With the improvement of people's living standards, the incidence of diabetes is increasing year by year, and there are more and more fracture patients with diabetes. Diabetic patients are often complicated with systemic microvascular and nervous system diseases because of their low self-resistance, with high surgical risk and many postoperative complications, and the incidence rate is about 17.2%. Therefore, it is very important to strengthen the perioperative care of diabetic patients. From 20061October 65438+ to February 2009 65438+ 34 cases of fracture complicated with diabetes were treated by surgery in our department. Due to the importance of preoperative and postoperative care, satisfactory results were achieved and no complications occurred. The report reads as follows:
Clinical data of 1
1. 1 general information
Among the 34 patients, there were 65,438+08 males and 65,438+06 females, aged 40-98 years, with an average of 62 years, including 65,438+08 femoral head and neck fractures, 8 thoracolumbar fractures and 8 diabetic foot complicated with ulcers. Both are type II diabetes.
1.2 processing method
All patients were given oral hypoglycemic drugs or subcutaneous insulin before operation. Blood sugar was measured after three meals. Fasting blood sugar was controlled below 7.8 mmol/L, and postprandial blood sugar was controlled below 9.4 MMO/L/L. The operation was performed under the condition of good general condition. Surgical methods: total hip replacement 18 cases, open reduction and internal fixation of fractures in 6 cases, posterior open bone grafting and internal fixation of thoracolumbar vertebrae in 2 cases, and debridement and suture of diabetic foot wounds in 8 cases. All patients were treated with anti-infection, dressing change, diet and blood sugar control after operation.
1.3 result
The incisions of 34 patients in this group were all healed in one stage, and no complications occurred during hospitalization.
2 nursing measures
2. 1 Psychological nursing Because of the long course of diabetes, diabetic patients have a certain understanding of diabetes, but they have insufficient understanding of surgery, heavy psychological burden and lack confidence in prognosis, and most of them are depression, pessimism and fear. Therefore, nurses should actively and enthusiastically care for patients and do a good job in the ideological work of their families in order to obtain their support. Explain the necessity of surgical treatment to patients and their families patiently and carefully, and introduce in detail the preoperative preparation, intraoperative cooperation and possible discomfort and precautions after operation, so that patients can have a more comprehensive understanding of the operation, thus reducing or eliminating their nervousness and fear, stabilizing their emotions and actively cooperating with treatment and nursing.
2.2 Health education
2.2. 1 diet education Diabetes mellitus is an endocrine and metabolic disorder disease, and trauma will cause a lot of energy consumption, which is easy to form a negative nitrogen balance. Therefore, diabetic patients should not only strictly control diet and stabilize blood sugar level after operation, but also increase nutrition and promote wound healing. After consultation with nutritionists, the recipe and total calorie distribution of each meal were worked out. According to the total calories required per day = standard weight? The dietary principle of calories per kilogram of body weight is: protein 15%, fat 25%, carbohydrate 60%, and no high sugar, starch, animal viscera and fat. Breakfast15, lunch 2/5, dinner 2/5. And it coincides with the time of insulin injection. The nurse in charge should strengthen the inspection of the ward during meal time, understand the patient's eating situation and supervise the normal diet plan.
2.2.2 During perioperative period, specialized education should guide patients to cough and expectorate effectively, take deep breaths, drink plenty of water, and do functional exercises at an early stage to prevent lung infection and venous thrombosis of lower limbs.
2.3 Observation of illness Observe closely the changes of consciousness, vital signs and peripheral blood circulation after operation, observe whether there are symptoms of cardiovascular and cerebrovascular diseases, and report to the doctor in time if any abnormality is found. Observe the bleeding, limb activity, feeling and blood supply of the wound. Pay attention to observe whether there is hypoglycemia to prevent ketoacidosis. 2.4 Wound Care Due to various factors such as decreased immune function and metabolic disorder of diabetic patients, wounds are prone to infection, and factors that aggravate infection such as surgical incision, bed rest and various drainage tubes are difficult to control. Therefore, prevention of infection is the key to treatment. Before the operation, skin preparation and shaving should be done carefully to prevent scratching the skin and increase infection factors. Strict aseptic operation should be carried out during dressing change after operation, and attention should be paid to keeping the wound dressing dry to avoid urine and urine pollution. When using adhesive tape to fix, pay attention to whether there is adhesive tape allergy, so as to avoid allergic blisters, leading to skin infection and ulcer.
2.5 Blood sugar control
During trauma and operation, the increase of insulin resistance, anti-infection and the release of inflammatory cytokines lead to insulin deficiency in diabetic patients. The patient was admitted to the hospital for consultation by a diabetes expert and made a treatment plan. All patients in this group were given oral hypoglycemic drugs or subcutaneous insulin before operation, and their blood sugar after three meals was measured. Fasting blood sugar was controlled below 7.8 mmol/L and postprandial blood sugar was controlled below 9.4 MMO/L/L. The dosage of insulin should be accurate, and the doctor's advice should be carefully checked before aspiration, and the injection site should be changed frequently, because multiple injections at the same site can produce subcutaneous induration, even ulceration and abscess formation.
2.6 Skin Care Diabetes patients have poor skin resistance, postoperative incision pain, limbs need to be restricted, and patients are unwilling to change their positions, which may easily lead to long-term local skin compression, ischemia and hypoxia, skin ulceration and soft tissue necrosis. Therefore, prevention of bedsore is the key and difficult point of nursing for patients undergoing diabetes surgery. Keep the bed clean, dry and tidy, help the patient turn over regularly, and massage the skin of the pressed part frequently. Attention should be paid to the cleanliness of perineum and gluteal fissure skin to avoid eczema and ulcer caused by secretion of gluteal fissure, urine or sweat stimulation, and use skin protective film to protect it when necessary. In summer, water pads should be provided to reduce the temperature and pressure of the skin at the compressed part. A towel should be laid on the water cushion, and the water cushion and towel should be replaced every 2 hours. For those who need traction with leather sheath after total hip replacement, we should pay attention to protect the ankle skin, avoid the direct contact between the edge of leather sheath and the skin, put a large cotton pad on the ankle, and regularly check whether the skin is compressed, and pay attention to the traction weight not to be too heavy to avoid pulling the skin.
2.7 Prevention of Complications Due to the decline of immune function and resistance of diabetic patients and the trauma of surgery, the body is in a state of stress, which further reduces the body's disease resistance and is prone to complications, which should be highly valued in nursing. For patients who stay in bed for a long time, help them turn over and tap their backs 1 time every 2 hours, instruct them to take a deep breath, cough and expectorate effectively, keep warm and prevent lung infection. Patients with indwelling catheter after operation should keep the drainage tube unobstructed, change the drainage bag 1 time every day, scrub the urethral orifice twice to prevent urinary tract infection, clamp the catheter regularly and train the bladder function. For patients with hypertension arteriosclerosis and cardiac insufficiency, the changes of vital signs should be closely observed before operation, so as to be alert to the occurrence of myocardial infarction or cerebrovascular accident.
3 abstract
Diabetic patients have low resistance, many complications and high surgical risk, which requires us to have a high sense of responsibility, rich professional knowledge and related knowledge in clinical nursing, to be predictive of common complications and to find out the changes of the condition in time. Make an accurate and effective nursing plan, manage patients' blood sugar well, pay attention to wound care and skin care, and avoid complications.
refer to
Lv Renhe, Diagnosis and treatment of diabetes and its complications [M]: People's Health Publishing House, 1997.
Tian Hui, Adjustment of treatment scheme for diabetes during operation and trauma [J]: Friends of Diabetes 2009, 1 1.
Huang Qiaoping, Zheng Hui, Wang Li 'ai, Nursing experience of hip fracture in elderly patients with diabetes [J]. Nursing Practice and Research 2009,6 (14).