nursing care of spontaneous esophageal rupture-nursing precautions-dietary taboos
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1. After the blood pressure is stable, give it a half-lying position. It is very important to keep the oral cavity clean. Oral care should be taken twice a day. Paraffin oil can be used to smear the chapped lips to keep them moist. In addition, some patients are thin, Lots of night sweats, Carrying thoracic drainage tube increases the difficulty of skin care, To prevent bedsore, Keep the bed flat, dry and free of slag, replace the spare mattress at any time, keep the clothes dry and flat, replace the clothes soaked with sweat in time, wipe the pressed parts with warm water every day and pay attention to avoid exposing the body to prevent catching cold, turn over once every 2 hours, fix the drainage tube when turning over, and move gently and steadily, avoid pushing, dragging, pulling and rough actions, and take care of them carefully.
2. Nursing care of drainage tube
(1) Gastric tube: Gastric tube should be continuously sucked under negative pressure, observe the quantity, color and nature of drainage fluid in time and record it in time, pay attention to prevent distortion or blockage of gastric tube, pay attention to fixing gastric tube to prevent it from coming out, replace negative pressure bottle in time and maintain continuous and effective negative pressure drainage, and report any abnormality to doctor in time. After intestinal peristalsis recovered and anus was exhausted, water-soluble contrast agent was taken orally for esophageal angiography, and the gastric tube was pulled out after no leakage was confirmed at the repair place. Liquid diet was given after extubation, and high-calorie and digestible food could be given after 24 hours without discomfort.
(2) Closed thoracic drainage tube: Strictly check whether the joints of drainage tube are sealed to avoid air leakage and slippage. Keep drainage unobstructed.
① If the patient's blood pressure is stable, take a semi-sitting position to facilitate drainage.
② Encourage patients to cough and take deep breaths, so as to discharge food residues and pus in the chest cavity and promote lung recruitment.
③ Prevent the drainage tube from being compressed, bent and blocked.
④ Squeeze the drainage tube alternately from top to bottom regularly to avoid the lumen being blocked by blood clots, pus and food residues.
⑤ In the water seal bottle, the liquid surface layer is lower than the pleural outlet plane of the drainage tube by more than 60cm to prevent the liquid from flowing back into the pleural cavity.
⑥ Closely observe the amount, properties and fluctuation range of water column of drainage fluid, and accurately record it, and notify the doctor in time if any abnormality is found.
⑦ After operation, the drainage tube is often squeezed to prevent blood clots or cellulose attachment from blocking the lumen to cover up bleeding signs and prevent pleural effusion. Closely observe the color, quality and quantity of drainage fluid and record the shift in detail. Keep the drainage bottle sterile, change the sterile physiological saline in the drainage bottle every day, and change the sterile drainage bottle every week. When changing, clamp the closed thoracic drainage tube with two hemostatic forceps to prevent the air from entering the thoracic cavity due to the slippage of one hemostatic forceps.
(3) Deep vein nursing: Deep vein nutrition is the main method for patients with spontaneous esophageal rupture, and the speed and amount of rehydration should be mastered to prevent heart failure caused by excessive dripping speed.
① Change the application under aseptic operation every day; ② After transporting the liquid, seal the tube with positive pressure of stock solution or 0.5% heparin sodium solution.
3. Nursing care of jejunostomy: The thoracic cavity has been infected, the condition is critical, the physical energy consumption is large, and the physique is emaciated. Fasting and closed thoracic drainage are performed. Whether the patients can supplement nutrition and strengthen their physique in time after operation becomes an important condition to ensure rehabilitation. Inorganic salts such as potassium, sodium and calcium are added to the water injection during the period. Tube feeding diet should be mixed with a variety of foods, which is reasonable and easy to absorb.
Ensure that the daily total calorie is 1500 ~ 2000kCal, and mix with mixed milk, broth, fish soup, milk powder, chocolate, nutritious rice flour, vegetable juice, oil, salt, etc., step by step from liquid, semi-liquid and mushy diet, and gradually increase the amount according to the patient's condition, and heat it before injection, so that the patient's intestinal function can adapt well. The diet should be injected slowly, and given to a half-lying position. Pay attention to observe whether there is abdominal distension, abdominal pain, diarrhea, etc. The prepared nutrient solution should be used up within 24 hours. Before and after the nutrient solution is injected, flush the tube with salt water to avoid residue retention and blockage. After dripping, wrap it with sterile gauze, and pin it in place to avoid pulling the nutrient tube out.
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