Topic: Application of holistic nursing in perioperative period of femoral head replacement.
Abstract: Fifty elderly patients with femoral neck fracture, aged 665438 0 ~ 84 years, underwent femoral head replacement. Through the holistic nursing in perioperative period, the original complications were controlled at the time of admission. Except for 2 patients with original respiratory diseases, there were no new complications after operation. Hip and leg exercises were carried out early after operation, and the operation achieved satisfactory results.
Key words: holistic nursing, femoral head replacement, perioperative period
From March 2003 to February 2004, our department treated 3 elderly patients with femoral neck fracture 1 13 cases, of which 50 cases underwent femoral head replacement. The overall nursing characteristics of perioperative period are summarized as follows.
Clinical data of 1
There are 50 cases in this group, including 20 males and 38 females. The age was 6 1 ~ 84 years, with an average of 69.3 years. There were 9 cases of cardiovascular diseases, 4 cases of respiratory diseases, 7 cases of diabetes, 2 cases of urinary tract infection and bedsore 1 case. Patients in this group were treated with tibial tubercle bone traction after admission, operated after 4 ~ 10 days, and discharged after 15 days. Two elderly patients with chronic bronchitis suffered from postoperative respiratory tract infection, which was controlled after symptomatic treatment.
2 Preoperative nursing
2. 1 general nursing before admission preoperative nursing is multidisciplinary comprehensive nursing, to ensure the safety and comfort of patients. Take the initiative to help with admission procedures, and introduce the general situation, conditions and equipment of the hospital to patients and their families, introduce the responsible medical staff, equip them with daily necessities, familiarize themselves with the surrounding environment, and make patients feel at home.
2.2 Psychological nursing timely grasps the personality characteristics, family relationship, social background and psychological state of elderly patients, provides targeted psychological support and guidance, eliminates patients' fears and anxieties, and helps patients build confidence in overcoming diseases and accept surgical treatment with a good attitude.
2.3 Observe and treat the complications. For patients with fractures and complications, we should strengthen patrol observation, pay attention to the changes of vital signs, and cooperate with doctors to treat complications. At the same time, attention should be paid to helping patients turn over and pat their backs, encouraging active coughing and expectoration, expanding their chests and increasing their vital capacity; Seriously do a good job in perineal hygiene; Encourage patients to drink about 2,000 ml of water every day; Cushion the buttocks with water, instruct the patients to carry out hip lifting training 30 ~ 50 times a day, effectively massage twice a day, and massage the carina and compressed parts when necessary. Through the above methods, the original complications were controlled and the new complications were reduced. Only 2 patients with primary respiratory diseases had lung infection aggravated, and were given anti-infective drugs, oxygen inhalation, atomized inhalation and sputum aspiration, 1 week for control.
2.4 Preoperative preparation and nursing inform the patient of the operation time, explain the necessity of the operation, make the patient full of confidence, make routine preparations one day before the operation, ensure a good sleep at night before the operation, assist the doctor to pull out the bone in the morning of the operation, disinfect with 75% ethanol, wrap the operation site with sterile cloth, and escort the patient into the operating room.
3 postoperative care
3. 1 The patient should receive it in time after the operation of vital signs observation, and carry out ECG monitoring according to the nursing after epidural anesthesia, closely observe and record the changes of vital signs in detail.
3.2 Posture and drainage tube nursing patients take a low pillow supine position after operation, and abduct the affected limb for 3O? Knees slightly bent. Wear? Ding? Straight shoes, prevent external rotation, don't lie on your side or cross your legs. Connect the drainage bag in time, keep a certain negative pressure and unobstructed, pay attention to the drainage volume, and contact the doctor in time if there is a lot or other discomfort.
3.3 Nursing to prevent complications: The organs of the elderly declined, and their nutritional status generally deviated. In addition, surgical trauma, low immune function and low anti-infection ability are prone to complications. Nursing work is particularly important, including: (1) eliminating intraoperative tension in time, restoring normal mood, keeping the ward quiet, creating a good rest environment for patients and giving them adequate rest. Those with severe postoperative pain should be given appropriate sedatives and drugs according to the doctor's advice. (2) For patients with cardiovascular and respiratory complications, strictly control the infusion speed, give oxygen when necessary, encourage patients to take deep breaths and chest-expanding exercises, and get out of bed after 3 days with bedside sling. (3) Elderly patients have poor gastrointestinal digestive function and less exercise in bed. After operation, we should strengthen nutrition, pay attention to diet regulation, and eat a small amount of light, digestible, high-calorie and vitamin-rich foods, such as fresh vegetables, fruits, fish and bean products. (4) Because of trauma and operation, the blood of the elderly is in hypercoagulable state, which is easy to cause deep vein embolism of lower limbs, so early functional exercise is extremely important. After anesthesia disappeared, all patients in this group performed static contraction of quadriceps femoris and ankle flexion and extension activities 50 times a day, and massage activities of affected limbs 65,438+0 times in the morning and afternoon respectively.
3.4 After three days of functional exercise, the patient gradually leans back, 1 week later, the knee joint and hip joint flexed for 8O? ~90? Come to the hospital for a follow-up visit with crutches for 4 weeks.
4 discussion
Femoral neck fracture is a common and frequently-occurring disease in the elderly. Conservative treatment of bed rest for a long time has two serious complications: nonunion and femoral head necrosis. Therefore, surgical treatment is becoming more and more common, and perioperative nursing work must be highly valued. Fracture in the elderly is often accompanied by other complications, which brings trouble to surgical diagnosis and treatment. Therefore, perioperative holistic nursing is particularly important. In this group, except for 2 cases of original respiratory diseases and postoperative pulmonary infection, other complications were effectively controlled and no new complications occurred. The curative effect of this group of cases is satisfactory, in which perioperative holistic nursing plays an important role, which requires close cooperation between nurses and patients and their families, adequate psychological care before and after operation, perfect preoperative preparation and accurate functional exercise, which can effectively prevent complications and restore the function of the affected limb.
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