Orthopaedic Common Disease Nursing-Routine doc
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-PAGE Section III, Orthopedic Disease Nursing Routine Section I Traction 1. Connect patients comfortably. Raise your head slightly, put a soft pillow on your waist, and keep warm in winter. 2. Pay attention to listening to the patient's complaints, check the blood circulation of the affected limb, skin color, temperature, arterial pulsation, and program environment of the affected limb. 3. Check frequently whether the traction strap is loose or scattered to prevent the traction hammer from touching the ground and the traction rope. Or slipping, the affected limb is in a general traction position; the amount of traction is moderate. 4. When performing skin traction, pay attention to whether there is inflammation or blisters on the skin of the traction site; check whether the adhesive tape is scattered. V. Bone traction should be clean and dry at the nail or needle eye, and the skin and the bed should be clean. Do not touch or move the traction needle. Drip 75% alcohol twice a day at the traction needle hole. 6. Prevent joint flexion and muscle atrophy. The patient has disciplined exercise, such as finger, toe, ankle and quadriceps movements. 7. Prevent your feet from sagging. It can be lifted with a footrest. Eighth, strengthen fundamental care to prevent complications. Frequently massage the pressured area; encourage patients to take a deep breath and cough strongly; drink plenty of water, eat more fruits and crude fiber foods, and point and massage the abdomen, add intestinal crawling, and give laxatives as required by the doctor; program the limbs on time to promote venous blood Backflow to prevent thrombophlebitis. Section 2 Plaster Fixation 1. Raise the affected limb to facilitate venous blood and lymphatic reflux and reduce limb swelling. Second, listen to the patient's complaints, check the temperature, color, swelling, feeling and activity environment of the extremities, and found that the speech was very timely. Always check the edges of the plaster and bone protrusions to prevent compression. 3. Do not move or press when the plaster is not dry. When the plaster is completely dry, the pillow should be cushioned according to its convex shape. 4. After the operation and patients with wounds, if they find that the plaster is penetrated by blood or pus, they should be treated in time. Fifth, the connection gypsum is clean to prevent the gypsum from being impregnated and polluted by water, urine, feces and other excreta. 6. Pay attention to functional training, prompt or instruct the patient to do isometric muscle contraction of plaster fixed limbs, and when the environment permits, motivate getting out of bed. Section III Spinal Fractures Merging Spinal Cord Injuries I. Lying on a hard-board bed with a soft or air mattress. The neck and waist are fixed when moving and transferring, and the spine's psychological curvature is connected, turning over in an axis. 2. Closely check the vital signs, limb feelings, limb muscle strength, and paraplegia plane environment. Third, connect the airway to reach 1. Point the patient to exercise breathing, add chest wall activities. 2. Cut off the excreta in the airway in time, encourage patients to automatically cough and take deep breaths daily, point out ineffective coughs, and prevent lung infection. When breathing is difficult due to the respiratory muscles, you can use a ventilator to help breathing, and give high concentration of oxygen inhalation. Fourth, prevent deep vein thrombosis. Avoid venous infusion of the limbs; raise the foot of the bed properly to help patients with passive lower limb daily activities. 5. Laxatives are given less than 2 times a week to promote bowel movements and exercise defecation reflexes. For abdominal insufficiency caused by abdominal contraction, perform gastrointestinal decompression as prescribed by your doctor. 6. Prevent urinary tract infections. The indwelling urinary catheter is connected to the urinary duct to encourage the patient to drink more water. After two weeks, the urine is intermittently discharged, and the urine is discharged every 4 hours. The urine tube and drainage bag are changed in time. Check and record the volume and nature of the urine. Disinfect the urethra 2 times a day. After 3 weeks, remove the urinary tube. 7. Establish a card for turning over every 2 hours to help the passive program of joints, connect the program areas of the main joints and the functional position of the limbs, to prevent the occurrence of muscle atrophy, pressure ulcers and atrophy of bone loss. Guardrails are placed on both sides of the bed to prevent falling when turning over. 8. Eat easily digestible food within the next 2 weeks, and eat more high-nutrient food and fruit after 2 weeks. Nine, strengthen patient communication, give accurate rehabilitation guidance, give motivation and psychological counseling. Rehabilitation exercise and function management. At the time of limb paralysis, 1. Acute stage of acute instability (2-4 weeks after spinal cord injury): In this period, the patient's vital signs are not changed. She should be absolutely bedridden and connected to the urinary tube. It will be intermittent after 2 weeks, 3 to 4 Urinate once every hour. Perform passive movements of the limbs to avoid muscle atrophy and muscle strength decline. The paralyzed limb is placed in a functional position. When the lower limb is paralyzed, the foot plate can be used to neutralize the ankle joint and prevent the foot from sagging. 2. The late stage of acute instability (4-8 weeks after the stage of acute instability): The condition is relatively unchanged during this period. The rehabilitation content is mainly supplemented by bed support exercises, because the patients have different degrees of spring and autumn, physical fitness, and spinal cord injury, so the exercise content The intensity is also different. Pay attention to the patient's cardiopulmonary function during exercise to prevent orthostatic hypotension and ensure spinal instability. 3. Mid-to-late stage rehabilitation: This period is for sitting and walking exercises for patients who are able to recover walking ability. The first is the supine position, which includes turning over on the bed, removing the cable body, and sitting on or beside the bed. The second is the sitting position, which includes sitting on a chair and sitting in a balanced position. Exercise the upper back muscles with dumbbells or pullers, and help the patient to massage the muscles 4-6 times a day to prepare for helping crutches. The third is sitting, including sitting up from a sitting position, sitting up from a squatting position, and sitting in a balanced position. Fourth, walking and walking in place. The fourth section of the cervical spine fractures and paraplegia 1. Lying on a hard board with the bed head raised 15-30 cm. The connecting beds are flat and comfortable. Use an air bed. Second, tilt your head back and restore the cervical curvature. Third, the purpose of connecting the traction target is to take the spine on a curve, do not twist the neck when turning over. Fourth, the joint fracture site is unchanged, and the cervical curvature of the cervical spine is connected when moving and transferring. Fifth, adjust the traction component according to the patient's tolerance and general conditions, and check whether the traction is invalid at any time. 6. Needle eye drops of 75% alcohol 1-2 times a day. Seven, turn over every 2 hours, do not twist the trunk when turning over. Eighth, check the patient's tactile sensation, temperature sensation, and the degree of recovery of various reflections, check the scope of the limb program, and keep a good record. Nine, paraplegic patients follow the paralysis care routine (see Chapter 10, Section 10). X. Rehabilitation exercises provide guidance to patients and their families to annotate the main function of exercise. The paralyzed limb is placed in a functional position, and the down foot can be used to neutralize the ankle joint to prevent the foot from sagging; the knee joints can be passively extended and flexed; patients with upper limbs can show dumbbells or pullers to train the upper back muscles. To prepare for Shuangguai, help the patient to massage the muscles 4 to 6 times a day. The palms of the hands should be massaged with force and accuracy. Cervical spine fractures 1. Preoperative nursing 1. Psychological nursing: Caring for the psychological response of patients, helping them establish their determination and courage to defeat the disease. 2. Prepare before surgery according to the doctor's advice, and abstain from drinking water on the morning of the operation. Second, pre-operative exercise 1. The physical function of the limbs on the bed should be followed by upper and lower limb extension and flexion, holding Shen uplift and limb movement programs. 2 bed and stool are undergoing adaptive exercise on the bed length to reduce urinary retention and constipation due to inability to bed defecation after surgery. 3. Tracheoesophageal elongation exercise The patient is supine, with the pillow under the shoulder, and the head will be raised later. The exerciser is sitting on the left side of the patient, and the other four fingers outside the left thumb are along the left side of the trachea of the patient. Continue to push the trachea and esophagus to the left, and try to relax at the beginning. After 5 to 8 minutes, the force is slightly strengthened. Try to move the trachea and esophagus across the midline. Respiratory exercise exercises guide patients to deep breathing and ineffective cough. 5. Prone position bed exercise neck surgery patients in the prone position for a long time, easy to cause obstruction of the respiratory tract, must be confirmed before surgery so that it can be adapted to, or step by step, starting at 10 to 30 minutes each time, 2 to 3 times a day , Currently gradually increased to 2 to 4 hours each time, 2 to 3 times a day. 3. Postoperative care 1. Essential items suction device, suction sputum tray, tracheotomy bag, sandbag 2. Closely observe the changes in the condition, measure breathing, blood pressure, pulse every half an hour, and change it every hour for four hours , After the smooth change to 2 to 4 hours once. 3. Due to the large blood loss during the operation, the blood volume may be insufficient, and the infusion and blood transfusion speed should be adjusted according to the condition. 4. Closely check the respiratory frequency, rhythm and complexion of the patient after connecting the airway and reach the sputum. Those with thin sputum and edema of the throat should be aerosolized. If the patient presents symptoms such as fatigue, drowsiness, nausea, etc., the occurrence of sleep apnea analysis signs (ie, apnea or hypopnea during sleep), and notice that the physician should be notified in time to do tracheotomy and tracheal intubation. preparation. 5. Check the changes of mouth dressing and drainage fluid. Under normal circumstances, the amount of drainage fluid should be less than 100ml in 24 hours after operation. Coarse, the patient is breathing blindly and struggling, reminding of programmatic bleeding, the doctor should be addressed in time and co-first aid. 6. Postoperative diet and nursing After the cold fluid diet was adopted, the cold semifluid was changed and the general diet was gradually changed after 3 days. The objective of cold fluids is to avoid the edema response due to intraoperative esophageal trauma. Warm diet can cause esophageal damage, edema response to esophageal sedimentation, and can increase the dark language of the neck. 7. The two-piece popular neck brace before and after wearing the neck brace can over-neck the program, help the neck mouth heal and promote the fusion of bone graft. 8. The patient should maintain the neutral position of the spine of the head when shifting the body position. Avoid excessive flexion, overextension and twisting. The number and frequency of neck programs should be reduced as much as possible within 24 hours. Local braking can reduce bleeding and prevent bone graft. Slip of the block. Nine, strengthen fundamental care to prevent postoperative complications. X. Functional recovery after functional refining has an indirect relationship with Shen Jian's functional refining. Patients should be instructed to perform refining in the following manner. On the first day after the operation, we performed finger, wrist, toe, and ankle joint programs. On the second day after the operation, we assisted the patients with limb elevation and joint passive programs. After 3 days, they helped the patients with passive limb programs and automatic program training. For patients with incomplete paralysis, the limbs are being massaged while doing passive exercise. After 3 weeks, he was assisting patients to get out of bed under the environment with excellent neck fixation (those who got the steel plate fixation can get out of bed the next day after surgery). At 1 month after the operation, the head and neck are under the neck and back, preventing and treating atrophic atrophy, which is beneficial to improving symptoms such as neck strain. Thoracolumbar fractures 1. Preoperative nursing 1. Do psychological care and keep their emotions unchanged. 2. Watch the patient's sleeping environment at night, keep warm, avoid colds, and monitor blood pressure and temperature. 3. Fasting for 8 hours before operation and 4 to 6 hours of water. Patients with diabetes and hypertension will continue to take drugs in the morning to avoid blood sugar and blood pressure caused by surgical stimulation. Swallow the drug with 5ml of water Yes, it is best to take 2 to 3 hours before surgery. 4. Prepare before surgery as directed by your doctor. Second, postoperative care 1, supine supine for 6 hours, head to one side, connect the airway to reach, give high flow of oxygen inhalation. 2. Take a closer look at changes in vital signs such as temperature, pulse, respiration, and blood pressure. 3. Nursing of the drainage tube Pay attention to the observation of negative pressure drainage, because the thoracolumbar spine surgery is more invasive, and there is more bleeding during the operation. Drainage negative pressure is placed in the dark postoperatively for 24 to 48 hours, and the drainage tube is connected and fixed. Check and record the drainage volume and nature. If the drainage volume reaches 200ml in 2 hours or 400ml in 24 hours, it is declared that there is programmatic bleeding at the surgical site, and it should be disposed of in time; if the drainage fluid is red or clear, it may be a cerebral spinal cord leak, and the negative pressure should be changed. Attracted as positive pressure, and adopted head-to-foot and foot-up positions, and closely observed the patient's extremities and movement environment. 4. Strengthen basic nursing to prevent complications. 5. Rehabilitation after surgery. On the day after surgery, you can flex and stretch your limbs and turn over. You can start training your quadriceps and calf triceps muscles 3 days after surgery. You can instruct your patients to train your back muscles 1 week after surgery. , 4 weeks after surgery can be sitting in bed, appropriate programs (such as chest expansion activities). Prevent bedriding complications, encourage coughing, continue to bed rest after being discharged from hospital on time axis, health education, avoid halo programs, review the film in the hospital in the next 3 months, such as the development of good bone growth, stable, but can go to the waist with the waist program, heavy labor within half a year After one year, remove the internal fixing steel plate according to the environment. Femoral fractures I. Preoperative care 1. Watch closely for changes in vital signs, measure body temperature, pulse, respiration, and blood pressure in a timely manner, and speak to the doctor in a timely manner. 2. Select and prepare the appropriate Thomas' frame for traction. 3. A rigid bed, connected to the neutral abduction of the affected limb at a 30-degree neutral position, T-shaped shoes can be worn to prevent displacement of the fractured end caused by external rotation. 4, adjust the position and the purpose of traction, according to traction surgery routine. . 5. Pay attention to the skin environment, especially the skin environment around the hips, scrub frequently, and turn over frequently. 6. Observe the toe-end automatic program to feel the environment. 7. Instruct patients to use the potty accurately; instruct patients to drink more water to prevent urinary system infection. 8. Do good psychological care. 9. Prepare before surgery as prescribed by your doctor. Second, postoperative care 1, supine supine for 6 hours after general anesthesia, head to one side, bend to, fast and water for 6 hours. 2. Look closely at vital signs and blood oxygen saturation. 3. Raise the affected limb, pay attention to the physical environment of the limb, moderately show the affected limb, promote blood circulation, and prevent stiff limbs. 4. Check the bleeding environment of the mouth. If there is a lot of bleeding, you should inform the doctor for treatment. 5. Check whether each pipeline has, is distorted or reversed, and the continuous drainage of the connection drainage. 6. Prevent bedsores. During traction, change the position every 2 hours, and change the position every 3 to 4 hours at night. Massage the tail of the palate to improve local blood circulation to prevent bedsores. 7, prevent constipation, pay attention to diet conditioning, eat more fresh vegetables and foods containing more fiber, link defecation every 1 to 2 days. 8, to prevent joint contractures, during bedtime connection to proper bed activities and exercise, to prevent wasteful atrophy of the limbs and joint contractures. Pay attention to the function of joints. The affected limb should always be in functional form. 9. Prevent fallout pneumonia. When helping the patient to turn over, they also help to pat the back, and encourage the patient to take a deep breath, add vital capacity, facilitate the discharge of sputum, connect the airway, and prevent pneumonia. 10. Prevent urinary system infection. Encourage patients to drink plenty of water, take more than 2000 ml daily, add urine output, clean the urethra, and prevent infection. 11. The health education room should be ventilated and ventilated frequently to keep the air fresh, pay attention to personal hygiene, and prevent colds. Instruct the patient to exercise muscles and joints and take a deep sink while sitting up, gradually adding exercise time and intensity. According to the environment after the operation, the pointing patient gradually transitioned from double crutches to single crutch gangs. At first, they changed to abandon the cane. When using the cane, they should try not to have a small show, and the family should be safe next to them. Try to avoid violent activities, avoid hip flexion and squatting, and minimize the negative heaviness and lateral stress of the affected hip. When lying on the side, a cushion of more than 12CM should be placed between the legs to prevent hip inversion. Do not cross your legs within 6 months after operation. No, avoid adduction and internal rotation. Manipulate both upper and lower limbs to support up and down. Be accurate, wear socks and shoes. Pay attention to properly conditioning the diet, nutrients, avoid excessive body sedimentation, quit smoking and alcohol. Continue to strengthen functional training, pointing patients to accurately use double crutches, patients with knee joint functional therapy. The function training should be moderate, the program scope should be from small to large, step by step, and not too rush, and each time should be non-inductive, to avoid adverse effects on fracture healing. After 2 to 3 months, review the film. If the fracture has healed bony, you can use single canal and walk behind. Section 8 Pelvic Fractures 1. Absolutely rest in bed. Second, look closely at vital signs, monitor blood pressure, pulse, breathing, blood oxygen saturation, etc., pay attention to shock phenomenon, check for other symptoms of net device damage. 3. Quickly establish infusion channels and provide emergency shock. Fourth, after the condition is stable, upper body training and lower limb massage. Fifth, strengthen fundamental care and actively prevent complications. 1. Encourage cough and deep breathing to connect the airways and prevent lung complications. 2. Inspire more water to prevent urinary system infection. 3. Pay attention to nutrients, eat more fresh vegetables and fruits, and connect stool. 4. The connecting bed unit is clean and tidy, and massages the local pressured part to prevent bedsores. 6. After the functional trainer's anesthesia subsides, the patient should be instructed to perform isometric contraction of the quadriceps femoris and gastrocnemius muscles and flexion and extension of the ankle and toes. From the second week after the operation, the patient's bed length was instructed to perform hip and knee joint activities, and patients could be assisted to perform knee flexion and hip flexion ten times per group, three to four groups per day. After two weeks of suture removal, the joint program category and intensity can be gradually added, and it is advisable that the patient does not feel frustrated. Hip flexion and abductor muscle training is performed three to four weeks after the operation, and an automatic program for the sinking joint is feasible. From 8 to 12 weeks, he gradually started to walk and stayed for the time being. After 12 weeks, she walked with complete sinking. The X-rays were reviewed every 1 to 2 months for the transfer patients. Section IX Hip Replacement 1. Do good psychological care and eliminate serious emotions. Second, strengthen nutrients, eat high-protein, high-vitamin, crude fiber foods. Third, urinate on the bed before surgery, and connect urination and unobstructed. 4. Prepare before surgery as prescribed by your doctor. Fifth, the affected limb is connected to the abduction neutral position. 6. The drainage tube at the connection port is unobstructed to prevent distortion and fragmentation. Check the color, nature, and quantity of the drainage material, and keep a good record. Seventh, strengthen the fundamental care to prevent various complications. Eight, functional training 1, the first stage of functional training (1 to 3 days after surgery), the secondary contraction of muscle static activity and distal joint activity. Quadriceps isometric contraction exercise: supine position, lower limbs do not stretch out of bed, quadriceps femoris automatically contracted to pull the sacrum to the proximal end, slow movement, each lasting 5-10 seconds, and then rest for 5 minutes, 90 days a day Time. Ankle joint activities: supine position, automatic toe extension and flexion activities, ankle joint plantar flexion and back extension, each movement for 10 seconds, then relax, 90 times a day. Gluteus muscle contraction activity: The patient stretches the legs in supine position, the upper limbs are comfortably placed on both sides of the body, and the hip muscles are contracted, connected for 10 seconds, relaxed, and placed 60 times a day. Metatarsal movement: supine position, the accompanying staff quietly urged the metatarsal upper, lower, left and left programs, 30 times a day. 2. The second phase of functional training (4-10 days after surgery), the second is to strengthen the isotonic contraction of muscles and joint activities. Bent leg lifting activities: supine position, lower limbs stretched and raised, requires the heel 20 cm away from the bed, stranded in the air for 2 to 3 seconds, the current stranding time is gradually added, 90 times per day. Hip flexion and knee flexion activities: supine position, the caregiver is holding one hand under the patient's knee and one hand supporting the heel, and is flexing the hip and knee flexion in an environment that does not cause pain and grief. At the mercy of. 3. The third phase of functional training (11 days to 1 month after operation), the exercise from bed to follow. Lying position abduction: supine position, lower limb flexion abduction, 120 times a day. Recumbent to seated exercise: Hold your hands up, abduct the affected limb, manipulate your hands and support legs to move the affected limb to the bedside, and place around 30 times a day. Sit-to-stand, crutch exercise: The patient moves to the bed, the healthy leg touches the ground first, the affected limb touches the ground, double crutches, manipulates the healthy legs and double crutches to support sitting, and starts to exercise for 2 minutes. To prevent orthostatic hypotension, it is currently added gradually. Exercises from sitting to walking with walking sticks: The affected limbs are not heavy, and there must be accompanying staff when walking with walking sticks to avoid accidents. The time depends on the patient's physical strength, and generally does not span 15 minutes each time, 3 times a day. 4. The fourth stage of functional training (1 month after operation), hip flexion: sitting, standing with both hands crutches or walking aids, sitting on the healthy side with one leg, body connection and vertical ground flexion. Ipsilateral hip flexion and knee flexion are limited to 90 degrees to strengthen the iliopsoas muscle strength. Knee extension: sit in a standing position, with both hands crutches or a walker, sit on one leg with the healthy side, and connect the body to the ground. The lower leg of the affected side is bent and raised to strengthen the quadriceps muscle strength. Hip abduction: The body position is the same. The hip joint abduction on the affected side is limited to 40 degrees to strengthen the hip abductor muscle strength. 5. The fifth stage of functional training (2 months after operation), you can use a stationary bicycle to train. When you start to step on the pedals, step backwards first, and when you feel that it is easy and comfortable to step backwards, then step forward. After doing coherence, increase the number and frequency of steps, 2 times a day, 15 minutes each time, and gradually add 3 times a day, 20-30 minutes each time. 6. The sixth stage of functional training (3 months after operation). During this period, the affected limb can gradually sink, and the cane is gradually changed from double to single to single cane. Hip replacement patients should not lie on their side for 3 months, and only lie supine when in bed to avoid heavy physical labor and violent sports programs. It is necessary to do "": that is, no effort to bend and suffer from hip squats, no, no sitting on a low bench, and no "erlang legs". When going upstairs, the healthy limb goes up first, the affected limb goes up, and when going downstairs, the affected limb goes down first, and the healthy limb goes down. After 6 months, you can choose to walk for daily training. It is not suitable for climbing, running with high legs, fast running and long distance trekking. Knee joint meniscus damage 1. Preoperative nursing 1. Psychological nursing Strengthen preoperative education, meaning and attention of surgery, and alleviate patient's anxiety; Introduce the characteristics and clinical experience of minimally invasive surgery in order to strengthen its determination of enemy surgery. 2. Preoperative preparations for comprehensive preoperative examinations after admission (blood routine, blood type, blood coagulation function, liver function, renal function, hepatitis, syphilis, electrocardiogram and response X-ray, MR and other imaging examinations); skin preparation for the operation area Fasting for 12 hours and water for 8 hours; Pointing patients are defecation in bed; Patients should be informed about the effect of knee muscle atrophy before surgery, and using healthy limbs as a model to guide patients to familiarize and control various rehabilitation exercises, including: Isometric contraction of the quadriceps, sacrum program, ankle activity, leg curl exercise, knee compression exercise, progressive resistance exercise, etc. Second, postoperative care 1. According to the routine nursing care after anesthesia, spinal or epidural anesthesia should be supine for 6 hours with fasting on the pillow and one side of the head to prevent infarcts; 2. Observe the changes in vital signs and give ECG monitoring. 3. Raise the affected limb by 30 ¡ã, observe the bleeding environment of the dressing, the peripheral blood flow of the affected limb, and the toe program. 4. Painful and sad care If the patient is instructed to take deep breathing activities, listen to music, watch TV, and pay attention to separation, if necessary, follow the doctor's advice and give an anesthetic; if the bandage is too tight, the analgesic effect is unsatisfactory, you should notify the doctor to check the operation area If the tension is too high, the bandage must be loosened and the blood circulation of the affected limb can be checked. The pain and sorrow can be relieved quickly. 5. Function: The histological fibrosis of the knee joint damage is presented earlier. If it is not early, the joint program will be limited within 4 days, and the damaged joint will be fixed for 2 weeks, which will lead to the fusion of connective tissue fibers and the joints. Features. Therefore, late functional training is very important. After the postoperative decline, the patient was instructed to perform isometric contraction of the quadriceps and ankle activities. 1. The quadriceps activity exercise will lay the thighs flat on the bed, the thigh muscles will be tense, relax after 10 to 15 seconds, 10 times / group, 3 to 4 groups / day, to promote venous blood return to the affected limb, and reduce lower limb swelling, Reduce the incidence of venous embolism. Do not exercise too much to avoid causing pain and sorrow to the patient. 2. Ankle movement Ankle dorsiflexion, knee flexion, contraction of quadriceps. The ineffective goal is to move the sacrum upwards. After 3 to 5 seconds, relax once, 10 times per group, and 3 to 4 groups per day to strengthen the muscles of the affected limb and promote blood circulation. 3． Starting from the first day after the bent leg lifting activity, the patient was supine, the knee flexed on the healthy side, the knee flexed on the affected side, and the ankle joint was functional. Slowly raise the leg to take 30 to 4 ¡ã from the bed surface. , Stranded in the air for 3 to 5 seconds, 20 to 30 times / group, 3 to 4 groups / day. The three activities were alternated, and the activity was gradually increased to 5 to 6 groups / day, and continued until rehabilitation. 4． On the third day after the operation, the compression bandage was removed, and the knee flexion activity was started, that is, the patient was sitting by the bed, and the legs naturally drooped. The healthy leg was placed in front of the affected calf, and the pressure was quietly pressed backwards to gradually increase the angle of flexion To the degree of energy, generally 100 degrees of flexion can be maintained for 1 minute or longer to avoid joint stiffness. 5. After the 4th national post-operative walking, the healthy limbs were moved first, and then the affected limbs. The thighs were driven by the strength of the quadriceps muscles, and the knees were flexed as much as possible. When suffering and sad and tolerable, I can sit up and walk close to the bed with double crutches, but the walking time should be ≤ 5m at the beginning, and it is gradually added to 10 minutes, gradually, to promote local blood circulation. However, the total walking time of 24 hours within 1 week after surgery should not be 20 minutes to avoid bleeding in the joint cavity. 6. Health education 1. On the 8th to 2 months after surgery, continue to consolidate the functions performed during the hospitalization and gradually increase the amount of programs and the ability to sink the weight of the affected limb. 2. Most of the patients can basically recover the knee joint program within 2 weeks after surgery, and can fully recover in 4 to 6 weeks. During this period, patients were encouraged to exercise as far as possible by cycling, walking, snorkeling, etc., but before the knee function was fully restored, they could not perform running and jumping programs. After 6 to 8 weeks, various appropriate sports programs can be performed, and activists can start exercising 3 months after surgery. 3. Reasonably place the rest time, pay attention to the connection between work and rest, and avoid excessive strain caused by fluid accumulation in the joint cavity. 4, eat high egg white (such as dairy products, soy products, meat, etc.), high calcium (sea products) food. Section 11 Patella Fracture 1. Preoperative Nursing 1. Do psychological care. 2. Make preoperative preparations as prescribed by your doctor. 3. The care of the affected limb should be reduced as much as possible, so that the affected limb is 15-20 cm above the level of the heart, so as to facilitate the return of venous blood and lymphatic blood. When it needs to be moved, it can be fixed with a splint and then moved. The method of the quadriceps strength of the patient before operation and the way of using the toilet in bed, and told the patient about some discomforts and countermeasures after surgery. Second, postoperative care 1. Follow the routine nursing after anesthesia. Spinal or hard linen is supine and supine for 6 hours with the head on one side to prevent infarction. 2. Closely observe the changes in vital signs; closely observe the blood circulation of the affected limb, skin temperature, neural sensations, ankle and toe programs, fullness of peripheral reincarnation, bleeding in the mouth, pulsating environment of the dorsal artery of the affected limb. 3. The nursing distinction between pain and sorrow is coded with pain and sorrow. It is still the pain and sorrow caused by dressing too tightly. If the coded pain instructs the patient to take a deep breathing activity, listen to music and watch TV, pay attention to it, and if necessary, follow the doctor's advice and give anesthetic and check for bad. Reflections, such as dizziness, nausea, and urinary retention. If the bandage is too tight and the analgesic is not effective, the physician should be notified to check the operation area. If the tension is too high, the bandage must be loosened and the blood circulation of the affected limb should be checked. 4. Nursing of drainage tube After the operation, the patient appropriately fixed the drainage tube to avoid dislocation or removal. 2. Link drainage Lida to avoid pressure and distortion of the drainage tube; squeeze the drainage tube on time to prevent it. Stream blocked. 3. Pay attention to the cleanliness of the contact between the drainage tube and the mouth to prevent infection. 4． Check the color, properties and quantity of the drainage fluid, keep a good record and speak to the doctor in time. After 5 days, the drainage tube was eradicated and the dressing was changed. 5, 6 hours after skin care to help patients turn over and massage to prevent pressure sores, the bed unit is clean and dry. 6. Limb care Gives the affected limb elevation, which is higher than the patient's heart level, which is conducive to blood circulation and prevents the affected limb from shrinking. 2. Patients were instructed to start ankle after anesthesia to prevent deep vein thrombosis. 7, to prevent oral infection, pay attention to the patient's environment. If the postoperative body temperature continues to be too high, consider the possibility of mouth infection and promptly address the physician to deal with it. Pay attention to the nature of mouth pain and sadness, and the presence of redness and swelling. 8. Dietary care guides patients, give them foods rich in vitamins and calcium and high-protein, high-calorie, high-fiber digestible diet, strengthen nutrients, and prevent the occurrence of constipation. 9. Postoperative function training 1. After anesthesia declines, toe flexion and dorsiflexion of the ankle-toe joint of the affected limb can be performed, once an hour for five minutes each time. Need to point out immediately to practice "quadric quadriceps isometric contraction", first exercise the limbs, then the affected limbs, one group every 2 hours, each group 6 to 8 times. 2 to 3 days after surgery, if there are no complications in the mouth, you can gradually perform automatic and passive flexion of the knee joint, gradually increase the amount of the program, and pay attention to avoiding the affected limb, pain and sadness. 2. Patients with functional training at the late stage of the fracture instruct the patient to perform automatic extension and flexion of the affected knee. The foot is sliding on the bed, and the knee can be flexed and extended as much as possible. It can start from 15 to 20 degrees for 30 to 40 flexion and extension programs, 5 to 6 groups per day. The program category is gradually added; the patient is instructed to perform "curved leg exercise" and "patella loosening exercise" on the affected limb 3 times a day, each time 50 to 100 times. After leaving the bed after 2 weeks, he walked on the ground with help. After 6 weeks, you can do squats step by step, 10 to 20 times per group, 2 groups per day. After 4 to 6 weeks, the external fixation is removed to strengthen the automatic flexion and extension of the affected limb. 10. Health education 1. Regular outpatient review. 2. Function training after discharge, such as quadriceps muscle contraction exercise, knee joint flexion and extension programs, plaster external fixation line up and down the sacrum. It is not advisable to do squats within 6 weeks after surgery. 3． Set a reasonable rest time, pay attention to the connection between work and rest, and avoid overwork. 4． The development environment of the postoperative epiphysis determines the time for removing the internal fixation. 5. Sun for one hour outdoors every day. Those who can not go outdoors can make up cod liver oil drops or vitamin D. Twelfth section fracture of tibia and fibula I. Strengthen psychological care. 2. Make preoperative preparations as prescribed by your doctor. 3. Fix the affected limb in time to prevent re-fracture or dislocation. Fourth, look closely at the changes in the disease 1. Watch the changes in vital signs. 2. Check the bleeding environment of the mouth dressing. 3. Touch the dorsal and posterior tibial arteries, observe the skin color, and measure the skin temperature and capillary response of the affected limb. 4, patiently listen to the patient's complaints, such as continued severe pain in the affected limb with progressive enlargement, severe swelling and shrinkage, unchanged skin reduction, severe pain when the toes are passively pulled, pale skin, and inflexible dorsal arteries Etc., presented appeal symptoms to consider osteofascial compartment analysis sign. Fifth, raise the affected limb to promote blood circulation and prevent swelling. 6. Strengthen basic nursing to prevent complications. 7. Functional training 1. In the late stage, the isometric contraction of the quadriceps, automatic flexion and extension of the toes, and passive programs of the sacrum are performed. 2. The knee flexion program can be done 3 days after internal fixation, and crutches can be assisted 5 to 7 days after external fixation. The affected limbs can not sink to the bed. After external fixation is removed, the joints can be enriched and gradually sink program. 3. Do a program to twist the affected limb, so as not to affect the invariability of the fracture end and cause the bone not to adjoin. Eighth, health education 1. Periodic review, found that blood circulation, feelings, and activities of the affected limb are very high, and seek medical treatment in a timely manner. 2. Continue to take bone-reinforcement medicines on time until the fractures heal and stabilize. 3. Show the affected limb to the ground with full leg to prevent fall, strengthen the knee and ankle joint extension and exercise, if the ankle function is hindered, perform ankle torsion, slope training and other functions. Those with strong joints can do squats and back extensions of the ankle joint and sit and bend knees and back extension. 4. Strengthen nutrients and promote fracture healing. Thirteenth lumbar disc herniation 1. Preoperative care 1. Lying on a hard-board bed and resting absolutely in bed. 2. Cough and sneeze. 3. Prevent constipation. 4. Use analgesics as directed by your doctor. 5. Exercise and urinate on the bed 3 days before the operation. 6. Follow the doctor's advice to make preparations before surgery. Second, postoperative care 1. Follow the routine nursing after anesthesia. 2. After the anaesthesia disappears, check the activities, feelings, and bowel movements of the lower limbs. If the lower limbs are impeded, the spinal cord may be damaged if the feelings disappear, and the lecturer will speak immediately. 3. Connect the drainage lida to avoid the distortion, pressure and escape of the drainage tube. Negative pressure should be appropriate, avoid excessively large and increase bleeding from the mouth. Record the color, nature, and volume of the drainage fluid and see if there is any cerebrospinal fluid outflow. 4. During the late postoperative turn-up, two people need to do it together. The spine is unifying the axis and the dressing fluid leakage environment is observed. The fixation is stable and the medicine is changed in time. 6, urination, such as listening to the sound of running water, hot compresses on the lower abdomen, massage and so on. When urination is ineffective, descending urinary catheterization is being performed with rigorous asthma, and the urinary catheter is left 12 to 24 o'clock. 7. From 7 to 10 days after the operation, gradually use "three-point" or "five-point" to gradually train the back muscles. 8. Make up nutrients and strengthen the body's resistance. Eat more fiber-rich foods, such as vegetables and fruits, to promote intestinal crawling. Disciplinary defecation. 9, health guidance. The fourteenth knee replacement is prepared according to the doctor's advice before surgery, psychological care, and eliminate serious emotions. Before the operation, urinate on the bed, and connect the urination and urination. Strengthen nutrients, eat more high-protein, high-vitamin, crude fiber foods. The supine occipital position was adopted after surgery to connect the airways. Connect the drainage tube smoothly, check the color, nature and quantity of the drainage material, and keep a good record. Strengthen basic care to prevent various complications. Function training 1. The first 3 days after the operation, the patient can be instructed to do flexion and extension of the toes and ankles after the anesthesia disappears on the day of surgery. Point the patient to do a strong upward hook and stepping on the foot, the lower limbs flex, and try to hook up with both feet as much as possible, linking for 5 to 10 s, and then doing the downward step for 5 to 10 s. Bent leg elevation: Stretching and tightening one knee joint on the bed, lift the foot 20 cm away from the bed surface, connect for 10 s, then lower it slowly, do one set every 2 h, each group 3 to 5 times or Until you feel the weakness of the thigh muscles, massage the affected limbs from feet to thighs and massage for 10 minutes every 2 hours. Pay attention to the mouth during the massage, so as not to add pain and grief. 2. 4 to 7 days after the operation, continue the training content of the first 3 days, and add the following: the patient is sitting on the bed, holding both lower 1/3 of the thigh with both hands, slowly lifting the thigh upwards, so that the knee joint is flexed Morphology, 5 to 10 times every 2 h. The patient sits next to the bed, with both lower legs hanging naturally under the edge of the bed. During exercise, if you feel violent pain, you can put a stool by the bed and put your feet on the stool. You can adjust the knee by adjusting the height of the stool Buckling angle.皇冠比分官网当患者天然下垂小腿习惯当前，能够正在坐位下屈曲关节。一：患者坐于床边，两腿天然下垂，健侧小腿放于手术侧脚踝上(双侧手术患者由协帮完成)，做向下悠压的动做。慢慢地尽量屈曲膝关节，正在最大屈曲位时，连结5～10 s。二：患者坐于床边，两小腿天然下垂，健侧脚放于患侧脚跟部，协帮患侧小腿做向上抬的动做，对于双侧手术的患者由协帮其完成，或者利用绷带，一头绑于脚底部，一头牵于本人手中，自行牵引使小腿抬起膝关节伸曲。顺应性坐起：正在医护人员的下，下床做顺应性坐立，沉心放正在健侧肢体上，患肢不负沉。双侧手术的患者下床时由两人扶持，沉心放正在双上肢上，坐立的时间随的增加逐步耽误。 3、术后8～14 d卧床曲腿抬高：仰卧于床上，伸曲并绷紧膝关节，然后用力将患肢抬高床面30¡ã，连结5～10 s后慢慢放下，每天3组，每组20～30次。下蹲：正在陪护人员的下，扶住雕栏，尽量往下蹲，同时脚跟不要分开地面，连结10～15 S后迟缓坐起，每日做3组，每组20～30次，下蹲的程度逐步添加。渐进式脚踝屈伸。一，坐正在凳子上，两小腿天然放正在地板上，迟缓地同时抬起双脚跟，曲到脚尖着地，连结5 s，然后放回曲到脚跟着地。二，坐正在凳子上，两小腿天然放正在地板上，一脚脚尖着地，另一脚脚跟着地，连结3～5 s，两脚交替进行。三，坐正在凳子上，两脚稍分隔，天然放正在地板上，将一只脚拉向臀部标的目的，另一只脚用力向前伸，交替拉伸两腿，留意正在整个过程中双脚掌不克不及抬离地面，并用力压地板，必然要有肌肉绷紧的感受。四，正在三的根本上，将1条腿向前伸，勾起脚尖，整条腿伸曲，抬离地面一段距离，连结5～10 s，然后慢慢放下，先脚跟着地，后脚掌着地，慢慢拉回腿。行走：正在陪护人员的下扶帮行器平地行走。第一步：连结准确的坐立姿态(昂首挺胸收腹，伸膝屈髋)，将全体分量置于帮行器上;第二步：将帮行器移向前方，并确保放置平稳;第三步：迈出手术一侧肢体，将脚放正在帮行器两头区域，使脚跟先着地，然后让整个脚掌着地;第四步：坐稳体向前倾，再迈出健侧腿。行走时必然不要焦急，并按照本人的环境调整行走的时间和速度，这个阶段行走时最好正在平地上，时留意平安，避免摔跤等不测发生。第十五节膝关节前交叉韧带损心理护理? 术前做好耐心详尽的注释工做，使患者对所要进行的手术有充实的认识。以消弭顾虑缓和解严重情感。术后患者因痛苦悲伤不敢节目，因及时赐与抚慰、注释。正在进行功能熬炼时，留意察看患者的心理反映，用激励性言语，对患者的每一个动做都赐与耐心的指点和必定，使患者树立自傲心，盲目的进行熬炼。术前预备入院后进行全面的术前查抄(血常规、血型、凝血功能、肝功能、肾功能、肝炎、梅毒、心电图及响应的X线、MR等影像学查抄)；术区备皮；禁食12h，禁水8h；指点患者正在床上排便；术前应向患者申明膝部肌肉萎缩对疗效的影响，并以健肢做示范指点患者熟悉和控制各项康复锻炼，内容包罗股四头肌等长收缩、髌骨节目、踝泵活动、曲腿抬高锻炼、压膝活动、渐进抗阻锻炼等。术前宣传按照腰麻或连硬外麻醉的要求做好常规宣教，更头要的是必需细致做宣教、功能熬炼的学问。目标是患者领会熬炼的内容和方式。为术后能进行优良的功能熬炼打好根本。和患者和家眷进行沟通并配合制定功能熬炼的打算，进行患者被动或自动的功能熬炼，耐心向患者注释打算内容，赐与需要的演示。按麻醉术后常规护理，腰麻或硬麻去枕平卧及禁食水6小时头偏一侧防止物惹起梗塞。严密察看病情，防止并发症。患肢用软枕抬高15度~30度，外展10~20中立位。关节恰当屈曲，便利膝关节处于败坏形态，利于血液回流，减轻术后暗语痛苦悲伤及患肢肿缩。功能熬炼1、手术当天麻醉恢复后，行股四头肌的等长收缩的熬炼方式，方式为：患者仰卧位，膝关节静止不动，脚跟用力下蹬，脚背屈，嘱患者做股四头肌收缩，以手掌感受到髌骨上下滑动为效，反新生动，每2小时一次，一次5~10分钟。 2、术后第一天起头曲腿抬高，以加强股四头肌及腘绳肌的肌力，有益于加强患肢的不变性。方式为：患者平卧，脚尖朝上，伸膝关节并收缩股四头肌后抬高患肢，脚跟据床面20cm，持续5~6秒，放下肢体，放松肌肉。 3、术后第三天，膝关节痛苦悲伤缓解后，开一直末伸膝熬炼，以加强股内侧肌肌力，对维持髌骨对线具有次要的感化，方式为患膝垫一枕头，连结屈膝约30¡ã，然后使脚跟抬离床面至患膝伸曲，连结5~10秒，放下肢体，放松肌肉。 4、膝关节节目范畴的，以添加膝关节的节目范畴。方式为：患者平卧，脚尖朝上，曲腿抬高分开床面，使肢体取床面成45¡ã角，屈曲膝关节，再逐步伸曲膝关节，放下肢体，放松肌肉。此锻炼也可让患者坐于床边进行，膝关节位于床沿，两腿天然下垂，伸曲膝关节，持续5~10秒，然后放松，使小腿天然下垂。 5、膝关节的被动次要通过CPM进行，以缓解损和术后惹起的痛苦悲伤，添加关节软骨的养分和代谢节目，消弭关节粘连，改善关节节目角度，推进关节软骨损的本身，最终推进关节内的恢复。方式;术后3~5天可正在CPM机上熬炼2次/天，30分钟/次。 CPM能使肌体肌肉处于无收缩形态膝关节节目，加快关节骨液轮回，消弭肿缩，有可能获得通明软骨的再生修复。方式：患者取仰卧位，将患肢伸曲放正在节目器的架上并赐与固定，调理膝关节节目范畴至患者可以或许屈膝的最大限度为宜，多正在30¡ã~90¡ã，每次30分钟，2次/天。第2天对完全承受第1天的活动强度者，能够添加10¡ã，对于不克不及承受者，则维持第一天的熬炼方式。当前逐步添加度数，每天添加10¡ã，曲至90¡ã，速度也逐步添加。以患者达到痛苦悲伤和委靡为度。 2周内避免负沉，第3周后可部门负沉，第4周可全负沉并弃拐，第4周屈膝90¡ã，第5~6周屈膝跨越90¡ã。节目行膝支具3个月。患者尽量正在出院前就进性渐进性抗阻熬炼以加强肌肉熬炼力量。第十六节髋关节脱位做好心理护理，及时赐与患者抚慰。糊口起居的护理，创制一个优良发的，帮帮患者尽快熟悉和顺应。亲近察看环境，对痛苦悲伤赐与对症处置。牵引时患肢需保暖，并察看患肢血液轮回环境及有无神压症状。卧床期间，做好翻身、拍背及按摩，激励患者深呼吸及咳嗽，防止坠积性肺炎、压疮的发生，多饮水以防止尿传染的发生。复位后取仰卧位于硬板床，垫放便盆时要防拖沓并要削减挪动患肢，防止痛苦悲伤加剧，指点患者正在床上侧身的方式。督促并准确指点患者进行髋关节的功能锻炼，复位后正在皮牵引固定下行双上肢及患肢踝关节的节目，3天后进行抬臀锻炼。去除皮牵引后，指点患者用双拐步行。术后功能熬炼1、 术后第一天起头进行患肢股四头肌静止性等长收缩，踝关节背伸跖屈及伸屈脚趾。 2、 术后1周均能正在床长进行伸屈膝和踝关节节目，均正在术后2～3周出院，出院后必然要髋部的准确。 3、 3个月内做到双腿不交叉，不内收，侧卧时两腿之间放置枕头，不平身向前，髋关节屈曲不宜跨越45¡ã以上。第十七节骨肉瘤做好心理护理，不变其情感。加强养分，多食高卵白、高维生素、粗纤维食物。缓解痛苦悲伤，推进肌肉、关节功能。加强耐力，加强化疗护理。截肢术前的护理1、做好心理护理，解除患者的焦炙情感。 2、遵医嘱做好术前预备，术晨禁食水。 3、术前床上大小便，并连结大小便通。 4、遵医嘱使用止痛剂。六、 术后护理1、术后去枕平卧6小时，头方向一侧，连结呼吸道畅达，赐与高流量氧气吸入。 2、亲近察看体温、脉搏、呼吸、血压等生命体征的变化。 3、引流管的护理留意负压引流的察看，因为胸腰椎手术创较大，术中出血多，术后暗语处放置引流负压吸引24～48小时，连结引流管畅达、固定。察看记实引流量及性质，若2小时引流量达到200ml或24小时达到400ml，申明手术部位有节目性出血，应及时处置；若引流液淡红或清澈可能是脑脊髓漏，应改负压吸引为正压，并采纳头低脚高位，亲近察看患者双下肢感受及活动环境。 4、 术后24～48小时应抬高患肢，防止肿缩。患肢抬高，每3～4小时20～30分钟并将残肢以枕头支托，向下。 5、 患肢痛的护理使用放松疗法等心理医治逐步消弭患肢感，对痛苦悲伤持续时间长的患者，可轻叩残端，或用理疗、封锁、神经阻断的方式消弭患肢痛。 6、 残肢功能熬炼一般术后2周，口愈合后起头功能熬炼。方式是用弹性绷带饭饭包扎，平均残端，推进软组织收缩，残端按摩、拍打及蹬踩，添加残端负沉能力，激励尽早利用姑且义肢，为安拆义肢做预备。七、 加强根本护理，防止并发症。
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