Coordination of Descending Aorta Replacement Surgery
To maintain the patency of the respiratory tract and the drainage tube, close observation of changes in condition is necessary to prevent the occurrence of reexpansion pulmonary edema, left heart failure, infections, and other complications. The patient recovered well and was discharged on January 3, 2011.
2 Nursing Care
2.1 Preoperative Care
Mission: In addition to routine preoperative care, focus on psychological care and effective breathing, coughing, sputum production, and preoperative training.
Breathing Technique Training: Train patients in coordinated respiratory muscle action to reduce the fixed role of muscle rigidity. Enable patients to straighten their posture, head forward, shoulders drooping, arms relaxed, and within reach on both sides of the pillow below the knee so that abdominal muscle relaxation training facilitates breathing; pressure in the chest or abdomen, breathing deep and slow.
Effective Cough Training:
(1) Explosive Cough: First, take a deep inhale and then close the vocal cords, followed by sudden contraction of the chest and abdomen, soon expelling gas. However, this can often cause pain after surgery.
(2) Segmental Cough: A series of whispered coughs, although almost as effective, but less painful.
(3) Vocal Cough: When patients experience pain during coughing, they can first take a deep breath, then open their mouth and keep the glottis open after coughing.
2.2 Postoperative Care
2.2.1 Close Observation of Condition Changes, Wary of Reexpansion Pulmonary Edema and Left Ventricular Failure.
Preoperative tumor oppression accounted for 55% of lung function. Surgical removal of giant tumors causes sudden decompression of the pressure on the lungs, leading to reactive hyperemia, lifting of pressure on the heart, not only increasing Rhodobryum but also causing left heart failure and congestive pulmonary edema, along with a series of complications. Therefore, closely observe T, P, R, BP, and oxygen saturation changes, observing the color, nature, and amount of coughed-up sputum. The control of infusion speed cannot be ignored to avoid entering too much liquid in a short period, sharply increasing circulating blood volume, causing cardiac overload leading to left ventricular failure and pulmonary edema. If patients suddenly experience chest tightness, difficulty breathing, chest pressure or pain, coughing up a lot of white or pink frothy sputum, pulse quick and weak, drop in blood pressure, cold sweats, and auscultation of the lungs covered with wet rales, contact the doctor immediately to take measures to address the situation urgently. This patient experienced chest tightness and wheezing the next day, and high-flow oxygen inhalation was given after a 50-70% alcohol wet treatment and 20mg ivst furosemide. 250ml of 5% glucose, 0.5 static point QO asthma pyridine, and 400ml blood transfusion were administered. The next day, the patient's condition eased, listening to clear lung breath sounds, slightly lower than the right side, without any smell or wet and dry rales. After the condition stabilized.
2.2.2 Postoperative Respiratory Management:
(1) Postoperative room temperature at 24°C is appropriate to avoid cold, lowered respiratory immunity, secondary respiratory infections, and increased secretions.
(2) Timely removal of respiratory secretions to maintain airway patency. The discharge of pent-up caused by hypoventilation, pulmonary infection, and atelectasis are important reasons. Effective coughing and expectoration can be treatment and prevention methods. Therefore, actively take measures to promote lung expansion. In this case, after 6 hours, the semi-recumbent position was adopted, standing up every Q2 ~ 4h, knocking back sputum loose to make it easy to cough up, and guiding deep and slow breathing and effective cough based on the actual situation of the patient. On the first postoperative day, due to incision pain, the patient could not cough, and guidance was provided to apply hand pressure over the cut while taking an audible cough. The next day, the patient experienced wheezing, and segmentation cough usage was guided, achieving good results. When patients cough ineffectively or have weak coughs, throat or chest wall stimulation is given to strengthen the effect of cough pressure with both hands. For sticky sputum, aerosol inhalation bid is given. If expectoration is difficult, such as hypoxia or increased heart rate, oxygen, suctioning, or tracheotomy if necessary is provided. After 4 days, guidance was provided to patients to blow up balloons for respiratory training to exercise respiratory function. Seven days after surgery, the chest showed good lung expansion.
2.2.3 Chest Tube Care:
Chest drainage tubes can drain pleural fluid and also observe whether intrathoracic bleeding or anastomotic leakage occurs. To prevent reexpansion pulmonary edema, the tube is clipped for two days postoperatively and intermittently opened. Close observation of the color, volume, and nature of the fluid drainage is necessary to keep the drainage open, accurately record 24h drainage, replace the water seal bottle with strict aseptic technique, observe whether the drainage pipe is loose or out, or obstructed. Missionary nursing and families must not allow the water seal bottle to raise more than a chest drain mouth to prevent drainage fluid reflux, causing chest infection or kicked, smashed, leading to open pneumothorax. In this case, extubation occurred 7 days later without any complications, and wound healing was good.
(Received Et-04-06)
Domestic System-TU: CN41.1094/R Advertising License No.: 4100004000868 Postal Code 136-23 Priced at $15.00