Nursing routine of skull base fracture

1。 Strict disinfection and isolation to prevent cross-infection, it is best to arrange patients in a single ward, and at the same time limit and reduce the visits of accompanying personnel. Wards should be ventilated in the morning and evening to keep the indoor air fresh, and ultraviolet disinfection should be carried out twice a day for 30 minutes each time. 2。 Ensure the correct lying position and promote the early closure of the leak. When cerebrospinal fluid leakage occurs, it is necessary to maintain a specific posture. Its purpose is to make brain tissue move to the dura mater of skull base under the action of gravity, which is helpful to local adhesion and plugging loopholes. Patients should definitely stay in bed. Those who are conscious of the fracture of anterior cranial fossa should be given a semi-recumbent position, and those who are unconscious should raise the head of the bed by 30 degrees and lie flat on the affected side. The patient with middle and posterior cranial fossa fracture lies supine. Maintain a specific posture until 3 days after stopping the leakage. Most patients often heal themselves within 1 week after injury. 3. Strengthen otorhinorespiratory care to prevent intracranial infection. Cerebrospinal fluid leakage during skull base fracture belongs to recessive open fracture, and improper nursing will cause intracranial infection. It is necessary to remove the blood and dirt in the nasal vestibule or external auditory canal in time to prevent the liquid from being blocked and flowing backwards. Put a sterilized dry cotton ball at the nostril or the mouth of the external auditory canal, replace it in time after soaking, and estimate the leakage according to the number of soaked cotton balls. Blowing your nose, sneezing, coughing violently, holding your breath, defecating, etc. can make increased intracranial pressure, aggravate cerebrospinal fluid leakage or cause pneumocranium, so patients with skull base fracture should pay attention to avoid the above actions. It is forbidden to pick your nostrils and ears, and it is forbidden to suck sputum in the nasal cavity or insert a stomach tube, drop medicine in the ear and nose, rinse and stuff. For patients with more respiratory secretions, take a deep breath and gently cough, cooperate with atomized inhalation and apply expectorant drugs to dilute the sputum and make it easy to cough up. If necessary, sputum can be sucked through the mouth. Strengthen oral care and control respiratory tract infection by intravenous antibiotics according to doctor's advice. 4. Diet care, the diet of patients with skull base fracture should be nutritious and easy to digest. It is not advisable to eat hard things that are irritating and need to be chewed hard. Diet should be rich in high protein and vitamins, eat more vegetables and fruits, keep the stool unobstructed and prevent constipation. Use kaisailu or enema when necessary to avoid forced defecation and increase intracranial pressure. 5. The method to determine whether the leakage fluid is cerebrospinal fluid. Normal cerebrospinal fluid is clear water, colorless and transparent. When brain injury occurs, bloody cerebrospinal fluid is easily confused with hemorrhage caused by otorhinolaryngology injury. When it is uncertain whether the leakage fluid is cerebrospinal fluid, the following methods can be used to identify it: ① Drop the leakage fluid on white absorbent paper or gauze, and there is a wide light yellow halo outside the blood, which looks like a lunar halo; ② Handkerchiefs soaked in cerebrospinal fluid do not become as hard as handkerchiefs soaked in snot or tissue exudate after drying; ③ Collect bloody leakage fluid to observe that bloody cerebrospinal fluid is not easy to coagulate; ④ Cerebrospinal fluid has high sugar content, which can be determined by urine sugar test paper; ⑤ In some patients with skull base fracture, cerebrospinal fluid can flow to the pharynx through the eustachian tube when the tympanic membrane is still intact, and patients can consciously swallow odorous or odorous liquid. 6. Observe whether there are symptoms of brain injury and intracranial infection, closely observe the patient's consciousness, pupils, vital signs and physical activities, and pay attention to the patient's high fever, headache, vomiting and neck stiffness. Record the illness. ~ generally speaking, for patients with brain trauma, nurses are often alert to the symptoms and signs of intracranial hypertension, but pay insufficient attention to intracranial depression. It is worth noting that when a large amount of cerebrospinal fluid leaks out, it can lead to the decrease of intracranial pressure, and the patient has symptoms such as apathy, headache, dizziness, blurred vision and decreased urine output. When intracranial hypotension occurs, supine position should be adopted to reduce the loss of cerebrospinal fluid and intravenous fluid replacement. 7. Psychological nursing and health education. Patients with skull base fracture generally show two psychological States: most patients are very scared when there are symptoms such as cerebrospinal fluid leakage and cranial nerve injury; However, mild patients lack enough attention to the disease and show disapproval. During hospitalization, patients need to stay in bed for a long time, with limited daily activities and high treatment costs. Patients often have anxiety and irritability. Nurses should do a good job in knowledge education and psychological care, so that patients can understand the relevant knowledge of skull base fracture, maintain a good attitude and actively cooperate with treatment.