脑梗死病人的个案护理.docVIP

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脑梗死病人的个案护理

学生姓名：黄新雯指导老师：吴玉娥

目录

一、介绍·························································1页

二、生理解剖···················································2-4页

三、病因及病理生理·············································4-5页

四、个案资料·····················································5页

五、入院评估···················································5-6页

六、相关检查·····················································6页

七、护理计划···················································6-7页

八、护理诊断·····················································7页

九、预期目标·····················································7页

十、护理措施···················································7-9页

十一、健康教育··················································10页

十二、体会······················································10页

十三、参考文献···············································10-11页

附录·························································11-12页

附录一：脑梗死介绍

附录二：肌力分级介绍

附录三：NIHSS介绍

一、介绍

脑梗死（cerebralinfaiction,CI)又称缺血性脑卒中(ischemiscstroke)，在脑血管病中最常见，约占全部脑卒中的70%（见附录）。本病好发于50-60岁以上中老年人，动脉粥样硬化者老年人多，且伴有高血压，脑梗死病人病前常有头晕、头痛、肢体麻木、无力等症状，多数在安静休息或睡眠时发病。神经缺失症状通常在1-2日内达到高峰。患者大多意识清楚或有不同程度的意识障碍。脑梗死后病人常因活动能力的丧失或减退而产生各种消极、不利于病人病情康复的心理。应用适时、合理的护理程序，对病人进行治疗、护理、健康教育时使病人一目了然，可预知自己住院期间的治疗、护理计划及目标，这样既满足了病人的知情权，又使病人积极主动地配合医疗护理工作，与此同时，也增加了与病人交流的机会，改善了医护患关系，从而提高病人的满意度及健康教育知识的掌握率。

生理解剖

1、脑由脑干、小脑、间脑、和端脑组成。脑干自上而下由中脑、脑桥和延髓组成。延髓在枕骨大孔处下接延髓，中脑向上与间脑相接，脑干的背面与小脑相连（如图一）。端脑是脑的最高级部分，主要由左、右大脑半球组成，划分有额、顶、颞、枕、岛叶，大脑的表层为灰质，称大脑皮质，深面的白质称髓质。大脑划分为多个不同的功能分区，负责支配随意运动、感觉、说话、情感和行为等（图二）。间脑一般被分成丘脑、丘脑上部、丘脑下部、丘脑底部和丘脑后部五个部分。丘脑是间脑中最大的卵圆形灰质核团，位于第三脑室的两侧，左、右丘脑借灰质团块（称中间块）相连。丘脑被Y形的白质板（称内髓板）分隔成前、内侧和外侧三大核群(图三）。前核群：位于内髓板分叉部的前上方，是边缘系统中的一个重要中继站，其功能与内脏活动有关。内侧核群：居内髓板内侧，其功能可能是联合躯体和内脏感觉冲动的整合中枢。外侧核群：位于内髓板外侧，可分为较小的背侧部和较大的腹侧部。传导躯干、四肢和头面部的深、浅感觉及味觉。

（图三）丘脑核群模式图

（图一）脑的正中矢状面

（图二）大脑皮质重要中枢

2、脑血液循环：脑是体内代谢最旺盛的器官，因而血液供应十分丰富。脑的动脉分属两个动脉系统：