Preoperative guidance
1 Dietary guidance: When patients with gastric cancer generally have symptoms, they are in the middle and late stages, and their body consumption is high, so they often have malnutrition symptoms. Should eat more nutritious, digestible, non-irritating, less residue diet, eat less meals. Those with severe obstruction should fast and be supplemented with high-energy nutrition or elemental diet intravenously according to the doctor's advice.
Gastrointestinal preparation: fully explain the importance of gastrointestinal preparation to patients, and ask patients to eat liquid diet, such as lean broth, milk and vegetable soup, the day before operation. Clean enema and fasting at night before operation, indwelling gastric tube in the morning, and gastric lavage with 300 ~ 500 ml warm normal saline every night for three days before operation to facilitate the smooth operation.
Preoperative education: practice urination in bed one week before operation to avoid urinary tract infection caused by prolonged indwelling catheter after operation. Teaching patients to cough effectively three days before operation is beneficial to prevent postoperative pulmonary complications. According to the operation method, explain the content, purpose and precautions of preoperative preparation to patients one day before operation, and ensure patients to sleep at night before operation.
Postoperative guidance
1 Position and activity guidance: Explain to patients and their families the importance of taking a semi-recumbent position after operation, which is conducive to smooth breathing and gastric tube drainage, and at the same time can relieve incision pain and appropriately increase activity. You can sit up one month after operation, move indoors for 3 ~ 4 days, and move in the corridor after removing stitches for 7 ~ 10 days, which is beneficial to the recovery of gastrointestinal function.
2. Nursing instruction of gastric tube: Explain the importance of gastric tube to patients and their families. Under normal circumstances, a small amount of dark red or brown gastric juice can flow out of the gastric tube within 24 hours after operation, generally not exceeding 300 ~ 600 ml, and the amount gradually decreases and can be stopped automatically. If there is a large amount of blood flowing out of the stomach tube within 24 hours after operation, there may be anastomotic bleeding, and the medical staff should be reported immediately for timely treatment. 24 ~ 48 hours after operation, if the gastric juice decreases and the color is normal, the intestinal peristalsis will recover, and the gastric tube will be removed when the anus is exhausted.
Dietary guidance: after fasting after operation, a small amount of drinks can be given on the same day, 4 ~ 5 tablespoons each time, once every 2 hours. If there is no discomfort, you can give a proper amount of liquid diet the next day, 50 ~ 80ml； each time; On the third day, a total liquid diet was given, each time 100 ~ 150 ml. If you return to normal after surgery, you can eat a low-sugar semi-liquid diet such as porridge on the fourth day and eat soft food two weeks later. Staple food and side dishes should be nutritious and easy to digest. However, if the patient has symptoms such as nausea and bloating after eating, he should still stop eating.
Observation of complications and nursing guidance: If the patient has symptoms such as abdominal distension, palpitation, sweating, dizziness, fatigue, vomiting, collapse and diarrhea after eating, especially after eating sweets 10 ~ 20 minutes, it may be dumping syndrome. Lying flat for a few minutes at this time can alleviate the above symptoms, and asking patients to lie flat for 20 ~ 30 minutes after eating in bed can prevent or alleviate the above symptoms. If you still feel abdominal pain and fever one day after operation, and you can see more liquid and stomach contents flowing out of the incision, it indicates that anastomotic leakage has occurred. At this time, we should continue to suck the discharged gastrointestinal fluid under negative pressure, keep the skin around the fistula clean and dry, and apply zinc oxide ointment for protection to prevent intestinal fluid from corroding the skin.
Discharge guidance
1 instruct patients to eat correctly and regularly. Eat less and more meals a month after operation, and then gradually eat normally according to your physical recovery.
Patients are required to rest within one month after discharge, take part in light work two months later, and engage in light work three months later according to their recovery.
3 keep a happy mood and avoid mental stimulation.
4 review regularly according to the doctor's advice.