A case study of a typical gynecological nursing round
: 10-bed patient, female, 39 years old, native of the city, college education, is a cadre at the municipal level, is married, has a son, healthy family, husband and wife relationship, son has not yet graduated from junior high school, the family economic environment is better. Good health. This time, I found a left breast tumor for 3 months, and was undergoing a local puncture in our clinic. The pathological speech was malignant. She was admitted on March 5 with breast cancer. Before admission, the patient had known the results of pathological examination. At the time of admission, the patient expressed silence, irritability, general vital signs, bilateral breast symmetry, no nipple depression, no galactorrhea, and the upper left quadrant of the left breast could touch a 2 〜 3 〜 3 Swollen mass, hard, relatively fixed, no touch on the ipsilateral axillary and clavicle, no tumour on the contralateral breast, and other auxiliary examinations were normal. After admission, after perfect preparations, it was sent on March 7. The operating room is undergoing radical mastectomy for left breast cancer with stable external anesthesia. Postoperative vital signs are stable, breathing is smooth, mouth dressings are fixed and clean, oral drainage tube is drained, and the infusion is treated with anti-inflammatory. There is no swelling of the affected upper limb. Now I have eaten food, but I have poor appetite and sleep. We have taken patients and family members to communicate many times, but the patient still has problems such as grief, lack of knowledge about the disease, pain and sorrow, and poor self-care ability.
: Yes, the most prominent indication of breast cancer is that the breast touches a painless mass. Patients are generally unintentional. I would like to ask Liang Hong: What kind of examinations are generally done in clinical practice to help diagnose?
: As women, we should pay attention to conducting self-examinations on schedule and controlling the methods of self-examination. There are also women who need to be self-inspected. Who can talk about self-examinations?
: Self-examination is usually carried out within one week after menstrual cleaning. The self-examiner sits in front of the mirror, relaxes his arms and hangs on his side, leans forward with his waist or hands raised behind the headrest, compares whether the bilateral breasts are symmetrical, whether the nipples have internal constriction, and the skin color. Then, lay the other finger flat on the contralateral breast, and check the lump from outside to the nipple in circles (check the other side with the two hands interchangeably), and check whether there is swelling in the armpits on both sides. Use your thumb and index finger to quietly Squeeze your nipples to check for galactorrhea.
: You can lie on your back while you are palpating, and it is best to perform self-examination on time for women over 30 years of age. We briefly reviewed the relevant knowledge of breast cancer. According to the environment of the patient, we will discuss how to care for the patient. From Shicai's introduction to the patient's medical history and the master's understanding of the patient, it can be seen that the patient's psychological problems are very serious. How can we carry out psychological care for this patient?
: When doing psychological care, we must pay attention to understanding the occupation, cultural nature of the patient, family, social support, and concerns when assessing the patient. The patient is younger, has a higher social status, and is in good health. Before the patient was admitted to the hospital, I knew the results of the pathological report. Regarding the patient's admission, I explained that the patient may have the following psychological problems:
Third, the female sexual characteristics that must be removed are sad and incompetent, unable to take over, and worry about issues affecting the family and so on. Lei Tong should pay special attention to the admission treatment of such patients. To control the patient's communication skills, avoid too many or require, and not to stimulate the patient, he should first do his family's work as his husband's thinking and work, so that the family members can work together. Give more care and encouragement, and strive to gain patient trust before gradually getting patient communication for psychological care. When the patient was admitted to the hospital, she expressed that her emotions were reduced, she was silent, had conflicting emotions, and she was irritable. When she was welcome, we should try to simply refer to her medical history, suggesting that the patient's initial diagnosis should be based on the pathological speech after the operation. Matters, affirming the need for surgical treatment and the prognostic environment of the same kind of cases, more is the care and convenience given to foreign operations. The current patient is the third day after the operation. We can also suggest the environment of the patient's successful operation, motivate the patient to actively face it, try to deal with the postoperative pain and sadness and other discomforts, and help the patient to fill his feet. Now the patient's irritability and resistance have been improved. After the patient's condition is improved, he can be introduced to the same kind of patient, so that the same kind of patient can come out during the recovery period to help the patient recover successfully.
: Well said, psychological care should be treated equally, understand the patient's environment from multiple channels, strive to obtain the support of family members and partners of the patient, and control the art of wording, such as appropriate hints, incentives, etc. And my family members realized that we are really caring for the patients, and we can do good psychological care as long as we trust the patients. Let's talk about the care of the mouth after the surgery again.
1. Observe the environment of mouth bandaging, and the connection is suitable for tightness. Declare the purpose of the pressure bandaging and the discomfort caused by the patient and family members, and tell the patient to give a timely speech if the bandage is too tight and the discomfort is unbearable. Check the blood flow on the upper limb of the affected side, and watch for swelling, bruising, and cold skin temperature.
: Yes, the master must control the goal of pressure bandaging, and clearly explain to the patient and his family members. The patient must tell the doctor in time if he fails to sue, and he cannot loose the elastic bandage casually. The master is invited to discuss again: How to point out the affected upper limb program?
: OK, may I ask: Why ca n’t I perform injections and pressure measurements on the affected upper limb after surgery? Why avoid abduction of the affected upper limb? Should the affected shoulder be braked?
： Due to radical surgery for breast cancer, the ipsilateral axillary, blood vessels, and lymphatic vessels may be damaged during the operation, and the affected side will be pressured and bandaged. The affected side's upper limb blood circulation is relatively poor, so it is not suitable for injection and pressure measurement. , Draw blood, etc. In the late postoperative period, avoidance of the affected upper limb abduction and shoulder joint program is to prevent pulling the flap.
: We must clearly tell patients and their families about the precautions after surgery and the main importance of common function training. The function training of the affected upper limbs is best to point the patients and their families in stages, such as
The third stage: 4 to 5 days after the operation, the affected upper limb touched the ipsilateral auricle and the contralateral shoulder. The fourth stage: 5 to 7 days after surgery, the affected upper limb slowly stretched, adducted, flexed the shoulder joint, and raised to 90 degrees. Fifth stage: 10-14 days after the operation, place the palm of the affected side behind the neck, gradually raise the upper limb of the affected side to the vertical position of the patient from the beginning of the exercise, reach the head, raise the chest, and then treat the disease. Cross your palms over the top and touch the opposite ear, comb, etc.
In order to expand the scope of the shoulder joint program, wall climbing exercises and upper limb twisting activities can also be performed at this time. In addition, patients can also develop various types of negative exercises for lifting, pulling, lifting, lifting, and lifting in daily life. Strengthen the strength of the affected upper limb to fully restore its function. The above training should be based on the patient's physical tolerance, as appropriate, to avoid excessive fatigue. This patient is currently on the third day after the operation. Before the operation, we have also issued a health booklet to the patient before and after the breast disease operation. After the operation, we have explained the precautions and instructed the patient to perform the first stage of training. The patient To be able to work together after surgery, it is still necessary to point out in stages and it is best to show patients the function of the affected upper limb.
: Yingcai Wu Ying demonstrated to the master the method of functional training of the affected upper limbs after breast cancer surgery. It is very good. After surgery, the patient and his family should declare the goal and main function of functional training of the affected upper limbs. Functional training should be carried out in stages. Pay attention to the gradual progress. Will the master talk again about how to make a hospital instruction?
1. Training of upper limb function after discharge: After discharge, the patient should continue to exercise the function of the affected limb. The above items can be repeated repeatedly, but in the near future, avoid using the upper limb of the affected side to move and extract sediment.
: In addition to reviewing the knowledge about breast cancer today, Shen Dian discussed the psychological care issues before and after surgery in 10-bed patients, as well as the contents of Shen Ding, post-operative health instructions, and discharge instructions. The master made a good preparation for this round of investigation. He was exceptionally elaborate on the patient's psychological problems. He was instructing the patient to conduct self-examination and exercise the function of the affected upper limb. The ward round master should control the nursing points and sink points of breast cancer before and after surgery, and pay attention to the care of Shen Lei and the patient. Today's rounds are over, thank you, master!
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