU. The guide also describes some of the career paths that culminate in leadership positions in critical care medicine.

危重病護(hù)理環(huán)境指南介 紹重癥監(jiān)護(hù)室及室內(nèi)護(hù)理人員，病人與病人入院、監(jiān)護(hù)和治療方式，及一些常用的生命支持設(shè)備等內(nèi)容。指南還包括如何向ICU小組介紹病人和如何在心理上作好 應(yīng)對(duì)ICU可能遇到的職業(yè)道德問(wèn)題的準(zhǔn)備。指南還對(duì)危重病護(hù)理醫(yī)學(xué)中領(lǐng)導(dǎo)職位職業(yè)提升途徑進(jìn)行了描述。

The hospital you are in today is different from the hospital your attending physician claimed as his or her environment. Lengths of stay are down, patient acuity is rising, and critical care units are proliferating. Although the health care system is changing, hospitals will always need an area to care for their sickest patients--a critical care center. The need for these units is growing as patients at all extremes of life—the most premature infants, adults with cardiovascular disease, the severely injured—are growing, both in absolute numbers and in proportion to the general population. Citizens of developed nations around the world are living--and staying active--into the ninth and tenth decades of life. When they become ill, they often require aggressive intervention to stabilize their delicate physiologic balance so they can heal.醫(yī)學(xué) 全在.線(xiàn)提供www.med126.com

你今天所在的醫(yī)院與你主治醫(yī)生以前 所說(shuō)的那種環(huán)境已大不相同。病人住院時(shí)間縮短、病人要求提高、危重護(hù)理病房不斷增多。雖然健康護(hù)理系統(tǒng)在不斷變化，但醫(yī)院將始終需要有一個(gè)護(hù)理最嚴(yán)重的病 人的區(qū)域 – 一個(gè)危重病護(hù)理中心。由于處于生命極端狀態(tài)的病人的增多，如早產(chǎn)兒、成人心血管疾病患者和重傷病人等，無(wú)論是按絕對(duì)數(shù)字還是按總?cè)丝诒嚷视?jì)算，對(duì)這些病房 的需求都在增長(zhǎng)。發(fā)達(dá)國(guó)家的人口正在邁向90歲、100歲。這些人生病時(shí)常常需要采取入侵性措施，穩(wěn)定其脆弱的生理平衡，使他們得以治愈。

The interventions required to manage life-threatening illnesses generally include both core supports--intensive nursing care and cardiopulmonary monitoring--as well as supports focused on the patient's particular illness. While nearly all ICUs are capable of providing a spectrum of care, many have developed a focused area of excellence: care of critically ill and injured children in the pediatric ICU (PICU); adult cardiac diseases in the coronary care unit (CCU); perioperative care, trauma care, and care of multiple organ dysfunction in the surgical ICU (SICU); care of neurological and neurosurgical patients in the neuroscience ICU; and so on. Many teaching hospitals also have graded critical care centers such as intermediate care units and telemetry units where patients who require more than ward care can benefit from specific monitoring and intervention.

威脅生命的疾病的處理措施包括核心 支持—重癥護(hù)理和心肺監(jiān)護(hù)—及以病人特定疾病為重點(diǎn)的支持措施。盡管幾乎所有的ICU都能夠提供整套的護(hù)理，但很多ICU都有自己的強(qiáng)項(xiàng)：兒科 ICU(PICU)危重病及受傷兒童的護(hù)理；冠心病監(jiān)護(hù)室的成人心臟病護(hù)理；外科ICU(SICU)的圍手術(shù)期護(hù)理、外傷護(hù)理和多種器官功能障礙的護(hù)理 等；神經(jīng)科ICU的神經(jīng)和神經(jīng)外科病人護(hù)理；等等。很多教學(xué)醫(yī)院也有不同等級(jí)的危重病護(hù)理中心，如過(guò)渡監(jiān)護(hù)治療病房和遠(yuǎn)程治療病房等。需要病房外護(hù)理的病 人可以從遠(yuǎn)程治療的特殊監(jiān)護(hù)和介入中受益。醫(yī)學(xué)全.在線(xiàn)提供

The more things get busy, the more you will appreciate that each team member in the ICU has a specific role.

你越忙就越有體會(huì)：每個(gè)ICU成員都有他特殊的作用。

The team leader is a physician. Students typically are assigned to train in intensive care units where the team leader is an intensivist physician who has received advanced training in the art and science of critical care medicine. In North America, added qualifications in critical care medicine are obtained after board certification in a primary specialty such as pediatrics, internal medicine, surgery, or anesthesiology. Many countries have established critical care medicine as an independent specialty.

ICU小組長(zhǎng)由醫(yī)生擔(dān)任。學(xué)生被指 定到重癥監(jiān)護(hù)室實(shí)習(xí)。通常，ICU組長(zhǎng)是一個(gè)重癥專(zhuān)科醫(yī)生，他在危重病護(hù)理醫(yī)學(xué)方面受過(guò)高級(jí)培訓(xùn)。在北美地區(qū)，專(zhuān)科醫(yī)生在擁有基本專(zhuān)業(yè)證書(shū)---如兒科、 內(nèi)科、外科或麻醉科等---后就可以去獲得另的危重病護(hù)理醫(yī)學(xué)資格證書(shū)。很多國(guó)家已將危重病護(hù)理醫(yī)學(xué)設(shè)為一個(gè)獨(dú)立的專(zhuān)業(yè)。

Irrespective of the training pathway, your team leader embraces the philosophy of critical care medicine, namely that a physician-led, multidisciplinary team can provide optimal care to the critically ill patient.

不管接受何種培訓(xùn)，組長(zhǎng)都會(huì)掌握危重病護(hù)理醫(yī)學(xué)的基本原理，也就是說(shuō)，一個(gè)由醫(yī)生領(lǐng)導(dǎo)的多學(xué)科小組能夠?yàn)槲Ｖ夭∪颂峁┳罴训淖o(hù)理。

The term "multidisciplinary" refers not only to other physicians who may participate as consultants or coattendings in the ICU, but also to the other health care professionals who work side by side, around the clock in the ICU. The most numerous of these are the critical care nurses, many of whom also have advanced training and certification in critical care and are recognized as CCRNs. Some have achieved even greater recognition and responsibility. They are the acute care nurse practitioners and clinical nurse specialists who complement the physician staff in establishing plans, writing orders, and directing management. Physician assistants also provide care in the ICU.

“多學(xué)科”一詞并不僅僅是指以會(huì)診 醫(yī)師或合作主治醫(yī)師身份加入ICU的其他醫(yī)生，它同時(shí)也指在ICU內(nèi)并肩晝夜工作的其他衛(wèi)生保健專(zhuān)業(yè)人員，其中以重癥監(jiān)護(hù)護(hù)士人數(shù)最多。他們當(dāng)中有很多人 在重癥護(hù)理方面受過(guò)高級(jí)培訓(xùn)，獲得過(guò)相應(yīng)的證書(shū)，是公認(rèn)的“重癥監(jiān)護(hù)注冊(cè)護(hù)士”。有些護(hù)士所受到的重視更大，被賦予的職任也更大。他們是急癥開(kāi)業(yè)護(hù)士和臨 床護(hù)理專(zhuān)家，他們是醫(yī)生的補(bǔ)充，參與制定計(jì)劃、寫(xiě)醫(yī)囑和指導(dǎo)治療。醫(yī)生助理也提供ICU護(hù)理。

Respiratory therapists are experts in many forms of pulmonary diagnosis and intervention. In addition to operating the mechanical ventilator, therapists often obtain and analyze arterial blood for blood gases and test patients' breathing strength by obtaining forced vital capacity, negative inspiratory pressure, and other parameters. In some hospitals, respiratory therapists perform endotracheal intubation in addition to supporting ventilation with "bag-and-mask" devices. The ICU team typically includes a pharmacist who helps you review medication profiles and determine if your patient is predisposed to side effects or drug interactions.

呼吸治療師是多種肺病診斷和治療的 專(zhuān)家，除了使用機(jī)械呼吸機(jī)外，這些治療師常常獲取并分析動(dòng)脈血?dú)�，通過(guò)用力肺活量、負(fù)壓吸氣及其他參數(shù)測(cè)試病人的呼吸力。在一些醫(yī)院，呼吸治療師除了用“ 袋-面罩”裝置支持通氣外也施行氣管內(nèi)插管。一個(gè)典型的ICU小組都有一個(gè)藥劑師，他幫助護(hù)士評(píng)估藥物性質(zhì)，確定病人是否會(huì)誘發(fā)副作用或藥物相互作用。

The pharmacist will help you calculate clearance rates from measured drug levels and plan dosing schedules for many of the medications used in the ICU.

藥劑師根據(jù)測(cè)得的藥物濃度幫助計(jì)算藥物清除率，為ICU使用的多種藥物計(jì)劃給藥方案。

The team also typically includes someone who is an expert in nutrition support such as a dietitian who has advanced training in enteral (gut) and parenteral (intravenous) nutritional support strategies and pitfalls. Other important members of the ICU team are the medical social worker, who provides ongoing psychosocial assessments and support; representatives of the chaplaincy staff, who are available on call to offer spiritual support to patients, families, and ICU staff members; and a unit secretary, who manages administrative tasks such as reception, telecommunications, and chart maintenance. In addition, the ICU staff generally includes many other trainees who are there to learn with you such as fellows, residents, nursing students, and dietetics students.

典型的ICU小組里還有一位營(yíng)養(yǎng)支 持方面的專(zhuān)家，如一位在腸道和非腸道(靜脈內(nèi))營(yíng)養(yǎng)支持方法及缺陷方面受過(guò)高級(jí)培訓(xùn)的營(yíng)養(yǎng)師等。ICU小組其他重要成員有社會(huì)醫(yī)療工作者，他為病人提供連 續(xù)的心理社會(huì)評(píng)估和支持；牧師代表，可以隨時(shí)招他為病人、家屬和ICU成員提供精神幫助；以及一位病房秘書(shū)，處理一些行政性工作，如接待、聯(lián)系及病案保管 等。此外，ICU成員通常包括其他很多在此學(xué)習(xí)的受訓(xùn)實(shí)習(xí)人員，如會(huì)員、高級(jí)專(zhuān)科住院實(shí)習(xí)醫(yī)生、護(hù)生及營(yíng)養(yǎng)學(xué)學(xué)生等。