1. Clinical data
Patient, male, 18 years old, student. Twenty days ago, there was no obvious inducement, and the right cheek was swollen, growing rapidly and without pain. He was admitted to the hospital on May 19, 2006 for definite diagnosis and further treatment. Physical examination: the right cheek and face are swollen, the tumor is oval, about 5.0cm×3.0cm in size, medium, without adhesion, with clear periphery, and the upper end extends under the zygomatic arch without pain. Cytological biopsy was performed on May 2, 2006, and it was reported as "adenoid cystic carcinoma of cheek". After active preoperative preparation, on May 25, 2006, adenoid cystic carcinoma of the right cheek was removed under general anesthesia, and frozen sections were examined during operation. After collection and investigation, it was further diagnosed as "adenoid cystic carcinoma of cheek", and extended resection was performed to remove part of temporal muscle, masseter muscle, medial pterygoid muscle and part of mandible. After careful observation, infection prevention, careful treatment and nursing, he recovered smoothly on the 7 th day after operation and was discharged from hospital. The postoperative pathological report is "correct"
Step 2: Nursing
2. 1 Admission education actively introduces the ward environment and rules and regulations, so that patients can know the location of toilets, bathrooms, boiling water rooms, dressing rooms, etc. , and understand the use and function of bedside pager. Understand the examination items and precautions after admission to help patients adapt to the hospitalization environment as soon as possible.
2.2 Psychological nursing Psychological nursing is embodied in every link of the treatment and nursing process. Combined with professional characteristics, it actively affects patients' psychology within the scope of professional knowledge and technical ability, and helps patients in various States to maintain their psychosomatic state [2]. Psychological nursing is not simply talking with patients, but combining with the implementation of various treatment and nursing measures.
2.2. 1 to establish a good nurse-patient relationship, we must first establish a people-oriented nursing concept, sympathize with and care for patients, patiently listen to patients' confidences, answer patients' questions, establish a mutual trust nurse-patient relationship, and actively and sincerely communicate with patients in easy-to-understand language.
2.2.2 Help patients build confidence in overcoming diseases. Malignant tumor causes great fear to patients and lacks confidence in treatment. In the process of nursing, help patients to establish confidence in overcoming diseases, and actively introduce disease-related knowledge, treatment programs and nursing measures, and finally win the trust of patients and their families.
2.2.3 Relieve patients' worries about postoperative defects. Cutting off part of the mandible will change the facial appearance and lead to deformity, which is cruel to a young man who is only 18 years old. Patients are worried that they will be laughed at and discriminated against by others after operation, resulting in inferiority complex. Explain the importance and necessity of operation through patient and meticulous explanation. A beautiful heart and life are more important than a beautiful appearance. As long as a person treats everything with a normal heart, his life will be colorful. Through our efforts, patients actively cooperate with medical care and complete the treatment together. The patient said that he will never be a weak person in life, but will definitely live a strong and happy life.
2.3 Preoperative preparation: assist in the pre-operative examinations, fully understand the general situation of patients, such as chest X-ray, electrocardiogram, biochemical examination, blood type, blood matching, etc., and make preparations for pre-operative skin preparation, first-aid drugs, indwelling catheter, etc., so as to make full preparations for the operation.
2.4 Oral care The oral cavity is a polluted environment with more than 40 kinds of pathogenic bacteria [3]. Oral hygiene is very important for postoperative wound healing. Patients should be instructed to gargle and brush their teeth every day to keep their mouths clean. Rinse your mouth with 1.5% hydrogen peroxide three days before operation, four times a day, and clean your teeth one day before operation to remove calculus and tartar, thus creating conditions for postoperative wound healing.
3. Postoperative care
3. 1 general nursing After general anesthesia, prepare various articles as usual. After the patient returned to the ward, he checked, collected pillows and lay flat, and asked the anesthesiologist about the operation process. Dynamic monitoring of vital signs: closely monitor the changes of respiration, pulse, blood pressure, heart rate and blood oxygen saturation and make records.
3.2 Keep the respiratory tract unobstructed and closely observe the bleeding of the wound. Do you have any dyspnea caused by laryngeal edema and tongue drop? Remove phlegm and blood in oral cavity and nasal cavity in time to prevent suffocation.
3.3 Drainage tube nursing tumor is located in the deep, involving a variety of tissues, leaving a large dead space, which is difficult to eliminate. At the end of the operation, the self-made 7# scalp needle drainage tube was placed in the wound cavity, connected with a 60ml syringe and pumped to negative pressure to form negative pressure drainage. Check whether the drainage tube is compressed, twisted or blocked at any time, whether it is fixed well, keep the drainage tube unobstructed, observe the color, nature and quantity of drainage fluid, and make a good shift change. When replacing the drainage device, it should be strictly sterile. Drainage tube is usually placed for 24 ~ 72 hours. If the drainage volume is less than or equal to ≤30ml within 24 hours, it can be reported to the doctor for extubation.
3.4 On the first day after psychological nursing, the patient found that his face became asymmetrical, but he was impatient, depressed and did not cooperate with the treatment. Later, the patient was transferred to a ward with few patients, and the ward environment was kept quiet to reduce noise. Take every opportunity to communicate with patients and explain the purpose and significance of postoperative treatment and nursing. The patient expressed his willingness to work together to overcome the disease.
3.5 Oral care postoperative oral care is very important. Besides instructing patients to rinse their mouths after meals, nurses must also do oral care every day, and rinse their mouths with 1.5% hydrogen peroxide four times a day to keep their mouths clean, prevent wound infection and promote wound healing as soon as possible.
4. Discharge guidance
Make a detailed recovery plan for patients, instruct patients to continue liquid diet 1 week, 1 week, change to normal diet after meals, develop the habit of brushing teeth or gargling after meals, keep the mouth clean, impart knowledge of disease health education, and instruct patients to go to specialized hospitals for radiotherapy two weeks later. Under tumor load, patients' effective intake decreased, while protein consumption increased due to high tumor metabolism. Most patients with malignant tumors are accompanied by protein deficiency in varying degrees. In addition, surgery, radiotherapy and chemotherapy have also caused different degrees of damage to normal tissues, and the repair of damaged tissues still needs a lot of protein [4]. Do a good job in dietary guidance, follow the principle of high protein, high vitamins, high sugar and low fat, eat more fresh vegetables, fruits, mushrooms, milk, beans, eggs, lean meat and seafood, try to choose the foods that patients like, use some drugs to strengthen the stomach and help digestion when necessary, encourage patients to drink more boiled water, pay attention to rest, improve their rehabilitation ability, and ask patients to come to the hospital for follow-up visits regularly.