Effect of preoperative nursing intervention on patients' spontaneous expectoration after thyroid disease operation
Objective: To explore the effect of preoperative nursing intervention on patients' spontaneous expectoration after thyroid disease operation. Methods: 92 postoperative patients with thyroid diseases were randomly divided into intervention group and control group, with 46 cases in each group. The intervention group received self-expectoration nursing intervention before and after operation, while the control group received routine nursing on the day of operation. Results: The effective rate of voluntary expectoration in the intervention group was higher than that in the control group (P
Preoperative nursing intervention; Thyroid diseases; Spontaneous expectoration
From March, 2009 to February, 2008, we carried out nursing intervention on 46 patients with thyroid diseases before and after operation, and achieved satisfactory results after close observation. The report is as follows.
1 data and methods
Select 1. 1.92 patients with thyroid diseases who underwent surgery at the same time, all of them were anesthetized by general anesthesia and tracheal intubation, and they were randomly divided into intervention group and control group, with 46 cases in each group. There were 22 males and 24 females in the intervention group. The age range was 15 ~ 68 years old, with an average of (50.0? 10.6) years old; Among them, there were 32 cases of partial thyroidectomy and 4 cases of Ye Quan thyroidectomy/KLOC-0. In the control group, there were 65438 07 males and 29 females. The age ranged from 25 to 72, with an average age (58.0? 1 1.8) years old; Among them, 38 cases underwent partial thyroidectomy and 8 cases underwent Ye Quan thyroidectomy. None of the above cases had respiratory diseases before operation, and the tracheal intubation was successfully inserted by an anesthesiologist at one time. There was no significant difference in age, sex, course of disease and pulmonary function examination between the two groups (P > 0.05). 0.05)。
1.2 Methods Patients in the intervention group were given self-expectoration nursing intervention before and after thyroid disease operation, while patients in the control group were given nursing intervention on the day of thyroid disease operation. The contents of nursing intervention include: disease knowledge education, psychological guidance, environmental preparation, and guidance on self-determination of sputum elimination methods. What should be observed after operation: the patient's psychological state of self-expectoration, the degree of dependence on nursing staff to assist expectoration, and postoperative complications. Patients can expectorate smoothly, feel comfortable in the respiratory tract and effectively expel phlegm; After operation, the respiratory secretions of patients increased, it was difficult to expectorate spontaneously, and they felt throat discomfort and expectoration was ineffective.
1.3 statistical method data were statistically processed by SPSS 13.0 software, and the data were processed by? 2 test or Fisher exact test, test level? =0.05。
Two results
2. 1 See table 1 for the comparison of spontaneous expectoration effect between the two groups.
3 Nursing intervention
3. 1 Disease knowledge education Implement disease knowledge education, telling patients that if they have long-term smoking and drinking habits before operation, or have symptoms of upper respiratory tract infection, bronchial secretions will increase after operation, so that patients and their families can understand the importance of self-expectoration.
3.2 Psychological Guidance Most patients will have fear and nervousness before operation. After operation, they are afraid of coughing and expectoration, which will lead to incision bleeding. Patients dare not cough and expectoration [1]. Educate patients whether they are afraid that expectoration will affect the discharge of respiratory secretions, but effective expectoration can relieve postoperative respiratory discomfort.
3.3 Environmental preparation Dry air will reduce the ciliary movement function of tracheal mucosa, making the sputum viscous and difficult to cough up [2]. Central air conditioning is used to maintain the ward temperature at 18~20℃ and humidity at 55%~70%.
3.4 Self-expectoration method guides patients to carry out effective self-expectoration exercise 2 days before operation. Methods: the patient gently pressed the incision with his hand, bent his knees, took a few deep breaths, then held his breath for 2~3 s, made a short and powerful cough for 2~3 times, and coughed up sputum. If the sputum is difficult to cough up, instruct the patient to take a semi-sitting and lying position, and the nursing staff instruct the family members to beat their backs with hollow fists, and vibrate the airway from the bottom of the lung to the top of the lung from outside to inside to help the patient expel phlegm. If the sputum is sticky, the patient can resume eating after anesthesia, and a small amount of water can be used to moisten the throat, which is conducive to coughing up sputum. Patients with thick phlegm who are not easy to cough up can also be inhaled with oxygen atomization. The composition of the liquid medicine is: mucosolvan injection 30 mg, chlortetracycline 5 ml, twice a day, 20 min each time. The liquid medicine is inhaled into the mouth through the liquid drops, reaches the lungs, and moistens the laryngeal mucosa at the same time, thus relieving the throat discomfort symptoms of patients [3].
4 discussion
After thyroid surgery, due to laryngeal trauma and stimulation, postoperative laryngeal edema, increased respiratory secretions, stimulated cough reflex and weakened cough reflex may lead to sputum obstruction. From the table 1, it can be seen that the effect of voluntary expectoration in the intervention group is better than that in the control group, because the patients in the control group are nervous and afraid after operation, the incision is painful, and their limbs are limited, so they can't clearly understand the method of expectoration. Patients in the intervention group can take care of themselves before operation, and can better master the transmission of relevant knowledge and information. According to the results of this experiment, preoperative nursing intervention is more conducive to patients' absorption and mastery of disease knowledge, so that patients can better cooperate with nursing staff after operation.
Therefore, comprehensive time nursing intervention is one of the important links to prevent respiratory tract obstruction and other complications after thyroid surgery. Correctly instruct patients to expectorate themselves. If they are afraid to cough because of the pain in the incision, they can gently press the incision with their hands. When coughing, the hand can exert proper force to reduce the incision traction and pain caused by coughing. When the sputum is thick and difficult to cough up, and the patient cannot fully understand the method of self-expectoration, atomized inhalation can be used to assist expectoration.
Surgery, as a stressor, will lead to strong psychological and physiological stress reactions in patients undergoing surgery. If these reactions are too strong, they will interfere with the smooth implementation of surgery and anesthesia and affect the therapeutic effect of patients [4]. Therefore, according to the possible discomfort and complications after operation, it is very important to make corresponding early nursing intervention. Nurses can understand patients' psychological state, cognitive ability and cooperation degree through preoperative inquiry and communication, and timely give targeted psychological and disease knowledge education and other nursing interventions, so that patients can correctly understand and master the method of self-expectoration, which is also helpful to relieve patients' tension and fear. As can be seen from Table 2, the psychological state of active cooperation in the intervention group is significantly higher than that in the control group, indicating that targeted nursing intervention before operation can change the psychological changes of patients after operation, thus enhancing their self-confidence in overcoming tension and fear. Therefore, preoperative nursing intervention has obvious effect on promoting patients' autonomous expectoration after thyroid surgery.
References:
Mou, Zhenfeng Li, et al. 100 cases of effective expectoration in thoracotomy [J]. Qilu Nursing Journal, 2007, 13 (16): 58-59.
[2] Ding, Mu Yafen, Cheng Hong, et al. 195 Experience of expectoration nursing for patients undergoing thoracic and cardiac surgery [J]. China Nursing Journal, 2006,3 (2): 64-65.
[3] Michelle Li and Yang Guangying. Application of evidence-based nursing in diet and expectoration nursing of thyroid surgery [J]. Nursing Practice and Research, 2009,6 (16): 31-32.
[4] Sun Fengyang. Sputum expectoration nursing care of chronic obstructive pulmonary disease complicated with infection [J]. Guide to Chinese Medicine, 2005,2 (11): 96.
Nursing papers before and after thyroid surgery 4
Nursing analysis of cough and expectoration after thyroid surgery
Objective: To analyze the nursing methods of patients with cough and expectoration after thyroid surgery. Methods: Fifty-four patients who underwent thyroid surgery in our hospital during 2011-2012+1were selected. All patients had expectoration and cough after operation, and were divided into observation group and control group according to the lottery method. The control group was given routine nursing, while the observation group was given rehabilitation training and treatment on the basis of the control group. Results: After nursing the patients in the two groups, the cough and expectoration of the patients in the observation group were obviously improved, and the total effective rates of the patients in the observation group and the control group were 65438 000% and 88.89% respectively, with statistical significance (P < 0.05). Conclusion: After giving patients effective cough relieving methods and drug treatment, good clinical results have been achieved, which is worthy of wide clinical application.
Key words: thyroid surgery; Cough and expectoration; Nursing; train
Thyroid surgery is one of the most common operations in clinical surgery. Because the surgical site is located near the trachea, and the blood circulation in the thyroid gland is rich, this kind of operation has great potential risks [1]. Many patients will have complications such as expectoration and cough after operation, and mild patients can gradually relieve themselves. However, severe patients will aggravate inflammation and edema due to long-term severe cough and expectoration, which will have a certain impact on wound healing. More serious patients may have severe conditions such as suffocation and bleeding. Therefore, it is very important to prevent and care for cough and expectoration after thyroid surgery. In this experiment, some patients in our hospital were given preoperative training and drug care, and good clinical results were achieved. The details are reported below.
1. Data and methods
1. 1
Fifty-four patients who underwent thyroid surgery in our hospital during the period of 2011-20/kloc-0+1were randomly divided into observation group and control group, with 27 patients in each group. The number of male and female patients in the observation group was 9 and 18 respectively, with an age range of 15 -78 years, with an average age of (35.8? 2.5) years old. There were 7 male patients and 20 female patients in the control group, with an age range of 18 -75 years and an average age of (4 1.5? 1.4) years old. Among the 54 patients, there were 5 cases of thyroid cancer, 8 cases of hyperthyroidism, 9 cases of thyroid tumor and 32 cases of nodular goiter. There is no significant difference between the two groups in general data such as sex, age and disease (P & gt0.05), which is comparable.
1.2 method
The control group was given routine care: the patients were comprehensively analyzed, and the causes of cough and expectoration were analyzed, so that patients fully realized that cough and expectoration were common postoperative complications, and their worries were eliminated, and they actively cooperated with medical staff for treatment, so as to achieve the purpose of relieving cough and eliminating phlegm. At the same time, it is necessary to ensure the fresh air in the patient ward and make the patient's living environment comfortable. At the same time, the use of air humidifier can prevent the air in the ward from drying, which has a certain effect on expectoration and relieving patients' cough. After the operation, some patients may have potential hypoxia due to cough and expectoration, and oxygen should be taken when necessary.
The patients in the observation group were given the following nursing care on the basis of the control group: firstly, the patients were instructed to carry out cough training before operation, and the secretions in the respiratory tract were eliminated in time to ensure the unobstructed respiratory tract. At the same time, for smokers, they need to quit smoking before operation. Giving the patient a cushion after operation is beneficial to expectoration and smooth breathing after operation. At the same time, strengthening effective cough training before operation can enable patients to correctly master the methods of coughing and expectoration. Effective cough after operation can relieve clinical symptoms and relieve patients' pain. Specific methods: The patient takes a seat, then takes a deep breath, slowly breathes for 5 -6 times, takes a deep breath until the diaphragm drops completely, holds his breath for 3s-5s, contracts his lips, slowly exhales the air in his lungs through his mouth, leans forward, coughs for 2-3 times from losing face, contracts and repolarizes when coughing, presses his upper abdomen with his hands to help expectoration, and instructs the patient to gently press the wound when coughing to prevent the wound from cracking and pain. Moreover, changing body position frequently is beneficial to expectoration [2].
Some patients still need medication.
① Oral administration of compound licorice mixture, antitussive and expectorant drugs, containing protective expectorant and antitussive agents, is beneficial to the improvement of cough symptoms of patients.
② Intravenous infusion of mucosolvan can increase the secretion of serous glands in respiratory mucosa, reduce the analysis of mucous glands, effectively reduce the viscosity of sputum, promote the secretion of pulmonary surfactant, increase the movement of bronchial cilia, and make sputum easy to cough up.
③ Atomization inhalation therapy. Mucosolvan oxygen atomization is often used in clinic, twice a day, and the inhalation time is generally controlled within 20 minutes. The treatment is to make the medicine enter the respiratory tract with the help of high-speed oxygen airflow, which can tell the truth to the patient's airway, eliminate inflammation, reduce the edema of respiratory mucosa and dilute the sputum in the body; Ensure that the patient's respiratory tract is unobstructed [3].
Cough for a long time can easily lead to myocardial hypoxia and ischemia, and even heart failure in severe cases. If the patient has other respiratory diseases before operation, it needs active clinical treatment. After the patient's respiratory symptoms have improved, he should be operated at an elective stage to prevent respiratory failure caused by sputum blockage after operation.
Efficacy evaluation of 1.3
Significant effect means that the clinical symptoms of patients completely disappear after nursing. Effective means that the patient's clinical symptoms have been improved to some extent, but he still has a slight cough and expectoration. Ineffectiveness means that the phenomenon of coughing and expectoration has not improved significantly after nursing.
Statistical analysis of 1.4
The data obtained in this experiment were analyzed by SPSS 1 1.0 statistical software. Represented by p
2. Results
discuss
To sum up, patients with cough and expectoration after thyroid surgery should be given targeted care, comfortable posture after surgery, reasonable diet and ward environment, which has a positive effect on cough and expectoration after surgery. No serious complications such as bleeding and asphyxia occurred in 54 patients in this experiment, and the total effective rate of patients in the observation group was as high as 100%, which was similar to the results reported in relevant literature [4.5]. Sufficient preparation before operation, instructing patients to carry out effective cough training, closely observing the changes of their condition after operation, ensuring their respiratory tract to receive regular and targeted drug treatment, and actively using a number of nursing measures are important conditions to ensure patients' rehabilitation, which is worthy of wide application in clinic.
refer to
[1] Yang Xiaohong, Yan Yanfang. Causes and nursing of cough and expectoration after thyroid surgery [J]. Modern journal of integrated traditional chinese and western medicine, 2012,21(9):10/3-10/4.
[2] Hongchun Wang, Lei Jiafu. Nursing measures of atomizing inhalation in the treatment of bronchopneumonia and cough [J]. Introduction to Traditional Chinese Medicine, 2007,4 (21): 67-67.
, Xie, Shi Xiaofeng, et al. Comfortable care of patients after thyroidectomy [J]. China Primary Medicine, 20 12,19 (7):1108-109.
[4] StackJr。 Characteristics of thyroid surgery in American academic and affiliated medical centers. Otolaryngology-Head and Neck Surgery, 2012,02.
[5], Fan, Zhang Yanmei, et al. Pre-operative sputum care for pulmonary tuberculosis patients [J]. Guide to Traditional Chinese Medicine, 20 1 1, 08 (1): 95-96.
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