Draw back enclosing the nursing _'s treatment of period of surgery of narrow pericarditis

Draw back enclosing the nursing _'s treatment of period of surgery of narrow pericarditis
Chen XiaoBing Wu XianRong 2005-12-13 13:08:52 Western medicine magazine in China Number 7 of Vol. 4 of April of 2003

Pericarditis mean pericardium chronic pathological change lead to the fact the pericardium increase thick, adhesion, even calcification, enable heart activity limited, relaxation and shrink of the heart are restricted and cause the blood to circulate obstacle disease all over, the patient's heart function fails gradually, because of being in heart failure finally and death. Result from the reason that the course of disease of acute pericarditis delays more, tuberculosis, suppurative infection; Virus, rheumatism, pericardium accumulate after,etc. the blood, the intersection of rheumatoid and pathological change, parasitic disease, radiotherapy can result in drawing back narrow pericarditis ing behind the traumatic operation. Its only curing the method is that an surgery excises and increases the thick pericardium, remove the constraint of the heart. According to the experience that clinic receives, careful and high-quality nursing contributes to reducing complication, reduce mortality. This text conducts on how to improve and enclose operation period attending to from the following aspects and explains.
Nursing before a skill
1.1 Doing a good job of the psychology has having palpitation, shortness of breath to draw back the narrow pericarditis patient to attend to, symptom such as being weak brings the mental burden, in addition face the frightened psychology of the operation, the patient has highly tense spirit; In addition, oxygen deficiency and CO that dyspnea causes 2 Retention, the patient can have the fidgets, have a liking for and sleep etc.. So should care about patient voluntarily, avoid appropriate language and behavior, explain in front of the skill to patient, postoperative attentive matters, in order to remove worry, set the mind at rest, cooperate and treat actively.
1.2 Thorax, and abdominal cavity store up the treatment of the liquid have thorax and abdominal cavity to accumulate a liquid patient, should smoke and suck 1- 2 days before skill, in order to improve, breathe and circulate function, reduce, go back the intersection of energies and quantity while being postoperative. Should strictly observe and operate aseptically during puncture, in case that the organism is infected.
1.3 Should carry out and resist the tuberculosis treatment to deal with tuberculosis pericarditis patient's skill strictly in tuberculosis pericarditis, advise patient, take medicine on time, control the intersection of tuberculosis and competent the intersection of surgery and treatment under activity, in case that postoperative tuberculosis spread.
1.4 Generally attend to and use medicine for the patient according to the doctor's order strictly, supplement the electrolyte, correct the low albumen blood disease. Strengthen nutrition, encourage the patient to eat the high protein, high vitamin, the diet of less salt, from intravenous to supplement protein in time, and limit patient's activity appropriately, prevents from heart's declining.
Postoperative 2 is attended to
2.1 The physical sign of the life is monitored and the foreign digitalis medicine is employed because fetters the fiber pericardium of patient's heart and is excised, loosened, heart relaxation and shrink function are improved immediately. But because its heart is oppressed long, it is unable that the cardiac muscle withers, it is apt to lead to the fact the heart expands and causes the myocardium damage and in heart failure and even excessively dies. So offer foreign the intersection of digitalis and drug therapy conventionally while being postoperative, improve the heart function. Observe the change of the physical sign of the life closely, every 1- 2h measures blood pressure, pulse, breathes, the lasting heart electricity is guarded, in order to find the arrhythmia in time.
2.2 Intravenous infusion quantity and control of the speed because the heart is oppressed with the passing of time, the activity is limited, after the pericardium is stripped, heart relaxation and shrink function are improved, the pulse pressure is raised, the difference of arterial pressure increases, venous pressure drops, the intravenous capacity of returns increases, the ones that silt up in organizing are humoral to include in the blood circulation, should control infusion speed and infusion amount strictly when so intravenous fluid infusion. The general adult's daily infusion is smaller than 1500ml, the speed is smaller than 40 drops min. Venous pressure of monitoring center (CVP) ,1/2h1 time, the water amount that record 24h and come in and go out. According to CVP, urine quantity and electrolytic change of serum, regulate the entering amount and supplement the electrolyte in time, keep water electrolyte balanced.
2.3 Body posture and nursing of drainage tube sober should fetch, lie in the location by half after being physical sign steady by lifing in patient, help to arrange the phlegm and improve and breathe. The ones that keep various drainage tubes are unobstructed, record property and quantity of guiding the liquid, deal with to the ill in time. There are ascites patients before the skill, should measure abdominal girth regularly, in order to understand ascites absorbed the situation.
2.4 The prevention of lung complication is because of a extravasated blood of lung minister, in addition the anaesthesia influences, reasons such as pain,etc. after the operation, the lung incident is infected, and then aggravate the heart to decline. So advise patient give up smoking conventionally in front of the skill, encourage and help the patient to act as effective cough, expectoration while being postoperative, and regular atomization is sucked, antibiotic of rational application. Encourage patient move about in bed early period, take food in early days, stock the less salt liquid the second day while being postoperative.
2.5 It is the first of postoperative pain of all surgery that pain attends to the pain intensity open the postoperative chest. Can adopt, ease pain pump walk, ease pain while being postoperative, through pump into, ease pain medicine in order to achieve the goal of relieving pain while being low dose of continuously. The nurse should observe and ease pain the operating position of the pump regularly, prevent the pump from being in charge of giving a discount, twisting or deviating from.
3 leave hospital guidance
The patient should insist that take medicine for 1.5- 2 years according to the doctor's order after leaving hospital, and reexamine regularly, find out about heart function situation; Absolutely give up smoking; Tuberculosis pericarditis patient continues resisting the tuberculosis treatment after leaving hospital, if does not adapt to going to a doctor at any time.
In a word, contract getting narrow to enclose operation, attend to, favorable to to reduce complication period the intersection of pericarditis and patient well, reduce mortality, raise the cure rate. We only pay attention to enclosing the nursing of period of operation, could fully improve the success rate of operation.
References
1 yellow filial piety step, Qin gentle and vast, the intersection of jade and fish hawk Sun. Modern chest surgery. Beijing: People's Medical Officer Press, 1997, 265-280.
Author's unit: 510120 Guangzhou Zhongshan University attaches to the second hospital

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