Patients often have fear because they don't understand the disease and treatment effect, which aggravates the feeling of pain. Therefore, nurses give necessary care to alleviate the stagnation of patients.
Keywords: orthopedics; Nursing medicine
I. Data and methods
A total of 290 orthopedic inpatients (in a hospital) were selected from April, 2009 to October, 2009, including 265,438+00 males, aged from 69 to 4, and 80 females, aged from 78 to 2. In the nursing of these 290 patients with orthopedic pain, we intervened from four aspects: general nursing, specialist nursing, drug nursing and psychological nursing, and achieved good results.
Second, symptomatic treatment.
1. drug analgesia for patients with severe pain or other nursing methods can not be relieved, use analgesic drugs to relieve pain. Mild pain: non-opioid drugs, antipyretic and analgesic drugs and anti-inflammatory drugs, such as aspirin and ibuprofen; Moderate pain: weak opioid drugs, such as paracetamol, codeine, buguizine; Severe pain: strong opioid drugs, such as morphine, pittidine, etc.
2. Technical analgesia physiotherapy, cold therapy, hyperthermia, ice compress, hot spring bath, microwave, infrared ray, etc.
Third, nursing.
1. The causes of pain caused by general nursing in orthopedics and traumatology can be divided into three categories: (1) acute pain, which is seen after trauma or disease, such as fracture and postoperative pain; (2) Chronic malignant pain, which occurs in malignant tumors or other progressive diseases, such as osteosarcoma and rheumatoid arthritis; (3) Chronic non-malignant pain is seen in patients with non-progressive tissue injury or cured injury, such as shoulder and back pain and proliferative arthritis. Before nursing, we should accurately understand the causes of patients' pain and correctly evaluate its degree, and adopt physiotherapy measures such as hyperthermia ice compress, hot spring bath, ultrasonic wave and infrared ray. In the process of nursing, we should pay attention to patients' reactions, especially to young children and the elderly, and carefully observe their performances, such as posture, facial expression, emotional state, sweating, muscle tension and so on. To understand the degree of pain and the relieving effect of nursing on it.
2. Specialized nursing
Pain is a common symptom of most orthopedic diseases, especially the postoperative pain of orthopedic patients. Most of them hurt muscles, muscle cavities, joints, periosteum and other receptors. The nature of pain is deep pain, which is a kind of soreness and scattered pain. In specialized nursing, patients should be helped to keep their affected limbs in a proper position, and the traction principle should be applied to help patients move their affected limbs, relieve pain and let patients cooperate with the treatment. For patients who are fixed with bandages and plaster after operation, first of all, we should observe the blood supply of the affected limb, whether the limb is swollen or not, whether the plaster is pressure sore or not, adjust the position of the joint limb in time, and open the window for inspection if necessary. Do not apply analgesic drugs easily, otherwise it will cause skin ulcer or even necrosis. For the pain caused by improper posture and overwork, it can help patients change their posture, reduce oppression and relieve pain. One day after operation, under normal circumstances, the pain can be gradually relieved. If it is not relieved or aggravated, and the body temperature does not drop or rise, incision infection should be considered, and the wound healing should be checked and reported in time.
3. Drug therapy
In drug care, the method of step-by-step administration is generally adopted. According to the patient's pain degree and specific situation, drugs are administered in steps from weak to strong, mainly using tramadol hydrochloride sustained-release tablets and mescontin controlled-release tablets, mainly taking orally. For severe pain affecting sleep, diazepam, indomethacin and demerol can be given by intramuscular injection. And give preventive medication according to the situation. In addition, we should often visit patients, comfort and encourage them, try our best to reduce their psychological pressure and improve the pain value; When using opioids, it is necessary to observe whether there is respiratory depression. Non-opioid drugs, such as nifedipine, should mainly observe whether there is a tendency of gastrointestinal bleeding. In addition to the above aspects, nurses should also pay attention to be warm, friendly, confident and generous when communicating with patients, be careful and skilled in operation, carefully observe the patient's reaction, the location, nature, rhythm and degree of pain, put themselves in the patient's shoes, feel their pain, let patients feel understanding and care, and effectively relieve their pain psychologically.
4. Psychological care
Patients often have fear because they don't know the condition and treatment effect, which aggravates the feeling of pain, so nurses give necessary care to alleviate the stagnation of patients. We should support patients with sympathy, comfort and encouragement, reduce their psychological pressure as much as possible, distract their attention, keep patients happy, stable and relaxed, and increase their tolerance for pain. When treating and nursing patients, actions should be accurate and gentle, avoid rudeness and minimize pain and stimulation. Such as debridement, catheterization, changing sheets, turning over and other nursing operations. When moving the patient, we should pay attention to maintaining a comfortable posture to avoid causing the patient's pain and at the same time seek the cooperation of the patient's family. When the patient is in pain, the accompanying family members will also be affected, showing anxiety, which will further affect the patient and aggravate the pain. Do a good job in the ideological work of patients and their families, so that patients have good psychological factors and accumulation state, and can also play a role in relieving pain and contributing to rehabilitation.
refer to
1, investigation and nursing of constipation in orthopedic patients in bed, Shi Min, Zhang Xiuqiong, Zhou Yongxia, Jiang Muyao, PLA Nursing Journal 2004-05-25 1 10.
2. Analysis of related factors of incision infection in orthopedic aseptic surgery and nursing intervention in operating room: Lu; Guide to traditional Chinese medicine 2011-01-2586
Abstract: With the acceleration of the current population aging process, the elderly population in China is also increasing, and the number of elderly orthopedic patients is also increasing. Most elderly orthopedic patients have different degrees of limb limitation. In addition, elderly orthopedic patients belong to the high-risk group, usually complicated with other cerebrovascular and heart diseases. Therefore, hospital orthopedics requires higher quality of clinical nursing.
Keywords: orthopedics; safety management
I. Data and methods
1. method
Before strengthening safety management, patients in the control group were only given routine orthopedic safety care, including health education, psychological care and safety management. The observation group was given enhanced safety management on the basis of routine orthopedic care. Before nursing, the unsafe factors in orthopedics were analyzed, the risk factors in orthopedics were determined through questionnaire survey, and targeted safety management strategies were formulated. Secondly, set up a professional nursing safety management team, form a three-level nursing safety management network, eliminate unsafe factors in orthopedics, correct potential safety hazards, conduct regular safety education and training for orthopedic nurses, enhance their sense of responsibility and strengthen their awareness of prevention. Then, according to the general information of each patient, the nursing staff made a personalized health education and safety nursing plan, and strengthened safety education for the patients' families. Distribute written materials, explanations and emergency handling operation demonstrations related to safety hazards to patients and their families, inform patients of simple self-help methods, encourage patients and their families to actively participate in safety management, and build a good nurse-patient relationship. At the same time, do a good job in ward safety management, appropriately increase the bed guard bar of the patient's bed in the ward, place dangerous goods such as sharp instruments and hot water bottles away from the patient, and place anti-slip mats in the corridor and bathroom of the ward to keep the interior of the ward clean and ventilated regularly. For orthopedic patients who stay in bed for a long time, help them turn over and help their families clean their skin to reduce the occurrence of pressure ulcers.
2. Evaluation indicators
Record the accident rate in the nursing process and count the number of complaints in the nursing process. Self-designed satisfaction questionnaire was used to evaluate the satisfaction of patients in the two groups.
3. Statistical analysis
SPSS 19.0 statistical software was used to process the research data. 2 test, p
Second, the result
1. Comparison of the incidence of unsafe events in the nursing process between the two groups.
During the nursing period, the observation group suffered from fall 1 case and pressure sore in 2 cases, and the overall incidence of adverse events was 6.6%. In the control group, there were 2 cases of scald, 2 cases of self-injury, 4 cases of fall and 5 cases of pressure sore, with a total incidence of 28.9%. There was significant difference between the observation group and the control group (P
2. Comparison of complaint rate and satisfaction rate between two groups in nursing process.
There were 44 complaints 1 piece in the observation group, and the satisfaction rate was 97.8%, which was significantly higher than that in the control group (80.0%). There was a significant difference between the two groups.
Three. discuss
With the acceleration of the current population aging process, the elderly population in China is also increasing, and the number of elderly orthopedic patients is also increasing. Most elderly orthopedic patients have different degrees of limb limitation. In addition, elderly orthopedic patients belong to the high-risk group, usually complicated with other cerebrovascular and heart diseases. Therefore, hospital orthopedics requires higher quality of clinical nursing. As an important part of nursing work, safety management is becoming more and more important in clinical nursing work. A large number of research reports believe that effective safety management can significantly reduce the incidence of risk events and improve the overall nursing quality of hospitals. In the clinical nursing of orthopedic patients, unsafe factors generally include four parts, namely, the professional level of nursing staff, the patient's own factors, and the risk assessment ability and responsibility of nursing staff. Generally, elderly orthopedic patients are usually complicated with multiple injuries, and their condition progresses rapidly, and their physical functions are in a stage of continuous degradation. If the nursing staff only follow the routine operation and carry out the doctor's advice mechanically, and lack the ability to deal with risk events and emergencies, it will easily lead to accidents, and it will be impossible to build a harmonious nurse-patient relationship and gain the trust of patients and their families [7-8]. Nursing safety is the premise to determine the quality of nursing, and it is also the basis for hospitals to provide patients with safe, satisfactory and high-quality services. It is also an important link to reduce medical disputes and medical accidents. Aiming at the hidden dangers in orthopedic nursing, it is the key to improve the quality of orthopedic nursing to carry out orthopedic nursing safety management and strengthen safety education. In this study, patients in the observation group were given intensive safety education on the basis of routine nursing, and nurses were regularly organized to carry out safety knowledge education and training to strengthen their sense of responsibility. Nurses are required to carry out health education and safety management in the nursing process, so that patients can get full right to know, inform patients and their families of any accidents that may occur during treatment and examination, establish a good nurse-patient relationship, and make patients and their families fully trust nurses, thus reducing the occurrence of medical disputes. At the same time, we urge nurses to master the general information of patients, carry out targeted nursing intervention, provide humanized nursing services for patients, give appropriate oral comfort to critically ill patients, correct their bad psychological emotions, popularize necessary health knowledge to each patient, and improve their treatment compliance. In addition, strengthen the preventive health care of wards, do a good job in nursing ward environment, avoid accidents caused by objective factors, and reduce the occurrence of risk events. The results of this study suggest that the accident rate of the observation group is significantly lower than that of the control group, and the patient satisfaction rate is significantly higher than that of the control group. At the same time, it is further confirmed that the implementation of intensive safety education program in the safety management of orthopedic patients can not only reduce the occurrence of medical disputes and accidents, but also optimize the quality of nursing and improve patients' satisfaction with nursing, which is worth popularizing.
refer to
1, investigation and nursing of constipation in orthopedic patients in bed, Shi Min, Zhang Xiuqiong, Zhou Yongxia, Jiang Muyao, PLA Nursing Journal 2004-05-25 1 10.