2.1 Psychological care though laparoscopic technology has been widely used, but to carry out laparoscopic resection of the colon less, patients and their families know little about the surgery and the prevalence of surgical patients fear, anxiety, tension and other adverse psychological states. In such a mental state of the surgery, the body will adapt to the environment of the endocrine system damage, affect immune function, reduce the body against viruses, bacteria resistance, reduced tolerance for surgery, increasing the chance of complications after surgery [2], so the psychological care is very important. Patients in the hospital, the nurse applied kind of attitude, serious work, skilled nursing skills, to obtain the trust of patients and their families, in plain language, in layman's language to explain the need for the surgery; detailed description of patients and their families should be This procedure is compared with the advantages and disadvantages of open surgery: removal of the colon with a scalpel, with less damage, less bleeding, less postoperative pain, quicker recovery, eating early, less pulmonary complications, shorter hospital stay, etc., but the surgery longer; physician should also take the reliability of surgical and clinical conduct, as well as the specificity and limitations of surgery, there may be converted to open surgery, so patients have a preliminary understanding of the surgery and fully prepared to make their informed consent, underwent surgery under no ideological concerns. Through psychological care, 2 patients emotional stability, and actively cooperate with surgery.
2 preoperative care
3 post-operative care
3.1 vital signs monitoring vital signs may reflect the patient's general condition, patients should be measured per hour, body temperature, pulse, respiration, blood pressure to a stable condition, observe the patient's complexion and state of mind, for early detection of abnormalities.
1 clinical data Example 1, the patient, male, 36 years old, due to intermittent mucus pus more than eight years, the recent increase, on December 7, 2004 admission. 8 years ago in patients with ulcerative colitis, medical diagnosis, has been hospitalized many times, an average of 1.2 years of patient 1. Diarrhea in the past six months increased, more than 20 times a day, watery stools, accompanied by blood, mucus and pus, tenesmus, tenesmus clear, with anal burning, weight loss, malaise embolism. Physical examination: T 38 ℃, weight loss, skin and mucous membranes dry, soft abdomen without tenderness, does not touch the tumor. Laboratory tests: serum potassium 3.3mmol / L, Hb 9.8g / L, patients with a history as long, complicated by malnutrition and fluid and electrolyte disorders, hospitalization by fasting, parenteral nutrition and electrolyte correction, 2004 December 18, under general anesthesia Laparoscopic total colectomy, the operation lasted 5.8h, the safe return of the ward. Postoperative day 1 due to weak physical activity limited to bed, the world of bed 2, 3 days after removal of intra-abdominal drainage tube and thus the flow of food, 12 days of discharge, length of stay 23 days.
Example 2, the patient, male, 41 years old, due to intermittent abdominal pain with blood and pus 3 years, 1 month increase in June 5, 2005 admission. Medical diagnosis of colitis 10 years ago, his father died of malignant colon polyps. Physical examination: T <38 ℃, was spasmodic abdominal pain, no radiating pain. No nausea, vomiting, blood and pus frequency range, for a long time up to 20 times / d or more. Hb 10.7g / L, colonoscopy can be seen from the anus to the ileocecal 20cm see multiple polyps, cluster-like distribution throughout the colon. Pathological examination of tubular adenoma. Genetic diagnosis of familial polyposis. The full preoperative preparation, in June 10th, 2004 under general anesthesia Laparoscopic total colectomy, the operation lasted 4h. Patients in bed after the first world events, starting 48h after the liquid food, 3 days after removal of peritoneal drainage tube, 7 days of discharge.
2.2 bowel preparation to do such surgery for bowel preparation, adequate bowel preparation reduce intraoperative contamination, to prevent postoperative abdominal and wound infection, anastomotic conducive to good healing [3], general surgery 3 days before beginning the system does not absorb oral bacteria intestinal drugs (neomycin or erythromycin in combination with metronidazole) to reduce intestinal bacteria, and taking laxatives (paraffin oil or glycerine, daily 20ml, or on behalf of a small amount of senna tea flush); 1 day before surgery cleansing enema the evening and morning surgery, especially surgery to return the morning lavage fluid should be no fecal residue up.
Laparoscopic total colectomy perioperative care
Author: slip Zhijuan, Dong Pei, Zhao Lihua Source: Published :04 -12-08 view: times [Abstract] Objective laparoscopic total colectomy perioperative nursing. Methods The subjects two cases of laparoscopic total colectomy for patients with adequate preoperative preparation, psychological care, supine and diet care, monitoring vital signs and complications of observation and care. Results 2 patients with satisfactory results, with no surgical complications, were discharged. Conclusions do a good job of preoperative and postoperative care is the basis of successful operation, and postoperative rehabilitation of patients is very important. Key words Laparoscopy; total colectomy; care laparoscopic total colectomy surgery in recent years the development of a high-tech surgery. Laparoscopic total colectomy is carried out under general anesthesia, it changes the method of abdominal surgery, but from the abdomen (umbilical, epigastric 4cm,
abercrombie france, both sides of the anterior axillary line in the lower abdomen) to play into the operation of equipment, home viewers in the umbilical, epigastric 4cm with a 5mm trocar at the hole, this hole as an auxiliary holes,
mbt chaussures paris, both sides of the anterior axillary line in the lower abdomen with a 12mm trocar punch, as the primary hole, suprapubic incision 6 ~ 7cm set of hand-assisted device,
abercrombie paris, operating under the monitor to complete colectomy. This procedure eliminates a huge abdominal incision, removal of the colon with a scalpel, with less trauma, less pain, quicker recovery, eating breakfast, the advantages of short hospital stay has been accepted by people [1]. However, the technologies for a short time, by the equipment, cost and other limitations, is still at the exploratory stage, so good with the success of the operation and care of patients after rehabilitation indispensable measures. Our department in December 2004 - June 2005 on two patients following the implementation of hand-assisted laparoscopic total colectomy surgery, and achieved good results, now nursing reported as follows.
2.3 to prepare the skin to prevent skin clean is an important part of wound infection, such as surgical abdomen from the umbilicus and the punch, so 1 day before surgery in addition to conventional shaved from the xiphoid to the pubic symphysis , to the posterior axillary line on both sides within the hair, the result of the umbilicus easily retained dirt, should pay special attention to disinfection of the umbilicus, be sure to clean the umbilicus, the first with a cotton ball into the umbilical fossa soapy water until softened dirt clean cotton swab with gasoline, repeated washing with soap and water, should not scrape, then cover with povidone-iodine, in order to achieve the prevention of infection.
3.2 supine, activity and diet in patients with anesthesia is not clear who, in order to prevent the tongue falling inhaled and oral secretions, and tracheal aspiration pneumonia caused by suffocation, should be given to the pillow supine, head to one side. Until the patient fully awake, stable vital signs after a given semi-recumbent position, and to hip flexion, reduce abdominal wall tension, which will help the drainage of exudate, increased lung ventilation, which will help breathing and circulation; encourage activity in patients with early postoperative 1 days out of bed, early recovery activities can promote bowel movements to prevent adhesions, intestinal obstruction occurred; after fasting need water until fully recovered bowel movements,
ralph lauren paris, flatus, no abdominal pain, bloating stomach can be removed start the flow of food into the tube, and then gradually transition to the semi-liquid food normal diet.
2.4 dietary requirements preoperative low-residue diet 2 days prior to fasting and easy gas-producing foods such as beans, milk and other food products, to reduce intestinal gas accumulation, to 1 day before surgery liquid food; preoperative 12h fasting, 4 ~ 6h water deprivation. Example 1 in patients with a history as long, complicated malnutrition and water, electrolyte imbalance, fasting 1 week before surgery, given parenteral nutrition and electrolyte correction, due to intestinal get rest, significantly reduced the number of diarrhea patients, in general, significantly improvement. More articles related to topics：
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