Post-operative care of gastric cancer (a) of gastric cancer in general care after surgery
1. Close observation of vital signs of early prevention of bleeding caused by insufficient blood volume pulse and blood pressure numbers down.
2. The patient supine to take 6 hours after the semi-recumbent position, such as taking blood pressure stable, keeping the abdominal muscles relaxation, reduce pain, help breathing and circulation.
3. To encourage patients to take a deep breath, to help patients expectoration, reduce postoperative pulmonary complications.
4. After every half-hour blood pressure, pulse 1, to a stable condition. And observe the patient consciousness, body temperature, respiration, etc., to prevent shock.
5. After fasting to restore bowel sounds, flatus, the clamping tube test drinking water, without bloating, abdominal pain, gastric tube can be removed, drink a little water. The next day a small amount of liquid diet, each 50_80mlo 3 days to every 100_150ml, 4_5 times a day, without adverse effects such as abdominal pain, bloating, 4 half days liquid, do not eat milk, pay attention to smaller meals.
6. Fast infusion of attention on the anemia and hypoproteinemia transfusion should be stopped.
7. Line decompression to relieve pressure on the gastrointestinal tract, the stomach contents to reduce the stimulation of the anastomosis to reduce stomach tension, anastomotic edema and prevention of anastomotic leakage and promote anastomotic healing. Decompression device is connected properly: sterile abdominal suction drainage tube connected, exhaust pipe should be open then vacuum suction piston, so as to avoid the formation of abdominal dead space, resulting in drainage of fluid flow is not easy. Closely observe the fluid drainage color, nature and quantity, and carefully recorded. 24-hour drainage, generally in about 200ml for the plasma-like light red exudate. Such as the day of surgery, blood red liquid in the short time out, volume of about 300 _ 500ml, and the pulse rate, blood pressure, pale and bleeding tendency should be considered, the need for timely reporting doctor. Is blocked or the side of the hole suck the stomach, promptly corrected, so as not to affect the decompression effect. Available a small amount of warm salt water rinse, if necessary, should be re-placed. Every 2 hours with NS flush tube, each no more than 20, and the corresponding out. Avoid flushing pressure, too much fluid, so as to avoid anastomotic bleeding.
8. To encourage patients to get out of bed early. General postoperative day 1 to day 2 can sit bedside activities, indoor activities can be of 3 days. Early activity can increase peristalsis, and promote early resumption of digestive function.
Post-operative care of gastric cancer (II) after eating
After 3 days of fasting, intravenous fluid infusion of about 3000ml. Decompression stops, you can drink a small amount of water. After eating practices.
Gastric post-operative care (c) observation of postoperative complications and nursing care
1. Anastomotic bleeding mainly for gastrointestinal decompression in the blood sucked out a lot, and even vomiting, rapid pulse, blood pressure decreased. If only decompression with blood, and vital signs were stable, could be given to hemostatic or blood transfusion; if still not effective, should be immediately ready to re-operation.
Vomiting when the patient supine, head to one side to prevent choking. While establishing two venous access, additional blood volume. Closely observe the patient's condition.
2. Duodenal stump fistula usually occurred in the days after surgery 5_10, manifested as right upper quadrant pain, fever, increased leukocyte and peritoneal signs. Should be immediately fast, continuous gastrointestinal decompression, and fully carry out intra-abdominal drainage. Close observation of changes in condition, and the duodenal stump with a doctor for making thin tube.
3. Anastomotic anastomotic obstruction is too small, the suture fell into the gastrointestinal wall too much or postoperative edema, can cause obstruction. The latter to be caused by edema and relieve itself after the disappearance of the former were caused by the use of decompression, obstruction can not be fundamentally alleviated, the need to re-anastomosis surgical reconstruction.
Enter the jejunal obstruction mainly for food mix for about 30 minutes there a sense of epigastric pain or nausea performance, threw a small amount of bitter fluid or bile. Obstruction of the output performance of the jejunum Cheung frequent vomiting, vomit, bile and food mixture. Input, a mix of anastomotic obstruction to deal with the same obstruction.
4. Dumping syndrome occurred at the beginning of sweets into the liquid, especially after the performance for the half-hour after eating or immediately after abdominal fullness discomfort, palpitation, sweating, dizziness, paleness, weakness symptoms of nervous system and circulatory system . Should guide the patient as appropriate, adjust their diets, and more into the protein in fatty foods, control of carbohydrate intake, and to gradually adapt to the patient. And in 30 minutes before a meal bile mechanical oral anti-drug, supine for half an hour after the meal.
5. Alkaline reflux gastritis occurred in Pichia type jejunostomy after a few months or years, showed sustained abdominal pain, aggravated after eating, drugs can not be alleviated, sometimes nausea and vomiting, vomit bile. Oral metoclopramide 5_ 10 mg, 3 times / day, or you bite forest 10mg, 3 times / day, there alleviate the symptoms of the role of effective drug treatment dollars to be symptoms of serious surgery.
Post-operative care of gastric cancer (d) patient education
1. Advise patients avoid alcohol and tobacco.
2. To develop a reasonable diet, smaller meals.
3. To develop good eating habits, Eat less fried foods, and irritating, and more into the high-calorie, high vitamin, high protein diet, eat more vegetables and fruit.
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