Surgical Admission Nursing Health Education

Theme 1: Health knowledge education on gastroduodenal ulcer

——Preoperative preparation, postoperative care

Preoperative preparation:

1. Dietary conditioning, eat less but more carefully, and choose foods with high nutritional value, such as milk, eggs, fish, etc. Supplement with vitamin-containing fruits and maintain small meals with frequent meals. It is better to eat soft rice and noodles as staple food.

2. Practice using the bedpan on the bed before surgery to prepare for defecation during the postoperative period. Practice deep breathing and coughing techniques.

3. Clean the intestines the day before the operation, and be guided in swallowing movements when the gastric tube is inserted on the morning of the operation.

Postoperative care:

1. It is normal for the body temperature to be below 38 or 5 degrees three days after the operation. It is the heat absorbed by the surgery and does not require treatment.

2. Keep each drainage tube unobstructed, do not bend it, and be careful not to pull the drainage tube when turning over or getting out of bed to prevent it from falling off. Patients with gastric tubes should receive oral care twice a day.

3. You can drink a small amount of water on the day after extubation, 4-5 tablespoons each time, once every 1-2 hours. Avoid milk and foods with high sugar content to avoid causing bloating. Eat small amounts and often, and avoid hard, oily, fried, strong tea, chili and other irritating foods.

4. Early out-of-bed activities: Sit up on the first day after surgery and move joints and muscles in bed. If there are no contraindications, you can start getting out of bed and supporting the bed on the second day to promote intestinal peristalsis and prevent intestinal adhesions. .

5. Exercise appropriately and do not lift objects weighing more than 10 pounds within six weeks to keep your mood comfortable. Theme 2: Health knowledge education on cholecystitis and cholelithiasis

——Cause, pre-operative, postoperative and discharge instructions

Cause:

Biliary tract infection-due to Bile retention, caused by bacterial or parasitic invasion.

Cholelithiasis - stone formation is mainly related to increased cholesterol metabolism, bile retention, biliary parasites and biliary infection.

Clinical manifestations:

Cholecystitis - paroxysmal pain in the right upper abdomen, which often occurs after greasy food or a heavy meal. The pain can radiate to the right shoulder, accompanied by nausea and vomiting. fever.

Cholelithiasis - abdominal pain, paroxysmal cramping and tenderness in the right upper quadrant and subxiphoid process. Chills and high fever, jaundice.

Treatment: Surgery is the main treatment.

Preoperative guidance:

1. It is advisable to eat a light, easy-to-digest diet, avoid fatty meat, fried, deep-fried and other high-fat foods, and supplement vitamins B, C, K.

2. If jaundice causes skin itching, follow the instructions and use medicine or warm water scrub to relieve the symptoms. Do not scratch with your hands to prevent infection.

3. No smoking before surgery to reduce the chance of lung infection.

4. Special inspection.

5. An enema is given one day before the operation, and a gastric tube and a urinary tube are placed on the morning of the operation.

Postoperative instructions:

1. Lie down for 6 hours after the operation and the blood pressure will be stable, taking a semi-recumbent position to facilitate drainage.

2. You can try getting out of bed on the second day after surgery to promote intestinal peristalsis and prevent intestinal adhesions.

3. Keep each drainage tube unobstructed, do not fold or press the drainage tube, and be careful not to pull it when turning over or getting out of bed to avoid falling off.

4. Diet: After intestinal motility is restored and the gastric tube is removed, you can eat a high-protein, high-fiber, low-fat diet and foods containing vitamins B and K.

5. T-tube care: Keep the drainage tube unobstructed and do not bend, press or fall off to avoid the formation of bile peritonitis. Generally, try clamping the tube about 2 weeks after the tube is inserted. If there is no discomfort after 48-72 hours Extubation may be considered, and biliary manometry or T-tube angiography may be performed before extubation.

Discharge instructions:

1. Keep your mood comfortable and restore the function of the gallbladder to secrete bile through appropriate physical exercise.

2. Due to cholecystectomy, bile will not be stored in the gallbladder, and the digestion and absorption of fatty foods will be affected. Therefore, it is advisable to eat a high-protein, low-fat diet, and avoid eating fatty meats, fried foods, and more. Eat fruits and avoid overeating.

3. If diarrhea occurs, send a thin and mushy stool for testing 2-3 times a day. If there are no red blood cells and white blood cells in the stool, it is normal. It may be due to eating a small amount of fatty food and not being able to absorb it well.

4. If you are discharged from the hospital with a T-tube, it means that there may be residual stones in the bile duct. After the operation, you will go to the outpatient operating room to remove them through the T-tube according to the doctor's instructions to avoid suffering from further surgery.

5. If the wound appears to be red, swollen, painful or has high fever, please return for a follow-up visit. Unless there are special circumstances, an outpatient examination will be conducted after one month.

6. There is no need to cover the wound with gauze 24 hours after the stitches are removed, and you can take a shower. Theme 3: Breast cancer health knowledge education (repost)

——Preoperative guidance, postoperative functional exercise

1. Cause: related to estrogen changes and endocrine disorders.

2. Symptoms: Painless lumps in the breast.

3. Treatment:

(1) Surgical treatment.

(2) Radiotherapy.

(3) Hormone therapy.

(4) Chemical drug treatment.

4. Preoperative guidance:

(1) Keep a happy mood.

(2) Eat a nutritious diet high in protein, high in calories, and high in vitamins to improve the body’s resistance.

(3) Breast cancer patients during pregnancy and lactation should terminate pregnancy and wean immediately.

(4) Skin preparation of the surgical field: Pay special attention to the cleaning of the nipple and areola. If skin grafting is required, the skin of the donor area should be prepared. If there are skin ulcers, the skin should be started three days before the operation. Change the dressing twice a day, and wipe and disinfect the skin around the ulcer with alcohol.

5. Postoperative functional exercise: In order to reduce the impact of scar shrinkage on the function of the affected limb, you can do fisting, wrist flexion and other movements on the 1-2 days after surgery, and elbow flexion exercises on the 3-4 days. On the 5th day, you can touch the contralateral shoulder and the ipsilateral auricle with the palm of your hand. On the 7th day, you can do shoulder exercises. On the 9th to 12th day, you can exercise the affected limb and do wall climbing exercises with your fingers. Initially, use the palm of the unaffected side to support the affected elbow. Slowly raise the head until it is at shoulder level. On the 14th day, practice placing the palm of the affected side on the back of the neck, starting with the lowered head position and gradually reaching the head-headed position. Theme 4: Perioperative health education for gastric cancer patients (zt)

Education content

1. Implement protective medical measures and provide psychological guidance

Patient family members The patient is required to keep confidentiality and cooperate in implementing protective medical measures, but the patient's family members should explain their condition and obtain cooperation. According to the different situations of patients, we actively provide psychological counseling and patiently, meticulously and popularly explain relevant medical knowledge to patients.

2. Preoperative guidance

(1). Dietary guidance: Patients with gastric cancer are usually in the middle or late stage when symptoms appear and seek treatment. The body consumes a lot and often suffers from symptoms of malnutrition. You should eat more nutritious, easy-to-digest, non-irritating, low-residue diet, and eat small meals frequently. Patients with severe obstruction should fast and supplement high-energy nutrition or elemental diet intravenously according to doctor's instructions.

(2). Gastrointestinal tract preparation: Fully explain the importance of gastrointestinal tract preparation to the patient, and instruct the patient to eat a liquid diet, such as lean meat soup, milk, vegetable soup, etc. the day before the operation. Cleanse enema and fasting the night before surgery, and leave a gastric tube in the morning to drain the gastric contents. For those with pyloric obstruction, gastric lavage with 300 to 500 ml of warm saline every night for three days before surgery will facilitate the smooth progress of the surgery. .

(3). Education before surgery: Practice urinating in bed one week before surgery to avoid urinary tract infection caused by leaving a urinary catheter for too long after surgery. Teaching patients to cough effectively three days before surgery will help prevent postoperative pulmonary complications. On the day before surgery, the content, purpose and precautions of preoperative preparation will be explained to the patient according to the surgical method. The patient should ensure sleep the night before surgery.

3. Postoperative guidance

(1). Posture and activity guidance: Explain to the patient and family members the importance of the patient taking a semi-recumbent position after surgery, which is conducive to breathing and drainage. The smoothness of the gastric tube can also reduce the pain of the incision and increase the amount of activity appropriately. You can sit up one month after the operation, move indoors on the ground in 3 to 4 days, and move in the corridor after the sutures are removed in 7 to 10 days, which is conducive to the recovery of gastrointestinal function.

(2). Gastric tube nursing guidance: Explain the importance of gastric tube to patients and their families. Normally, a small amount of dark red or brown gastric juice can flow out from the gastric tube within 24 hours after surgery, generally no more than 300 ~600ml, the amount gradually decreases, and can stop on its own. If a large amount of blood flows out of the gastric tube within 24 hours after surgery, there may be anastomosis bleeding, and medical staff should be reported immediately for prompt treatment. If gastric juice decreases, color becomes normal, intestinal motility recovers, and anal exhaust occurs 24 to 48 hours after surgery, the gastric tube should be removed.

(3). Dietary guidance: fast after surgery. After the gastric tube is removed, a small amount of drink can be given on the same day, 4 to 5 tablespoons each time, once every 2 hours. If there is no discomfort, it can be given the next day. Give an appropriate amount of liquid diet, 50-80ml each time; on the third day, give a full amount of liquid diet, 100-150ml each time.

If the patient returns to normal after surgery, you can eat porridge and other low-sugar semi-liquid diets on the fourth day. After two weeks, you can eat soft foods. The staple food and side dishes should be nutritious and easy to digest. However, if the patient develops nausea, bloating and other symptoms after eating, he should still stop eating.

(4). Observation of complications and nursing guidance: If the patient develops upper abdominal distension, palpitation, sweating, dizziness, fatigue, vomiting, etc. after eating, especially 10 to 20 minutes after eating sweets. Symptoms such as collapse and diarrhea may be dumping syndrome. At this time, lying down for a few minutes can relieve the symptoms. Instructing the patient to stay in bed to eat or lie down for 20 to 30 minutes after eating can prevent or alleviate the above symptoms. If you still feel abdominal pain and fever one day after the operation, and you can see a lot of fluid and gastric contents flowing out from the incision, it indicates an anastomotic leak. At this time, negative pressure should be continued to aspirate the outflowing gastrointestinal fluid and maintain the fistula. The skin around the mouth should be clean and dry and protected by applying zinc oxide ointment to prevent intestinal juice from corroding the skin.

4. Discharge Instructions

(1). Instruct patients to eat correctly and regularly. They should eat small meals frequently within one month after surgery, and then gradually eat normally depending on their physical recovery.

(2). Instruct the patient to rest within one month after being discharged from the hospital, to participate in light labor after two months, and to engage in light work according to his recovery situation after three months.

(3). Feel comfortable and avoid mental stimulation.

(4). Follow the doctor’s instructions for regular review. Hernia repair

1 Preoperative guidance

(1) If you have a chronic cough, you should take oral cough medicine before surgery to cure the cough, because coughing will cause increased abdominal pressure;

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(2) If you have constipation, you can take honey water, paraffin oil, and fiber-containing foods. Such as spinach, etc., to relieve constipation;

(3) If you smoke, please quit smoking immediately, because smoking aggravates bronchitis and cough, which is detrimental to surgical recovery;

(4 ) Keep warm and avoid catching a cold;

(5) Practice using the toilet in bed to avoid difficulty urinating due to not being used to defecating in bed during bed rest;

(6) Please Buy a bag of table salt before surgery.

2 Postoperative instructions

(1) Wrap the salt in a dry towel and press it on the wound to prevent bleeding, and remove it after 12-24 hours;

(2) Observe the wound dressing for excessive bleeding;

(3) It is not advisable to use the semi-recumbent position too much to avoid increasing abdominal pressure and affecting the healing of the surgical repair site. Generally Lie on your back for three days after the operation. If you adopt a semi-recumbent position the next day, the knee joint should be flexed and a soft pillow placed under the knee to relax the abdominal wall and reduce tension;

(4) Keep the wound dry, if necessary The dressing should be changed in time when urine is wet to avoid wound infection;

(5) Diet: You can eat liquid or soft food 6-12 hours after the operation, and regular food the next day;

< p>(6) Temporary loss of bladder function due to anesthesia or surgical stimulation after surgery. You may have difficulty urinating, and we will induce urination or place a urinary catheter before surgery;

(7) Please keep warm to prevent coughing due to cold.

3 Discharge Instructions

(1) Please balance work with rest and gradually increase the amount of activity. Generally, you should not participate in heavy physical labor within three months; do not lift heavy objects;

(2) Drink more water and eat more high-fiber diet, such as vegetables and fruits, to prevent constipation;

(3) If you have heart and lung diseases, please treat them early, because repeated coughing will cause Leading to recurrence of hernia

Thyroid surgery

1 Preoperative guidance

(1) Practice posture: Before surgery, practice neck hyperextension position (as shown on the following page) (shown), the method is to lie in a semi-recumbent position, put a pillow under the shoulders, and tilt the head back.

Among them, patients with thyroid tumors practice 1.5 to 2 hours/day, patients with nodular goiter 2 to 2.5 hours/day, and patients with hyperthyroidism 2.5 to 3.5 hours/day, step by step;

(2) Pain should be maintained Calm down and don’t be nervous. If you have insomnia, you can take diazepam orally as directed by your doctor;

(3) If you have symptoms of exophthalmos, you can take a semi-recumbent position. The semi-recumbent position can help reduce eye congestion. You can wear black Wear glasses for protection, and use eye ointment for protection during sleep;

(4) You should eat high-calorie, high-vitamin foods before surgery, such as fish, meat, fruits, etc.; because the disease makes you have a strong metabolism and consume a lot ;

(5) Routine examinations that you need to do: In addition to routine blood, urine, stool, and biochemical electrolyte tests, you also need to do them (the following examinations will be taken to you by the staff of our nursing center) :

①Neck radiography: to understand whether there is pressure on the esophagus and the nature of the nodules, whether there is calcification;

②Electrocardiogram: to understand the heart function;

③ Throat and neck examination: Understand the function of the vocal cords;

(6) Your preoperative medication:

① Drugs such as methimazole can control the symptoms of hyperthyroidism, but can cause thyroid enlargement. Congestion is not conducive to surgery;

② Oral iodine: It is used to reduce congestion, shrink and harden the thyroid gland, which is conducive to surgery; dosage: three times a day, starting from 5 drops each time , add 1 drop to 15 drops each time every day, and then maintain until the time of surgery; for example, 5 drops each morning, noon and evening on the first day; 6 drops each morning, noon and evening on the second day; 7 drops each morning, noon and evening on the third day. By analogy, up to 15 drops, use a 1mL empty needle to absorb the iodine solution, add the prescribed number of drops to steamed buns, cakes and other foods for consumption. The above medicines must be taken according to the doctor's advice.

2 Postoperative instructions

(1) You should be in a semi-recumbent position after returning from the operating room, which is conducive to breathing and drainage of wound exudates;

< p>(2) If you cough when you feel secretions in your pharynx, just cough normally. Severe coughing will irritate the surgical site and cause the ligature to fall off and bleed;

(3) Please reduce your talking after surgery. In order to keep the vocal cords and larynx in a resting state;

(4) You can take liquid food 1-2 days after the operation to reduce difficulty in swallowing and throat discomfort. If the nerves are damaged, warehouse cough occurs. , you can eat semi-solid food, such as cakes, noodles, etc.;

(5) Please take the following measures to reduce pain;

① Avoid excessive extension of the neck, excessive bending can cause compression Hyperextension of the trachea can cause traction pain;

② The head should be moved slowly; rapid head movements should not be allowed;

③ When standing up, please support the head with your hands. To prevent pain caused by suture pulling;

④ If you find the following conditions, please notify the doctor and nurse immediately:

a. Abnormal sensation and numbness in the limbs around the mouth, tremors and twitching of the limbs;

b. The incision is red, swollen, hot and painful;

c. Difficulty breathing, voice change, pressure, neck tightness, excessive bleeding;

d. Rapid heartbeat, body temperature higher than 39°C, and lethargy.

3 Discharge Instructions

(1) Please ask the nurse or doctor about the dosage, usage, and side effects of the medicines you will take when you are discharged;

(2) If you are Patients who have had total thyroidectomy need to take long-term thyroxine replacement therapy;

(3) If you have hoarseness or aphonia, this is a symptom of laryngeal nerve damage. Please use drugs that promote nerve recovery appropriately. Combined with physical therapy and acupuncture to promote recovery, recovery will generally occur within 3-6 months;

(4) 2 weeks after the suture removal, move the neck back and forth, left and right, to prevent scar shrinkage;

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(5) You need to engage in regular activities, which will help stimulate the function of the residual thyroid gland;

(6) Diet:

① Postoperative hypothyroidism During this stage, caloric intake should be reduced to prevent weight gain;

② Avoid eating thyroid-suppressing foods (radish, soybeans, etc.);

③ Do not eat pepper, cinnamon, ginger, white pepper, etc. Tartaric acid, bamboo and other foods. Nursing care of patients undergoing surgery for pancreatic head cancer

Pancreatic head cancer accounts for 2/3-3/4 of pancreatic cancers. It is a digestive system cancer that has gradually increased in recent years. It is highly malignant and develops rapidly, making early diagnosis difficult. , the prognosis is poor.

Clinical manifestations include upper abdominal pain, fullness, discomfort and gastrointestinal symptoms due to pancreatic and bile duct obstruction and increased intraluminal pressure; jaundice caused by cancer compressing or invading the common bile duct, which is progressively aggravated and accompanied by skin Itching, slow pulse, tendency to bleed; weight loss and fatigue due to reduced diet, indigestion, lack of sleep, and energy consumption by cancer. Once pancreatic head cancer is diagnosed, if there is no distant metastasis, pancreaticoduodenectomy or cholecystojejunal or duodenal anastomosis should be performed as soon as possible; external fistula, that is, percutaneous hepatobiliary catheter drainage (PTCD) or cholecystostomy. Common nursing problems include: ① sleep disorder; ② constipation; ③ risk of oral mucosal changes; ④ risk of skin damage; ⑤ potential complications - infection; ⑥ potential complications - insufficient body fluids; ⑦ lack of knowledge: often Percutaneous transhepatic puncture cholangiography (PTC), endoscopic retrograde cholangiopancreatography (ERCP) and other relevant knowledge; ⑧ Lack of knowledge: postoperative rehabilitation nursing knowledge.

1. Sleep disorders

Related factors:

1 Upper abdominal pain and discomfort with fullness.

2 Itchy skin.

Main manifestations:

1 Main complaint is that the skin is itchy and uncomfortable and cannot fall asleep, or sleep is interrupted due to pain in the upper abdomen.

2 The patient is restless and has poor sleep quality, manifested by listlessness, fatigue, and inability to concentrate.

Nursing goals:

1 The patient complains of getting enough sleep, and is more energetic after sleep.

2 The patient can express and master methods that are beneficial to promoting sleep.

Nursing measures:

1 Provide a quiet and comfortable resting environment in the ward to avoid the influence of adverse stimulation.

2 Instruct the patient to take a comfortable lying position, such as lying on the side or slightly bending the lower limbs, to reduce the local pressure or tension caused by the cancer and reduce the patient's upper abdominal pain and fullness.

3 Give the patient a bath with warm water every day, keep the skin clean and dry, and avoid using alkaline soap or shower gel that is too irritating to the skin.

4 Tell the patient to wear cotton, soft underwear, change them promptly after contamination, and keep the underwear clean and dry.

5 Remind patients to avoid drinking stimulating and exciting drinks such as coffee or strong tea before going to bed. They can drink an appropriate amount of hot milk or listen to soft music before going to bed to promote falling asleep.

6 If necessary, give sedative-hypnotics as directed by the doctor, and evaluate the effects of the medication.

Key evaluation:

1 Whether the patient’s sleep quality has improved.

2. Whether the patient knows how to reduce the triggers that affect sleep.

2. Constipation

Related factors:

1 Pancreatic and bile duct obstruction leads to obstruction of the discharge of bile or pancreatic juice, and gastrointestinal digestive dysfunction.

2 Improper diet.

Main manifestations:

1 Mainly complaining of difficulty and pain during defecation, and dry and hard stool.

2 The frequency of defecation decreases, and a mass can be palpable in the left lower abdomen.

Nursing goals:

1 The patient complains that constipation symptoms are reduced or disappeared.

2 The patient masters the methods to promote the formation of stool or keep the stool soft and hard, and establish the habit of regular defecation.

Nursing measures:

1 Encourage the patient to eat and increase the fiber content in the diet. At the same time, bananas can be eaten to promote stool discharge.

2 Instruct patients to drink enough water every day, drink 1500-2000mL, and drink 1 cup (200-250mL) of water before going to bed.

3 Teach the patient to perform abdominal massage in the direction of intestinal peristalsis.

4 Urge patients to have a regular life and avoid consciously suppressing the urge to defecate.

5 Instruct patients to develop the habit of regular bowel movements.

6 If necessary, use laxatives or give low-pressure enema as directed by the doctor.

Key comments:

1 Is the patient's defecation timely and regular?

2 The patient complains whether it is easy and painless to defecate.

3. Risk of oral mucosal changes

Related factors:

1 Low water intake or fasting.

2 The body temperature is too high and saliva secretion is reduced.

3 With an indwelling gastric tube, mechanical friction damages the oral mucosa.

4 After general anesthesia and intubation.

Main manifestations:

1 Mainly complaining of dry mouth, dry tongue, and throat pain.

2 The lips are chapped, the tongue surface is eroded, and the throat is congested.

Nursing goals:

1 The patient complains that the mouth feels refreshed and there is no discomfort.

2 There are no abnormal changes in the patient’s oral mucosa/tissue.

3 The patient masters general oral care methods.

Nursing measures:

1 Observe and record the current status of the patient’s oral mucosa/tissue, and choose appropriate oral care methods.

2 Provide patients with oral hygiene care and improve oral hygiene. For those in generally good condition, instruct them to brush their teeth in the morning and evening and after meals.

3 During the high fever period, encourage patients to drink more water and rinse their mouths with Dobe liquid.

4 During fasting and when the gastric tube is indwelling, provide oral care to the patient with normal saline every day to prevent oral complications.

5 For those with chapped lips, apply a little paraffin oil for protection; for those with cracked or eroded tongue surfaces, apply gentian violet locally to reduce inflammation after oral care; for those with throat congestion and pain, use steam inhalation or ultrasonic atomization Inhaled.

6 Provide patients with light, nutritious, soft and hard meals, and avoid eating overly hot, cold, hard, spicy and other irritating foods.

Key evaluation:

1 Whether there are any abnormal changes in the patient’s oral mucosa/tissue.

2 The patient mainly complained whether his mouth felt clean and comfortable.

4. Risk of skin damage

Related factors:

1 Jaundice causes itchy skin.

2 Postoperative multi-tube drainage, such as abdominal drainage tubes, jejunostomy tubes, etc.

3 Stay in bed for a long time and do not understand the importance of activities in bed.

Main manifestations:

1 Complaints of skin itching and having to scratch.

2 Complaints of skin pain at the pressure area.

3 There are scratches on the skin, and the skin where the bony protrusions are pressed is red, tender, or even damaged.

Nursing goals:

1 The patient’s skin is intact.

2 The patient can describe self-protective measures to prevent skin damage.

3 Patients can understand and accept skin care.

Nursing measures:

1 Explain to the patient the causes of skin itching and educate the patient on measures to protect the skin:

(1) Do not scratch the skin when itching , to avoid scratching.

(2) Use warm water to bathe or bathe every day, and avoid using rough towels and irritating soaps or body washes.

(3) Wear cotton underwear and keep it clean and dry.

(4) Antipruritic agents can be used appropriately.

2 During bed rest, pay attention to skin care:

(1) Use safflower alcohol to regularly massage the skin on bony protrusions and pressure areas to promote local blood circulation.

(2) Encourage and assist the patient to turn over every 2 hours to reduce the time of local skin pressure.

(3) If necessary, place an air ring, cotton ring or sleep on an air bed at the pressured area of ??the bony prominence.

(4) Keep the bed unit clean, dry, flat and free of debris.

(5) Do not use broken toilets and avoid dragging and pulling.

(6) Wash the perianal area and vulva with warm water promptly after defecation and keep the local skin clean and dry.

3 During the fasting period, the patient is provided with nutrition through intravenous and other channels; when eating, the patient is encouraged to eat more nutritious foods such as high protein and high vitamins to prevent further decline in resistance caused by malnutrition.

4 Keep the skin around the abdominal drainage tube mouth dry. When the dressing becomes wet, it should be replaced in time to prevent skin damage and infection.

Key evaluation:

1 Whether the patient correctly masters skin self-protection measures.

2 Whether the patient cooperates with nursing care.

3 Whether the skin is damaged.

5. Potential complications - infection

Related factors:

1 Surgical incision.

2 Postoperative multi-tube drainage.

3 Various invasive operations.

4 Phlegm stasis.

Main manifestations:

1 High body temperature.

2 Progressive pain, redness, swelling or purulent discharge from the incision.

3 The skin around the drainage tube mouth is red, swollen or has purulent secretions.

4 The drainage fluid is turbid or purulent fluid flows out.

5 The patient has obvious bladder irritation or dry and wet rales on auscultation of the lungs.

Nursing goals:

1 The surgical incision heals as scheduled.

2 The skin around each drainage tube opening is normal.

3 The patient did not have bladder irritation or other complications.

Nursing measures:

1 Closely monitor vital signs. It is a normal reaction for the body temperature to reach 38.5°C within 48-72 hours after surgery. If the body temperature continues to rise, you can be alert to the occurrence of infection. .

2 Listen to the patient’s chief complaint and learn whether there are progressive pain, redness, swelling and other inflammatory symptoms of the incision at any time.

3 Secure the drainage tube properly and keep it open to prevent accumulation of drainage fluid and causing abdominal infection.

4 Observe the nature of the drainage fluid frequently and record it to detect signs of infection early.

5 Those with urinary catheters should use 0.1% sterilized cotton balls to disinfect the urethra orifice twice a day or wash the vulva to prevent retrograde infection of the urinary system.

6 Teach the patient the correct way to expectorate and encourage the patient to cough up sputum to prevent the occurrence of accumulating pneumonia.

7. Auscultate the patient's lung breath sounds frequently to understand whether there are sputum sounds and whether the breath sounds are thickened.

8 Follow the doctor’s advice and use antibiotics rationally to prevent infection.

Key comments:

1. Whether the patient’s temperature is normal.

2. Check whether there are any signs of infection in various susceptible parts.

3 Symptoms: Cancer invades the stomach, duodenum, etc., causing digestion and absorption disorders, vomiting blood or melena.

Main manifestations:

1 The skin and mucous membranes are dry and have poor elasticity.

2 Fast heart rate, rapid pulse, low blood pressure, oliguria, and high urine specific gravity.

3 Vomiting and melena.

4 Excessive bleeding of bloody fluid from the abdominal drainage tube.

Nursing goals: The patient's body fluid balance is manifested by stable vital signs, good skin elasticity, and normal urine output and urine specific gravity.

Nursing measures:

1 Pay attention to the patient's skin elasticity and mucous membrane condition, as well as mental state.

2 Observe and record the volume and characteristics of the drainage fluid, and pay attention to the occurrence of complications such as biliary fistula or pancreatic fistula.

3 Record the fluid intake and output in detail over 24 hours, especially the patient’s urine volume and urine specific gravity.

4 Follow the doctor’s advice and promptly inject vitamin K1 intramuscularly to improve coagulation function.

5 Ensure smooth input of fluids and prevent insufficient fluid replenishment.

6 If hematemesis or melena occurs, you should:

(1) Quickly replenish fluids to maintain smooth flow.

(2) Cross-combine blood and prepare for blood transfusion.

(3) Observe and record the amount of bleeding.

(4) Let the patient's head turn to one side to prevent suffocation.

(5) Comfort and calm the patient.

(6) Give hemostatic drugs as directed by the doctor, and actively assist the doctor in taking hemostatic measures.

Key comments:

1 Whether the skin elasticity is good.

2 Whether the vital signs are stable.

3 How effective is it in stopping bleeding?

7. Lack of knowledge: Knowledge of percutaneous transhepatic cholangiography (PTC), endoscopic retrograde cholangiopancreatography (ERCP), etc.

For details, please refer to the standard care plan for cholangiocarcinoma patients related content.

8. Lack of knowledge: postoperative rehabilitation nursing knowledge

Related factors:

1 Never suffered from this disease.

2 Lack of information sources.

Main manifestations:

1 Ask medical staff about the above-mentioned relevant knowledge.

2 The patient shows anxiety.

Nursing goals:

1 The patient can explain the key points and significance of various rehabilitation measures.

2 Have a certain level of understanding of chemotherapy and be able to persist in it.

Nursing measures:

1 Explain postoperative rehabilitation measures and their significance to the patient.

(1) Early activities, such as turning over in bed, getting out of bed, etc., are helpful to promote the recovery of intestinal function and prevent the occurrence of intestinal adhesions.

(2) Keep the wound dressing clean and dry to prevent various drainage tubes from protruding, twisting, being compressed and causing obstruction.

(3) After the sutures are removed, the wound should still be covered with sterile gauze to prevent moisture and infection.

(4) Eat reasonably and eat a high-protein, high-calorie, high-vitamin diet to improve the body’s resistance.

(5) Quit smoking and drinking, avoid eating spicy foods, and eat small amounts frequently to avoid overeating.

2 Explain to patients the necessity, safety and precautions of chemotherapy.

3 Tell the patient to review regularly to detect early signs of recurrence in a timely manner and to see a doctor at any time if there are changes in the condition.

Key evaluation:

1 Whether the patient takes correct self-protection measures.

2 Whether the patient understands and accepts chemotherapy.