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[]
[]
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["退院時（急性期病院）の医学情報"]
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[null,null,null,null,null,"　",null,null,null,"　"]
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[]
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["緊急連絡先"]
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[null,"あなたとの関係",null,null,{"$f":"P1名前・連絡先!C10&\"\"","v":""}]
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[null,"あなたとの関係",null,null,{"$f":"P1名前・連絡先!C15&\"\"","v":""}]
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[null,"住所",null,null,{"$f":"P1名前・連絡先!C16&\"\"","v":""}]
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[null,"電話番号",null,null,{"$f":"P1名前・連絡先!C17&\"\"","v":""}]
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[null,"※必ず連絡が取れるところをご記入ください"]
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[null,"回復期病院",null,null,{"$f":"'P2.地域連携'!E6&\"\"","v":""}]
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[null,"療養期病院",null,null,{"$f":"'P2.地域連携'!E10&\"\"","v":""}]
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[]
[null,"ケアマネージャー\n地域包括支援センター",null,null,{"$f":"'P2~3.SW・退院支援'!E22&\"\"","v":""}]
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[null,"社会福祉施設",null,null,{"$f":"'P2~3.SW・退院支援'!E27&\"\"","v":""}]
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[]
[null,"かかりつけ歯科",null,null,{"$f":"'P2.歯科'!E31&\"\"","v":""}]
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[null,"その他",null,null,{"$f":"'P2~3.SW・退院支援'!E35&\"\"","v":""}]
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[]
[null,null,null,null,null,null,null,"石川県心不全地域連携パス・手帳",null,null,null,null,"P2"]
["退院時（急性期病院）の医学情報"]
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["身長・体重",null,null,"身長",{"$f":"'P3.看護師'!E3&\"\"","v":""},"cm","入院時体重",null,{"$f":"'P3.看護師'!I3&\"\"","v":""},"kg","(BMI",{"$f":"'P3.看護師'!L3","v":{"$error":"#DIV/0!"}},"）"]
[null,null,null,null,null,null,"退院時体重",null,{"$f":"'P3.看護師'!I4&\"\"","v":""},"kg","(BMI",{"$f":"'P3.看護師'!L4","v":{"$error":"#DIV/0!"}},"）"]
["診断\n心不全の基礎疾患",null,null,null,null,{"$f":"'P3.医師'!F5&\"\"","v":"　"},null,null,null,{"$f":"'P3.医師'!J5&\"\"","v":"　"},null,null,null,null,false]
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[null,null,null,null,null,{"$f":"'P3.医師'!F9&\"\"","v":"　"},null,null,null,{"$f":"'P3.医師'!J9&\"\"","v":"　"},null,null,null,null,false]
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["植え込みデバイス",null,null,null,null,null,null,null,null,null,null,null,null,null,false,false,false,false,false,false,false]
[null,null,null,"メーカー(",null,{"$f":"'P3.医師'!F19&\"\"","v":"　"},null,null,null,null,null,null,"）"]
[null,null,null,"　設定   (",null,{"$f":"'P3.医師'!F20&\"\"","v":""},null,null,null,null,null,null,"）"]
["心臓病手術の既往",null,null,null,null,null,null,null,null,null,null,null,null,null,false,false,false]
[null,null,null,null,null,null,null,"（",{"$f":"'P3.医師'!I22&\"\"","v":""},null,null,null,"）",null,false,false]
[null,null,null,null,"（",{"$f":"'P3.医師'!F23&\"\"","v":"　"},null,null,"）（",{"$f":"'P3.医師'!J23&\"\"","v":"　"},null,null,"）",null,false]
[null,null,null,null,"（",{"$f":"'P3.医師'!F24&\"\"","v":"　"},null,null,"）（",{"$f":"'P3.医師'!J24&\"\"","v":""},null,null,"）"]
[null,null,null,null,null,"（",{"$f":"'P3.医師'!G25&\"\"","v":"　"},null,null,null,null,null,"）",null,false]
["在宅酸素治療など",null,null,null,null,"安静時（",null,{"$f":"'P3.医師'!H26&\"\"","v":""},")L　労作時（",null,{"$f":"'P3.医師'!K26&\"\"","v":""},")L",null,null,false,false]
[null,null,null,null,null,null,null,"（",{"$f":"'P3.医師'!I27&\"\"","v":""},null,null,null,"）",null,false,false]
["障害者手帳",null,null,null,null,"｛",null,null,null,null,"（",{"$f":"'P2~3.SW・退院支援'!L67&\"\"","v":""},")級｝",null,false,false,false,false,false,false]
["介護認定",null,null,null,null,"（",{"$f":"'P2~3.SW・退院支援'!G68&\"\"","v":"　"},"）",null,"（",{"$f":"'P2~3.SW・退院支援'!K68&\"\"","v":"　"},"）",null,null,false,false,false]
["アレルギーの既往",null,null,null,null,"(",{"$f":"'P3.看護師'!G30&\"\"","v":""},null,null,null,null,null,")",null,false,false]
["フレイル",null,null,null,null,null,{"$f":"'P3.PT・OT'!G31&\"\"","v":""},"点",null,null,null,null,null,null,false]
[null,null,null,null,{"$f":"'P3.PT・OT'!E32&\"\"","v":""},"点（","バランス",{"$f":"'P3.PT・OT'!H32&\"\"","v":""},"歩行",{"$f":"'P3.PT・OT'!J32&\"\"","v":""},"立ち上がり",{"$f":"'P3.PT・OT'!L32&\"\"","v":""},"）",null,false]
[]
["その他",null,null,null,null,"（","心拍数",{"$f":"'P3.PT・OT'!H34&\"\"","v":""},"bpm",{"$f":"'P3.PT・OT'!J34&\"\"","v":""},"W",{"$f":"'P3.PT・OT'!L34&\"\"","v":""},"Mets）",null,false]
[null,null,null,null,{"$f":"'P3.PT・OT'!E35&\"\"","v":""},"kg",null,{"$f":"'P3.PT・OT'!H35&\"\"","v":""},"m",null,null,{"$f":"'P3.栄養士'!L35&\"\"","v":""},"kg/m2",null,false,false,false]
[null,null,null,null,null,"（",null,"and",null,"or","/and",null,"）",null,false,false,false,false]
[null,null,null,null,null,null,{"$f":"'P3.PT・OT'!G37&\"\"","v":""},"点",null,null,null,null,null,null,false]
[]
[]
[null,null,null,null,null,null,null,"石川県心不全地域連携パス・手帳",null,null,null,null,"P3"]

{"sheet":"P4退院時(回復期療養期)の医学情報 ","index":10,"n_rows":33,"n_cols":13,"rows_kept":33,"cut":false,"hidden":false,"merged":[[9,1,9,4],[9,5,9,7],[9,8,9,11],[0,0,0,12],[1,5,1,6],[3,2,3,3],[3,5,3,6],[3,7,3,8],[3,10,3,11],[5,1,5,11],[6,0,7,0],[6,1,6,8],[8,1,8,2],[8,4,8,11],[23,0,25,0],[24,3,24,4],[27,5,27,10],[30,5,30,10],[10,0,13,0],[12,4,12,5],[13,3,13,10],[15,0,17,0],[17,2,17,4],[18,0,21,0],[20,4,20,8],[20,10,20,11],[21,4,21,8]]}
["退院時（回復期・療養医療施設）の医学情報"]
[null,null,null,null,null,"記載日：",null,null,"年",null,"月",null,"日"]
[]
["身長・体重","身長",null,null,"cm","退院時体重",null,null,null,"kg"]
[]
["診断\n心不全の基礎疾患"]
["心機能\n*EF:左室駆出率",null,null,null,null,null,null,null,null,"EF(",null,")%"]
[null,"(EF<40%)",null,null,"(40%≦EF<50％)",null,null,"  (EF≧50％)"]
["心胸郭比(CTR)",null,null,"％"]
["退院時NYHA",null,null,null,null,"心不全ステージ"]
["合併症"]
[]
[null,null,null,"(Cr",null,null,"mg/dl)"]
[null,null,"(",null,null,null,null,null,null,null,null,")"]
[]
["植え込みデバイス"]
[]
[null,"設定(",null,null,null,")  ","(",null,")回/分"]
["心臓病手術の既往"]
[]
[null,null,null,"(",null,null,null,null,null,")","生体弁"]
[null,null,null,"(",null,null,null,null,null,")"]
[]
["在宅酸素治療など"]
[null,null,null,"安静時（",null,null,")L,","労作時(",null,")L"]
[]
[]
["障害者手帳",null,null,null,"(",null,null,null,null,null,null,")"]
["介護認定",null,null,null,"(",null,")",null,"(",null,")"]
[]
["アレルギーの既往",null,null,null,"(",null,null,null,null,null,null,")"]
[]
["フレイル",null,"(",null,")点",null,null,"(",null,")点"]

{"sheet":"P5~6石川県心不全地域連携診療計画書","index":11,"n_rows":31,"n_cols":35,"rows_kept":31,"cut":false,"hidden":false,"merged":[[28,30,33,39],[6,28,6,32],[7,34,7,39],[8,30,8,39],[9,30,9,39],[15,28,17,29],[18,28,22,29],[25,28,26,29],[27,28,27,29],[23,28,24,29],[9,28,9,29],[5,28,5,39],[6,34,6,39],[8,28,8,29],[23,14,24,15],[25,14,27,15],[9,14,9,15],[13,14,14,15],[13,16,13,25],[14,16,14,25],[11,14,11,26],[12,14,12,26],[5,14,5,26],[6,14,6,19],[6,20,6,25],[8,14,8,15],[28,14,31,15],[15,16,19,18],[15,14,19,15],[20,14,22,15],[20,16,20,26],[8,0,8,1],[9,0,9,1],[8,2,8,12],[9,2,9,12],[8,16,8,21],[9,16,9,21],[8,22,8,26],[9,22,9,26],[2,2,2,7],[2,8,2,9],[2,0,2,1],[3,0,3,1],[6,0,6,5],[6,6,6,11],[5,0,5,12],[10,6,10,11],[11,6,11,11],[10,2,10,5],[11,2,11,5],[10,0,11,1],[12,6,12,11],[16,2,16,12],[12,0,15,1],[12,2,13,5],[16,0,18,1],[19,0,22,1],[23,0,24,1],[25,0,29,1],[25,2,29,5],[30,0,33,1]]}
["石川県心不全地域連携診療計画書"]
[]
["患者氏名",null,{"$f":"P1名前・連絡先!C2&\"\"","v":""},null,null,null,null,null,{"$f":"P1名前・連絡先!E3","v":"男性"}]
["生年月日",null,{"$f":"P1名前・連絡先!C4&\"\"","v":""},"年",{"$f":"P1名前・連絡先!E4&\"\"","v":""},"月",{"$f":"P1名前・連絡先!G4&\"\"","v":""},"日",{"$f":"P1名前・連絡先!C3&\"\"","v":{"$error":"#NUM!"}},"歳"]
[]
["急性期医療機関",null,null,null,null,null,null,null,null,null,null,null,null,null,"回復期・療養期医療機関",null,null,null,null,null,null,null,null,null,null,null,null,null,"生活期医療機関"]
["入院日",null,null,null,null,null,"地域連携計画説明日",null,null,null,null,null,"説明者サイン",null,"転院日",null,null,null,null,null,"地域連携計画説明日",null,null,null,null,null,"説明者サイン",null,"地域連携計画説明日",null,null,null,null,null,"説明者サイン"]
[null,"年",null,"月",null,"日",null,"年",null,"月",null,"日",null,null,null,"年",null,"月",null,"日",null,"年",null,"月",null,"日",null,null,null,"年",null,"月",null,"日"]
["施設名：",null,{"$f":"'P2.地域連携'!E2&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,"施設名：",null,{"$f":"'P2.地域連携'!E6&\"\"","v":""},null,null,null,null,null,{"$f":"'P2.地域連携'!E10&\"\"","v":""},null,null,null,null,null,"施設名：",null,{"$f":"'P2.地域連携'!E14&\"\"","v":""}]
["主治医：",null,{"$f":"'P2.地域連携'!E4&\"\"","v":""},null,null,null,null,null,null,null,null,null,null,null,"主治医：",null,{"$f":"'P2.地域連携'!E8&\"\"","v":""},null,null,null,null,null,{"$f":"'P2.地域連携'!E12&\"\"","v":""},null,null,null,null,null,"主治医：",null,{"$f":"'P2.地域連携'!E16&\"\"","v":""}]
["経過",null,"超急性期",null,null,null,"安定期",null,null,null,null,null,"退院日",null,"転院基準",null,null,null,null,null,null,null,null,null,null,null,null,null,"在宅基準"]
[null,null,"入院～数日",null,null,null,"数日～約2週間",null,null,null,null,null,null,null,"・心不全に対する入院治療やリハビリテーションの継続が必要",null,null,null,null,null,null,null,null,null,null,null,null,null,"　軽度の機能障害はあるものの、自宅での生活に支障がない"]
["達成目標\n\n退院転院\n基準",null,null,null,null,null,null,null,null,null,null,null,null,null,"・侵襲的な高度治療は必要としないが、施設や自宅での生活を行えるようにする",null,null,null,null,null,null,null,null,null,null,null,null,null,"一般療養型介護施設基準"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"経過",null,"転院日～退院",null,null,null,null,null,null,null,null,null,"退院日",null,"　自宅での生活は困難であるが、心不全症状はコントロール"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"入院期間：およそ１～３か月程度",null,null,null,null,null,null,null,null,null,null,null,"　できている"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"達成目標\n\n退院転院\n基準",null,"自宅\n\n一般・療養型\n\n介護施設等",null,null,null,null,null,null,null,null,null,null,null,"達成目標",null,"・内服治療を継続し、食事・活動などの生活習慣に"]
["治療\n処置\n検査",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　気を付けながら、再発予防ができる"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・健康生活の維持・向上ができる"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"治療\n薬剤\n検査",null,"・内服治療を継続します"]
["食事\n栄養",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・体重・血圧管理を行います"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"治療\n処置\n検査",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・症状に応じて採血、レントゲン、心電図、"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　レントゲンなどを行います"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"・再発予防に取り組みます"]
["リハビリ\n活動",null,null,null,null,null,null,null,null,null,null,null,null,null,"食事\n栄養",null,null,null,null,null,null,null,null,null,null,null,null,null,"食事",null,"・塩分摂取量、水分摂取量について適切な"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　指導を行います"]
["説明\n指導",null,"医師：病状説明\n看護師：入院生活\nについて説明\n薬剤師：必要時\n薬の確認",null,null,null,"必要に応じて下記指導を行います",null,null,null,null,null,null,null,"リハビリ\n活動\n生活",null,null,null,null,null,null,null,null,null,null,null,null,null,"活動",null,"・日常生活の維持に向けて、筋力低下予防の"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　運動指導を行います"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"相談",null,"・療養支援について相談を受けます"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"医療相談",null,"今後のことについて相談します",null,null,null,null,null,null,null,null,null,null,null,null,null,"\nこの診療計画書を用いることで、 \n心不全の状態に応じた、とぎれることのない安全で質の高い医療を受けることが可能となります。"]
[]
["医療相談",null,"今後のことについて相談します"]

{"sheet":"P29くすりについて（薬剤師）","index":12,"n_rows":21,"n_cols":10,"rows_kept":21,"cut":false,"hidden":false,"merged":[[7,2,7,9],[17,5,17,9],[20,5,20,9],[4,2,4,9],[5,2,5,9],[6,2,6,9]]}
["くすりについて（薬剤師）"]
["くすりは医師の指示通り、用法容量を守って忘れずに飲みましょう"]
[]
["急性期","回復期\n療養期"]
[null,null,"心不全はかぜなどと違い治る病気ではありません。調子がよくなっても、\nくすりをやめると悪くなります。自己判断で中止や変更はしないでください。"]
[null,null,"くすりは飲み忘れや重複がないように、一包化やこの手帳の服薬チェック欄、\nカレンダーなど利用して記録しましょう。"]
[null,null,"副作用と思われるような気になる症状が出た場合は、我慢や遠慮せずに\n医師に知らせましょう"]
[null,null,"他の医院を受診する際、心臓のお薬を飲んでいること、その内容を必ず医師に\n伝えましょう。お薬手帳を活用すると便利です。"]
[]
["その他説明事項"]
[]
[]
[]
[]
[]
[]
[null,null,"急性期","説明日",null,"年",null,"月",null,"日"]
[null,null,null,"説明者","薬剤師"]
[]
[null,null,"回復期・療養期　説明日",null,null,"年",null,"月",null,"日"]
[null,null,null,"説明者","薬剤師"]

{"sheet":"P30.あなたのおくすり（薬剤師）","index":13,"n_rows":41,"n_cols":10,"rows_kept":41,"cut":false,"hidden":false,"merged":[[8,2,8,9],[16,0,38,9]]}
["あなたのおくすり①"]
[]
[null,"（",null,null,"）"]
[]
[]
[null,"（",null,null,null,null,null,null,null,"）"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,"石川県心不全地域連携パス・手帳",null,null,null,"p30"]
["あなたのおくすり②（添付）"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,"石川県心不全地域連携パス・手帳",null,null,null,"p31"]

{"sheet":"P32運動について（理学療法士）","index":14,"n_rows":27,"n_cols":10,"rows_kept":27,"cut":false,"hidden":false,"merged":[[26,5,26,9],[12,2,12,9],[1,0,1,9],[2,0,2,9],[9,2,9,9],[10,2,10,9],[11,2,11,9],[13,2,13,9],[23,5,23,9]]}
["運動について（理学療法士）"]
["適度な運動の継続は、体力・筋力や血管、呼吸機能を維持、向上させ、身体全体の状態を改善させる"]
["ことで心臓の負担を減らし、心不全にも良い効果を発揮します。"]
[]
["あなたにとっての適切な運動と運動能力"]
["＊脈拍数",null,"/分",null,"W",null,"METs","程度の運動"]
["＊Peak VO2/AT",null,null,"ml/kg/分",null,"ml/kg/分"]
[]
["急性期","回復期\n療養期"]
[null,null,"運動前後は、準備運動と、整理体操を必ず行いましょう。"]
[null,null,"適した靴を履き、涼しい時間帯に1日30分程度の有酸素運動を週3日以上行いましょう\n（1日につき10分程度、2～3回にわけても効果はあります）"]
[null,null,"適度な運動とは息は弾むが、会話が出来る程度の運動のことです。"]
[null,null,"体重が増加傾向にある時（1週間に2kg以上の増加）は、運動を控えましょう。"]
[null,null,"運動中に、いつもとは異なる激しい胸痛や息苦しさを感じた時には、すぐに運動を中止し、場合によっては医療機関の受診も考えてください！"]
[]
["その他説明事項"]
[]
[]
[]
[]
[]
[]
[null,null,"急性期","説明日",null,"年",null,"月",null,"日"]
[null,null,null,"説明者","理学療法士"]
[]
[null,null,"回復期・療養期　説明日",null,null,"年",null,"月",null,"日"]
[null,null,null,"説明者","理学療法士"]

{"sheet":"P33食事について（管理栄養士）","index":15,"n_rows":27,"n_cols":10,"rows_kept":27,"cut":false,"hidden":false,"merged":[[26,5,26,9],[10,2,10,9],[11,2,11,9],[12,2,12,9],[6,2,6,9],[7,2,7,9],[8,2,8,9],[9,2,9,9],[13,2,13,9],[23,5,23,9]]}
["食事について（管理栄養士）"]
["あなたのお食事"]
["＊１日に必要なエネルギー",null,null,null,"kcal"]
["＊減塩　１日摂取塩分　6g未満"]
[]
["急性期","回復期\n療養期"]
[null,null,"1日3食食べましょう。"]
[null,null,"毎食、主食・主菜・副菜を揃え、バランスよく栄養を摂りましょう。"]
[null,null,"ゆっくりよく噛んで食べるようにしましょう。"]
[null,null,"薄味に心掛け、佃煮や漬物・梅干・干物など塩分の多い食品は控えましょう。"]
[null,null,"アルコールは控えましょう。"]
[null,null,"菓子類・果物の食べすぎには気を付けましょう。"]
[null,null,"肉料理中心よりも魚料理（特にイワシ・サバ・サンマなどの青魚）がおすすめです。"]
[null,null,"野菜・果物・海藻類、大豆製品など食物繊維を積極的に摂りましょう。"]
[]
["その他説明事項"]
[]
[]
[]
[]
[]
[]
[null,null,"急性期","説明日",null,"年",null,"月",null,"日"]
[null,null,null,"説明者","管理栄養士"]
[]
[null,null,"回復期・療養期　説明日",null,null,"年",null,"月",null,"日"]
[null,null,null,"説明者","管理栄養士"]

{"sheet":"P34生活について（看護師）","index":16,"n_rows":24,"n_cols":10,"rows_kept":24,"cut":false,"hidden":false,"merged":[[23,5,23,9],[3,0,4,0],[3,1,4,1],[4,2,4,9],[3,4,3,9],[5,0,7,0],[5,1,7,1],[2,2,2,9],[8,2,8,9],[9,2,9,9],[10,2,10,9],[20,5,20,9]]}
["生活について（看護師）"]
["急性期","回復期\n療養期"]
[null,null,"毎日同じ時間に体重、血圧、脈拍を測りましょう。"]
[null,null,"体重が",null,"kg以上に増えたら、生活習慣を見直して、"]
[null,null,"心不全の症状があれば、病院に受診しましょう。"]
[null,null,null,"水分制限はありません。"]
[null,null,null,"水分制限があります。",null,"（1日",null,"ml以下にしてください。）"]
[null,null,null,"（トルバプタンを内服している場合の水分制限については医師と相談してください）"]
[null,null,"禁煙しましょう！"]
[null,null,"毎日の排便状態に注意して、便秘や便が固くなってきたら、下剤を内服しましょう"]
[null,null,"風邪などの予防に手洗い・うがいを行いワクチンなど予防接種を受けましょう"]
[]
["その他説明事項"]
[]
[]
[]
[]
[]
[]
[null,null,"急性期","説明日",null,"年",null,"月",null,"日"]
[null,null,null,"説明者","看護師"]
[]
[null,null,"回復期・療養期　説明日",null,null,"年",null,"月",null,"日"]
[null,null,null,"説明者","看護師"]

{"sheet":"P67～68考えてみよう","index":17,"n_rows":45,"n_cols":8,"rows_kept":45,"cut":false,"hidden":false,"merged":[[40,0,40,8],[44,0,44,8],[19,0,19,3],[25,0,25,8],[26,0,26,2],[28,0,28,8],[36,0,36,8],[18,0,18,8],[2,0,2,8],[4,0,4,8],[5,0,5,1],[11,0,11,8],[12,0,12,1]]}
["考えてみましょう"]
[]
["あなたの思いを整理するのにお役立てください。\n書きたいと思ったときに好きなところだけ書いてみてください。\n漠然とした形でも結構です。医療者や家族とあなたの思いを共有しましょう。"]
[]
["Q.生活の中で、大切にしていることは何ですか？\n　例：家族、仕事、長生きする、一人の時間、食べること、好きに生きることetc"]
["大切にしていることが",null,null,"ある",null,"ない"]
["大切にしていること（思いつくだけ書いてください）"]
[]
[]
[]
[]
["Q.生活の中での目標、希望があれば教えてください。\n　例：旅行に行きたい、入院せずに元気に生きたい、子供や孫が成人するまで生きていたい"]
["目標や希望が",null,null,"ある",null,"ない"]
["具体的目標や希望："]
[]
[]
[]
[]
["Q.「こんな状況や想いは嫌だな」という具体的な状況は思い浮かびますか？\n　例：家族に迷惑をかけてまで生きたくない、制限を受けていきたくない、延命治療は受けたくない"]
["こんな状況はいやだなという状況が",null,null,null,null,"思い浮かぶ",null,"思い浮かばない"]
["具体的な状況は："]
[]
[]
[]
[]
["Q.自分の最期に関して考えたことがありますか？"]
["最期の時について考えたことが",null,null,null,null,"ある",null,"ない"]
[]
["Q.考えたことがある場合、「こうだったらいいな」という、あなたの希望、そして理由を\n　教えてください。\n　例：家で最期を迎えたい、病院で最後を迎えたい、辛くないようにしてほしい"]
["希望："]
[]
[]
["理由："]
[]
[]
[]
["Q.このようなことを家族で話し合ったことがありますか？"]
[null,"あります",null,null,"ありません"]
[null,"話すタイミングが無い",null,null,"あまり話し合いたくない"]
[]
["Q.あなたにとって大事なことを話す相手は誰ですか？"]
[]
[]
[]
["Q.今後のあなた自身の将来について話し合ったことをよろしければ教えてください。"]