응급환자 관리학

제1장ｌ건강과 환경•17
1. 건강과 질병•17
1) 건강과 질병 ·······················································································································17
2) 건강 결정요인 ····················································································································20
3) 건강모형 ·····························································································································21
2. 건강증진•25
1) 건강증진 개념의 대두 ·······································································································25
2) 건강증진의 정의 ················································································································28
3) 건강증진 발전과정 ·············································································································29
4) 건강증진 관련 이론 ···········································································································32
5) 국내 건강증진 활동 ···········································································································38
6) 지역사회 통합건강증진사업 ·······························································································44
3. 보건의료체계•47
1) 보건의료체계의 개념 ·········································································································47
2) 보건의료체계의 구성요소 ··································································································48
4. 인간의 기본 요구•50
1) 인간의 기본 욕구 ··············································································································50
2) 인간의 욕구 단계 ··············································································································50
5. 가족과 지역사회•52
1) 가족 ····································································································································52
2) 지역사회 ·····························································································································54
6. 인간의 이해와 발달 단계•54
1) 인간이해에 대한 관점 ·······································································································54
2) 성장발달의 개념 ················································································································55
3) 성장발달의 특성 ················································································································56

제2장ｌ감염관리•61
1. 감염•62
1) 감염의 개념 및 감염단계 ····································································································62
2) 특수병원체의 종류 ···············································································································63
3) 감염관리 시 응급구조사의 역할 ·························································································65
2. 감염관리•65
1) 감염회로 ·······························································································································65
3. 소독과 멸균•68
4. 격리•75
1) 표준주의지침 ························································································································76
2) 전파경로별 주의 ··················································································································76
5. 무균술•77
1) 내과적 무균술 ······················································································································77
2) 외과적 무균술 ······················································································································93
6. 상처 및 염증•102
1) 상처 ····································································································································102
2) 염증 ····································································································································104
3) 상처치유의 과정 ················································································································105
4) 상처치유에 영향을 미치는 요소 ·······················································································106
5) 상처조직의 관리 ················································································································107

제3장ｌ활력징후 및 기본검사•117
1. 활력징후의 정의 및 해석•117
1) 활력징후의 정의 ···············································································································117
2) 활력징후의 해석 ···············································································································118
2. 혈압•119
1) 혈압의 생리적 기전 ·········································································································119
2) 혈압을 조절하는 요인 ·····································································································120
3) 혈압 변화에 영향을 미치는 요인 ···················································································121
4) 혈압 측정방법의 종류 ·····································································································121
5) 혈압측정 시 발생하는 오류 ····························································································123
6) 비정상적인 혈압 ··············································································································124
3. 맥박•125
1) 맥박의 정의 ·····················································································································125
2) 맥박을 측정하는 목적 ·····································································································125
3) 맥박에 영향을 미치는 요인 ····························································································126
4) 맥박 측정 방법 ················································································································127
4. 호흡•130
1) 호흡의 정의 ·····················································································································130
2) 호흡평가 ···························································································································130
3) 이상호흡 ·························································································································131
4) 호흡에 영향을 미치는 요인 ····························································································131
5) 호흡 측정 방법 ················································································································133
5. 체온•133
1) 체온의 정의 ·····················································································································133
2) 체온 측정치의 전환법 ·····································································································135
3) 체온측정부위 ····················································································································135
4) 체온에 영향을 미치는 요인 ····························································································136
5) 체온계의 종류 ··················································································································136
6) 체온 측정 방법 ················································································································137
6. 기본검사•138
1) 심전도 ······························································································································138
2) 맥박산소 측정기 ··············································································································138
3) 혈당측정기 ·······················································································································139
4) 동맥혈 가스 분석 ··············································································································141
7. 혈액검사•144
1) 기본혈액검사 ······················································································································144
2) 혈액배양검사 ····················································································································148

제4장ｌ호흡관리•153
1. 호흡기계의 해부•153
2. 호흡의 생리•154
1) 환기 ····································································································································154
2) 확산 ····································································································································156
3) 산소와 탄산가스 이동 ·······································································································156
4) 호흡조절 ·····························································································································157
3. 호흡기계 평가•158
1) 일차평가 ·····························································································································158
2) 병력청취 ·····························································································································158
3) 신체검진 ·····························································································································159
4) 호흡기능을 평가하기 위한 일반적 방법 ··········································································161
4. 호흡기능의 장애•163
1) 저산소증 ·····························································································································163
2) 비정상 호흡 ·······················································································································163
5. 일반적인 처치 원칙•166
1) 호흡양상 ·····························································································································166
2) 심호흡과 기침 ····················································································································166
3) 안위증진 ·····························································································································167
4) 약물 ····································································································································171
5) 산소투여 ·····························································································································172
6) 네블라이저 ·························································································································180
7) 가슴관 삽입술 ··················································································································180
8) 기도관리 및 처치 ············································································································181
9) 기계적 인공호흡 ··············································································································187
10) 코(비)인두 및 입(구)인두 흡인방법 ··············································································191
11) 기관절개관 흡인 방법 ···································································································194

제5장ｌ체온유지관리•199
1. 체온조절•199
1) 열 생산 기전 ····················································································································200
2) 열 손실 기전 ····················································································································201
2. 체온조절의 기전생태•202
1) 피부의 작용 ·····················································································································202
2) 땀남(발한) ························································································································203
3) 신경조절 ···························································································································203
3. 체온조절의 장애 요인•203
1) 악성 고열증 ·····················································································································203
2) 신경계 부전 ·····················································································································204
3) 순환계 부전 ·····················································································································204
4) 피부손상 ···························································································································204
5) 내인성 발열물질 ··············································································································204
6) 극한 환경 ·························································································································204
4. 체온의 상승•205
1) 발열 ··································································································································205
5. 열성장애•208
1) 열경련 ······························································································································208
2) 열피로 ······························································································································208
3) 열사병 ······························································································································208
4) 열성장애에 노출될 위험성이 높은 환자 ··········································································209
5) 열과 관련된 질환에 위험성이 높은 환자 교육방침 ························································209
6. 저체온•210
1) 저체온의 종류 ····················································································································210
2) 저체온증의 단계 ················································································································211
3) 저체온 환자에 대한 평가와 중재 ·····················································································211
4) 저체온증에 노출되는 잠재적 위험성이 높은 환자의 예방교육 ·······································211
7. 동상•212
8. 열 적용과 냉 적용•213
1) 열 적용과 냉 적용의 생리적 효과 ···················································································213
2) 열 적용과 냉 적용 시의 주의점 ·······················································································213
3) 열 요법의 국소적 이용 ·····································································································214
4) 냉 요법의 국소적 이용 ·····································································································217
5) 저체온 요법의 적용방법 ····································································································220
9. 체온유지관리 실습•221
1) 열 요법 ······························································································································221
2) 냉 요법 ······························································································································225

제6장ｌ활동과 안위 관리•229
1. 운동•229
1) 운동 개념 ···························································································································229
2) 신체역학 ·····························································································································230
3) 운동의 종류 ·······················································································································232
4) 관절 운동 ···························································································································233
5) 장기간 부동이 신체에 미치는 영향 ··················································································239
6) 보행 보조도구 사용법 ·······································································································243
7) 억제대 ································································································································245
8) 환자 옮기기 ·····················································································································249
2. 자세•250
1) 자세법의 기본 지침 ·········································································································251
2) 자세의 종류 ·····················································································································251
3. 수면•256
1) 수면의 생리 ·····················································································································257
2) 수면의 특징 ·····················································································································258
3) 수면의 단계별 특징 ·········································································································259
4) 수면에 영향을 미치는 요인 ····························································································260
5) 수면장애 ···························································································································263
6) 편안한 수면을 돕는 방법 ································································································266
4. 통증•267
1) 통증의 정의 ·····················································································································267
2) 통증의 유형 ·····················································································································268
3) 통증 기전 ·························································································································269
4) 통증 반응 ·························································································································270
5) 통증에 영향을 미치는 요인 ····························································································271
6) 통증 관리 ·························································································································272

제7장ｌ수분과 전해질 관리•279
1. 수분과 전해질의 분포 및 조성•279
1) 수분의 분포 및 조성 ·······································································································279
2. 수분의 조절•283
3. 산-알칼리 균형•285
1) 산-알칼리 균형 조절 기전 ·····························································································285
2) 산-알칼리 불균형 ············································································································285
4. 수분과 전해질 불균형의 원인•287
1) 출혈, 화상, 외상 ···············································································································287
2) 과도한 땀남(발한)과 증발 ·································································································287
3) 불충분한 섭취 ····················································································································287
4) 소화기계 장애 ····················································································································287
5) 콩팥(신장)기능의 장애 ······································································································288
5. 수분과 전해질 불균형의 관리•288
1) 환자 평가 ···························································································································288
2) 섭취량과 배설량 측정 ·······································································································290
3) 위관을 통한 영양관리 ·······································································································291
4) 관리 ····································································································································294
5) 정맥요법 ·····························································································································295

제8장ｌ배설관리•299
1. 배뇨•299
1) 비뇨기계의 해부·생리 ·······································································································299
2) 배뇨장애 ·····························································································································301
3) 진단적 검사 ·······················································································································303
4) 자연배뇨를 돕는 방법 ·······································································································305
5) 배뇨관련 평가 ····················································································································305
6) 도뇨방법 ·····························································································································306
7) 배뇨문제를 가진 환자 관리 ······························································································319
2. 배변•321
1) 소화기계의 해부·생리 ·······································································································321
2) 배변장애 ·····························································································································323
3) 진단적 검사 ·······················································································································325
4) 평가 ····································································································································326
5) 배변을 돕는 방법 ············································································································326
6) 관장 ··································································································································327
7) 인공항문 ···························································································································330

제9장ｌ투약관리•335
1. 투약의 원리•336
1) 투약의 원리 ·····················································································································336
2) 약물의 형태 ·····················································································································340
3) 약물의 작용 ·····················································································································341
4) 약물작용에 영향을 미치는 요인 ·····················································································344
5) 약물오용과 남용 ··············································································································345
6) 약용량 측정법 ··················································································································346
7) 약물용량의 계산 ··············································································································348
2. 경구 투약•350
1) 경구 투약의 장·단점 ······································································································350
2) 경구 투약 시 유의사항 ···································································································351
3. 비경구 투약•351
1) 비경구 투약 ·····················································································································351
2) 비경구 투약의 장·단점 ···································································································352
3) 주사방법과 사용부위 ·······································································································352
4) 비경구 투약을 안전하게 하기 위한 방법 ·······································································353
5) 주사기와 바늘 ··················································································································355
6) 주사약 준비 ·····················································································································357
7) 주사 방법 ·························································································································359
4. 수혈•391
1) 수혈의 목적 ·····················································································································391
2) 수혈의 종류 ·····················································································································392
3) 수혈 방법 ·························································································································393
4) 수혈 시 부작용 및 합병증 ································································································394
5. 국소적 약물투여•395
1) 피부약 ································································································································395
2) 눈 세척과 약 넣는 법 ·······································································································396
3) 귀 세척과 약 넣는 법 ·······································································································397
4) 코에 약 넣는 법 ················································································································398
5) 질 세척과 약 넣는 법 ·······································································································399
6) 곧창자(직장)에 약 넣는 법 ·······························································································401

제10장ｌ응급수술 관리•403
1. 수술 유형•403
1) 목적에 따른 유형 ··············································································································403
2) 긴급성에 따른 유형 ···········································································································404
3) 위험 정도에 따른 유형 ·····································································································404
2. 수술 대상자에게 위험을 유발할 수 있는 영향 요인•404
1) 연령 ····································································································································404
2) 일반적 건강상태 ················································································································405
3) 영양상태 ·····························································································································405
4) 투약 ····································································································································405
5) 정신건강상태 ······················································································································405
3. 수술 전 준비•406
1) 대상자 준비 ·······················································································································406
2) 수술실 준비 ·······················································································································408
4. 수술 중 관리•409
1) 마취의 유형 ·······················································································································410
2) 기본 수술기구와 봉합 재료 ······························································································411
3) 상처봉합(꿰맴) 술기 ··········································································································419
5. 수술 후 관리•426
1) 수술 후 호흡기계 관리 ···································································································426
2) 수술 후 순환기계 관리 ···································································································426
3) 수술 후 통증관리 ············································································································427
4) 수술 후 상처관리 ············································································································427
5) 상처소독과 드레싱 ···········································································································428
6) 봉합사 제거 ·····················································································································430
7) 상처배액과 흡인 ··············································································································430
8) 자세와 운동 ·····················································································································433
9) 수분공급과 식이 ··············································································································433
10) 배설 관리 ·······················································································································434

제11장ｌ임종관리•435
1. 죽음에 대한 개념•435
1) 개념 ··································································································································435
2) 사망의 과정 ·····················································································································436
3) 임종 환자의 관리요구 ·····································································································439
4) 임종 중 관리 ····················································································································442
2. 사망 후 관리•442
1) 사망 후 임상적 징후 ·······································································································442
2) 사망과 동시에 진행되는 변화에 의한 추정 ···································································443
3) 사후관리 ···························································································································444
3. 임종과 죽음에 대한 보건의료인의 반응•446
4. 예기치 않은 죽음을 당한 유족을 위한 중재•447
1) 급작스런 죽음이 발생했을 때 ·························································································448
2) 가정으로 돌아가기 ···········································································································449
3) 자연유산이나 조산에 직면한 가족을 돕는 방법 ····························································449
5. 호스피스의 개념과 목적•450
1) 호스피스의 개념 ················································································································450
2) 호스피스의 목적 ················································································································450
3) 호스피스의 형태 ················································································································450
4) 호스피스 대상자 선정 ·······································································································452
5) 호스피스 관리의 주요 원칙 ······························································································452
6. 사전돌봄계획과 연명의료•453
1) 사전돌봄계획의 개념 ·········································································································453
2) 연명의료의 개념 ················································································································454
3) 연명의료의 유보·중지 ·······································································································455
4) 연명의료결정 관련 사례 ····································································································457

제12장ｌ기록•461
1. 응급환자 기록의 정의 및 용도•461
2. 병원 전 처치 기록지 작성법•463
1) 기록지 유형 ·······················································································································464
2) 요청 및 출동에 관한 사항의 기록 ···················································································465
3) 환자정보의 기록 ················································································································465
4) 응급구조사의 추정진단 ·····································································································466
5) 응급처치 내용 ····················································································································466
6) 확인 ····································································································································466
7) 특히 유의해야 할 병원전 기록사항 ··················································································467
8) 병원전 기록에 대한 결론 ··································································································470
3. 구급활동일지•471
4. 응급실 기록지•474
5. 병원 EMR•475
6. 기타 병원 기록지•489
참고문헌 ······························································································································· 499
찾아보기 ······························································································································· 501