Endoscopic nasal surgery nursing experience
【Abstract】 Objective To investigate the nasal endoscope in the clinical application of nasal diseases and care effect. Methods 520 cases of nasal disease, patients were using the endoscopic sinus surgery, and carefully do a good job of preoperative, intraoperative and postoperative health education, psychological care, to fully mobilize the active support of surgical patients and post-operative and orderly
treatment. Results of patient care through the care and
intensive care, so that surgery was uneventful in 520 cases, no postoperative infection, no psychological barriers and discharged, so that satisfaction to 95%. Conclusions high incidence of nasal disorders, forms diversified, in particular, sinusitis and nasal polyps are more prevalent. The scope of these diseases is small, part of the special effects of the use of endoscopic sinus surgery is better, but it also requires nursing staff in the new technical aspects of treatment, care and skill, psychological care and depth, strong sense of responsibility. Through the 520 cases of patients before and after surgery care, so that they discharged, treatment and care quality higher satisfaction rate.
Key words endoscopic surgery; psychological care; Experience
Nasal disorders diseases much more complicated, especially in nasal polyps and sinusitis is a disease, Rhinology, one of the most common diseases. As part of a special, easy to relapse over the past conventional surgery. With the gradual maturity of endoscopic surgery and advanced medical equipment, so that nasal surgery has been rapid development, and maintaining physiological function of the nasal cavity and the reduction of surgical wound, reducing the
recurrence rate. Conditions, higher and higher in the surgical circumstances, to require nursing care model also need to constantly change the past to ensure the smooth progress of surgery so that patients discharged.
A clinical data
I Bureau since March 2003 ~ June 2007, a total of 520
cases of treated patients with nasal disease. 375 cases were male and female 145 cases, the youngest 13 years old, maximum 81-year-old, with an average 50.12 years of age. Time of onset: short in 6 months to 11 years. Diseases: 130 cases
fully sinusitis, sinusitis and nasal polyps exist 336 cases, 50 cases of simple sinusitis, papillary tumor in 4 cases. The clinical performance: nasal congestion, purulent nasal discharge flow, decreased sense of smell, headache, dizziness, memory decline and so on.
2 Care
2.1 Preoperative Care
2.1.1 The psychological care of nasal disease is a chronic disease, treatment is difficult, easy to relapse. As the treatment time prolonged, repeated, large, patients tend to lose confidence in treatment, to have misgivings about the treatment, fear of surgery, especially for endoscopic sinus surgery and superficial, lack of confidence, while listening to others talk about is a relatively good surgical methods , there are still serious doubts about the proportion of
patients. For patients with fear, suspicion and other states, as a nurse, first of all we should care about patients, give patients a sense of trust, in particular, must have good communication skills before surgery in order to carry out
health education [1], to enable patients to understand their disease, so that patients understand the surgical process and the advanced nature of surgery, but also to enable patients to understand that there may be problems in surgery, to enable
patients to put down the burden, actively cooperate with the surgery, to establish the confidence to overcome the disease, from reactive to proactive, do not want surgery to take the initiative from the surgery.
2.1.2 preoperative preparation endoscopic sinus surgery
instruments seem small, small part, but related to the successful operation and postoperative results [2], in patients with preoperative preparation is the basis of successful operation, so nurses should be detailed preoperative examination, auxiliary examination of patient
records, and some nurses think this is a medical matter, it is not true, and truly do care and can test a preoperative nursing staff and the overall quality of surgical proficiency. If preoperative cardiac conditions, gastrointestinal
conditions, hematopoietic system problems are related to the operation was successful and surgery an important link unexpected, so preoperative preparation work is also an integral part of nursing staff. In particular, shear vibrissa, hair, bathing, neoadjuvant check sound, are an integral part of nursing work, particularly in patients with preoperative vital signs is to ensure that the basis for successful operation.
2.2 post-operative care
2.2.1 routine care for patients with topical anesthesia
plus local anesthesia, routine care to take semi-sitting
position, is a kind of nasal surgery to reduce bleeding position, because the head and face rich in blood vessels, blood pressure is relatively lower limbs large, easy bleeding after surgery, it is a semi-sitting position Nose surgery
conventional position. Pairs of general anesthesia patients, should take the position general anesthesia, the patient sits flat to the pillow, head to one side to prevent inhalation of vomit trachea, and timely clean-up respiratory secretions,
enhancing oxygen. Bleeding tendency of patients to have appropriate cold compress to reduce capillary permeability, reducing tissue edema, reducing bleeding and the relief of pain [3]. Because postoperative bilateral nasal packing, the
patient could only mouth breathing, oral care is particularly important. In addition to encourage patients to the water, the patient should always keep moist mouth, reduced in patients with dry mouth due to caused by mouth breathing, but also
reduced the throat caused by coughing, increased wound pain and bleeding. Obvious pain in patients with the proper use of sedatives and pain medications. Reposted elsewhere in the paper for free download http://
2.2.2 Vital Signs of drug-care post-operative reaction of
the majority of patients showed postoperative symptoms such as bleeding, surgical fever, unstable blood pressure, rapid heart rate, headache and so on. Pharyngeal mucosa due to mouth breathing caused by congestion and edema, so that patients
hypoxia symptoms, shortness of breath, out of sweating and so on, according to the above, the vital signs observation is one of the key work of post-operative care when problems are
discovered in time to take measures. Such as the right to take
physical cooling in patients with fever, hypoxia oxygen inhalation in patients with timely, high blood pressure or arrhythmia patients should promptly report a doctor to take corresponding measures. When the patient after the removal of gauze, edema of nasal mucosa are still state, can not use nasal breathing, we should play specialist areas of nursing, such as the use of ephedrine-point nose, lack of oxygen to
continue oxygen therapy, bleeding time hemostasis. Prevention of postoperative infection, according to doctor's advice and
timely anti-infective therapy, fever subsided, in addition to the physical cooling, the use of drugs to be cool, and to identify causes of fever. Observed after 1 week to do office work, diligence examination, patients need to do more work
[3]. Nasal endoscopic surgery, is currently more advanced, but a large number of reported complications. Thus, in addition to doing routine care, the ground observation is very important, we should closely observe whether the orbital hematoma, eye
movements, with or without diplopia or decreased vision, complications to be considered is the operative or postoperative complications were infection, especially the optic nerve infection caused by the blind, many see in this report, in addition to observe the eye condition, but also observe the nasal secretions, there is water discharge occurs, do not rule out cerebrospinal fluid rhinorrhea, should promptly report the timely processing of physicians, in general, intranasal post-surgery patients to achieve three
ground is the nursing staff can not shirk responsibility.
2.2.3 The psychological care after nasal surgery limited in scope, but part of a special, along with a number of bilateral nasal packing gauze, so that the organization in a
pressure situation in the nose, the pain can often occur, especially cause headache, dizziness; swallowing wound stimulation, also affect the impact of swallowing, eating, at the same time there is leakage logistics portal, so often seen in patients with irritability, tension, fear of individual
patients, ideological concerns are more needed at this time nursing care, care, diligence and to the bedside sympathy, diligence and clear the face bloody things, diligence and the mobilization of fluid in patients with eating some food [4].
Patients should be encouraged not afraid of difficulties and ride out the storm, so that the disease early recovery, to enable patients to understand health care concern, care to alleviate the suffering of patients, in good psychological
care at the same time, but also for family workers and ideological work, so that the family actively cooperate with the officers, coordinated care and support to patients from the side, so that patients with more confidence, and lay a good foundation for recovery.
3 Discussion
In the 520 cases of endoscopic nasal surgery patients, I understand: When the patients with early admission, do meticulous patient care and health education to enable patients to have a better understanding of the disease itself,
but also let patients know the importance of a smooth operation and, if necessary Sexual and surgical problems that may arise among them, so that patients have confidence in the face of disease, to participate actively in treatment of disease and create good conditions for recovery. In patients after surgery to do the right care, in particular nasal surgery is unique, highly specialized, partial care should be skilled, the operation moves gentle, to be patient, and meticulous; good service attitude, in-depth psychological care
may make the patient a speedy recovery.
4 discharge guide
4.1 Health guidance Zhu Huanzhe attention to the nasal cavity health, and strengthen the physical exercise, attention to work and rest, do not over-exertion to avoid a cold, try to
eat spicy spicy food, smoking cessation alcohol.
Note 4.2 medication after discharge from hospital in time to guide the use of nasal drops, preventing adhesion, when the intranasal method has to be correct, so that drugs can full
access to the paranasal sinuses, to play a pharmacodynamics.
4.3 Review on time and explain to patients and regular
review of endoscopic sinus surgery nasal cavity clean the importance of regular follow-up after discharge from hospital
more than 6 months and 3 months of the general 1 to 2 weeks referral 1 and 3 months after the return visit a month times, in particular, within 1 month after endoscopic removal should be intranasal crusts to keep the nose clean, to promote mucosal growth, restore sinus function [4].
【References】
1 GUO Yu-hua, Huang You-feng. Endoscopic sinus surgery in
patients with health education. Zhongyuan Medical Journal, 2005,32 (4): 64.
2 Tang Ruxia .186 cases of endoscopic sinus surgery care. Fujian Medical Journal, 2004,26 (6) :212-213.
3 Zeng Chun-Rong, Li Feng Germany. Endoscopic sinus surgery complications and prevention. Hainan medical journal, 2005,16 (9): 146.
4 Zhang He, Jing Suqing. Chronic rhinitis patients before and after surgery nursing experience. EENT Journal of Modern China, 2007,4 (1) :91-92. Reposted elsewhere in the paper for free download http://