Model essay on nursing of thoracic surgery: Comfortable nursing of patients undergoing thoracic surgery is to make people achieve the most pleasant state in physiology, psychology, spirit and society, or reduce their unhappiness. When patients come to the hospital, their needs focus on the effectiveness and comfort of medical services. Although medical treatment is effective, patients may not be satisfied. On the contrary, if you get due respect, care, love and help during the treatment, patients will definitely feel comfortable, and even if their condition does not improve, they will feel that medical services are effective. Our hospital combines comfortable nursing mode with holistic nursing, and applies it to patients undergoing thoracic surgery, so that patients can achieve physical, psychological, social and spiritual comfort while receiving treatment with the help of nursing staff.
Clinical data of 1
38 patients, aged 65438 07-68, were randomly selected, including 23 cases of esophageal surgery, 5 cases of lung cancer, 2 cases of spontaneous pneumothorax, 7 cases of cardiac surgery and 65438 0 cases of mediastinal tumor.
2 nursing
2. 1 Comfortable nursing before operation
2. 1. 1 Create a comfortable environment with complete facilities such as sanitary shower, central air conditioning and hot water supply. Use closets and bedside tables to properly place patients' daily necessities, and use art wall hanging to beautify the ward, so that the ward is clean, bright, quiet and comfortable, with appropriate sound, light, temperature and humidity. The catering staff will book daily meals and order food, boiled water and medicine. The patient's senses are stimulated benignly, which is beneficial to treatment.
2. 1.2 create a good atmosphere, pay attention to the beauty of clothes and the gfd of nursing staff, do a good job in admission reception, do a good job in admission education, help patients handle the relationship between roommates and patients, make patients feel comfortable from new interpersonal relationships, and minimize the unhappiness caused by attention and care, thus having full confidence in this treatment.
2. 1.3 psychological intervention, advocating emotional service, face-to-face communication, flexible use of communication skills, explaining disease-related knowledge, explaining matters needing attention, evaluating psychological state, and meeting patients' psychological needs. Support and care from family, school, work unit and other social relations can also reduce or eliminate mental stress.
2. 1.4 Dietary guidance should be carefully evaluated to guide reasonable diet, improve nutritional status and improve tolerance to surgery.
2. 1.5 practice lung function and effective cough, explain the purpose and necessity of expectoration after thoracotomy to patients and their families, and instruct patients to take a deep breath and take a semi-recumbent position or a sitting position, three times a day, each time for 10 minute, so as to increase vital capacity and reduce the occurrence of postoperative respiratory complications. Effective cough method: semi-recumbent position or sitting position, cough hard after a short pause at the end of deep inhalation, and the gas rushes out quickly, and its movement promotes the secretion to move up or be coughed up.
2. 1.6 Comfortable nursing of preoperative preparation explains the content, purpose and precautions of preoperative preparation to patients, so as to obtain their cooperation.
2.2 postoperative comfortable nursing
2.2. 1 pain care 100% patients put painless in the first place in their physiological internal comfort needs. Pain is the most unbearable problem for patients, and it is also the most urgent problem for comfortable nursing. PCA analgesia pump is the first choice for comfortable nursing, which embodies the effect of continuous and constant analgesia and makes patients actively cooperate with nursing. Semi-recumbent position can be used after operation to reduce incision tension and relieve pain. When turning over and coughing, press the incision by hand, properly fix the drainage tube, and keep the drainage tube moving synchronously with the body to reduce the discomfort caused by the stimulation of the drainage tube. All kinds of nursing operations are gentle and skilled.
Respiratory nursing
2.2.2. 1 Continue to inhale oxygen for 4-6L/min for about 48 hours. 2.2.2.2 helped him turn over and instructed him to cough effectively. He knocks 1 time every 2 hours, from bottom to top, from outside to inside, making the sputum loose and easy to cough up.
2.2.2.3 conventional atomization inhalation. Dosing: Gentamicin 80000 U+ Dexamethasone 5mg+ Chymosin 4000U+ Mucosol 15mg twice a day, each time 15-20 minutes, to dilute the sputum and make it easy to cough up.
2.2.2.4 practices blowing balloons.
2.2.3 Nursing care of drainage tubes Explain the importance and precautions of each drainage tube to patients in detail to eliminate the fear of drainage. Properly fix, avoid twisting, compression, folding and countercurrent, and pay attention to the necessary support and assistance when turning over.
2.2.3. 1 patients with indwelling gastric tube can tie the gastric tube behind their ears with rope, fix it properly, and instruct them to prevent prolapse and keep smooth drainage. They can wet their lips with wet cotton swabs and cover their mouths with wet gauze when necessary to reduce water loss and increase comfort.
2.2.3.2 thoracic drainage tube should be properly fixed to avoid twisting, compression and folding. Observe the color, quantity and nature of drainage fluid at any time, squeeze the chest tube regularly, observe the fluctuation of water column, change the chest bottle every day, and report to the doctor in time if any abnormality is found.
Patients with indwelling catheter in 2.2.3.3 should be properly fixed, avoid pressing under the skin when turning over, regularly clamp the catheter to avoid countercurrent, change the urine bag every day and clean the perineum every day.
2.2.4 After the activity education, you can move your limbs and turn over, encourage patients to get out of bed as soon as possible, promote intestinal peristalsis, and reduce complications such as bedsore and venous thrombosis of lower limbs.
2.2.5 Nursing care of poor sleep quality should try to create a comfortable sleeping environment, reduce visits, keep the room quiet, the light is soft, and the daily nursing work is mild. At the same time, do a good job in psychological care and reduce the psychological burden.
3 discussion
Comfortable nursing is integrated into people-oriented holistic nursing, which runs through the whole nursing service, making patients feel comfortable and warm like relatives and have confidence in the operation, creating good conditions for the smooth operation and postoperative recovery, improving the quality of nursing service, increasing patients' satisfaction and receiving good social benefits. At the same time, it also brought new impetus to the professional quality of nurses and further improved the quality of nursing service.
Take the exam and contribute.
[1] Liao Honghui. Carry out comfortable nursing research and provide quality nursing service. Heilongjiang Nursing Journal,1999,5 (7): 40-41.
[2] Lu Liehong. Investigation and analysis of patients' needs for physical and mental comfort [J]. Journal of Nurses' Continuing Education, 2002, 17 (12): 937-938.
Model essay on nursing in thoracic surgery 2: postoperative nursing guidance for patients in thoracic surgery Keywords: patience; nurse
After thoracic surgery, correct, timely and multifaceted nursing is very important in the process of patients' anesthesia awakening, wound healing and physiological function recovery. Postoperative care of patients in thoracic surgery plays a vital role in the success or failure of surgical treatment. In our daily work, we summarized a set of systematic and feasible guiding principles for postoperative nursing according to the problems that are easy to occur after thoracic surgery and our own practical work experience. According to this principle, combined with practical problems, nursing work was carried out systematically and pertinently, which improved the postoperative nursing level of patients in thoracic surgery and promoted their rehabilitation.
Help patients recover their respiratory function as soon as possible after 1 operation.
After thoracic surgery, the effects of anesthetics and anesthetic auxiliary drugs have not completely disappeared, and factors such as chest incision pain and chest strap restraint will affect breathing and even lead to hypoxemia. Therefore, patients often need to enter the recovery room after surgery. Adjust the patient's good respiratory and circulatory function to help the patient regain consciousness as soon as possible. During the recovery room, patients should closely monitor vital signs [1], rationally use narcotic drugs, fully replenish circulating blood volume, and adjust moderate blood acid-base balance and electrolyte content. When necessary, the concentration of inhaled oxygen should be increased, and the tracheal catheter should be kept according to the condition, or mechanical ventilation should be given for a short time to ensure the patient's respiratory tract unobstructed and avoid CO2 retention and hypoxia [2 ~ 3].
2 Nursing care of postoperative pain
Pain after thoracic surgery can lead to changes in respiratory and circulatory functions, endocrine and immune functions, and even lead to complications such as atelectasis, hypoxemia and hypercapnia, which will affect the surgical effect and the recovery of patients. Our main experiences in nursing postoperative pain are as follows: (1) Psychological nursing: let patients know the causes of pain and encourage them to have confidence to overcome the pain psychologically; Instruct patients to take a deep breath, breathe rhythmically, and focus on breathing exercise to effectively promote lung recruitment; Nurses and their families often talk to patients or instruct patients to massage around the skin rhythmically and steadily or stare slightly to divert attention and relieve postoperative pain; In addition, you can listen to some light music to relax your spirit and achieve the effect of relieving pain [3]. (2) Nursing care of applying analgesics [4 ~ 5]. For postoperative pain with obvious nature and clear reasons, preventive medication and regular medication should be taken, rather than waiting until the pain is unbearable. At the same time, maintain a stable blood concentration and observe the adverse reactions of drugs. For patient-controlled analgesia, the purpose and usage of patient-controlled analgesia should be informed after operation, and the analgesic effect should be evaluated by regular rounds, and the patient's blood pressure, pulse and breathing should be monitored. (3) ordinary care. Assist patients in body position change, cough and other activities; Correctly fix closed thoracic drainage tube, urinary tube and nasogastric tube; Prevent wound infection; Create a comfortable environment and avoid the pain induced or aggravated by environmental factors such as strong light and noise.
3 Nursing care of respiratory tract
Strengthening respiratory care, clearing respiratory secretions in time and keeping respiratory tract unobstructed are very important for preventing and treating postoperative complications of thoracic surgery, especially pulmonary infection. (1) Ward environment requirements: The indoor temperature of laminar disinfection ward in ICU is 20℃ ~ 24℃ and the humidity is 50% ~ 60%. Ordinary wards require fresh air and ultraviolet disinfection once a day to reduce the number of accompanying and visiting personnel and avoid increasing exogenous infection. (2) Postoperative posture nursing: Before anesthesia, you should lie on your back with your head tilted to one side. After the patient was awake, his blood pressure was stable. Can you change the semi-recumbent position and raise the head of the bed by 30? ~60? , in order to facilitate the exchange of lung gas, and can relax the chest and abdomen muscles and relieve incision pain. (3) Keep the respiratory tract unobstructed: ① Instruct the patient to take a deep breath and cough from the depths at the end of deep inhalation, so as to facilitate the discharge of sputum. (2) often pat the patient on the back. Methods: The patient took a semi-recumbent position, stood on the affected side of the patient, tapped the contralateral lung with the cupped palm, and tapped the contralateral lobe with wrist strength, from bottom to top, from outside to inside. ③ Sputum is sticky, difficult to cough up, and can be atomized and inhaled. Medication: 20 ml of normal saline and 80,000 u of gentamicin. -chymotrypsin 4 000 u, three times a day, 20 min each time, to dilute the sputum, reduce the resistance of sputum, which is beneficial to the discharge of sputum, and at the same time, the drug directly enters the alveoli, reducing infection. ④ Encourage patients to blow balloons. Suffering from deep breathing, the diaphragm drops, and ineffective intra-cavity ventilation is improved, which is beneficial to the discharge of pneumothorax and effusion, ensuring effective ventilation and preventing lung infection. ⑤ Encourage patients to exercise in bed. Instruct and assist patients to get out of bed and do moderate exercise to increase vital capacity and reduce pulmonary complications, but avoid excessive exercise. Patients with cardiovascular diseases should be cautious to prevent accidents. (4) do a good job in oral care. Oral care can reduce bacteria in the mouth, prevent bacteria from moving down, and reduce the chance of lung infection. Sober patients can also encourage gargling, but it is necessary to prevent accidental swallowing. (5) Correct use of analgesics. Postoperative incision pain and intubation discomfort limited the patient's cough. Postoperative analgesia should be sufficient. Analgesic pump should be used for 48 ~ 72 h or given according to the doctor's advice. On the one hand, it can relieve pain, on the other hand, it can make patients get enough rest, maintain physical strength and avoid weak cough. (6) Fully replenish the amount of liquid. Attention should be paid to the administration time and infusion speed to avoid pulmonary edema caused by too fast [6].
4 Rehabilitation nursing
Early activities and rehabilitation exercises play an extremely important role in postoperative care of patients with thoracic surgery, and play a positive role in promoting postoperative functional recovery of patients. (1) Get out of bed early after operation. Before anesthesia, nurses do passive activities for patients, exercise upper limb joints and massage lower limbs. Especially for elderly patients, it is necessary to regularly exercise the joints of limbs, especially below the knee joint, to prevent venous thrombosis of lower limbs. When the patient is awake, he can be encouraged to take a deep breath. Ask him to take the initiative to do the activities of fingers, toes, wrists, ankles, elbows, shoulders and hip joints, especially the activities of the upper limbs on the surgical side. After the patient's blood pressure is stable, he can turn over, turn his neck, lie half or sit. (2) Early postoperative ambulation: Generally, on the third day after operation, when the patient's condition is stable and the closed thoracic drainage tube has been removed, encourage and assist the patient to get out of bed. Sit in the chair beside the bed for a while, 2 ~ 3 times a day, try to walk on the bed on the fourth day, and then gradually increase the activity. If the patient really has a sharp pain in the incision, Getting out of bed should not be carried out reluctantly. If necessary, painkillers can be given, and then getting out of bed can relieve the pain, so as to alleviate the pain of patients and achieve the expected effect [7 ~ 8].
refer to
Yang Minghua Zhongling 1. Observation and nursing care of patients with blood pressure, heart rate and blood oxygen saturation after surgical anesthesia. Fujian Medical Journal, 2000,22 (4):154.
2. Deng, Jing, et al. Nursing experience of patients undergoing thoracic surgery during anesthesia recovery period. PLA Nursing Journal, 2004,21(4): 77-78.
3 Yu Liying. Nursing guidance for patients in thoracic surgery before and after operation. Medical Theory and Practice, 2005, 18 (6): 72 1.
4 Yu Shu Street, Li Jianping. Related factors, analgesia and nursing care of postoperative pain in thoracic surgery patients. Journal of Practical Nursing, 200 1, 17 (12): 33-35.
5 Huang Shumin. Postoperative analgesia and nursing care of patients undergoing thoracic surgery. Tianjin Nursing,1999,7 (3): 92-93.
6 Yin, high. Respiratory nursing care of postoperative patients in thoracic surgery. Chinese and foreign health abstracts, 2008,5 (7): 91.
Zhang Lijuan, Ma Yumei and Peng Jiuling. Early postoperative activities and nursing care of thoracic surgery patients. Heilongjiang medicine, 200 1, 25 (8): 6 15.
Qi Jumei, Zhang Xiangyun, Zhang Junyi. Nursing care of early postoperative activities and rehabilitation training for thoracic surgery patients. Henan Journal of Surgery, 2006, 12 (4): 97-98.
Discussion on related articles of nursing papers in thoracic surgery;
1. On the papers of surgical psychological nursing
2. Model essay on surgical nursing.
3. Surgical nursing papers
4. Model essay on surgical nursing
5. Surgical clinical nursing papers