操作准备与术后护理：你会遇到的题目

🧠 为什么重要

心导管检查前要询问既往对碘造影剂的反应（仅有贝类过敏并不是避免使用造影剂的理由）和肾功能情况，在操作前后暂停metformin，按医嘱保持NPO；操作后检查穿刺部位有无出血或血肿，比较远端脉搏、颜色和温度，让肢体按医嘱时长保持伸直，并鼓励多喝水以清除造影剂。支气管镜检查和上消化道内镜检查（EGD）前要保持NPO，操作后直至咽反射恢复前也要保持NPO。胸腔穿刺时坐在床边桌上直立并向前倾，穿刺针插入期间不要咳嗽或移动；操作后警惕气胸（突发呼吸困难、呼吸音消失），并预期要进行胸部X线检查。腹腔穿刺前立即排尿以避免膀胱穿刺损伤，测量体重和腹围，大量放液后警惕低血容量。腰椎穿刺时取侧卧位并屈膝抱腿；操作后按医嘱平躺，鼓励多喝水，并报告严重头痛或漏液情况。肝活检前先检查凝血功能，让患者在穿刺时呼气并屏气，然后右侧卧位约2小时以压迫穿刺部位，并警惕出血。EEG检查前要洗头，不摄入咖啡因，不使用镇静剂，并且不要跳过正餐。MRI检查前要筛查金属、植入物和起搏器。结肠镜检查前一天进行肠道准备并进食清流质；操作后预期会出现腹胀和排气，若出现严重疼痛、发热或出血则报告，因为这些提示穿孔或出血。在进行桡动脉血气分析前，进行Allen试验以确认尺侧侧支循环；操作后用力按压至少5分钟（如果患者服用抗凝剂或有凝血障碍，则约10分钟或更久）。

CARDIAC CATHETERIZATION: ask about any prior reaction to iodinated contrast (a shellfish allergy alone is not a reason to avoid contrast) and about kidney function, hold metformin around the procedure, keep NPO as ordered; afterward check the insertion site for bleeding or hematoma, compare distal pulses, color and temperature, keep the extremity straight for the ordered hours, and push fluids to clear the dye. BRONCHOSCOPY and UPPER ENDOSCOPY (EGD): NPO before and until the gag reflex returns afterward. THORACENTESIS: sit upright leaning forward on an overbed table, do not cough or move during needle insertion; afterward watch for pneumothorax (sudden dyspnea, absent breath sounds) and expect a chest X-ray. PARACENTESIS: void immediately before to avoid bladder puncture, measure weight and abdominal girth, watch for hypovolemia after large-volume removal. LUMBAR PUNCTURE: side-lying with knees drawn up; afterward lie flat as ordered, encourage fluids, and report severe headache or leakage. LIVER BIOPSY: check coagulation studies first, have the client exhale and hold during insertion, then lie on the RIGHT side for about 2 hours to compress the site and watch for bleeding. EEG: wash the hair, no caffeine, no sedatives, and do not skip meals. MRI: screen for metal, implants and pacemakers. COLONOSCOPY: bowel prep and clear liquids the day before; afterward expect cramping and flatus, and report severe pain, fever or bleeding, which suggest perforation or hemorrhage. Before a RADIAL arterial blood gas, perform the Allen test to confirm ulnar collateral flow; afterward apply firm pressure for at least 5 minutes (about 10 minutes or longer if the client takes anticoagulants or has a coagulopathy).

🏥 真实场景

🦵 一名患者在股动脉心导管检查后，右脚变得苍白、发凉，足背脉搏比左侧弱。护士检查穿刺部位（无出血）并立即呼叫医疗服务提供者：血栓或痉挛正在阻塞导管所用的动脉。该操作后的远端脉搏检查不是例行文书工作；它们能发现威胁肢体的缺血。

🦵 After a femoral cardiac catheterization a client's right foot becomes pale and cool with a weak pedal pulse compared with the left. The nurse checks the site (no bleeding) and calls the provider immediately: a clot or spasm is blocking the artery used for the catheter. Distal pulse checks after this procedure are not routine paperwork; they catch limb-threatening ischemia.

📌 要点总结

• 心导管检查后：穿刺部位、脉搏、腿伸直、补液；暂停metforminAfter cardiac cath: site, pulses, leg straight, fluids; metformin held
• 支气管镜检查或上消化道内镜检查后，直至咽反射恢复前不得进食或饮水No food or fluids until the gag reflex returns after bronchoscopy or upper endoscopy
• 胸腔穿刺：坐起向前倾；腹腔穿刺：排尿；LP：平躺；肝活检：右侧卧位Thoracentesis: sit forward; paracentesis: void; LP: flat; liver biopsy: right side

✅ 自我测试