Long XiaoqingrAbstract summary of 1 cases of gallstone patients before and after operation nursing ,patients according to the nursing difficulty take the diet nursing, psychological nursing measures ,through careful nursing care ,children through ,rehabilitation hospital .
r Key words gallstones psychological nursing diet nursing rstonesand trees ( including the gallbladder bile in the formation of condensation ) ,is the most common clinical diseases of the digestive system of .
The main clinical manifestations included episodes of abdominal pain ,acute inflammation ,if the stones into the bile may occur after total or following complications :jaundice ,biliary and inflammatory disease and pancreatitis ;but most of the patients may have no symptoms .
According to different parts of stones ,divided into gallstones ,liver inner pipe stone ,bile and stone aggregate .r 1clinical data ofpatients with r,male ,43 years old,married ,Zhangjiajie city Wulingyuan District Road board ,patients in 2011 02month 07 days11 when casewithout obvious rust by subxiphoid severe pain ,was continuing, no radiation sweat out ,accompanied by nausea ,vomiting, 2,as the stomach contents, no coffee color and red liquid ,no fever and jaundice ,no diarrhea and melena .
For the sake of diagnosis and treatment of patients with mental disease hospital ,after crossing ,urine stool normal ,unsolved .He had a history of periodic hypokalemia history ,deny his medical history, deny drug and food allergies .
r admissionexamination :T36.7 C P68R20BP170/ 110mmHg/ min / min in normal development ,nutrient medium ,nerve in awake ,acute pain was ill ,automatic posture ,skin sclera yellow dye ,lip no cyanosis ,Jin soft ,clear breath sounds of bilateral lung ,stomach smell and dry moist rales ,heart rate of 68 beats / min,law neat without noise, sound slightly obtuse ;plain abdominal soft ,subxiphoid tenderness ,no rebound pain and muscle tension ,Murphy syndrome, negative ,no more than the abdominal tenderness, hepatosplenic ribs without palpable ,bowel sounds normal ,double branches without edema .
r 2 nursingr2.1 general nursingr2.1.1should beprostrate or the right to sleep, such as left to sleep when the gallbladder stone mouth face downward, under the action of gravity from the gallbladder gallbladder neck and easy to fall into place incarcerated ,causing biliary colic .
r 2.1.1control heatreducing weight, eating every meal should control gross ,raise seven or eight points ( especially dinner ) .To keep the weight in the ideal range ,overweight and obese subjects should lose weight .
r 2.1.3reduced fat and cholesterol.Strictly limit the animal offal ,animal brain ,eggs ,egg yolk ,crab with high cholesterol foods ,eat up to four eggs per week ,and avoid overeating or excessive hunger ,as far as possible shaoliangduocan .
r 2.1.4high-quality proteinsupplement .You can choose to fish ,shrimp ,poultry, tofu and less oil beans products ,fruits and vegetables are rich in dietary fiber .r 2.1.5grainshave benefits more than the selection of food containing dietary fiber ,high food ,including maize ,millet ,potato ,oats and other coarse grains ,in order to promote bile excretion .
r 2.1.6spicy tobacco and alcoholto get rid of .r 2.1.7exquisitecooking method .Cooking should be light, preferably take stewed ,cooking ,stewing soup and other methods .Avoid fried ,grilled, smoked half-raw, half-ripe ,cooking methods ,and minimize the use of spices ,so that it is suitable for functional changes in the biliary tract after operation ,reduce the burden on the digestive system .
Generally taken Shaoliangduocan do rmethod,meal intake should not be too raise .Food can be the low-fat semi flow or low-fat soft rice .Such as all kinds of porridge ,noodles ,bread ,biscuits ,patch ,tofu ,egg white ,fat free milk and low fat meat ,vegetables ,fruits and other less fiber .
r 3.1 preoperativenursing r3.1.1relief of preoperativetension operation is on stress stimuli ,not only physically invasive stimulation ,but also produce a certain psychological reaction .
Nursing personnel should be properly explained to the patients condition ,according to the patient cultural background ,use proper language to explain the preoperative patient preparation should be done and simple operation process and nursing measures ,in order to alleviate the patient anxiety .
r 3.1.2 eliminationin patients patients often worry that resection of the gallbladder can induce cancer ,fear of operation failure or accident .Preoperative patients presenting to a conservative treatment of potential danger and operation therapeutic advantages ,introduces the operation doctor and anesthetist ,make the patient feel medical staff to its condition is very understanding ,the operation is very responsible ,in order to enhance patient safety .
When the patient wants a doctor operation ,under normal circumstances should be satisfied, it can effectively eliminate patients state .r 3.1.3stimulate thepatient in some patients preoperatively on himself and his family feel anxious ,self-confidence is reduced and cause a kind of negative psychology .
Medical practitioners should encourage patients to express their emotions and feelings ,try to change the patient this negative psychological ,continue to give guidance ,help them form correct cognitive evaluation ,establish a correct outlook on life ,stimulate the patient ,bad mood conversion .
Medical staff should cooperate closely with families ,common to patients with psychological support .r 3.1.4to patientsand belongs to a person sick leave home and work, was admitted to the hospital ward ,needs an operation ,all alone ,fear ,helplessness psychology, lack of sense of belongs .
Carefully before operation to investigate patients ,for patients with psychological support ,targeted for physiological and psychological nursing care of from first to last ,make the patient feel with their trust ,people familiar with the care of their own hearts ,have to rely on ,have sense of belongs .
r 4.1 postoperativenursing r4.1.1,eat less spicy spice ,carbonated drinks ,alcohol and so promote the secretion of gastric juice and gastric juice food ,will stimulate cholecystokinin ,increase the occurrence of stones .
4.1.2 all mealsto fixed time consumption .Biliary excretion of irregular ,gallbladder bile can easily solidified into stone .4.1.3 dietary fibercan reduce the cholesterol in the blood function .
To deter and rich in fiber ,vegetables ,brown rice germ rice ,seaweed and other .Patients with gallstones, attention must be paid to light diet ,eat less greasy food .To be light and to what extent ,do not have clear standards ,I insisted that the ordinary diet ,eat more vegetables ,eat less fat and animal oil ,regular diet ,quit smoking wine ,eat snacks, strengthen exercise .
If you do not adhere to light diet ,eat plenty of still rich diet ,smoking and drinking ,easily lead to stone recurrence .After gall-stone operation ,usually do not need medication to prevent .
Should be checked regularly ,can be between 6 months and 1 yearsof upper abdominal B ultrasound reexamine an once ,so that early detection ,early treatment .4.1.4 restricted fat diet.Elevated cholesterol is easily produced gallstones ,to limit the rich in animal fat eggs ,cream ,butter ,liver ,eggs and other food .
Gallstone patients after the first day need to fast ,because the stomach is still in the state of anaesthesia ,the patient can only drink soup ,the very next day can eat .Bile and gallstone patients after operation requires fasting three rdays,either 1 or 3 daysafter the operation ,the patient, are the need to endure hunger ,must give the digestive function of time ,lets it recover .
Some patients will have postoperative diarrhoea ,nausea ,vomiting ,the body will be in a very weak state .After 1 to 3 days,still can not greatly raise here ,because your gastrointestinal experience such preoperative and postoperative torture ,can bear so heavy burden .
r 5.1drug carecompliance ( give Lidan alcohol benzyl alcohol ) analgesia ,lifting the sphincter of Oddi spasm ,increase bile secretion ,strengthen the gallbladder contraction .Dan Ling ( trepibutone ) cholecystectomy after many patients appear fat digestive disorders ,slightly greasy food will suffer from abdominal pain, diarrhea and other symptoms .
This product can promote the secretion of bile, on fat digestion and absorption to have stimulative effect .r 6.1life carein fasting gallbladder bile is stored in the gallbladder mucosa ,constantly absorbing moisture inspissated bile ,cholesterol / egg phosphorescence lipid bulla formed ,bile viscosity increase ,regular meals stimulate human body secretion cholecystokinin on gallbladder contraction function ,so that the drained bile ,so regular circulation of bile helps prevent gallstones formation ) ;adjusting diet structure, avoid high protein ,high fat ,high calorie diet ,proper eating fiber-rich foods can reduce cholesterol ;hemolytic disease and cirrhosis patients should be active treatment of the original diseases ,prevent the formation of pigment gallstones ;long time parenteral nutrition ,should be regularly use the gallbladder cholecystokinin emptying ;subtotal gastrectomy or vagotomy patient ,gallbladder emptying ,increased incidence of gallstones ;pay attention to food hygiene ,preventing infection of biliary tract ,constitute a worm eggs ,as the core of the gallstone formation .
r 7.1rehabilitation nursingpatients according to their condition to choose their own rehabilitation training such as :walking ,qigong ,Tai Chi, to enhance physical fitness .After a week do minor activities within three weeks ,not to mention more than 5 kg.
Pay attention to mental nursing ,keep optimistic mood, avoid extreme emotion ,pay attention to cold temperature moderate ,make liver section of .Based on the summary rgallstones in patients withcare ,I feel the most is clinical nurse must be skilled nursing practice skills ,keen observation and analysis ability ,can use the nursing process method solution in patients with existing or potential health problems .
Patients on medical personnel with strong dependence ,nurses face tense rescue and the critically ill work situation ,in the reception of first time independent completion of the rescue work ,An Zhi rescue bed ,An Zhi ,oxygen inhalation ,monitoring of vital signs ,ECG monitoring ,intravenous infusion ,venous blood collection of specimens ,such as intravenous drug nursing skills .
Exercise a keen powers of observation, close observation of patients with chest pain location ,nature is very important, give positive .Nurses to work in studying business technology ,pioneering and innovative ,rigorous and meticulous ,decisive and agile ,seek truth from facts ,the patients have a high sense of responsibility and sympathy .
The nursing of patients with gallstones me understanding the nursing coordination .The deepest feeling and: dietary control is to prevent gallstones, gallbladder cancer is the most ideal prevention method .
Prevention of gallstones should pay attention to diet ,diet should be diverse, in addition ,cold ,greasy ,high protein ,spicy food and spirits to help wet heat ,so that the cholestasis ,also should eat less .
Pay attention to food hygiene ,preventing infection of biliary tract ,constitute a worm eggs ,as the core of the gallstone formation .Rich in vitamin A and vitamin C in fruits and vegetables ,fish and seafood food helps Qingdan dampness ,the dissolution of stones ,should eat more .
Life should be the law ,pay attention to work and rest ,often take part in physical activities ,breakfast time ,avoid fat ,reduce the number of pregnancy is not roftenimportant preventive measures .
Every night to drink a cup of milk or breakfast eat a fried egg ,can make the gallbladder emptying ,timing contraction ,reduced bile in the gallbladder in the residence time .Reference r1surgery