To summarize and discuss the nursing measures of thyroid cancer before and after operation. The nursing strategies and effects of 17 patients with thyroid cancer were reviewed from the aspects of psychology, preoperative preparation and postoperative observation. Results Through all-round nursing, patients were helped to get through the critical period. 1 patient with chylous leakage was cured and discharged. Conclusion Comprehensive nursing before and after operation can effectively alleviate the illness and promote the recovery of the disease.
Keywords: thyroid cancer, nursing
Thyroid cancer is one of the common malignant tumors in the neck. Because of the large scope of operation, the rapid change of postoperative condition and the high incidence of complications, which seriously affect the smooth recovery of patients, it is particularly important to strengthen preoperative and postoperative nursing. From 2011.7-2012.12 to 17, our department has strengthened the pre-and post-operative care of thyroid cancer patients from the aspects of physiology, psychology and condition observation, and the curative effect is satisfactory. The nursing experience is summarized as follows:
1. Clinical data
1. 1 general information 17 All patients in this group were thyroid cancer patients, all of whom were confirmed by postoperative pathology, aged 26-66 years, including 5 males and 2 females 12. Postoperative pathology was papillary thyroid carcinoma, including 3 cases of nodular goiter and 2 cases of lymphocytic thyroiditis.
1.2 treatment and prognosis in this group, there were 7 cases of bilateral total thyroidectomy, 7 cases of standard radical thyroidectomy 1 1 case, 8 cases of neck lymph node dissection, and 8 cases of chylous leakage 1 case. All patients were given holistic nursing treatment during hospitalization. Physiologically and psychologically, improve preoperative preparation, closely observe the condition after operation, strengthen the observation and nursing of incision and drainage tube, and pay attention to postoperative complications.
2. Preoperative care
2. 1 Psychological nursing patients often find masses unintentionally or during physical examination, with short and sudden medical history, or the masses suddenly increase over the years, and are worried about the prognosis of the disease, showing tension and anxiety. Therefore, they should treat patients warmly, make them adapt to the hospitalization environment as soon as possible, communicate with patients more, understand their psychological state, explain the necessity of surgery and the role of preoperative preparation, relieve patients' ideological concerns and actively cooperate with the treatment of diseases. According to the patient's condition, give sedative and hypnotic drugs according to the doctor's advice to make him in the best physical and mental state for surgery.
2.2 preoperative preparation should guide patients to do posture exercises, that is, put a soft pillow on their shoulders to keep their heads low and their necks outstretched, so as to expose the surgical field during the operation. Instruct them to master the strategies of deep breathing and effective cough. Instruct them to eat a diet with enough calories, high protein and vitamins, and encourage patients to eat fresh vegetables and fruits. Follow the doctor's advice before operation, improve various auxiliary examinations, and prepare the neck and chest skin according to the situation.
3. Postoperative care
3. 1 Observe the condition, take oxygen and ECG monitoring according to the doctor's advice after operation, closely observe the changes of vital signs, and observe whether the patient has dyspnea, hoarseness, choking in drinking water, numbness of hands and feet, convulsions, etc., and observe whether there is thyroid crisis. If there is any abnormality, report it to the doctor for symptomatic treatment.
3.2 Observe whether the skin around the incision of drainage tube and nursing incision is swollen, bleeding and cyanosis. Squeeze the drainage tube regularly, keep it unobstructed and effective, closely observe the amount, color and nature of the drainage fluid, and report the symptomatic treatment in time if there is bleeding or chylous leakage.
3.3 After operation, the patient's neck should be braked under the guidance of posture and diet to avoid excessive bleeding. After conscious anesthesia and stable blood pressure, the patient can be changed to semi-recumbent position to reduce incision tension, which is beneficial to smooth drainage tube and smooth breathing. After 6 hours, according to the patient's condition, give a warm and cool semi-liquid diet to avoid overheating. Observe whether there is discomfort such as choking when eating.
3.4 Observation and nursing of postoperative complications
(1) Dyspnea and bleeding are the most serious postoperative complications, which mostly occur within 48 hours after operation. Prepare a tracheotomy bag at the bedside according to the doctor's advice, and immediately cooperate with the bedside rescue or enter the operating room to quickly remove the hematoma; If the patient has laryngeal edema, tell him not to talk and use hormones according to the doctor's advice.
(2) Observe whether there is hoarseness or aphonia after the injury of recurrent laryngeal nerve. Do a good job of comfort explanation to relieve patients' anxiety.
(3) Injury of the external branch of the superior laryngeal nerve can reduce the tension; Internal branch injury occurs when eating or drinking water by mistake. When suffocation occurs, help the patient sit up and eat or eat semi-liquid food.
(4) When the parathyroid injury occurs numbness of lips and limbs, hand and foot convulsions, intravenous injection of 10% calcium gluconate should be given immediately. When convulsing, immediately put a tongue depressor or spoon handle between the upper and lower molars to prevent biting the tongue. Limit foods with high phosphorus content, such as milk, lean meat, egg yolk, fish, etc.
(5) Observing the drainage fluid after chylous leakage, the drainage volume suddenly increased from yellow to milky white. You should suspect the occurrence of lymphatic leakage, find a doctor to check the drainage fluid in time, and make a diagnosis and treatment early. According to the doctor's advice, effective medical care measures such as continuous constant negative pressure suction, diet restriction, nutrition supplement and octreotide application were given. 1 patient with chylous leakage was completely cured after active treatment.
3.5 discharge health guidance
(1) Teach patients to check their necks by themselves and make regular follow-up visits after discharge.
(2) Guide them to practice neck activities and promote the functional recovery of the neck. Cervical lymph node dissection should start the functional exercise of shoulder joint and neck after the incision is healed to prevent the shoulder from sagging. Functional exercise should last until 3 months after discharge.
(3) Help them adjust their mentality and cooperate with the treatment.
(4) For total thyroidectomy, adequate thyroid preparation should be given at an early stage to prevent tumor recurrence.
(5) Avoid iodine diet and seafood after operation.
4. Summary
The incidence of thyroid cancer is increasing year by year, and surgical resection is the most effective strategy to improve its prognosis. Because of the trauma of radical surgery for thyroid cancer, nursing work is becoming more and more important in the curative effect of surgery and the prognosis of patients. Careful nursing is an important guarantee for the success of the operation. In a word, comprehensive nursing care of patients from the aspects of physiology, psychology and health can effectively alleviate the illness and promote the recovery of the disease.
References:
[1] Yellow,,. Perioperative nursing care of patients with thyroid cancer [J]. Contemporary nurses 20 1 1, (1): 67-68
Zhou Lei, Chen Xiujuan, Li Jing. Perioperative nursing of thyroid cancer [J]. Modern nursing 201,30 (3):151-1.
Li, Liu Pingxian. Application of octreotide in the treatment of chylous leakage after radical thyroidectomy [J]. Journal of Physician Training, 2005,28 (3): 36-37.