Combined chemotherapy plays an important role in the comprehensive treatment of advanced non-small cell lung cancer, but its side effects are serious, such as bone marrow suppression, digestive tract reaction, hair loss and so on. Observation and nursing are summarized as follows. 1. Psychological nursing. Psychological care for lung cancer patients should focus on four elements: premise, foundation, key and core. Good doctor-patient relationship is the premise of psychological nursing; The tacit cooperation between nurses and patients' families is the basis of implementing psychological nursing; Correctly grasping the psychological characteristics of patients is the key to psychological nursing; It is the core of psychological nursing to help patients correctly understand diseases, actively cooperate with diagnosis and treatment, stimulate their potential survival consciousness and improve their disease resistance. Nurses do four elements well, which can make patients cooperate with treatment with the best mentality. 2. Prevent infection. Closely observe the patient's peripheral blood picture, and carefully check and record the cardiovascular system, respiratory system, digestive system, urinary system, exercise system and nervous system after daily nursing rounds. In addition to disinfection of wards and bedding, oral mucosa, skin and perineum should be cleaned and disinfected. Instruct patients to rest, don't go to other wards, reduce medical visits and avoid cross infection. Tell patients not to pick their noses casually to prevent nosebleeds; Brush your teeth with a soft toothbrush to prevent gum bleeding. 3. Do a good job in health education guidance. For patients with mild or moderate diarrhea, observe, evaluate and record the frequency, color, character and quantity of defecation and the stimulation to perianal skin, assist patients to do well in perianal skin care, and inform patients of the importance of cleaning anus after defecation; Instruct patients to eat liquid and semi-liquid which are easy to digest and contain little cellulose, and avoid spicy, cold and hard food.
4. Skin toxic reaction. Please avoid scratching and keep your skin clean and dry to avoid infection. 5. Muscle ache reaction. It usually occurs 2 ~ 3 days after chemotherapy, and most of them return to normal after 1 week. In addition to giving painkillers according to the doctor's advice, we should also pay attention to explaining to the patient and let him know that this symptom is reversible. And assist in daily life care, massage sore parts, help them divert their attention, reduce discomfort, and carry out physical therapy if possible. 6. arrhythmia. Nursing staff should observe at the bedside so as to find problems in time and deal with them in time; ECG monitoring should be given when taking medicine, and the changes of vital signs should be closely observed. If there is any change, you should report it to the doctor immediately and cooperate with the doctor to deal with it accordingly. At the same time, psychological care should be done to make patients feel safe. 7. Allergy. When patients have hypersensitivity reactions such as tracheal spasm, dyspnea and blood pressure drop, they should stop taking drugs, take oxygen and apply pressor drugs immediately until they return to normal. In the process of nursing, we should overcome careless thoughts, observe closely and prepare for rescue. 8. Edema and serous cavity effusion. The main manifestations are peripheral edema, and serous cavity effusion in severe cases. Nurses should cooperate with doctors, strictly follow the doctor's advice, especially urge patients to use hormones according to the doctor's advice, and closely observe the changes of patients' weight and surrounding edema. Evaluate edema when edema occurs, measure the circumference of the most serious part of edema every day, guide patients to raise their lower limbs, increase venous blood return, and guide patients to wear loose and soft clothes to prevent skin abrasions. 9. Nursing care of toxic and side effects of digestive tract. The nursing quality of digestive tract reaction directly affects the durability and effect of chemotherapy. Encourage patients to eat a small amount and eat more, and the diet should be light. During the third chemotherapy, patients with chemotherapy generally suffered from loss of appetite. Intravenous supplementation alone can not guarantee the energy supply of patients, which is not conducive to disease recovery. Patients can be given oral multi-enzyme tablets to help digestion and stimulate appetite. At the same time, we should patiently persuade and encourage patients to eat. Pay attention to the frequency, quantity and color of vomiting in patients with severe vomiting, and cooperate with the application of antiemetic treatment. Patients with liver function impairment should be instructed to stay in bed, eat less and eat more meals, and enter a nutritious and digestible diet. 10. Do a good job of self-care guidance before and after discharge after chemotherapy. Most patients are worried when they leave the hospital. They are worried that they will not be able to recover further or even get worse because of the loss of a good medical environment. Therefore, medical staff must patiently and meticulously do a good job in patients' ideological work and relieve patients' various concerns. Instruct patients how to insist on chemotherapy after discharge, go to the hospital for chemotherapy regularly, develop a regular life, combine work and rest, and go outdoors appropriately. For those with serious hair loss, you can wear a wig and pay attention to food hygiene.
Second, the nursing of radiotherapy for lung cancer
Radiotherapy is one of the means to improve the quality of life and prolong the life of patients. However, during radiotherapy, patients may have a series of psychological or physiological reactions. Therefore, taking reasonable nursing measures to reduce the occurrence of radiotherapy reaction is the key to ensure that patients can successfully complete radiotherapy and recover as soon as possible. 1. Psychological nursing. Nurses should keep abreast of patients' ideological trends, explain in detail the necessity, function and possible reactions of radiotherapy, eliminate their psychological obstacles and make them cooperate with treatment with a positive attitude. 2. Diet care. Provide reasonable and sufficient nutrition for patients, ensure the color and fragrance of food, and promote the appetite of patients.
Lung cancer is a very common cancer, ranking second in the mortality rate of malignant tumors in China. The general symptoms of lung cancer are not obvious. Cough, shortness of breath, blood in sputum and other symptoms similar to tuberculosis may appear in the early stage. Advanced patients may have fever, emaciation, fatigue and even cachexia.
The digestive system function of patients with early and middle stage lung cancer is perfect. After the clinical diagnosis, we should take the time to supplement the body with nutrition in order to improve the physique, enhance the resistance and prevent or delay the emergence of cachexia. If nutrition is fully supplemented before clinical treatment, patients with better physical condition will have stronger tolerance to chemotherapy and radiotherapy, and the treatment effect will be better; Similarly, patients with better physical condition are more likely to receive surgical treatment and recover faster than patients with poor nutritional status. Therefore, patients with early and middle stage lung cancer should be supplemented with various nutrients as soon as their digestion and absorption capacity permit, such as high-quality protein, carbohydrates, fats, inorganic salts and multivitamins. According to the symptoms of lung cancer patients, such as cough and hemoptysis, there are many prescriptions and prescriptions for nourishing yin, moistening lung, stopping cough and stopping bleeding. For example, there are nourishing yin and moistening lung, almond jellyfish, lily, water chestnut and other foods. Lotus root knot, lotus seed, persimmon, pear, yam, lily and tremella all have the functions of relieving cough, astringing and stopping bleeding. According to folk remedies, lung cancer patients can also eat nourishing food, such as clams, tortoise shells, turtle meat, glutinous rice and so on.
Compared with digestive tract tumors, the dietary problems of lung cancer patients should be better solved. In addition to the above Chinese medicine nourishing food, lung cancer patients should choose milk, eggs, lean meat, animal liver, bean products, fresh vegetables and fruits. You can try to increase the patient's food intake and frequency. It should be noted that patients with lung cancer should avoid greasy food, spicy food and irritating food such as tobacco and alcohol.
Three, lung cancer perioperative care
1 preoperative nursing
1. 1 Strengthen psychological care, improve health education and strictly quit smoking. Smoking in ICU increases carboxyhemoglobin in tracheal secretions and blood, which has great influence on surgery and postoperative. For elderly patients who smoke for a long time, explain the importance of quitting smoking, and patiently persuade patients to quit smoking two weeks before operation. In view of the fact that all cancer patients are accompanied by different degrees of psychological disorders, nurses should strengthen the publicity and psychological counseling of cancer prevention knowledge according to the patient's condition, personality, culture and family background, so that patients can cooperate with treatment with a positive attitude. 1.2 create a clean ward environment, adjust the temperature and humidity of the ward according to the comfort of patients, keep indoor air circulation, and disinfect the air regularly to prevent the respiratory function from being aggravated by colds. 1.3 Total nutrition support encourages patients to eat. For those with poor preoperative nutritional status, ensure adequate water intake and carry out nutritional support treatment to increase the tolerance to surgery. 1.4 instruct preoperative exercise to improve patients' lung function, and explain the purpose and significance of preoperative preparation and early postoperative functional exercise to patients and their families. Demonstrate and guide patients to practice deep breathing and abdominal breathing with lung function dilator every day, and encourage patients to carry out effective breathing training; Help patients master the skills of expectoration, and emphasize the importance of coughing and expectoration, so as to remove the worries of pain caused by coughing.
2 postoperative care
2. 1 Closely monitor ECG monitoring indications and changes of lung function. During the postoperative stay in ICU, the changes of heart rate, blood pressure, respiration and percutaneous oxygen saturation were closely observed (new SpO protocol). Changes in pathophysiology and various factors after lung cancer thoracotomy reduce ventilation function and ventilation/blood flow ratio, which may lead to hypoxemia. These changes are more likely to occur in patients with decreased preoperative ventilation function. According to the amplitude and frequency of breathing and the change of spo _ 2, patients were given adequate oxygen therapy in time, BIPAP non-invasive ventilation if necessary, and even invasive mechanical ventilation through tracheal intubation to correct hypoxemia. Check blood gas and electrolyte items every day, monitor patients' heart rate changes and preoperative ECG reports, master patients' 24-hour inflow and outflow, observe the performance of unintentional dysfunction, and strengthen cardiac protection and anti-heart failure treatment and nursing for arrhythmia patients. Active symptomatic treatment can reduce the incidence of respiratory failure and heart failure. 2.2 Management of respiratory tract after lung cancer thoracotomy, due to pain, anesthetic and other reasons, the patient's expectoration function is weakened, airway ciliary activity is reduced, and secretions are easy to stay; And chest bandage fixation, long-term bed rest and so on. It also restricts respiratory movement, thus affecting lung recruitment and leading to lung infection, which is more obvious in patients with original ventilation disorder. Therefore, the postoperative patients are conscious and their vital signs are stable, which is beneficial to ventilation and keeps the closed drainage of thoracic cavity unobstructed. Routine airway atomization, when resting in bed, patients are required to take a slow and deep breath with diaphragm, hold their breath when inhaling deeply, and then cough a short and powerful cough from the chest; Assist him to change his posture regularly, encourage and guide the patient to cough effectively after meals 1h and 2 ~ 3h hours before meals. By beating the patient's back rhythmically and moderately, the sputum attached to the alveolar and bronchial walls will be loosened indirectly, so that the patient can cough up sputum effectively, thus exercising lung function and promoting lung recruitment. For the elderly, the weak and those with ineffective cough, use fiberoptic bronchoscope to suck sputum when necessary. 2.3 Patients should be encouraged to carry out early activities after early functional exercise. Instructing patients to exercise properly in bed before removing chest tube can effectively prevent atelectasis and venous thrombosis of lower limbs, and improve ventilation and circulatory function. When the vital signs are stable and the chest tube is removed, the patient can move around in bed and get out of bed step by step. 2.4 Psychological Care After the patients after thoracotomy are regularly admitted to ICU, they often show anxiety and loneliness due to the relatively isolated environmental conditions, the pain caused by surgery and the fear of postoperative recovery and prognosis. Nurses should create a quiet, peaceful and orderly atmosphere, patiently explain any treatment, obtain the cooperation of patients, and perform various operations skillfully, accurately and quickly; For patients who are afraid of coughing because of wound pain, giving analgesic drugs when necessary will help patients relax and ensure the smooth progress of treatment. 2.5 Dietary care According to the needs of the illness, learn more about the patients' eating habits, explain the importance of postoperative nutritional support, point out the misunderstandings in diet treatment, and encourage patients to list foods with high calorie, high protein and high fiber.
Iv. Nursing care of patients with lung cancer treated by arterial catheter intervention 1. Psychological nursing. Interventional treatment of lung cancer with arterial catheter is a new technology. Explain the treatment process, matters needing attention and treatment effect to patients in detail before treatment, so that patients can be fully prepared and cooperate with treatment with a positive attitude. 2. Strictly grasp the indications of interventional chemotherapy. The diagnosed lung cancer has no bleeding, and is generally in good condition. There are no serious heart and kidney diseases, hematological diseases and bleeding history, severe arteriosclerosis and hypertension. 3. Make all kinds of preparations before treatment. Such as routine examination, bleeding and coagulation time determination, iodine allergy test, liver and kidney function, skin preparation at puncture site, etc. 4. Predictive nursing. After interventional therapy of femoral artery catheter, the patient needs to lie flat, and the limb on the intubation side is limited for 24 hours. In order to avoid urinary retention and difficulty in defecation after treatment, patients should practice defecation in bed before operation. 5. Nursing after treatment. Absolute bed rest within 24 hours, giving low-flow oxygen inhalation and increasing tissue oxygen supply. Regularly measure blood pressure, pulse and respiratory changes and make records; The limb on the intubation side should be straight, and the movement should be restricted within 24 hours to avoid bending; Intubation local pressure bandage for 24 hours, supplemented by 0.5 kg sandbag pressure if necessary, observe whether there is bleeding and subcutaneous hematoma formation, and handle it in time if it is abnormal. 6. Look carefully. Observe the pulse, limb color, body temperature and swelling of dorsal foot artery, and compare with the opposite limb. If the pulse of dorsum pedis artery weakens or disappears, nail bed is pale, body temperature drops and swelling, it is because the bandage is too tight and the pressure is too high, which affects the arterial filling and venous return of lower limbs and should be bandaged again.
7. Observe the side effects of drugs. Cisplatin is nephrotoxic, adriamycin is cardiotoxic, and mitomycin can inhibit bone marrow. Observe cardiac and renal functions and bone marrow hemogram frequently. If the patient has symptoms such as nausea, vomiting and chest pain, inform the doctor in time.
Five, the diet care of lung cancer patients