95例慢性鼻窦炎病人行鼻窦内镜手术治疗的护理[1](Nursingcareof95patientswithchronicsinusitisun

1、95 例慢性鼻窦炎病人行鼻窦内镜手术治疗的护理1 ( Nursing careof 95 patients with chronic sinusitis undergoing endoscopicsinus surgery 1)General nursing, tenth volume March 2012, third early edition (244th total), 595General nursing, tenth volume March 2012, third early edition (244th total), 595StrengthenOral care, espec

2、ially in patients with gastrointestinal bleeding or coma, prevents oral sensationDye. Controlling blood sugar is an important measure to reduce nosocomial infection in diabetic patientsDoctor guide medication, diet management, monitoring of blood glucose and urine glucose.The skin pruritusThose whoi

3、tch, trim their nails, prevent scratching, and cause infection. The bodyresistance,Rational use of antibiotics to prevent double infection.2.5 psychological care, liver disease with diabetes mellitus,two kinds of diseases coexist for life, need longMedication in the year, repeated illness, lifelong

4、treatment, long-term control diet, so that patients negative psychologicalShoulder heavy, easy to produce bad mood. In addition, most patients are concerned about insulin treatmentManyworry that the application of insulin can lead to lifelong applications and refuse the use of insulin. Therefore,The

5、 nurse should patiently answer the patient's questions and promptly meet the patient's needs and encourage and comfort him,Caring for and caring for patients, helping patients to build up confidence in overcoming diseases, and keeping patients happyThe best mental state to receive treatment

6、and care.2.6 medication guidance, due to the influence of liver disease, the patient's blood sugar is difficult to control, so everyMonitoring blood sugar. Adjust the insulin according to the blood sugar and the patient's eatingThe amount of. The blood sugar should not be controlled too low,

7、 the fasting blood glucose should be controlled at 7mmol / L to 8mmol / LAdvisable. For patients injected with insulin, the dosage should be accurate. When insulin is infused intravenously,Pay attention to uniform input to prevent blood sugar level because of infusion speed. Popular insulin oftenKno

8、w, explain, oral hypoglycemic agents can cause liver damage, insulin is currently the best guaranteeThe dual effect of liver and blood sugar lowering, and selecting the proper insulin dosage form is correctDosage; choose the appropriate injection site, should always change the injection site, to pre

9、vent subcutaneous hardeningThe occurrence of the knot, strict disinfection, prevention of infection. Observe the reaction after medication and monitor it regularlyBlood sugar, adjust the dosage, do not arbitrarily change the drug, withdrawal. Guide the patient in proper use and calculationMethod for

10、 calculating insulin dosage and method for preserving medicine. Instruct patients to carry sugarTake the medicine when hypoglycemia occurs.2.7 discharge guidance according to the specific circumstances of the discharge of the patient, discharge guidance: informThe patient should work and rest, maint

11、ain an optimistic attitude, live a regular life, eat a reasonable diet, stop smoking and quit smokingWine; blood glucose and urine glucose and insulin injection method of self monitoring of church patient identification of low bloodThe symptoms of sugar, attention to prevent all kinds of infection,

12、regular review, change follow-up.3 experienceLiver disease and diabetes are all systemic diseases, both of which coexist and influence each otherComplex and changeable, through the positive treatment and the strict condition observation, the reasonable nursing measure mayPrevent all kinds of complic

13、ations, improve liver function, control diabetes, improve the patient'sQuality of life.Reference ：1 Chang Yufeng, Guo Cuiying, Peng Lihua, et al. Clinical observation and nursing care of hypoglycemia in patients with diabetes mellitusLi J. Nursing research, 2007, 21 (Supplement 1): 166167.2 Jing

14、 Shujuan. Nursing care of patients with hepatic encephalopathy J. Family nurses, 2008, 6 (4A): 898Eight hundred and ninety-nineAuthor introduction: Bai Na (1979 -), female, nurse, undergraduate, unit: 110003, people's Liberation ChinaArmy Second O two hospital.(received date: 20111112)(edited by

15、 Wang Zhaolin.)95 cases of chronic sinusitis were performedNursing care of endoscopic sinus surgeryMaoyanminAbstract: Objective to summarize the nursing of endoscopic sinus surgery for chronic sinusitis patients. Methods endoscopic sinus surgery was performed on 95 patients with chronic sinusitisInt

16、ensive psychological care, preoperative preparation, postoperative observation of changes in condition and dressing filling and oozing of blood, strengthening postural care, diet care, life care, complications, observation and care.result nasal bleeding occurred in 2 patients, and bleeding stopped a

17、fter treatment. 85 cases were cured, 10 cases improved. No serious complications occurred after the operation.Conclusion chronic sinusitis should be strengthenedThe nursing of nasal endoscopic sinus surgery is the guarantee of successful operation.Keywords: chronic sinusitis; endoscopic sinus surger

18、y; nursing careCLC number: R473.76, document identification code:Cdoi:10.3969 / j.isSsn.16744748.2012.07.012 article number: 16744748 (2012) 3A059502The main clinical manifestations of chronic sinusitis were nasal congestion, nasal congestion, headache, olfactory dysfunction and so on, and 92 cases

19、were anesthetized. After operation, the nasal cavity was filled with vaseline gauze 48h to 72h, and the strips were removedMore than the treatment of acute sinusitis is not complete or recurrent attacks, conversion, and after metamorphosis nasal cavity, sinus irrigation, change dressings. Regular vi

20、sits were made 1 months to 6 months after the operation.The reaction is closely related. Endoscopic sinus surgery for chronic sinusitis with tissue loss 1.3, resulting in 2 casesof postoperative nasal bleeding, nasal compression, and useIt can keep the physiological function of nasal cavity and para

21、nasal sinus well. October 2009 - bleeding after hemostasis stopped, 85 cases recovered, 10 cases improved, and no severe postoperative complications occurredIn August 2011, we performed endoscopic sinus surgery for 95 patients with chronic sinusitis, with severe complications.At the sametime, nursin

22、g has been strengthened and good results have been achieved. The nursing summaryis as follows. 2 nursing1 clinical data 2.1 preoperative care1.1 general information from October 2009 to August 2011, our department of paranasal sinus endoscopy, 2.1.1 psychological care, chronic sinusitis, long course

23、 of disease, patients have multiple medical treatment, andSurgical treatment of chronic sinusitis in 95 patients, 50 males and 45 females, aged 15 years to unsatisfactory experience, combined with endoscopic sinus surgery, is a new technique developed in recent years70 years old, average 52 years ol

24、d, all underwent CTexamination, diagnosed with hypertension, 15 cases of diabetes, patients lack of awareness of it,The operation effect, safety and confidence of postoperativerecovery are notIn 8 cases, all the related indexes were controlled before operation. Foot, anxiety, fear. Nurses should str

25、engthen psychological care, care and consideration for diseases1.2 treatment methods were endoscopic sinus surgery, 3 casesof general anesthesia, local people for different age, educational level, occupation, personality characteristics of patients with psychological supportWanfang Data596. 596Hold

26、and health education, and introduce the advanced and scientific endoscopic sinus surgery to the patientsTo clarify the operation procedure and time, and how tocooperate with the operation; to eliminate the anxiety and fear of the patientPsychology enables the patient to take the initiative and coope

27、rate with the operation.2.1.2 preoperative preparation: routine blood, electrocardiogram, paranasal sinuses, CT andEndoscopic examination to understand the patient's physiological and pathological status, grasp the nasal cavity and paranasal sinus lesionsCondition. Clinical examination of the ey

28、e, including vision, eye movements, pupil and fundusSo as to compare them postoperatively. The preoperative skin preparation: preoperative bathing dressing, male patient shaveBeard removal. For patients with nose hair cut off. Diet instruction: general anesthesia, preoperative fasting,10h can be use

29、d to reduce the burden of the stomach and intestines, and prevent the nausea and vomiting after anesthesia;Local anesthesia can be injected into half fluid diet before surgery.2.2 postoperative care2.2.1 postural care, general anesthesia, patients after surgery to give the pillow supine position, he

30、ad deviationSide, timely removal of respiratory secretions, respiratory tract patency, life characteristics of smoothAfter 6 hours, change to semi recumbent position. After local anesthesia, the patients were taken semi supine position. Semi recumbent positionThe utility model can reduce the pressur

31、e of the head blood flow to the nasal cavity wound, relieve pain and bleeding, and isbeneficial to the woundThe discharge of blood or secretions in the mouth is convenient for observing the postoperative blood flow.2.2.2 closely observed the changes in the condition, the patient's life character

32、istics, complexion and spiritStatus. Among them, the monitoring of blood pressure is particularly important, high blood pressure is increased bleeding wound, or evenThe main cause of bleeding. Have a history of hypertension, take medicine on time. Within 3D after operationHeat of absorption, such as

33、 persistent fever or high fever, that indicates woundinfection or complications, should be reportedTell the doctor to take care of it. If the patient is mentally high, comfort the patient and report the operationSuccessful success, distracting the patient and relaxing the patient.2.2.3 observed dres

34、sing, tamponade, and oozing of blood. Nasal surgery was different from the rest of the bodyThe wound is not sutured, while the vaseline gauze is used to block and stop bleeding. fromIn operation and packing stimulation, the nasal mucosasecretes some secretions and contains a small amount of bloodThe

35、 formation of blood outflow liquid. This is a normal phenomenon. Tell the patient not to panic. The fluid in the mouthThe body can not swallow, should spit out, so as to observe the amount of bleeding. Do not loosen the yarn by itselfFree of bleeding. Instruct the patient to avoid sneezing or coughi

36、ng so as not to cause the dressing to come outBlocked or strayed into the respiratory tract. If the nasal cavity is removed from the posterior nares, it can swim along the soft palateDon't pull out the edge horizontally.2.2.4 diet care, local anesthesia, postoperative, warm, cold, semi fluid die

37、t, whole bodyAnesthesia patients awake, 6h, semi fluid diet;Encourage the patient to be light and digestibleFood, avoid overheating, strong and stimulating strong food, reduce bleeding factors; less food and moreRinse your meals before meals and after meals. Change from 3D to 5D to regular diet. Man

38、y patients don't have oneThe appetite refused to eat, and the nasal cavity filled with 2 nasal passages and swallowed the foreheadAnd nasal cavity distending pain aggravating, wound ooze blood to increase to relate 1. Nurses should strengthen propaganda and education to diseaseIt is clear that p

39、roper diet is beneficial to recovery of physical strength, recovery of wounds and avoidance of hypoglycemiaThe occurrence of the disease encourages the patient to eat.2.2.5 life care is due to surgical trauma, nasal packing and mouth opening breathingPostoperative pain, headache, dry mouth and nasal

40、 distention and pain can occur in the patients. NurseLife support, life care, psychological care and knowledge instruction should be given. Postoperative24h was given routine cold compress to reduce capillary permeability and inhibit groupThe swelling and the sensitivity of nerve endings can be effe

41、ctively controlled by reducing the nasal bleedingThe purpose of pain 2. Instruct patients to drink more water so as to relieve the discomfort of dry mouth. Appropriate increaseIndoor humidity. Timed window ventilation reduces visitor attendance. Strengthening oral care.Gargle with chlorhexidine garg

42、le every day and keep your mouth clean. Tell the patient to avoid as much as possibleAvoid sneezing. If you have a sneeze, ask the patient to open his mouth and press his nose to relieve it.Tell the patient the discomfort of the nose, forehead, distending pain, dry mouth, and so on, which will gradu

43、ally decrease after 2DThe cavity pack is removed and removed and the patient's confidence is increased.The prevention and treatment of complications of.6 is the key to reduce complications. (2) and (2) observe the change of the condition in time and deal with it in time. Epistaxis is endoscopic

44、sinus surgeryThe most common complication. When the patient returns to the ward, he instructs the patient to spit the liquid in the mouthIn order to accurately observe the amount of bleeding. If the patient has a continuous flow of blood in the noseOut of gauze or cotton swab after the still oozing

45、blood, or repeatedly spit blood or blood clots, the whole bodyThe anesthetic patient has frequent swallowing movements and should be reported to the doctor immediately. There were 2 cases of this diseaseNasal bleeding occurred in one patient and was stopped by nasal packing and bleeding after the us

46、e of hemostatic drugsStop it 。 The intracranial complication is mainly caused by the injury of dura mater, mainly cerebrospinal fluid and noseLeakage is the most serious complication of endoscopic sinus surgery. The patient should be closely observed after the operationNo watery secretions flow from

47、 the nasal cavity. If there is a continuous discharge of water samples, lower your headA colorless liquid that flows at a pressure or when the nose is flowing and is dried and crusted and saltyTaste 3, with cerebrospinal fluid rhinorrhea, should be done immediately to identify the identification of

48、sugar, is the brainSpinal fluid or nasal discharge?. Tell the patient not to blow his nose vigorously or cough violentlyConstipation, elderly patients with hypertension should be actively treated for primary diseases, and give spiritual comfort,Keep the patient calm. Orbital complications are often

49、caused by intraoperative injury of paper templatesThere should be orbital hematoma and optic nerve injury. The nurse should closely observe whether the patient has diplopia or visionThere was no obstruction, orbital congestion, swelling, eyeball protrusion and movementDoctors should be promptly repo

50、rted to deal with.2.2.7 nasal cavity nursing, according to the nasal cavity condition, the nasal cavity stops the gauze strip after the surgery 48h72h gradually removed, after removal, strengthen nasal care.Instruct the patient to apply the drops correctlyNasal medicine and nasal spray makethe medic

51、ine give full play to the curative effect. Nasal irrigation: take out the sliverThe nasal cavity is flushed from day to day to reduce the nasal cavity scab adhesion and promote secretion dischargeA method of irrigation is provided for flushing after discharge from the hospital. Cooperate with doctor

52、 for nasal cavity dressing change.8 .3 discharge instruction: health instruction: instruct the patient to pay attention to the nasal hygiene and prevent the cold,Strengthen physical exercise, pay attention to work and rest; do not eat spicy, stimulating food, quit smoking, wine.Avoid contact with dust and other irritating substances, timely treatment of allergic diseases.The orderThe patient reviews on time: after the patient leaves the hospital, still needs many times by oneself nas