Esophagus cancer nurses the knowledge
May 1st, 2008 Guage
First, esophagus cancer surgery nurses
[before the technique, prepares]
1. before pressing the thoracic surgery general technique, to nurse the convention.
2. the nutrition supplement, improves the whole body condition. Swallows the degree according to the patient to give the diet, has anemia, the dehydration, the malnutrition to use judgment to give the blood transfusion, the fluid infusion, the vein high nutrition and so on.
3. strengthens oral cavity nursing, after reducing the technique, complication; Regarding has the obvious esophagostenosis and the inflammation patient, before the technique, takes orally the intestinal tract antibiotic, reduces the inflammation and dropsy.
4. before the digestive tract preparation technique, 1d enters the few dregs diet, after 8:00 pm fasts, and uses the soapy water sausage 1 time. A colon generation of food harnesses the surgery to prepare: Before the surgery, id 1:00 pm, 2:00, 3:00, 6:00, 9:00 various clothing armor niter zuo 200mg, celebrates magnamycin 0.5g; After 4:00 pm, takes orally 10% mannitol 1000ml, a half hour takes orally; Before the technique, 3d enters the few dregs diet, before the technique, 1d enters the fluid medium, after 8:00 pm fasts, parallel soapy water clean sausage 1 time.
5. the surgery early morning sets at disinfection stomach tube 1.
[after the technique, nurses]
1. after pressing the thoracic surgery technique, after nursing the convention and the anaesthesia, conventional nursing.
2. after the technique, should key strengthen respiratory tract nursing, the essential fashionable nose drive pipe attracts the phlegm or the bronchoscope attracts the phlegm, eliminates the respiratory tract secretion, promotes pneumoectasia.
3. fasting period strengthens oral cavity nursing, maintains the oral cavity is clean.
4. stomach and intestines reduced pressure nursing according to stomach and intestines reduced pressure nursing convention.
5. chest cavity drainage’s nursing besides presses common chest cavity drainage nursing, should the special attention chest fluid nature and the quantity. If after the technique, the blood final proof chest fluid are excessively many or in the pink is accompanied by the fat drop, should be vigilant the chylothorax possibility.
6. the strict observation margin seeps out the situation, maintains partial clean, whether there is watch out for the margin infection, to split and to kiss the heal fistula the sign.
7. diet nursing
(1) fasts the period gives the vein nutrition support, maintains the solution is unobstructed, observation medicine response.
(after 2) the esophagus and rushes to the gate technique 5-7d, kisses the heal tensity, the blood according to the stomach and intestines function’s restoration and the technique to decide the feed time for the situation. Gets up from the few potable waters, fluid medium, semiliquid food diet, few many meal. After colon generation of esophagus technique, eats food the time suitable suitable detention.
(after 3) stomach generation of esophagus technique, strengthens the diet propaganda: Few many meal, before avoiding resting, lies down is eating food, after the feed, is by all means must slow, or sits well for a half hour, prevents the back-streaming not suitably, the belt is too tightly, after the feed, avoids movement which has lowers the head bends the waist.
(4) gives the high protein, the high Vitamin, the low fat, the few dregs diet, after and observes the feed, whether there is to obstruct, situations and so on ache, vomit, diarrhea. If the discovery symptom should suspend the diet.
Second, after esophagus cancer excision method, the pate kisses the heal fistula nursing
after 1 technique, the close observation, discovered as soon as possible kisses the heal fistula the occurrence: After esophagus cancer technique the patient, specially possibly has the patient who the pate kisses the heal fistula, after the technique, should give the close observation. Observation emphasis point for body temperature, mood and pate wound. In this group of 23 example patient has 20 examples after the technique 4~5d appears gives off heat, the body temperature 38℃ about, and appears is agitated restlessly, the multi-perspirations, losing sleep and so on. Inspection pate wound obviously partial inflamed, tenderness, subcutaneous emphysema, this prompt had the pate to kiss the heal fistula. This time should take the measure as soon as possible, the margin wound drainage. 20 examples present the body temperature, in the mood aspect unusual patient, some 17 examples inspected and process the pate wound promptly, the result after kissing the heal fistula occurred about 18d to heal. Because some 3 examples observe insufficiently carefully, presents the unusual change to the patient not to be able the stitch in time, finally the wound cicatrization time lengthens obviously, reaches equally for 1 month. The wound detention heals the reason considered after to kiss the heal fistula occurs, the partial secretion increases, but has not been able the prompt drainage, to cause the tissue tension to advance, blood circulation barrier, infection aggravation. This result indicated that after the technique, the close observation, the early time discovered that kisses the heal fistula the occurrence and the stitch in time, is guaranteed the wound heals as soon as possible premise.
2 pate wound nursing: The pate wound must the full drainage, the prompt flushing, the replacement surgical dressing, maintain the wound is clean. In this group of 23 examples has 11 example fistula mouth to be big, the pus smelly secretion are many, we use Acrinol Yeshi to spread, trades the medicine every day 2~3 times, the effect is good, after 4~5d, the secretion obvious reduction, changes to again washes must the peaceful fluid flushing. Other 12 example fistula mouth is small, with washes directly must the peaceful fluid flushing trade the medicine, daily 1~2 times. After the above processing, the majority wounds occurs after the fistula 10~12d present the good cicatrization condition, the Granulation tissue are fresher. Some 3 examples have the latter 3 week wound cicatrization condition change for the better in the fistula. This time again distinguishes auxiliary by the infrared local irradiation, the promotion blood circulation, the wound smoothly to heal.
3 nutrition nursing
3.1 jejuna feed: The pate tallies the fistula patient to be unable after the oral cavity feed, this group of 23 example good jejunum ostomy, carries on the jejunum to feed. Nutrition (TPN) compares with the complete stomach and intestines outside, uses the jejunum to feed the price to be inexpensive, meets the physiological needs, the laboratory monitor project are few, the drive pipe has the big flexibility, is not easy to stop up, and the complication are few. This group of 23 examples use the method which continues to drip into, drips into the essential factor nourishing cream for my courtyard nutrition branch configuration, drips into total quantity 2 500~3 000ml every day. Nourishing cream after warming drips into makes the syrinx, starts when speed suitable slow, approximately 300ml/h, speeds up gradually to 500ml/h. After using the jejunum feeds, every week must reexamine 2 time electrolyte, the hepatorenal function, makes the corresponding adjustment according to the concrete change. Some 12 examples had symptoms and so on varying degree distension of the abdomen, diarrhea, after undergoing just right for the illness processing, alleviates.
3.2 jejuna make the syrinx nursing: Makes the syrinx to give truly fixedly, takes strict precautions against Watt. The regular disinfection makes the syrinx orifice and the outer wall. The flushing makes the syrinx lumen, prevents the jamming. After the jejunum feeds finished, the orifice properly wraps up, antipollution. The abdomen skin contact makes the syrinx place to give the zinc oxide cataplasma to spread scratches, prevents the skin breakage.
Third, esophagus cancer technique back row phlegm nursing
after 1 conventional row of phlegm nursing technique, the convention uptakes oxygen to the patient, before the general anesthesia sober, should blow out promptly the oral cavity, swallows in the throat and trachea’s secretion, after the general anesthesia sober, should take half decubitus rest, and replaces the body posture frequently, to the patient explained that the technique back row phlegm’s importance, encourages it to carry on the deep breathing frequently, when its forcibly cough row of phlegm, medical personnel available both hands hold back patient’s wound place gently, reduces the ache. If sends the breath table because of the wound ache shallowly not to dare to cough, when even the secretion accumulation causes the reflective bronchial tube convulsion creates the oxygen deficit, must give the analgesic, maintains the normal breath movement, favors the effective platoon phlegm. The phlegm sticks when thick is not easy to cough, may give the medicine or with the atomization insufflation dispel phlegm the sterilization. Simultaneously whips the thoracic wall, the vibration adherency in the bronchiole wall’s sputamentum, causes it to carry over the big bronchial tube, easy to discharge.
2 therapeutic athletics have when the condition makes 2 times every day to the patient the therapeutic athletics, generally the arrangement after giving the analgesic carries on, gives the 15min atomization inspiration (in atomization fluid to be possible first to join bronchial tube relaxant, vasoconstriction medicinal preparation and chymotrypsin and so on), then carries on the postural drainage alternately, the thoracic wall strikes against, the vibration and the forcibly cough, altogether approximately 20min, the therapeutic athletics time should guarantee the full oxygen uptake.
3 causality row of phlegm through not creates the stimulation trachea, the initiation cough reflex, may achieve the elimination respiratory tract secretion the effect [1]. After pulling out the trachea cannula, 1h starts the patient to hold sits up, the racket carries 30s, nurse stands right flank the patient, method one: The left hand supports the patient shoulder back, the right hand index finger and the middle finger the nest holds back gently on the breastbone touches the trachea, draws out the cough reflex, when patient cough, lets loose rapidly holds back the finger. Method two: With attracts the phlegm tube aseptically from the nasal cavity insertion to the glottis place, draws out the cough reflex. Another nurse stands left side of the patient, both hands cover the patient chest wound, reduces the wound ache which the cough causes, later each 4h will carry on the causality row of phlegm 1 time.
4 attract the phlegm law, when in the lung has the massive phlegm to call or one side respiratory murmur decreases (situations and so on elimination pneumothorax, product fluid), should take the following measure to restore the bronchial tube to be unobstructed positively, avoids the lung not opening.
4.1 pass through the mouth nasal cavity to attract the phlegm suitable choice soft to attract the phlegm tube not suitably, the negative pressure oversized, attracts the phlegm time not to be suitable surpasses 15s, when easy to cause the oxygen deficit and the mucous membrane damage, the phlegm are many should pay attention increases attracts the phlegm number of times, but cannot increase each time attracts the phlegm time, should after one time attracts the phlegm waits the full oxygen uptake second time to attract the phlegm again.
4.2 pass through the textile fiber bronchoscope to attract the phlegm technique latter 1 example use textile fiber bronchoscope to attract the phlegm, executes under the bedside partial mucous membrane anaesthesia, before attracting the phlegm, and attracts the phlegm gap, for patient full ventilation, found the blocking spot, after the ablution blocking bronchial tube’s secretion, the lung might the very quick implement for squeezing, attract around the phlegm to give the chest to pass or to absorb the piece to carry on the comparison.
4.3 pass through the trachea cannula to attract the mental disorder tube intubation to attract the phlegm to request to attract the phlegm tube certainly to suffice to be long, if does not have long attracts the phlegm tube, may the trachea insert the oral cavity outside the pipe cutter to go a part, like this may increase attracts the phlegm tube’s effective attraction length, can achieve truly attracts the phlegm effect.
4.4 pass through the tracheotomy to attract the phlegm technique latter 3 example patient gas channel secretion to be many, the cough incapable or must the long time application life-support machine, in the bed by-passing tracheotomy, the tracheotomy is not only advantageous attracts the phlegm, but may also reduce the ventilation dead space, increases the ventilation quantity, but after tracheotomy, has the respiratory tract secretion easily dry, the infection possibility increases and so on questions, should strengthen nursing, strict aseptic technique.
In summary, after esophagus cancer technique, only then takes the positive effective platoon phlegm measure, could let the patient pass lungs complication this difficulty, reduced in hospital time, the relieve pain, soon will be discharged.
Fourth, in esophagus cancer radiotherapy concurrent complete obstruction nursing
before 1 psychological nursing radiotherapy, should complete the propaganda work first to the patient, helps the patient to get sick and the correct treatment understanding to illness, informs response which and processing method the patient and in the family member radiotherapy will possibly appear, matters needing attention, will obtain the patient and family member’s positive coordination. After explanation illumination, the tissue edema, the condition aggravates by no means that reduces patient’s fear and anxious, enumerates fellow patient who some clinical symptoms similar and succeeded pass this time, made them to set up it to defeat the confidence which illness got sick.
2 diet instruction basis obstruction’s condition, before has not had the complete obstruction, eats food suitably the egg soup, the bean curd, the yogurt, the non-dregs vegetable soup, the lotus root starch and so on high nutrition few stimulation soft food, simultaneously takes Vitamin B 2, E, A and so on. Eats food the best body posture is the seat or half decubitus, chews carefully, cannot urge the patient, after each time food, the potable water flushes the esophagus, available celebrates magnamycin 80,000 U, the daily 3 oral administrations, and need to pay attention to the diet the color, smell and tastes to rest on patient’s taste replacement. Once has the complete esophagus obstruction, fasts, to fast immediately period gives the prompt fluid infusion, when the necessity to give outside the stomach and intestines the nutrition.
3 condition observations (does 1) observe the patient to eat food closely the chest to be whether there is stuffy, the scant of breath, chokes coughs, spits up blood as well as the life symptom change, by against esophagus perforation or massive hemorrhage. Once diagnoses for the esophagus perforation or the massive hemorrhage, fasts, to endure the water immediately, the oxygen uptake, the chest cavity closed type drainage, prepares the aspirator, the autogenous cutting package maintains the respiratory tract is unobstructed, completes each rescue work. (2) the fluid infusion correction water, the electrolyte are balanced, provide the enough quantity of heat. (3) early the effective anti-infection and the large dose hormone’s application, treats the successful key. Because the complete obstruction often is accompanied by the partial mucous membrane infection, but infects can aggravate dropsy, the large dose hormone is effective in the alleviation partial mucous edema.
because after 4 being out of hospital instructions the radiotherapy had ended, 6 months later, because the blood vessel organization and the knot contract organization’s hangfire change, the esophagus mucous membrane withers gradually, the pipe wall muscle and the knot contract the organization fibrosis narrowly, the esophagus lumen [2]. Therefore, we should complete the propaganda to the patient, when feed speed easy slow, enters the soft food as far as possible, avoids certain foods irritant food, after the feed, drinks warm boiling water 30~50ml to flush the esophagus, after all pills and the capsule suitably grind the depilation water used dissolves swallow, prevent to have the stem to choke the symptom.
Fifth, how should esophagus cancer constipation nurse and the nutritional therapy?
Because esophagus cancer later period the internal organs owe empty, cloudy Tianjin lose ru, cannot lubricate the intestinal tract, because may also the diet not enter, the bowel movement loses ru has the constipation. After the constipation produces, may aggravate esophagus cancer symptom. Therefore time home nursing should achieve:
(1) moderate massage abdomen, promotes the stomach and intestines creeping motion;
(2) drinks the fruit juice and the Run intestines drinks;
(3) coordinate acupuncture;
(4) nutritional therapy method available below folk remedy:
①Sesame seed almond honey gruel: Sesame seed 15g, apricot kernel 9g, honey 9g boils the gruel food, moistens dry areas the bowel movement.
②Hemp kind pine nut gruel: Hemp seeds and nuts 15g, loose seeds and nuts 15g, millet 100g boils gruel clothing it, may raise the blood bowel movement.
③Skin bread banana soup: The skin bread, the banana with boils, bowel movement of the clothing.
④Mulberry chopping block applesauce: Sang Zhenzi, the applesauce, swallows the food slowly, makes up empty damages, passes the bowel movement.
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