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宜儒 發問時間: 社會與文化語言 · 7 年前


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The American Association of Critical-Care Nurses published an evidence-based practice alert in 2006 that offered guidelines for oral care of the mechanically ventilated patient. In addition,Grap and Munro and Collard and Saint recommended raising the head of the bed to an elevation of 30˚ to 40˚, using endotracheal tubes that have a dorsal lumen above the endotracheal cuff,and sporadically changing ventilator circuits.Grap and Munro presented supporting evidence indicating that critically ill patients who are intubated for more than 24 hours are at higher risk for VAP, and therefore, mouth care and oral health should be an important part of nursing care.Current literature identified a problem with adequate oral care in the intubated patient that included the definition and quantification of oral care. Bergmans and colleagues provided evidence that prevention of bacterial colonization of the oropharynx is the key to preventing VAP.The Centers for Disease Control and Prevention guidelines. determined that the primary route of bacterial entry into the lungs is through the oropharynx during episodes of microaspiration.Several studies have verified that removing bacteria from the oropharynx requires the removal of dental plaque, and the only way to remove the plaque is with toothbrushing.Pearson and Hutton and others found that the majority of nurses use a soft Toothette® instead of toothbrushing and that the Toothettes do not remove plaque as effectively as toothbrushes;consequently,oral bacteria can proliferate.Pearson and Hutton completed a controlled trial that compared the ability of foam swabs and toothbrushes to remove dental plaque and to quantify any differences.They concluded that toothbrushing skills must be taught to nurses and clinical support staff.Schleder reviewed the pathogenesis of bacteria; identified risk factors, including colonization of the oropharynx; and recommended the following approaches:

2 個解答

  • 7 年前

    美國的臨界護理護士協會發表循證實踐警報提供準則的口腔護理機械通氣病人的 2006 年。此外,Grap 和芒羅和柯拉德和聖建議提高到海拔 30˚ 到 40˚,床頭使用有氣管內箍帶,背腔的氣管內管和分散地改變呼吸機電路。Grap 和芒羅提出證據表明插管 24 小時以上的危重病患者是 VAP,風險更高,因此,嘴裡關心和口腔健康應該是護理工作的重要組成部分。當前文學發現的問題以足夠的口腔護理中包含的定義和量化的口腔護理的病人插管。柏格曼和他的同事提供證據口咽部細菌定植的預防是預防呼吸機相關性肺炎的關鍵。中心的疾病控制和預防的指導方針。確定肺部細菌進入的主要路線是通過口咽期間 microaspiration 的情節。幾項研究已驗證除菌從口咽須清除牙菌斑和去除菌斑的唯一方法是與刷牙。皮爾森和哈頓和其他發現大多數的護士不刷牙使用軟 Toothette ® 和 Toothettes 做不作為牙刷有效地去除菌斑 ; 因此,口腔細菌可能會激增。皮爾森和哈頓完成比較能力的泡沫棉簽和牙刷去除牙菌斑並量化的任何差異對照的試驗。他們的結論必須向護士和臨床支援工作人員教刷牙技能。施勒德審查了發病的細菌 ;確定風險因素,包括殖民化口咽 ;推薦以下方法:

    2013-10-13 20:43:53 補充:

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  • 7 年前

    hello shane wang do i know you are you sure i dont think i know you hello

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