Thorax mirror treat malignant thorax accumulate nursing _'s treatment of liquid

Thorax mirror treat malignant thorax accumulate nursing _'s treatment of liquid
1 [the skill is attended to ] 1.1 The psychology is attended to It is that malignant tumour is invaded and behaved in later period of the pleura that the malignant thorax accumulates the liquid. The course of disease is long, water of chest still can't be controlled after the repeated thorax punctures and releases liquid,etc. to deal with, and influence the breathing function, with having difficulty in breathing in various degree, influence patient's life quality greatly. Therefore patients are mostly pessimistic and desperate, have lost and treated confidence, though would like to accept VATS surgery treatment, but there is more worry, are afraid the surgery therapeutic effect is not good. To its psychological characteristic, we make the corresponding nursing measure, on the basis of establishing good trust relation, offer patient sincere comfort to encourage. Mechanism, advantage and undergraduate course of explaining clear thorax mirror operation to the patient have launched the situation of VATS, result recently. Recommend the similar operation patient to talk about realizing, dispel misgivings instead of knowing at the same time, enhance confidence, make its happy to undergo an operation treatment. Do a good job of the propaganda and education to patient and relative before the skill, the postoperative attentive matters before pleura fixation basic principle, skill, it is explained, explain various questions that the patient puts forward conscientiously that careful to patient and relative, dispel unsettled mood, in order to obtain and cooperate with best. And do a good job of relative and cooperate for psychological support together. 1.2 Have difficulty in breathing and attend to Group this have in front of because in the 16 skill, patient of example, and a large number of thorax accumulate liquid, influence the breathing function, with have difficulty in breathing in various degree, offer, fetch, lie location by half, have difficulty in breathing getting serious, suck for the oxygen, pay attention to observing the patient's breath situation, assist the doctor to walk if necessary the thorax is punctured and smoked the liquid (this group have 12 examples) ,In order to improve to have difficulty in breathing. Assist the patient to fetch the suitable, comfortable body posture according to puncturing the position before puncturing, the thorax should rigorously enforce aseptic technical operation to puncture, puncture and keep a close eye on complexion, pulse, breathe the situation in the course, unusual to stop operating immediately. Release the liquid to be less than 1000ml each time. Puncture, pay attention to replying the hydropic appearance of a sex lung. There aren't this 12 groups this kind of complication happen in one. 1.3 Improve the nutritional status Because the patient belongs to later period malignant tumour, the course of disease is long, wear by the repeated chest, a large number of proteins lose, become thin, the whole body situation is bad. Carry on important internal organs inspections such as three major routine, heart, liver, lung, kidney,etc. before the skill; Analysis of regular vim and vigour; The lung function is determined; Assess patient's tolerance to the operation. Instruct patients it is apt to digest the food to enter high protein, high heat more, is rich in vitamins as much as possible. Improve the nutritional status, improve the tolerance of performing the operation correctly. Obvious, low albumen blood disease, hemoglobin to becoming thin 1.4 Guidance before the skill and preparing In order to enable postoperative patient to resume smoothly, prevent lung complication. We explain the postoperative importance of coughing and deeplying breathe to the patient effectively in front of skill, teach them how to grasp cough effectively, the method to deeply breathe. To having the infeted of respiratory tract, suck atomization, select rational antibiotic for use to treat, control and infect actively. And teach the patient a method of a postoperative early activity before the skill. Other the intersection of preparation and work method with general anesthesia turn on the intersection of chest and skill, prepare against skin, skin, try on, mix blood, defecate and practise etc. at the bed conventionally in front of the skill. 2 [postoperative nursing ] 2.1 The physical sign of the life is observed VATS operation adopts the intubate general anesthesia of one pair of tracheas, is good for in the skill the lung is kept in touch with, good for the lung to keep in touch with in the skill continuously, does not keep in touch with irritating flowing continuously of the lung, shunt and increase in the lung, cause the postoperative hypoxemia disease. [1]Offer oxygen intake while being postoperative, lasting blood and oxygen saturation lever monitor, fetch the arterial blood and go on the analysis of vim and vigour regularly, understand that shuts the state with patient oxygen, contribute to finding the disease inclination of hypoxemia in time. Such as presenting hypoxemia disease, deal with immediately. Postoperative the intersection of heart and electricity guard with blood pressure monitoring, have patient, disease of cardiovascular vessel, should be deemed to guard the target to advanced age especially, and do a good job of preventative nursing. There are 3 example patients to find the arrhythmia, the ischemic oxygen deficiency change of cardiac muscle in this group, pull through after dealing with in time. 2.2 The thorax drainage tube is attended to The intersection of general anesthesia and blood pressure, pulse wake up, breathe behind the steady 6h fetching, lying in the location by half, help to breathe and guide, keep the thorax drainage tube unobstructed, push the drainage tube regularly, observe and record the guiding amount, color. Malignant thorax accumulate liquid walk pleura guide quantity to be usually more while being postoperative while being fixed, guide liquid to be getting many, guide tube, inject by chest into along platinum 100mg inserting and in charge of 12- 24h, repeat if necessary. Wait for water of chest to disappear, pull out the drainage tube after every day is less than 100ml. [1]Cui YingJie, the treatment of the thorax drainage tube is after to making the fixation of pleura with the talc powder: Insert, in charge of the 1st day while being postoperative, begin to guide on the 2nd day. [2]I department have 5 example initial stage competent water seal bottle, guide only, guide time in 72- 120h (average 86h) . Adopt negative pressure (- 0.78 - - 0.98kPa) later Attract continuously, it is 48- 96h (average 76h) to guide time ,Guide time to obviously shorten. We think, the postoperative negative pressure thorax is guided, can more totally accumulate the thorax the liquid to guide clean, make the lung swell as soon as possible, make one layer of pleuras of dirty layer and wall close and stick to, help the adhesion to take shape, shorten and guide time. 2.3 The respiratory tract is managed Because malignant thorax accumulate liquid, make it swell completely not to suffer from the intersection of side and lung, the intersection of VATS and pairs of of the intersection of trachea and intubate general anesthesia under operation, good for the lung to keep in touch with in the skill, make the skill side lung wither, so in order to make the skill future trouble side lung swell as soon as possible, the general anesthesia begins to encourage patient's deep breath by oneself, cough to arrange the phlegm promptly after waking up, treat the intersection of life and the intersection of physical sign and stability fetch, lie in the location by half behind the 6h, and on the basis of stopping the pain, every 2h assists the patient to sit, strike, carry, and atomization suck 3 times a day, do benefit to angry way to be wet to take to rank the phlegm, keep the respiratory tract unobstructed. Guarantee chest guide tube guide fully, discharge in the thorax accumulating liquid in time at the same time. Check two lung respirations every day, judge the lung swells, observes patient's dyspneal improvement situation. Observe according to this group, because thorax mirror operation damages the tissue few, it is small to cut-out, postoperative pain is relatively light, most patients can adopt oral medicine to stop the pain, does not need skin note to stop
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