There is a lot of knowledge about surgical nursing. Do you know anything about surgical nursing? The following are the knowledge points of surgical nursing that I brought to you. Welcome to reading.
The most important cation in extracellular fluid is Na+, and the main anions are Cl-, HCO3- and protein. The daily sodium requirement of normal adults is 4.5g.
1. The main cations in the intracellular fluid are K+ and Mg+, and the main anions are HPO42- and protein. What is the daily potassium requirement of normal adults? 4g .
3. The normal value of serum sodium is 135? 150 mmol/L the normal value of serum potassium is 3.5? 5.5 mmol/L
Sodium: eat more and row more, eat less and row less, and don't eat or row. Potassium: eat more rows, eat less rows, and don't eat rows.
4. Definition of hypertonic water shortage: both water and sodium are deficient, but the water shortage is more than sodium deficiency, so the serum sodium is higher than the normal range, and the extracellular fluid is hypertonic, also known as primary water shortage.
5. Isoosmotic water shortage definition: water and sodium are lost in proportion, serum sodium is still in the normal range, and the osmotic pressure of extracellular fluid remains normal. Because the amount of extracellular fluid decreases rapidly, it is also called acute water shortage or mixed water shortage, which is the most common type of water shortage for surgical patients.
7. The principle of intravenous rehydration: salt before sugar, crystal before glue, fast before slow, alternate rehydration and supplement urine potassium. Note: urine volume must be >; Potassium can only be supplemented at 40 ml/h.
8. There are three main reasons for hypokalemia: insufficient potassium intake; Excessive potassium loss; Potassium enters the cell from outside the cell (the distribution of potassium is abnormal
9. Clinical manifestations of hypokalemia: (Trilogy of hypokalemia: myasthenia, abdominal distension/intestinal paralysis, arrhythmia)
The earliest manifestation is muscle weakness, and in severe cases, tendon reflex is weakened, disappeared or flaccid paralysis.
Nausea, anorexia, decreased intestinal peristalsis, decreased bowel sounds, abdominal distension, paralytic intestinal obstruction, colic and constipation.
Conduction block and abnormal rhythm
Confusion, irritability, impatience, lethargy, depression
Nocturnal enuresis and urinary retention
Abnormal aciduria
10. Clinical manifestations of metabolic acidosis:
Take a deep breath and breathe quickly. The exhaled gas smells like ketone (rotten apples).
Dull expression, fatigue, lethargy, mental confusion, disorientation, stupor and coma.
Acidosis is often accompanied by high potassium, which can cause muscle tension reduction, tendon reflex weakening or disappearance, skeletal muscle weakness and flaccid paralysis.
Slow heartbeat, weakened heart sounds, arrhythmia and low blood pressure.
Nursing care of patients with surgical shock. Factors affecting effective circulating blood volume: adequate blood volume; Effective cardiac output; Good peripheral vascular tension. Excessive changes in any one factor may lead to a sharp decline in effective circulating blood volume, which may lead to shock.
2. Hemorrhagic shock and septic shock are the two most common types of shock in surgery.
3. Treatment principle of shock: eliminate the cause of shock as soon as possible; Restore effective circulating blood volume as soon as possible; Improve microcirculation; Improve heart function; Correct metabolic disorder
4.7. The relationship between central venous pressure and fluid replacement
Liquid displacement test
Fluid replacement test: take 250ml of isotonic saline and soak it in 5? If the blood pressure rises within 0/0 minute after intravenous drip/kloc-0, CVP will not change, indicating that the blood volume is insufficient; If blood pressure remains unchanged and CVP increases (3? 125pxH2O), indicating cardiac insufficiency.
8. Nursing care of patients with septic shock;
Infection control: Only by actively dealing with the primary focus and giving adequate and effective antibiotic treatment can shock be corrected.
Replenishing blood volume: Restoring sufficient circulating blood volume is an important link in the treatment of septic shock.
Correct acidosis: give 5% sodium bicarbonate solution to correct acidosis.
Application of vasoactive drugs: For patients with cardiac insufficiency, drugs can be given to enhance myocardial function, such as cedilanid. To improve microcirculation, vasodilators can be used. Vasodilators must be used on the basis of supplementing blood volume.
Corticosteroids are generally used in septic shock and severe shock.
9. Clinical manifestations of shock patients?
Pre-shock: nervous and irritable; Pale face, cold limbs, rapid pulse, shortness of breath, normal or decreased blood pressure, decreased pulse pressure and normal or decreased urine volume.
Shock stage: apathy, unresponsiveness, cyanosis or mottling of skin, cold limbs, rapid pulse, shallow breathing, progressive decrease of blood pressure, atrophy of superficial veins, prolonged capillary filling time, and symptoms of metabolic acidosis; oliguria
Late stage of shock: confusion or coma, obvious cyanosis or mottling of skin and mucosa all over the body, cold limbs, weak pulse, irregular breathing, undetectable blood pressure and anuria.
Anesthesia nursing 1. Fasting: avoid vomiting and aspiration, fast within 12 hours before anesthesia, and ban alcohol within 4 hours; Allergy test of local anesthetics, medication before anesthesia
2. The purpose of medication before anesthesia (30-60 minutes before operation)
Calm down, make patients emotionally stable, cooperate, and relieve anxiety and fear.
Suppress saliva and airway secretions, and keep the respiratory tract unobstructed.
Reduce the side effects of anesthetics and eliminate some unfavorable nerve reflexes.
Improve the pain threshold, relieve preoperative pain and enhance the analgesic effect of anesthesia.
3. Prevention and treatment of complications
(1) Nausea and vomiting: For those who vomit frequently, keep the gastrointestinal decompression unobstructed and suck out the gastric residue in time;
(2) Asphyxia: improve gastrointestinal preparation before operation, fast for 8- 12 hours and drink water for 4 hours before elective operation to ensure gastric emptying and avoid reflux, vomiting or aspiration of gastric contents during operation; Clean the mouth, once the patient vomits, immediately clean up the vomit in the mouth and other places to avoid the residue in the mouth causing aspiration;
(3) Respiratory obstruction (the most common)
4. Prevention and nursing of pain after spinal anesthesia
Puncture with a small needle during anesthesia
Improve puncture technique to avoid repeated puncture.
Fully replenish water during perioperative period to prevent dehydration.
Give supine position for 4~6 hours after spinal anesthesia.
If you have a headache, lie on your back and give analgesic drugs according to the doctor's advice.
5. Prevention and nursing of toxic reaction of local anesthetics.
Avoid injecting local anesthetics into blood vessels: you need to pump back before each injection, and you can inject only after you confirm that there is no blood.
Limit the total amount of local anesthetics: one dose shall not exceed the maximum limit or multiple small-dose injections, and the elderly and the weak shall be halved, and the parts with rich blood circulation shall be halved.
Add the right amount of adrenaline: Adding the right amount of adrenaline can constrict blood vessels and slow down the absorption of local anesthetics.
Medication before anesthesia: give diazepam and barbiturates.
Watch carefully. Actively deal with toxic reaction: once it happens, immediately stop injecting drugs and take oxygen.
6. Total spinal anesthesia is the most dangerous complication of epidural anesthesia. It is the phenomenon of total spinal nerve block caused by the puncture needle or catheter mistakenly entering the subarachnoid space and mistakenly injecting all or most of the local anesthetic into the subarachnoid space.
Manifestations: Dyspnea, blood pressure drop, confusion or unconsciousness within a few minutes after drug injection, followed by respiratory arrest and even cardiac arrest.
Nursing care of patients before and after operation. Preoperative preparation:
Respiratory tract ready to quit smoking: quit smoking 2 weeks before operation.
Anti-infection: antibiotics, ultrasonic atomization
Deep breathing: Thoracic surgeons should train abdominal breathing; Abdominal operators, training chest breathing.
Effective Cough: Take a sitting position or a semi-sitting position, lean forward slightly, cough a few times first, then inhale deeply and cough hard.
General operation of gastrointestinal preparation: fasting 12 hours before operation and drinking water for 4 hours.
Gastrointestinal surgery: preoperative 1? No.2 began to eat liquid food. Fasting 12 hour before operation, and alcohol prohibition for 4 hours.
Gastric tube insertion or gastric lavage: suitable for patients undergoing gastrointestinal surgery.
Enema: general surgery: 0.5% at night before operation? 1% soapy water enema once. Colorectal surgery: 0.5% at night 2 days before operation? 1% soapy water enema once, and clean enema was performed the night before operation and the morning of operation.
2. Traditional bowel preparation before colorectal surgery:
Eat a semi-liquid diet with less slag on the third day before operation and a liquid diet on the second day before operation.
Oral laxatives (such as senna, magnesium sulfate and castor oil) were taken 3 days before operation.
Enema was performed with soapy water once in the evening of 2 days before operation, and the enema was cleaned in the evening of 1 day before operation and the morning of operation.
Oral antibiotics (metronidazole, karamycin, gentamicin) one day before operation.
3. According to the anesthesia method, arrange the lying position.
General anesthesia: lie flat, remove the pillow and tilt your head to one side.
Subarachnoid anesthesia: 6? 8 hours
Epidural anesthesia: supine 4? Six hours, no pillows.
After brain surgery, if there is no shock and coma, take the bedside and raise it 15o? 30 supine position, with high head, high feet and low slope.
After neck and chest surgery, the patient was placed in a semi-seated position.
After abdominal surgery, the patient was placed in a low and half-seated position.
After spine or hip surgery, adopt prone or supine position.
Raise the affected limb after limb surgery
Shock patients should adopt supine position and concave position.
4 diet care:
Fasting 1~3 days is required after abdominal surgery, especially after gastrointestinal surgery. After the gastrointestinal function is restored and the anus is exhausted, a small amount of liquid can be fed for 5~6 days, and soft food can be changed for 7~9 days. General metal food will be started after 10~ 12 days.
After non-abdominal surgery, those who have no discomfort under local anesthesia can eat as needed, and those under general anesthesia can eat only after they are fully awake and have no vomiting. Give them liquid first, and then change it to semi-liquid or general food as appropriate. You can eat after 6 hours of spinal anesthesia.
5. Classification and grading of wound healing:
Class I incision: aseptic incision.
Class II incision: possible contamination.
Class ⅲ incision: contaminated incision.
Grade A healing: the wound healed well without adverse reaction.
B-class healing: the incision has inflammatory reaction, but it has not festered.
Class C healing: the incision is suppurated and needs incision and drainage.
Example: The wound healed well after subtotal thyroidectomy (I/ A).
Incisional hematoma after subtotal gastrectomy (II/ B)
The incision healed well after appendectomy.
7. Drainage tube care * * * Same principle: fixation, patency, patency and observation.
8. Postoperative complications
Clinical manifestations of atelectasis: early postoperative fever, increased respiration and heart rate, voiced or solid sound during percussion, weakened and disappeared respiratory sound during auscultation, and localized moist rales. Treatment: Turn over, pat the back and position to expectorate, take a deep breath, cough and expectorate, ultrasonic atomization and antibiotic treatment.
Treatment of deep venous thrombosis: raising the affected limb and braking; Avoid intravenous infusion through the affected limb; Local massage is strictly prohibited to prevent thrombus from falling off; Urokinase, dextran, heparin and warfarin were given.
9 Preoperative health education
Inform the patient of the condition and let the patient understand the necessity of the operation.
Inform them about anesthesia and operation, so that they can master the specific content of preoperative preparation.
Strengthen nutrition before operation, pay attention to rest and appropriate activities, and improve anti-infection ability.
Quit smoking, brush your teeth in the morning and evening, rinse your mouth after meals, and maintain oral hygiene; Keep warm to prevent upper respiratory tract infection.
Instruct patients to do various exercises before operation, including respiratory function exercise, bed exercise, bedpan use, etc.
1 1. Getting out of bed early after operation is helpful to increase vital capacity, improve systemic blood circulation, prevent deep venous thrombosis, promote the recovery of intestinal function and reduce the occurrence of urinary retention.
12. Hand-washing nurse (instrument nurse): the nurse who directly cooperates directly participates in the operation and actively cooperates with the surgeon to complete the whole operation process. Mainly responsible for the supply of instruments, articles and dressings during the operation.
13. cleaning the operating room: through certain air cleaning measures, the number of bacteria in the operating room is limited to a certain range, and the air cleanliness reaches a certain level.
14. What should I do if the wound dressing oozes blood?
Open the dressing to check the incision to find out the bleeding situation and causes, and handle it according to the degree of bleeding: 1) When a small amount of bleeding occurs, it can generally be stopped by changing the incision dressing, pressure dressing or systemic use of hemostatic agents; 2) When the amount of bleeding is large, we should speed up the infusion, and at the same time, we can expand the blood volume by blood transfusion or plasma, so as to make preoperative preparations for re-operation to stop bleeding.
Nursing care of patients with surgical infection. Surgical infection: refers to the infection requiring surgical treatment, including trauma, burns, surgery, instrument examination or invasive examination, and infection after treatment.
2. The characteristics of surgical infection: most of them are mixed infection of several bacteria; Most of them have obvious local symptoms and signs; Infection is usually limited. With the development of pathology, it causes suppuration and necrosis. , destroy the tissue, form scar tissue after healing, and affect the function.
3. Furuncle: refers to the purulent infection of a single hair follicle and its sebaceous glands. The common pathogen is Staphylococcus aureus.
4. carbuncle: it is an acute purulent infection caused by multiple adjacent hair follicles and their sebaceous glands, sweat glands and their surrounding tissues. The common pathogen is Staphylococcus aureus, which often occurs in the neck, back and upper lip.
5. Acute cellulitis: it is an acute diffuse suppurative infection that occurs under the skin, fascia, muscle space or deep cellulite. The most common pathogen is hemolytic streptococcus type B, followed by Staphylococcus aureus. It is characterized by rapid diffusion, not easy to be restricted, and has no obvious boundary with normal tissues.
6. erysipelas: acute inflammation of the skin and its reticular lymphatic vessels. What are the common pathogens? -Streptococcus hemolyticus. Common in the face, followed by limbs (lower limbs); Lesions are characterized by rapid diffusion, clear boundary between lesion area and surrounding normal tissues, less tissue necrosis or local suppuration, and contact infectivity. Prevention and treatment: 50% magnesium sulfate, wet and hot compress, bedside isolation.
7. Danger zone 3: When squeezing the nose, upper lip and its surrounding furuncle, bacteria can enter the venous sinus of intracranial cavernous sinus through the canthus vein and ophthalmic vein, causing intracranial purulent cavernous sinus venous sinusitis.
8. Treatment principle of abscess: If the abscess has a sense of fluctuation or aspiration, it should be cut and drained. Treatment principle: treat the primary infection focus, apply antibiotics and enhance the body's resistance. Local symptoms: superficial abscess: sense of fluctuation; Deep abscess: deep tenderness; Abscess caused by mycobacterium tuberculosis: cold abscess
9. Sepsis: refers to the invasion of pathogenic bacteria into the blood circulation, persistent existence, rapid reproduction, production of a large number of toxins, causing serious systemic symptoms; Sudden chills and high fever, up to 40℃? At 4 1℃, ecchymosis often appears on the skin, conjunctiva and mucosa, and is often accompanied by mental changes.
Bacteremia: refers to a small amount of pathogenic bacteria invading the blood circulation, which is quickly eliminated by the human defense system, causing no or only a short and mild systemic reaction.
Toxicology: refers to the serious systemic reaction caused by a large number of toxins, serious injuries or infections produced by pathogenic bacteria after entering the blood circulation; High fever, rapid pulse and anemia are its three main symptoms.
10. Clinical symptoms of tetanus:
Incubation period: The average incubation period of tetanus is 6? 12 day, which can be shorter than 24 hours or longer than 20 hours. 30 days or even months, the shorter the incubation period, the worse the prognosis.
Precursor symptoms: fatigue, dizziness, headache, masseter muscle tension, pain, chewing weakness, fidgeting, yawning, etc. , often lasting 12? 24 hours
Attack period: masseter (occlusal) facial muscle (? Wry smile? Face) Neck muscle (stiff neck) Dorsal abdominal muscle (recurve bow) Limb muscle (flexion) Diaphragm (dyspnea)
1 1 TAT desensitization test: divide 1ml antitoxin into 0. 1ml, 0.2ml, 0.3ml and 0.4ml, dilute them with normal saline to 1ml respectively, and inject them in batches with an interval of half an hour until the injection is completed. Observe the patient after each injection.
Nursing care of burn patients. burn
Staging: acute body fluid exudation stage: shock stage, starting a few minutes after injury, 2? 3 hours is the fastest, and 8 hours is the peak. 12? Slow down after 36 hours, stabilize after 48 hours, and start to absorb again.
Acute infection period: 72h later, repair period: 5-8 days after injury.
Classification: according to burn depth, degree and burn area. 1) three-degree quartering method. Depth: I degree and shallow II degree are shallow burns, and deep II degree and III degree are deep burns. 2) Degree: The total area is mild: degree II.
2. Indications of various therapies
Bandage therapy: superficial second degree burns of limbs and small area burns of trunk, which is not suitable for the author.
Exposure therapy: eschar protection of large area, head and face, perineum and third degree wounds.
3. Stages and manifestations of burn patients:
Grade I: no blisters, burning itching and skin erythema.
Second degree: blisters, large blisters, thin walls, flushing at the base and severe pain.
Shallow second degree: the blister is small, the blister wall is thick, the base is red and white, the hair is painful, and reticular vascular embolism can be seen.
Third degree: no blister, dermoid wound, eschar, dendritic embolism of blood vessels under eschar, no pain, scar after recombination, affecting function.
4. Fluid replacement in the first 24 hours after injury: colloid fluid and electrolyte fluid * * * 1% burn area (degree II and III) should be supplemented per kilogram of body weight, plus the daily physiological water requirement of 2000ml. Type of fluid replacement: the ratio of colloid fluid to electrolyte fluid is 0.5: 1. Fluid replacement speed: fast first, then slow down. Half of the total fluid replacement should be input within the last 8 hours, and the other half should be completed within the remaining 16 hours. For example, a patient with superficial second-degree burns weighing 60kg, with an area of 50%, received 50% fluid replacement in 24 hours after injury. 60? 1.5+2000=6500(ml), where the colloidal solution is 50? 60? 0.5= 1500ml, and the electrolyte solution is 50? 60? 1=3000ml, water content is 2000ml, and the total amount of rehydration is 3250ml within 8 hours after injury. The order of rehydration: first crystal, then glue, first salt, then sugar, first fast and then slow.
5. China nine-point method: (head, face and neck) 3, 3, 3, (double upper arms, double forearms and hands) 7, 6, 5, (front and back of trunk and perineum) 13, 1, (double hips and double thighs).
Nursing care of tumor patients. Tumor: a new organism formed by excessive proliferation or abnormal differentiation of body cells under the long-term action of different starting and promoting factors.
2. The occurrence and development of malignant tumors can be divided into precancerous, in-situ and invasive cancers; Precancerous stage: obvious epithelial hyperplasia with atypical hyperplasia; Cancer in situ: usually refers to the early cancer in which cancer cells are confined to the epithelial layer and have not yet broken through the grassroots; Invasive carcinoma: refers to carcinoma in situ that breaks through the basement membrane and infiltrates the surrounding tissues, destroying the normal structure of the surrounding tissues.
3. Clinical manifestations of tumor:
Local manifestations: lump, pain, ulcer, bleeding, obstruction, infiltration and metastasis.
Systemic manifestations: not obvious in the early stage, or only emaciation, fatigue, emaciation, low fever, anemia and other symptoms. Symptoms of systemic failure may appear in the late stage, showing cachexia.
4. Skin care of radiotherapy patients:
Avoid rubbing, physical and chemical stimulation and scratching when irradiating wild skin; Keep it clean and dry. When taking a bath, it is forbidden to wipe with soap and thick towels, and some of them are sucked dry with soft towels. Wear soft cotton clothes and change them in time; If there is erythema on the local skin, it is forbidden to tear it by hand and fall off naturally. Once torn, it is difficult to heal. Wear a hat when going out to avoid direct sunlight and reduce the stimulation of sunlight on irradiated wild skin; Stop itching with dry ice
5. Reaction after chemotherapy: phlebitis and venous embolism; Skin and soft tissue injury caused by drug extravasation; Nausea and vomiting, diarrhea and abdominal pain; Organ function damage; Bone marrow suppression, etc
Nursing care of neck diseases. Determination of basal metabolic rate: basal metabolic rate% = (pulse rate+pulse pressure)-11The normal value is+10%, and the clinical significance is +20%? 30% is mild hyperthyroidism, +30%? 60% were moderate hyperthyroidism and +60% were severe hyperthyroidism.
2. The function of iodine agent: inhibiting the release of thyroxine; It can reduce thyroid blood flow, reduce gland congestion and make glands shrink and harden. Usage: The compound potassium iodide solution is usually taken orally, three times a day, with 3 drops of 1 day, 4 drops the next day, and then increased to 16 drops a day, and then this dose is maintained. Because iodine can only inhibit the release of thyroxine, but not the synthesis of thyroxine, stopping taking it will lead to a large amount of decomposition of thyroglobulin stored in thyroid follicles, which will make the original symptoms of hyperthyroidism reappear or even aggravate, so people who do not intend to have surgery should not take iodine!
3. Nursing care of common complications after thyroid surgery?
Dyspnea and asphyxia: give supine position to facilitate breathing and drainage; Keep the wound drainage unobstructed; Diet: give warm and cool liquid food 6 hours after operation to avoid eating overheated food, which will cause vasodilation at the operation site.
Recurrent laryngeal nerve injury: patients are encouraged to pronounce after operation, which can be recovered after 3~6 months of treatment by managers.
Injury of superior laryngeal nerve: Pay attention to diet care and encourage patients to eat hard food, which can be recovered after treatment by the general manager.
Hand and foot convulsion: observation: pay attention to blood calcium concentration.
Diet: Appropriately limit foods with high phosphorus content such as meat, dairy products and eggs.
Calcium supplement: the lighter person takes calcium orally; In severe cases, vitamin d can be supplemented. Hand and foot convulsions should be injected with 10% calcium gluconate.
4. Thyroid crisis: The symptoms are high fever, rapid and weak pulse, hyperhidrosis, irritability, delirium and even coma within 12~36h after operation, often accompanied by vomiting and diarrhea. First aid measures include:
Iodine: Reduce the level of thyroxine in circulating blood.
Hydrocortisone: Anti-stress reaction
Adrenergic blockers: reserpine and propranolol reduce the response of surrounding tissues to adrenaline.
Sedative treatment: phenobarbital sodium, etc.
Cooling treatment, keeping the body temperature at 37℃
Intravenous infusion of a large amount of glucose solution
Oxygen inhalation reduces tissue hypoxia.
Patients with heart failure, plus digitalis preparation.
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