To summarize the clinical nursing experience of a patient with thrombotic thrombocytopenic purpura after secondary heart valve replacement. Nursing key points：dynamic monitoring of hemodynamic indexes，the refinement of fluid management；sequential anticoagulant therapy to reduce bleeding risk；closely monitoring blood calcium concentration to avoid citric acid accumulation reaction；strengthening the breathing training and shortening the mechanical ventilation time；early enteral nutrition support to reduce gastrointestinal stress response. After careful treatment and nursing care，the symptoms and signs of patients improved significantly 26 days after surgery. The respiratory support of patients was changed from invasive ventilator assisted ventilation to venturi mask oxygenation，and he was transferred to the general ward for further treatment.

Objective To analyze the prevalence and risk factors of 3 types of skin injuries in the elderly through multicenter cross-sectional survey,so as to provide bases for formulating prevention strategies for skin injuries in the elderly. Methods On March 31,2021,1 067 nurses from 50 hospitals in 16 provinces,2 autonomous regions and 2 municipalities included inpatients over 60 years old and inspected their skin from head to toes to identify pressure injury（PI）,incontinence-associated dermatitis（IAD） and skin tear（ST）,and meanwhile collected demographic,healthcare condition and PI risk assessment data. Statistical software was used for descriptive analysis,Pearson correlation analysis and logistic regression analysis. Results Totally,14 470 cases were obtained. The average age was（73.35±8.90） years old. The total prevalence of skin injuries was 6.69%,and the prevalence of PI,IAD and ST was 3.91%,1.89% and 0.89%,respectively. Logistic regression analysis showed that the risk of PI,inability of self-care,hypoproteinemia and anemia,comorbidity over 2 chronic diseases and ≥70 years old were the independent risk factors of PI in the elderly. The risk of PI,inability of self-care,hypoproteinemia,comorbidity over 2 chronic diseases,length of hospital stay≥8 days and the age of over 80 years were the independent risk factors of IAD in the elderly. The risk of PI and hypoproteinemia were independent risk factors of ST in the elderly. Conclusion Skin injuries of the hospitalized elderly are the result of multiple factors,while PI and IAD are the most typical ones,and the risk factors of different types of skin injuries are also different. When formulating prevention strategies,we should not only pay attention to the independent role of risk factors,but also consider the combined role of risk factors,take comprehensive preventive measures to improve the prevention effect.

Objective To compare the sealing effects of direct and indirect pressure measurement methods on cuffs with taper and columnar shapes. Methods Cuffs were divided into the taper and columnar shapes,both groups were measured using direct and indirect measurement procedures,and the fluid leakage of two groups were observed. The direct measurement method monitored pressure by a directly linked handheld pressure gauge,while the indirect measurement method added a 3-way stopcock between the handheld pressure gauge and the cuff. We locked the 3-stopcock to stabilize handheld pressure gauge reading at 32 cmH₂O before measure the pressure. Results The pressure of the taper shaped cuffs in direct measurement group was（21.73±0.30） cmH₂O while the pressure of column shaped cuffs was（25.01±0.13） cmH₂O,which showed a statistically significant difference （P<0.01）. Fluid on the two types of cuffs all leaked after direct measurement. The pressure of the taper shaped cuffs in indirect measurement group was（31.08±0.31） cmH₂O,and（31.10±0.17） cmH₂O in columnar shape,without significant difference（P>0.05）. Fluid on the taper shaped cuffs didn’t leak after indirect measurement procedures yet the fluid on column shaped cuffs all leaked. Conclusion The direct measurement method can cause pressure decreasing in taper and column shaped cuffs as well as fluid leakage. Indirect measurement method can lose only 1~2 cmH₂O of pressure for taper and column shaped cuffs,and the taper shaped cuffs can seal fluid leak effectively.