Microsurgery Nursing Care for Extremities
Psychological situation: Evaluate the patient's awareness of the disease, whether it is serious, anxious, horrified, etc., conduct psychological counseling according to the different expressions, and tell the patient that serious emotions, anxiety, etc. will cause vasospasm and cause surgical failure. Patient recognition, vital signs, oral bleeding environment, limb program ability, ability, skin environment, limb system dynamic environment. Operating room: Connected at room temperature 22-25 degrees to prevent vasospasm caused by changes in room temperature; connected 50-60% relative humidity is of major significance in preventing static electricity. Internal fixation materials and sutures required during surgery. Drug preparation: anticoagulation, anti-vasospasm, expiry date and quality of hormone drugs. Second, routine care intends to take measures 1. Recognize and check the patient's information, and strictly check the surgical site to prevent errors. 2. For patients, automatically take invalid communication to avoid emotional impulses. 3. Keep the broken fingers (toes) well. Multi-finger (toe) breaks should be placed in a 4C refrigerator in order to be used. 4, according to the surgical site, the surgical position should be suspended. During the operation, pay attention to the environment of warmth and pressure on the skin to connect the urine. 5. Strict aseptic operation to prevent postoperative infection and the failure of the operation, bringing severe consequences to the patient. 6. When using a tourniquet, pay attention to the time taken for the tourniquet bandage to prevent damage to the nerves and excessively long periods of time leading to severe ischemia and reperfusion injury of muscle tissue. 7. Use an electric knife to stop bleeding during the operation. Adhere a suitable negative plate according to the patient's spring and autumn, body sinking, and nutrient conditions to avoid skin contact with metal materials and prevent burning. 9. After the operation, the patient will be escorted to the ward safely. 3. Case care plan (1) Broken finger (toe) replantation 1. After receiving the emergency surgery notification, interrogate the surgical system to obtain the surgical position and prepare the necessary items and first aid facilities for the operation 2. The patient is to be operated At the entrance of the room, the patient's family members and the surgeon cooperated to check the patient's identity and take the surgical method. 2. Severe finger (toe) replantation surgery is delicate and takes a long time. It requires patients to be quiet and together, and to do a good job of patient psychological care. The emotions are very much affected by the operation. 4. The surgeon, anesthesiologist, and circuit itinerary San Park checked the patient's information before the start of anesthesia, before the skin was cut, and before the operation room was separated. 5. Patients are now private and given appropriate coverage. 6, the patient is safe and comfortable, and closely observe the changes in the condition, vital signs and bleeding volume. Connect the respiratory tract and the various channels. Pay attention to the skin pressure environment. 7. Surveillance of the operation personnel's harsh aseptic technique. Make up for the items and dressings needed on the operating table in time. Accurately fill in the record of surgical nursing. 8. Specifications for the labeling of the built-in objects, and the care record detailing the name, location and quantity of the implant. 9. Assess the patient's tolerance to the tourniquet and check for any complications from the tourniquet. 10. Strictly observe any adverse reactions after using drugs during the operation. 11, safe and accurate use of equipment. 12. Prevent the patient from falling into bed after operation. Set up all pipes properly during transfer and lift gently. Take the ward harshly to explain. (B) Peripheral nerve exploration and repair 1. Visit the patient one day before the operation to evaluate the individual environment of the patient and formulate a nursing plan. Take the special items required by the doctor. 2. Do a good job of psychological care, and take timely communication with patients and their families before surgery. 3. After the patient enters the operating room, check the patient's environment again carefully, and establish two venous channels for the healthy limbs, and the fluid, blood and product can be input smoothly. 4. The surgeon, anesthesiologist, and circuit itinerary San Park checked the patient's information before the start of anesthesia, before the skin was cut, and before the operation room was separated. 5. Patients are now private and given appropriate coverage. 6. Put the erythromycin eye ointment on the patient and close the upper and lower eyelids before placing the body. Use a film to prevent the cornea from drying and make good eyes. 7, the patient under the head of the head ring, slender pillow under the shoulder, soft pads at the knees and calves, to connect the foot functional position. Enrich the surgical site. 8. The patient is safe and comfortable, and closely observe the changes of the condition, vital signs and bleeding volume. Connect the respiratory tract and the various channels. Pay attention to the skin pressure environment. 9. Surveillance of surgical personnel with strict aseptic technique. Make up for the items and dressings needed on the operating table in time. Accurately fill in the record of surgical nursing. 10. Safe and accurate use of equipment. 11. Prevent the patient from falling into bed after operation. Set up all pipes properly during transfer and lift it gently. Take the ward harshly to explain. Surgical position Microsurgery for limb movements is mostly supine. Postoperative complications such as nerve damage and pressure ulcers should be prevented. Replantation of severed finger (toe) replantation surgery completely or incompletely replanted finger (toe) body. Anesthesia examples Nerve block Anesthesia surgery position supine position preparation 1, equipment and dressings: hand outsourcing, electric drill bag, micro-tool package, popular dressing bag, surgical gown bag. 2. Disposable items: disposable pads, gloves of various types, 23 blades, 3-0, 4-0, 9-0, 10-0 5ml needles, leather needles, suitable Kirschner pins, bandage , Small gauze pads, large gauze, etc. 3. Preparation of special items: hydrogen peroxide, 0.2% iodophor, etc. 4. Equipment: 1 high-power microscope, electric tourniquet 1 medicine preparation lidocaine, ropivacaine, dextran 40 injection, 0.9% sodium chloride injection, heparin sodium injection, papaverine injection. Surgical pace and surgery common Surgical pace is common 1. Swipe the mouth. Conditioned at room temperature 22 to 24 and humidity 50% to 60% 30 minutes before surgery. Check the broken fingers, wrap them with a sterile dressing, and put them in the 4C refrigerator freezer for use when replanting. Do a good tripartite check, assist in rest position, help patients with weight loss, edema and other soft pillows to support the bone bulge to prevent pressure sores Place a tourniquet cuff on the upper end of the affected limb. Help to dump hydrogen peroxide and saline. 2. Disinfect and spread towels. After the operation, the required sterile bag was opened again, and the disposable items needed on the table were prepared and hit the table. Take the doctor's inventory of equipment, dressings and other items and record that they are nursing. 3. Debridement. Clean up inactivated tissues sequentially. Adjust the lights, activate the tourniquet (continuously use for 10-15 minutes per hour to relax), and record the start time and tourniquet use and completion time. Set up the microscope, connect the power supply, and check whether the various parts of the microscope are normal. 4, flush the mouth again. Help the dumping of hydrogen peroxide and psychological saline, pay attention to aseptic operation. Because of the long operation time, the patient is in serious horror with different degrees of disagreement, giving the necessary comfort and annotation. 5, Kirschner wire fixed off the bone. Help to remove the battery from the drill. Put the internal fixation on the instrument table, record the quantity used, and paste the 3M sterilization tape on the surgical care record sheet. Take a close look at the surgical process and the patient's vital signs, and pay attention to the brightness and conditioning of the light at any time. Monitor the aseptic technique of the personnel on stage. 6. Sequential repair of blood vessels, nerves, and tendons, and transplantation for those who cannot repair. Adjust the microscope light source, focal length, and table distance according to the requirements of the surgeon. Intravenous infusion of dextran 40 injection solution reduces blood viscosity and adds local blood circulation. Prepare heparin-warm saline and pour as required by the procedure. Make up small gauze pads and large gauze in time, and record the quantity on the surgical care record sheet. Keep an eye on patients to keep warm. Frequently check the tightness of the tourniquet to obtain the utilization time, and promptly inform the doctor, in case the time is too long, which will cause severe muscle ischemia and ischemia and reperfusion damage. During the operation, pay attention to the changes in the patient's condition and the pressured part, and connect the veins to the patency. Pay attention to the urine drainage environment to connect the urination. 7. Check whether the repaired blood vessels are accessible. Muscle injection papaverine injection solution to prevent vasospasm. Pay attention to see if the patient has any adverse reactions after medication. 8, flush the mouth, make sure there is no program bleeding. Connect the operating room with a clean and tidy floor, connect all kinds of tubes, and layer by layer sutures. Check again the items used in the operation and confirm that they are correct. 10. Bandage the mouth. In accordance with the number and completeness of the inventory of instruments, dressings, etc., the tripartite inspection was completed again, and the aseptic table and various instruments were assisted to be removed, and the completion time of the operation was recorded. 11. The plaster support is fixed externally and is to be dried. Take a closer look at the blood circulation environment around the affected finger (toe). Check the skin condition of the patient's heel, chin and tail under pressure. After the gypsum is dry, return the patient to the ward and do the job. Care points: 1. Room temperature 22 ～ 24, humidity 50% ～ 60%. 2, items need to be prepared before surgery to prevent delay in the surgical process. 3. Because trauma can cause serious emotions to patients, patients must be channeled before surgery to relieve serious emotions and actively co-operate. 4. Strict aseptic technique is performed during the operation. Establish at most two veins, and the infusion is smooth. Monitor the patient's vital signs closely, pay attention to keeping warm, and connect all kinds of tubes to reach. 5. Check closely for any adverse reactions after medication. 6, good pressure site to prevent pressure ulcers. 7, pay attention to the inventory of items and equipment before and after surgery to prevent loss. Peripheral nerve exploration repairs the brachial plexus nerve and its branches (axillary nerve, musculocutaneous nerve, median nerve, ulnar nerve, radial nerve) and the sciatic nerve and its branches (tibial nerve and peroneal nerve) of the lower extremity. Jam and stick. Anesthesia examples Anesthesia operation position supine article preparation 1, equipment and dressings: hand wound bag, popular dressing bag, surgical gown bag. 2. Disposable items: disposable pads, gloves of various types, blades 11 and 23, 3-0, 4-0, 5-0, 9-0, 10-0 line needles, drainage tubes, rubber Drainage tablets, electric words, bipolar electrocoagulation forceps, leather, round needles, bone wax, blood drive belts, sterile bandages, small gauze pads, large gauze, etc. 3. Preparation of special items: 75% alcohol, 0.2% iodophor, etc. 4. Drug preparation: 40mg triamcinolone injection. 5. Equipment: High power microscope 1 Surgery step and common surgery step 1. Beautiful blue line drawing, marking operation secret words. Do a good tripartite check, assist in rest position, properly fix the patient, and the patient is private. Apply erythromycin eye ointment to the cornea, and support soft bones for patients with weight loss and edema to prevent pressure sores. According to the patient's spring and autumn, body sinking, nutritional conditions, paste the appropriate negative plate. 2. Disinfection, spread towels, wear surgical gowns and paste protective film after disappearing again. Open the required aseptic package, prepare the required disposable items on the table and hit the table. Take the doctor's inventory of equipment, dressings and other items and keep records of care 3. The various instruments are adjacent. Adjacent to the electric knife, suction. 4. Whisper. Cut the skin, muscles, and mucous membranes in sequence and adjust the lighting and the operating room temperature to record the beginning of the operation. Prepare the microscope. 5. Exploring and repairing both ends of the broken nerve and repairing it. Those who cannot repair it are transplanted. Turn on the microscope and adjust the appropriate height. During the operation, pay attention to the changes of the patient's condition and the pressured part, and connect the veins unobstructed, and pay attention to the urine output. Monitor the aseptic technique of personnel on stage. 6. Nerve entrapment and adhesion should be loosened and peeled off. Take a close look at the surgical process and the vital signs of the patient, pay attention to the brightness and conditioning of the light at any time, and make up for the small gauze pads and large gauze in time. Check again the items used in the operation and confirm that they are correct. 9, pressure bandaging secret words. In accordance with the number and completeness of the inventory of instruments, dressings, etc., the tripartite inspection was completed again, and the aseptic table and various instruments were assisted to be removed, and the completion time of the operation was recorded. 10, surgery completed. Help the patient to be kept warm. Check the skin environment of the pressured parts such as the heel and tail of the patient, and then return the patient to the ward for the job. Nursing points: 1. Items need to be prepared before surgery to prevent delay in the surgical process. 2. Patients under general anesthesia should pay attention to apply erythromycin eye ointment before surgery, paste gauze on the eye and cornea. 3. Aseptic technique is performed strictly during the operation. Establish at most two veins, and the infusion is smooth. Monitor the patient's vital signs closely, pay attention to keeping warm, and connect all kinds of tubes to reach. 4. Wipe dry or attract the mouth and nose excrement and blood at any time during the operation, and connect the airways. 5. Due to the long operation time, the pressured part should be well to prevent pressure ulcers 6. Pay attention to the inventory of items and equipment before and after the operation to prevent loss.