內(nèi)科護(hù)理學(xué)重難點(diǎn)分析（1）一、循環(huán)系統(tǒng)疾病常見癥狀有哪些？1呼吸困難是指呼吸時(shí)病人感到空氣不足、憋氣、呼吸費(fèi)力。循環(huán)系統(tǒng)疾病病人出現(xiàn)呼吸困難主要見于左心功能不全，其產(chǎn)生的主要原因是肺瘀血、肺組織彈性下降。其特點(diǎn)為活動(dòng)、勞動(dòng)時(shí)發(fā)生或加重，休息時(shí)緩解或減輕；仰臥時(shí)加重，坐位時(shí)減輕。2心悸是指病人自覺心跳或心慌并伴心前區(qū)不適感。主要發(fā)病原因包括：心臟搏動(dòng)增強(qiáng)。心律失常。心臟神經(jīng)官能癥。3胸痛循環(huán)系統(tǒng)疾病時(shí)發(fā)生的胸痛常由心肌缺血、缺氧所致，暫時(shí)性的缺血引起心絞痛，典型特點(diǎn)是病人在體力勞動(dòng)、情緒激動(dòng)或飽餐等誘因作用下發(fā)生胸骨后或心前區(qū)疼痛，呈壓榨、緊縮或憋悶感，可向左肩、頸、左上肢放射，疼痛一般持續(xù)數(shù)分鐘，經(jīng)休息或使用硝酸甘油制劑后緩解。4水腫心源性水腫是右心功能不全的主要表現(xiàn)，心源性水腫的特點(diǎn)是首先出現(xiàn)在身體下垂部位。5暈厥是一時(shí)性廣泛腦組織缺血、缺氧引起的短暫、突然的可逆性意識(shí)喪失。導(dǎo)致暈厥發(fā)生的原因很多，除腦血管病變外，各種器質(zhì)性心臟病均可引起暈厥。這類由于心排血量突然下降出現(xiàn)的暈厥稱為阿斯綜合征。二、心功能不全的概念和NYHA心功能不全分級(jí)標(biāo)準(zhǔn)。心功能不全是指在靜脈回流正常的情況下，由于原發(fā)的心臟損害引起心排血量減少，不能滿足組織代謝需要得一種綜合征。臨床上以肺循環(huán)和（或）體循環(huán)淤血以及組織血液灌注不足為主要特征，故亦稱為充血性心力衰竭。NYHA心功能不全分級(jí)標(biāo)準(zhǔn)：級(jí)：體力活動(dòng)不受限。日?；顒?dòng)不出現(xiàn)心悸、呼吸困難、乏力、心絞痛等癥狀。級(jí)：體力活動(dòng)輕度受限。休息時(shí)無(wú)癥狀，一般日?；顒?dòng)即可出現(xiàn)心悸、呼吸困難、乏力、心絞痛等癥狀，休息后很快緩解。級(jí)：體力活動(dòng)明顯受限。休息時(shí)無(wú)癥狀，輕于日常的活動(dòng)即可出現(xiàn)明顯的心悸、氣短、呼吸困難、乏力、心絞痛等，休息較長(zhǎng)時(shí)間后癥狀可緩解。級(jí)：不能從事任何體力活動(dòng)。休息時(shí)即出現(xiàn)心悸、氣短、呼吸困難、心絞痛等癥狀，稍活動(dòng)后癥狀明顯加重。三、洋地黃藥物的適應(yīng)癥及其毒性反應(yīng)。洋地黃適應(yīng)證：適用于中、重度心功能不全患者。對(duì)伴有快速心房纖顫的患者特別有效。不宜應(yīng)用的情況：預(yù)激綜合征伴心房顫動(dòng)；二度或高度房室傳導(dǎo)阻滯；病態(tài)竇房結(jié)綜合征；急性心肌梗死心功能不全，在最初24小時(shí)以內(nèi)者。對(duì)洋地黃中毒及過敏者應(yīng)禁用。洋地黃類藥物的治療量和維持量個(gè)體差異較大，在同一病人的不同病期亦有差別，因此必須隨時(shí)結(jié)合病情變化加以調(diào)整。洋地黃的毒性反應(yīng)：胃腸道反應(yīng)，表現(xiàn)為惡心、嘔吐、食欲不振等；神經(jīng)系統(tǒng)反應(yīng)，為頭痛、頭暈、黃視綠視等；心臟方面反應(yīng)，可表現(xiàn)為引發(fā)的各種心律失常，多見室性期前收縮(甚至二聯(lián)律)、室上性心動(dòng)過速伴房室傳導(dǎo)阻滯、交界區(qū)心律、房室傳導(dǎo)阻滯等。四、心肌梗死主要護(hù)理措施的內(nèi)容。1休息：發(fā)病后1-3天內(nèi)應(yīng)絕對(duì)臥床休息，以減少心肌耗氧量。2止痛：遵醫(yī)囑給予哌替啶或嗎啡止痛，定時(shí)給予硝酸甘油或硝酸異山梨醇酯，給予2-4Lmin持續(xù)氧氣吸人。3保持情緒穩(wěn)定：當(dāng)病人胸痛劇烈時(shí)，應(yīng)盡量保證有一名護(hù)土陪伴在病人身邊。4飲食護(hù)理：最初2-3天以流質(zhì)飲食為主，以后隨病情緩解逐漸過渡至半流食、軟食和普食。5心電監(jiān)護(hù)：在冠心病監(jiān)護(hù)病房行連續(xù)心電圖、血壓、呼吸監(jiān)測(cè)。6排便護(hù)理：囑病人排便時(shí)嚴(yán)禁用力以免增加心臟負(fù)擔(dān)。7溶栓護(hù)理：心肌梗死發(fā)生不足6小時(shí)的病人，可遵醫(yī)囑給予溶栓治療，護(hù)士應(yīng)做好以下工作：詢問病人是否有溶栓禁忌證；準(zhǔn)確、迅速配制并輸注溶栓藥物；注意觀察用藥后有無(wú)寒戰(zhàn)、發(fā)熱、皮疹等過敏反應(yīng)，用藥期間注意觀察病人是否發(fā)生皮膚、粘膜、內(nèi)臟出血；使用溶栓藥物后，定期描記心電圖，抽血查心肌酶，并詢問病人胸痛情況，為溶栓是否成功提供資料。五、高血壓病人對(duì)降壓藥物的選擇。1伴有左心室肥厚者選用ACEI，其次為鈣拮抗劑和受體阻滯劑。2胰島素抵抗者選用ACEI，1受體阻滯劑。3伴有冠心病者選用受體阻滯劑，鈣拮抗劑，ACEI較有效。4腎功能異常者ACEI對(duì)早期糖尿病性腎病伴有高血壓者具有保護(hù)腎功能的作用。內(nèi)科護(hù)理學(xué)重難點(diǎn)分析2責(zé)任教師 甘 強(qiáng)一、呼吸系統(tǒng)疾病常見癥狀。1.咳嗽、咳痰從咽到小支氣管粘膜受到刺激均可引起咳嗽。判斷咳嗽的性質(zhì)，咳嗽、咳痰與時(shí)間、體位的關(guān)系，咳嗽的音色、痰的性狀和痰量、咳嗽的伴隨癥狀對(duì)疾病的診斷很重要。2.咯血咯血量的多少與受損血管的性質(zhì)及數(shù)量有直接關(guān)系，而與疾病嚴(yán)重程度不完全相關(guān)。根據(jù)咯血量不同分為小量咯血(每次少于100ml)、中等量咯血(每次100300ml)、大量咯血(每次300ml以上)?？┭牟l(fā)癥有窒息、休克、肺不張、肺部感染等。窒息和休克是咯血直接致死的主要原因，應(yīng)及時(shí)識(shí)別與搶救。3.呼吸困難常見病因及臨床表現(xiàn)：1)肺原性呼吸困難：是臨床最常見的呼吸困難。根據(jù)其特點(diǎn)分為吸氣性呼吸困難；呼氣性呼吸困難混合性呼吸困難2)心源性呼吸困難：左心功能不全時(shí)呼吸困難主要由肺循環(huán)瘀血引起；右心功能不全時(shí)呼吸困難主要由體循環(huán)瘀血引起。3)中毒性呼吸困難：由酸中毒、毒血癥和藥物中毒等引起。4)血源性呼吸困難：由于紅細(xì)胞攜氧能力降低或變性所致。二、敘述肺結(jié)核臨床類型有哪些？1原發(fā)型肺結(jié)核：包括原發(fā)綜合征及胸內(nèi)淋巴結(jié)結(jié)核。2血行播散型肺結(jié)核：包括急性、(急性粟粒型肺結(jié)核)亞急性、慢性血行播散型肺結(jié)。3繼發(fā)型肺結(jié)核1）浸潤(rùn)性肺結(jié)核：此型為肺結(jié)核中最常見的一種類型，多見于成年人。早期及病灶較小者，常無(wú)明顯癥狀及體征。胸部X線片：顯示在肺尖和鎖骨上下有片狀、絮狀陰影，邊緣模糊，可融合形成空洞。2）空洞性肺結(jié)核：本型臨床癥狀較多，常有發(fā)熱、咳嗽、咳痰、反復(fù)咯血等，痰結(jié)核菌陽(yáng)性。3）結(jié)核球：結(jié)核球直徑多在24cm間。4）干酪性肺炎：當(dāng)人體處于免疫力明顯低下，且有大量結(jié)核桿菌感染時(shí)，病灶呈干酪樣壞死、液化，進(jìn)而形成空洞及支氣管播散。病人出現(xiàn)明顯結(jié)核中毒癥狀，痰結(jié)核菌陽(yáng)性。5）纖維空洞性肺結(jié)核：臨床表現(xiàn)病程遷延，常有咳嗽、咳痰、反復(fù)咯血等，肺功能嚴(yán)重受損。病人痰中帶有結(jié)核桿菌且常耐藥，成為結(jié)核病的重要傳染源。4結(jié)核性胸膜炎：包括結(jié)核性干性胸膜炎、結(jié)核性滲出性胸膜炎、結(jié)核性膿胸。三、自發(fā)性氣胸臨床類型。根據(jù)胸膜裂口的情況及胸腔壓力的不同，可分為三種臨床類型：1閉合性(單純性)氣胸胸膜破裂口較小，隨肺萎陷而關(guān)閉，空氣不再繼續(xù)進(jìn)入胸膜腔，故胸膜腔積氣量較少，胸內(nèi)壓接近或稍超過大氣壓。2交通性(開放性)氣胸胸膜破裂口較大或因兩層胸膜間有粘連和牽拉而不能關(guān)閉，隨吸氣和呼氣活動(dòng)氣體自由進(jìn)出胸膜腔，使胸腔內(nèi)壓接近大氣壓。3張力性(高壓性)氣胸胸膜破裂口呈單向活瓣或活塞作用，吸氣時(shí)活瓣開放，氣體進(jìn)入胸膜腔，呼氣時(shí)活瓣關(guān)閉。這樣每次呼吸運(yùn)動(dòng)均有空氣進(jìn)入胸膜腔而不能排出，故而使胸腔內(nèi)氣體愈積愈多，胸膜腔內(nèi)壓力迅速升高為較高正壓，形成高壓性氣胸。抽氣后胸膜腔內(nèi)壓可下降，但不久又迅速?gòu)?fù)升。胸膜腔內(nèi)高壓可使肺臟受壓，并使縱膈向健側(cè)移位，靜脈回心血流受阻，造成呼吸、循環(huán)功能障礙，甚至危及生命，故需緊急治療。四、簡(jiǎn)述呼吸衰竭按動(dòng)脈血?dú)夥治龇诸悺?.型呼吸衰竭 即缺氧性呼吸衰竭，血?dú)夥治鎏攸c(diǎn)是PaO2<60mmHg，PaCO2降低或正常。主要見于肺換氣障礙（通氣血流比例失調(diào)、彌散功能損害和肺動(dòng)靜脈分流）疾病。2.型呼吸衰竭 即高碳酸血癥性呼吸衰竭，血?dú)夥治鎏攸c(diǎn)是PaO2<60mmHg，同時(shí)伴有PaCO2>50mmHg，系肺泡通氣不足所致，單純通氣不足低氧血癥和高碳酸血癥的程度是平行的，若伴有換氣功能障礙則低氧血癥更為嚴(yán)重，如COPD。內(nèi)科護(hù)理學(xué)重難點(diǎn)分析（3）責(zé)任教師 甘 強(qiáng)一、敘述門靜脈高壓癥的表現(xiàn)。脾腫大、側(cè)枝循環(huán)的建立和開放、腹水是門靜脈高壓的三大表現(xiàn)，其中側(cè)支循環(huán)開放對(duì)診斷門靜脈高壓有重要意義。(1)脾腫大：晚期脾臟大常伴脾功能亢進(jìn)，即表現(xiàn)白細(xì)胞、血小板和紅細(xì)胞計(jì)數(shù)減少。(2)側(cè)枝循環(huán)的建立和開放：在正常情況下，門靜脈收集腹腔臟器的靜脈血，入肝后經(jīng)肝靜脈出肝臟，注入下腔靜脈回右心房，當(dāng)門靜脈壓力增高時(shí)，腹腔臟器回心血流經(jīng)肝受阻，導(dǎo)致門靜脈系統(tǒng)與腔靜脈之間建立側(cè)枝循環(huán)。臨床上重要的側(cè)枝循環(huán)包括：食管和胃底靜脈曲張，常因門靜脈壓力明顯增高、粗糙堅(jiān)硬食品機(jī)械損傷或劇烈咳嗽、嘔吐致腹內(nèi)壓突然增高可引起曲張靜脈破裂；腹壁和臍周靜脈曲張；痔靜脈擴(kuò)張，破裂時(shí)引起便血。(3)腹水：75以上失代償期患者有腹水，且是肝硬化最突出的臨床表現(xiàn)。腹水形成后病人常有明顯腹脹感，尤其飯后更著，大量腹水使橫膈抬高可出現(xiàn)呼吸困難、臍疝及雙下肢水腫，腹部膨隆呈蛙腹?fàn)?，腹壁皮膚繃緊發(fā)亮，叩診有移動(dòng)性濁音，部分病人出現(xiàn)胸水，多見右側(cè)。二、敘述肝性腦病的主要護(hù)理措施。1病情監(jiān)測(cè)：觀察記錄生命體征、瞳孔變化、出入量，注意意識(shí)障礙及有無(wú)行為異常。2避免誘發(fā)因素：如發(fā)現(xiàn)感染癥狀；避免大量進(jìn)液；避免快速利尿和大量放腹水，缺鉀者補(bǔ)充氯化鉀，堿中毒可用精氨酸溶液靜脈滴注；發(fā)生便秘者，可口服或鼻飼硫酸鎂導(dǎo)瀉，也可用生理鹽水或弱酸溶液洗腸，忌用肥皂水灌腸。3飲食護(hù)理：開始數(shù)日禁食蛋白，每日供給熱量12001600千卡和足量的維生素，脂肪類物質(zhì)可延緩胃的排空，應(yīng)盡量少用?；杳哉呖杀秋暬蜢o脈補(bǔ)充葡萄糖供給熱量。清醒后可逐步增加蛋白質(zhì)飲食，最好給予植物性蛋白如豆制品。顯著腹水者鈉量應(yīng)限制在250mg/d，入液量應(yīng)加以控制，一般為尿量加1000mld。4精神錯(cuò)亂病人的護(hù)理：注意躁動(dòng)病人的保護(hù)；防止抓傷皮膚，經(jīng)常剪指甲；正確對(duì)待病人的失常行為。5昏迷病人的護(hù)理：按昏迷護(hù)理常規(guī)進(jìn)行護(hù)理。6藥物護(hù)理：遵醫(yī)囑迅速給予降氨藥物，并注意觀察藥物的療效及副反應(yīng)。三、什么是血液透析，有哪些適應(yīng)證血液透析是利用半透膜的物理特性使兩種不同濃度及性質(zhì)的溶液發(fā)生物質(zhì)交換，用來取代腎臟排泄廢物的功能，故又稱為人工腎臟。適應(yīng)證：（1）急性腎衰，其指征為：血尿素氮28.6mmol/L、肌酐709mol/L。高血鉀：血清鉀6.0mmol/L。高血容量：血壓增高超過基礎(chǔ)血壓的4kPa（30mmHg）、體重進(jìn)行性增長(zhǎng)超過23kg、有急性左心衰、肺水腫的先兆。嚴(yán)重酸中毒：HCO315mmol/L。少尿超過4天或無(wú)尿超過2天。（2）慢性腎衰至尿毒癥晚期，應(yīng)定期施行透析治療。（3）急性藥物或毒物中毒 當(dāng)發(fā)生巴比妥、苯巴比妥等藥物中毒時(shí)，可以利用血液透析除去血液中藥物。血透清除毒物如甲醇、乙醇、砷、汞等。四、泌尿系統(tǒng)常見癥狀1腎性水腫：是由腎臟疾病引起的水腫，基本上分為腎病性水腫及腎炎性水腫兩大類。腎性水腫是腎臟疾病最常見的癥狀，常見于急、慢性腎炎和腎病綜合征。腎性水腫先發(fā)生在組織疏松部位，如眼瞼及面部，晨起時(shí)尤為明顯，能起床活動(dòng)者下午以雙下肢水腫明顯，嚴(yán)重者可延及全身，甚至胸、腹腔積液，腎性水腫多伴有血壓增高、蛋白尿及血尿等改變。2腎性高血壓：指腎臟病變引起的血壓高，且高血壓嚴(yán)重程度與腎臟疾病嚴(yán)重程度及其預(yù)后密切相關(guān)。臨床表現(xiàn)：具有高血壓病一般癥狀，頭痛、頭暈、耳鳴、失眠等，腎性高血壓也可累及臟器，如心臟擴(kuò)大、心力衰竭或發(fā)生高血壓腦病等。各種類型腎小球病變均可產(chǎn)生高血壓，并常在疾病過程中逐漸加重，高血壓發(fā)生或加重多是導(dǎo)致腎功能損害的重要因素。3尿量異常：正常成人24小時(shí)尿量為10002000ml，每日尿量少于400ml為少尿，若少于100m1為無(wú)尿，少尿、無(wú)尿多見于急、慢性腎衰及血容量不足而導(dǎo)致腎小球?yàn)V過率下降。每日尿量2500ml稱為多尿，常由腎小管濃縮功能受損所致，見于慢性腎炎、糖尿病腎病及急性腎衰多尿期。夜尿量超過白天尿量或夜尿持續(xù)750ml，稱為夜尿多，常是腎濃縮功能減退的早期表現(xiàn)。4蛋白尿：每日尿蛋白量持續(xù)超過150ml稱為蛋白尿。蛋白尿定性均為陽(yáng)性，而24小時(shí)蛋白定量更可靠。蛋白尿常見于各種腎小球疾病。若蛋白尿發(fā)生由于體位、運(yùn)動(dòng)、發(fā)熱、寒冷等引起稱為生理性蛋白尿，表現(xiàn)蛋白尿較輕，一般24小時(shí)尿蛋白定量不超過1g，持續(xù)時(shí)間較短，誘因去除后蛋白尿在短期內(nèi)消失。5血尿：新鮮尿離心沉渣后每高倍鏡視野紅細(xì)胞3個(gè)，或1小時(shí)尿紅細(xì)胞計(jì)數(shù)10萬(wàn)，或12小時(shí)計(jì)數(shù)50萬(wàn)，均可診斷為鏡下血尿。尿外觀為洗肉水樣、血樣或有血凝塊時(shí)，稱為肉眼血尿。血尿發(fā)生原因多為腎小球腎炎、腎盂腎炎、結(jié)石、腫瘤等。6尿路刺激征：尿意頻繁而尿量不多為尿頻；一有尿意急不可待要排尿?yàn)槟蚣?；排尿時(shí)會(huì)陰、下腹、尿道感到攣縮樣疼痛或燒灼感稱尿痛。尿頻伴尿急、尿痛稱為尿路刺激征。常為膀胱三角區(qū)及膀胱頸受刺激所致，為尿路感染的常見癥狀。7腎區(qū)疼痛及腎絞痛：急、慢性腎臟疾病，常表現(xiàn)單側(cè)或雙側(cè)腎區(qū)，持續(xù)或間歇性隱痛或鈍痛，多由于腎包膜牽拉所致。輸尿管結(jié)石可表現(xiàn)病側(cè)發(fā)作性絞痛，并向下腹、會(huì)陰、大腿內(nèi)側(cè)放射，多伴血尿，疼痛劇烈時(shí)可有惡心、嘔吐、大汗淋漓、面色蒼白，甚至引起休克。內(nèi)科護(hù)理學(xué)重難點(diǎn)分析（4）責(zé)任教師 甘 強(qiáng)一、特發(fā)性血小板減少性紫癜主要護(hù)理措施。1病情觀察：注意觀察皮膚粘膜出血部位、范圍，內(nèi)臟出血量及出血是否停止，血小板計(jì)數(shù)20109/L應(yīng)警惕腦出血。2休息與活動(dòng)：根據(jù)血小板計(jì)數(shù)。3飲食：根據(jù)病情可選用流食、半流食或普食，富含高蛋白、高維生素、少渣飲食。4癥狀護(hù)理：針對(duì)不同部位的出血采取相應(yīng)措施。5預(yù)防腦出血：血小板小于20109/L時(shí)則有腦出血危險(xiǎn)，注意觀察有無(wú)腦出血先兆癥狀。6藥物護(hù)理：患者服用大劑量糖皮質(zhì)激素56周左右易出現(xiàn)庫(kù)欣綜合征、高血壓、感染、血糖增高等，用藥期間向病人及家屬解釋藥物副作用。7對(duì)多次復(fù)發(fā)者的指導(dǎo)：向病人及家屬說明本病為慢性病，易反復(fù)發(fā)病。二、急性白血病臨床表現(xiàn)。多數(shù)起病急驟，主要表現(xiàn)為發(fā)熱、出血、貧血及各種器官和組織浸潤(rùn)所引起的癥狀和體征。1、發(fā)熱：發(fā)熱為半數(shù)患者早期常見癥狀，可高熱也可低熱。2、出血：多數(shù)病人有不同程度的出血表現(xiàn)，出血部位可遍及全身，尤其急性早幼粒白血病易合并DIC，出血可更嚴(yán)重。常見皮膚瘀點(diǎn)、瘀斑、鼻衄、齒齦出血、口腔血腫。眼底出血可致視力障礙，顱內(nèi)出血最為嚴(yán)重，常表現(xiàn)劇烈頭痛、嘔吐等，出血最主要原因是正常血小板減少。3、貧血：部分病人早期可無(wú)貧血，隨病情發(fā)展而加重。4、白血病細(xì)胞浸潤(rùn)器官和組織的表現(xiàn)1）骨骼和關(guān)節(jié)：常有胸骨下段局部壓痛，提示骨髓腔內(nèi)白血病細(xì)胞過度增生。四肢骨骼、關(guān)節(jié)可有疼痛，常以兒童多見。2）肝、脾及淋巴結(jié)腫大：一般肝、脾輕度至中度腫大。淋巴結(jié)腫大以急淋白血病較多見。3）中樞神經(jīng)系統(tǒng)白血病：中樞神經(jīng)系統(tǒng)被白血病細(xì)胞浸潤(rùn)時(shí)，多發(fā)生在緩解期，輕者表現(xiàn)頭痛、頭暈，重者表現(xiàn)為頭痛、嘔吐、頸強(qiáng)直，甚至抽搐、昏迷，但不發(fā)熱，腦脊液壓力增高。4）其他部位：牙齦可增生、腫脹；眼部常見白血病細(xì)胞浸潤(rùn)眼眶骨膜，可引起眼球突出、復(fù)視或失明。三、慢性并發(fā)癥是糖尿病的主要危害，也是造成病人生活質(zhì)量下降和死亡的主要原因，常在診斷糖尿病之前已經(jīng)發(fā)生，可單獨(dú)出現(xiàn)也可多種并發(fā)癥同時(shí)并存。1大血管病變：主要表現(xiàn)為大、中動(dòng)脈粥樣硬化，常侵犯主動(dòng)脈、冠狀動(dòng)脈、腦動(dòng)脈、腎動(dòng)脈和四肢動(dòng)脈等，肢體動(dòng)脈硬化以下肢動(dòng)脈常見，表現(xiàn)為下肢疼痛、感覺異常和間歇性跛行，嚴(yán)重供血不足可致肢體壞疽。2微血管病變其損害可遍及全身，其中比較重要的是：（1）糖尿病腎?。撼Ｒ娪诓∈烦^10年的患者，是1型糖尿病患者的主要死因，對(duì)于2型糖尿病患者，其嚴(yán)重性僅次于冠狀動(dòng)脈和腦血管動(dòng)脈粥樣硬化病變。（2）糖尿病性視網(wǎng)膜病變：病程超過10年者，大部分會(huì)合并不同程度的視網(wǎng)膜病變，是病人失明的主要原因之一。（3）糖尿病心肌?。盒呐K微血管病變和心肌代謝紊亂可引起心肌廣泛性壞死稱糖尿病心肌病，可誘發(fā)難治性心力衰竭、心律失常、心源性休克等。3神經(jīng)病變：表現(xiàn)為肢體對(duì)稱性感覺異常，有時(shí)伴痛覺過敏，下肢較上肢嚴(yán)重，晚期可出現(xiàn)運(yùn)動(dòng)神經(jīng)受累。4糖尿病足：WHO將糖尿病足定義為與下肢遠(yuǎn)端神經(jīng)異常和不同程度的周圍血管病變相關(guān)的踝關(guān)節(jié)或踝關(guān)節(jié)以下的足部感染、潰瘍和（或）深層組織破壞。是截肢、致殘的主要原因。四、甲狀腺腫主要護(hù)理措施。1向高危人群及患者講解本病與碘缺乏的關(guān)系，以及食用碘鹽的重要意義，教育其改變爆鹽等不良烹飪習(xí)慣。另外，地方性甲狀腺腫高發(fā)區(qū)人群應(yīng)增加海帶、紫菜等高碘食物的攝入，尤其是孕婦、乳母、兒童等需碘量增加者。2對(duì)服用碘劑治療的患者，應(yīng)囑其每日服碘劑約200g，不可擅自增量，以免誘發(fā)碘甲亢等疾病。3對(duì)甲狀腺腫大明顯者服用干甲狀腺素的注意事項(xiàng)：病人服藥時(shí)，應(yīng)從小劑量開始，緩慢增加劑量。服藥期間若出現(xiàn)心悸、多汗、手震顫、消瘦、神經(jīng)興奮性升高和失眠等表現(xiàn)，應(yīng)及時(shí)就診遵醫(yī)囑減量或停用。另外，應(yīng)避免與苯妥英鈉、阿司匹林、口服降糖藥合用，因其可增加甲狀腺激素的作用及其不良反應(yīng)。請(qǐng)您務(wù)必刪除一下內(nèi)容，O(_)O萬(wàn)分謝謝！2015年中央電大期末復(fù)習(xí)考試小抄大全，電大期末考試必備小抄，電大考試必過小抄Indonesia has emerged as a top vacation destination for Chinese this summer, along with Thailands Phuket island and the Maldives archipelago. Encouraged by growth in Chinese travelers to Indonesia, the government in Jakarta has recently relaxed its visa policy. Since June 10, Chinese tourists can enter Indonesia through nine appointed locations, including the Soekarno Hatta International Airport in Jakarta, the Ngurah Rai International Airport in Bali and the Kuala Namu International Airport in Medan, by just getting their passports stamped on arrival. Officially, it is called the "free-visa" scheme. The new policy also means Chinese tourists can save $35 on visa fees, which will likely make trips to Indonesia more alluring. While such an arrangement allows Chinese visitors to stay up to 30 days for the purpose of traveling, those seeking extensions will need to get paid visas from that countrys missions inBeijing,Shanghai,GuangzhouorHong Kong, according to an official at the Indonesia embassy in Beijing. Santo Darmosumarto, head of the embassys information, social and cultural section, says the new policy is aimed at strengthening people-to-people contacts between the two countries. Dai Yu, marketing director of Ctrip, a major Chinese online travel agency, says: "Weve seen a nearly 50 percent growth over the previous month in the number of Chinese tourists to Bali since the policy was announced." During his trip to China in March, Indonesian President Joko Widodo proposed that his country and China aim to increase two-way visits to a maximum of 10 million people in the next few years. The Indonesian government has set their sights on greeting 2 million Chinese tourists by the end of this year, according to the official. "The Indonesian government hopes that Indonesian nationals would also be given preferential treatment while visiting China," says Darmosumarto. In 2013, the number of Chinese tourists who visited Indonesia stood around 807,000. Last year, it increased to 959,000, he adds. Bali remains the most popular site among Chinese tourists. In February, more than 92,200 Chinese tourists made trips to Bali, ranking first among overseas visitors, the Bali Times reported. Last year, the island witnessed more than 586,000 arrivals from China, an increase of 51 percent over 2013. "Bali isnt just for sightseeing, but also for weddings, honeymoons, golf and many outdoor activities," says Fan Wenqing, a marketing executive at Garuda, Indonesias national airliner. Garuda offers three nonstop flights between Beijing and Bali, and four each week between Beijing and Jakarta. There are daily flights from Guangzhou, inGuangdongprovince, and Shanghai to Jakarta as well. It takes from six to eight hours on a nonstop flight to reach Indonesia from China. Indonesia is home to more than 17,000 islands. Tourists can tour Yogyakarta to see Prambanam and Borobudur, two historical and religious sites, and explore the local handicraft markets. The base of a volcano, Bandung, which is also known as the "Paris of Java", is ideal for adventure-seekers. Many ecotourism destinations, such as Toba Lake in Sumatra, Tanjung Puting National Park in Kalimantan and Bunaken in Manado, are places the embassy official recommends for tourists. Indonesia boasts world-class surfing facilities along the shores of Sumatra down to Nusa Tenggara Islands. Recently, Lombok, a sister island east of Bali has gotten so much attention from Chinese travelers that some travel agencies are offering twin packages for Bali and Lombok. The best time to visit Bali is from May to October, when it doesntrainmuch and the weather is cool. At press time, a weeklong package from Shanghai or Guangzhou to Bali was a little more than 3,000 yuan ($480) on Ctrips website. Chinese tourists have taken a shine to rafting in Ubud, sightseeing in Tanah Lot, and surfing and diving in Nusa Lembongan, says Dai. Civet coffee, essential oil and woodcarvings are among the most popular products for Chinese tourists in Indonesia, she says. Indonesian food is also something that visitors shouldnt miss. Local cuisines feature many spices, including peppers and cloves, and coconut pulp. Fried rice, "dirty duck" and roast suckling pig are recommended. Childrens illustration books first appeared in the 1600s in Europe. Their passage to China, however, took much longer, roughly 300 years. In China, childrens illustration books have a history of just 100 years and their development can be divided into four stages. From early 1900s to mid 1900s, a large number of books and magazines with illustrations appeared with the fast development of the modern publishing industry. The illustrationarts at that time were a mixed genre of Chinese traditionalpaintings and the westernstyle, and most of the stories originate from the fundamental changes that China experienced after the collapse of Qing Dynasty (1644-1911), the warlord struggles and the war against the Japanese invasion. The second stage was from mid 1900s to late 1970s, when the "cultural revolution" (1966-76) ended. The fast development of some special publishing houses for children gave birth to a large number of illustration-story books, which made a good use of folk art techniques, such as wood board carving, frescoes, and ink and wash painting, etc. Many of the popular stories are from Chinese history and wars after 1900s. The third stage is from early 1980s to late 1990s, a golden period for the development of childrens illustration books. The reform and opening-up brought in new concepts and ideas from the West to China, a country that had been closed to the West for nearly three decades. Fast development of economy, society and culture provided the writers and painters with a lot of inspiration to create new literature works and draw illustrations. China also imported large amounts of childrens illustration books from the West and Japan. Many young parents in China have a strong nostalgia about childrens illustration books they read in the 1980s and 1990s. This is also the last era in Chinas artistic innovation before the advent of the Internet period. The fourth stage is featured with the spread of the Internet and the other computerized means of art innovation. The hand-drawn childrens illustration books are gradually replaced by cartoons drawn and copied by software and machines, and shown on tablets, computers, television and smart phones, instead of books. Hainan Tropical Wildlife Park and Botanical Garden is natures haven, with no less than 4,000 rare birds and animals representing 200 species. With tropical forest covering over 90 percent of its area, the garden offers beautiful views of a wide range of tropical plants, flowers and fruit trees. The scenic spot about 25 kilometers from the center of Haikou offers a drive-thru safari tour where you can get up close with elephants, lions and bears. The "Safari on Foot" area features walking trails where visitors can see the rest of the animals, including hippos and monkeys, and feed them for a small fee. Visitors also can see what happens when you breed a lion and a tiger. Two unique attractions are rare hybrids: a liger, the offspring of a mallion and a female tiger and a tigon, which is created by a female lion and a male tiger. As ateaching center of the National Popular Science Education program, the park also serves as a second classroom for students to learn about wildlife and plants. Since it was established in 1995, it has received more than one million student visitors. At a crucial moment when pessimism has brought the Greek crisis to such a head that the country is closer to a default on its debt repayments than ever, Li offered a spark of enthusiasm to restart the stalled talks by calling on Greece and its creditors to reach a last-minute deal that will allow Greece to remain in the eurozone. Given the escalation of the countrys crisis over the weekend sent a shock wave through the global stock markets on Monday, there are ample reasons to worry about the uncertainties surrounding the events in Greece and the effect a default would have on Europe, relations between China and the EU, global financial stability and the nascent global economic recovery. Greece has announced that it will hold a referendum on a bailout plan proposed last week by the countrys creditors. In response, Greeces eurozone partners have refused to extend the countrys bailout program and the European Central Bank capped its emergency support for the countrys banks. A real danger now looms of Greece exiting the euro, which might derail the global economic recovery and damage the long-term viability of the euro as a currency. However, such a tragedy is neither certain nor unavoidable. The EU should shoulder its responsibility to prevent the Greek crisis from overshadowing the fragile global recovery. As a major customer and supplier of the 28-nation EU, and a responsible long-term holder of Eurobonds, Chinas confidence in and commitment to a strong eurozone offers EU leaders the necessary support to look at the Greek crisis from a broader and longer perspective. When Li said that China will not only consider a China-EU investment platform to back European Commission President Jean-Claude Junckers plan to revive the European economy, but also buy more bonds issued by the European Investment Bank, EU leaders should be clear that China wants to see the EU maintain its integrity and a forward trajectory. Such a confidence-building effort is particularly valuable, especially from such a large country as China which already has a huge stake and seeks to further expand it in a strong eurozone. It will be a tragedy to allow inaction over the Greek crisis to stand in the way of growth-boosting Sino-EU cooperation. Like a shining pearl, West Lake is the symbol of Hangzhou city. From ancient times, many poems have praised the amazing scenery of the lake. At the very beginning, the West Lake was a part of the Qiantang River. In the year 822, Bai Juyi, a famous poet and an officer of the Tang Dynasty (AD 618-907), suggested to build a stronger causeway to store water so that the lake was doubled in size. And during the Song Dynasty (AD 960-1279), many temples and pagodas were built due to a Buddhist revival, and the look of West Lake was formed at that time.The West Lake is quite big and features different classic views from different locations. Technically, there are ten scenes which were marked by Emperor Qianlong with four-character inscriptions 200 years ago, such as the Melting Snow on the Broken Bridge and Sunset Glow over Leifeng Pagoda.