Papers Category:Medicine Papers
- Nursing Papers
I heart mitral valve replacement surgery undertaken by the Section since the 3 cases of postoperative subdural hematoma cases were retrospectively analyzed, now nursing experience are described below.
A clinical data
This group of cases, 1 male and 2 females, aged 46 to 62 years, history of preoperative pain in all joints, including 1 case with mitral valvuloplasty and closed postoperative coagulated hemothorax history. 2 cases of cardiac function grade Ⅲ , Ⅳ grade 1 cases, preoperative have a long-term recurring heart palpitations, shortness of breath, tiredness, when obviously. The two cases had atrial fibrillation, 1 case with lung ecchymosis. Two set uses a mechanical valve replacement valve, after 48 ~ 72h concurrent subdural hematoma, after timely and accurate treatment and care, 3 patients were discharged.
2 Preoperative Care
Strengthen the psychological care and health education, to eliminate the patient's fear of missionaries after the treatment with the method and importance. Strict bed rest, reducing myocardial oxygen consumption, cardiac taking digitalis, diuretics, potassium supplement, and intensification of liquid applied improving myocardial energy supply.
3 post-operative care
311 patients into the intensive care unit, use the multi-function monitor for monitoring, ventilator-assisted breathing, to keep the airway patency, diligence and listen to lungs breathing sound, intermittent suction, and endotracheal Dropping, regular monitoring of blood gas analysis, accurate adjustment of ventilator.
If the patient regained consciousness, adjustment of ventilator settings, respiratory pattern gradually reduced the frequency of close observation until the breathing machine off.
312 to maintain hemodynamic stability, to ensure an adequate blood supply to the brain, close observation of blood pressure, central venous pressure, left atrial pressure, mean arterial pressure 1017kPa can be maintained.
313 close observation in patients with consciousness, pupil, altered consciousness, such as the emergence intense headache, nausea, vomiting frequency jet should be vigilant against intracranial hypertension.
In case of bilateral pupil size, shape irregular, light reflex retardation, should be alert to the risk of hernia, nurses should actively cooperate with timely reporting and dealing with doctors.
314 anticoagulation after valve replacement nursing care is a special link.
Nurses should tell patients taking anticoagulant drugs necessity and taking methods, dosage must be precise, regular monitoring of prothrombin time, abnormal and timely adjustment of anticoagulant dosage prescribed by a doctor. Infusion needle injection pay attention to pinhole bleeding. Closed thoracic drainage and intracranial drainage closely observed the process of drainage fluid containing blood. Doing missionary hospital, will urge sufferers from time to time, quantitative service anticoagulant drugs, regular check prothrombin time. Church of the patient attention to gums, skin, mucous membranes, urine bleeding tendency, female patients to observe the amount of menstruation, abnormal immediate medical treatment.
315 Intracranial subdural hematoma after removal of brain hematoma is the most prominent secondary changes, reached a peak after 48 ~ 72h. Intracranial pressure can cause life-threatening. We are in nursing should be to avoid affecting the operation of intracranial pressure, head elevated 30 ° , head to keep the median to avoid flexion, hyperextension, skew and so affect the brain venous operation. Try to avoid over-stimulation and continuous care operations. Accurate implementation of the dehydration treatment of living wills, records 24h access to water, maintain water, electrolyte, acid-base balance and a stable internal environment to maintain intracranial drainage tube patency, pay attention to drainage of liquid color, quantity, nature. Timely sedation, analgesia, to ensure adequate sleep, reducing brain tissue oxygen to alleviate the suffering of patients.
Early postoperative functional exercise to prevent complications and improve quality of life of patients in the future it is very important.