Observation and nursing of indwelling catheter
1. Symptoms of urinary tract irritation Urinary tract irritation is one of the common complications after catheterization. The patient consciously has bladder irritation symptoms such as lower abdomen discomfort, frequent urination and urgency. It is mainly caused by improper placement or movement of double J-tube, which leads to too long catheter in bladder and stimulates the triangular area of bladder or posterior urethra. For the symptoms of mild urinary tract irritation, tell the patient not to be nervous, and observe whether the symptoms are relieved or disappeared by adjusting the body position. Children should pay attention to urination interval and urine volume, and listen to their complaints. Those with obvious symptoms are given spasmolytic treatment, and the position of double J tube can be adjusted through cystoscope if necessary.
2. After placing double J-tube for urine reflux, the filling stimulation of renal pelvis and ureteral cone is lost, which leads to the obvious weakening or disappearance of ureteral peristalsis. The direction of urine flow depends on the pressure between renal pelvis and bladder. Normal renal pelvis pressure is 0.978 ~ 65438±0.467 kPa, bladder pressure.
3. Urine and drainage status Due to the long time of double J tube intubation and the stimulation of the upper and lower ends to the renal pelvis and bladder mucosa, hematuria is easy to cause. Therefore, attention should be paid to the changes of urine color and urine volume after operation. Generally, hematuria should be gradually relieved 3 days after operation, and it can be slightly aggravated after activity. The way to observe the color of hematuria is to take samples every morning and observe and compare the color of urine. If the patient suddenly has symptoms such as bright red urine, swelling pain in kidney area, abdominal discomfort, etc., he should report to the doctor in time to check whether the double J tube is blocked due to the slippage or up-and-down movement of the double J tube, or there are sediments, mucus and blood clots in the urine. Patients should be urged to drink more water and "naturally flush" the urinary tract after operation. It is necessary to strengthen perineal care, and do not leave a catheter after operation to prevent retrograde infection. [Collected by Medical Education Network]
Discharge guidance
Discharge guidance is one of the important contents to ensure patients to see a doctor on time, do a good job of self-observation and nursing. In this group 1 patient with ureteral calculi took part in manual labor after discharge, and painless gross hematuria with blood clot suddenly appeared 1.5 months after catheterization. Outpatient examination found that the double J tube moved up to the ureter and was taken out after operation. Therefore, it is suggested to strengthen the health education for patients, guide their life, daily life, diet and activities after discharge, do not stretch their limbs and waist at the same time, and do not squat suddenly and do heavy physical labor; Parents should also be instructed not to let their children play and run violently to prevent the double J tube from slipping or moving up and down. At the same time, it is also necessary to guide patients to observe the changes of urine color and urine volume and make follow-up visits on time, and see a doctor in time if any abnormality is found. It is reported in the literature that foreign body stimulation in bladder can increase the possibility of bladder tumor, so it is very important to remind patients to see a doctor regularly and extubate on time. For patients with postoperative stones, instruct them to pay attention to adjusting the pH of urine and drink plenty of water to prevent urinary salt from precipitating to form stones or blocking double J tubes. In this group, a small amount of urinary salt precipitation was found in the convoluted part of bladder during extubation, with double J tubes.