Perioperative nursing care of benign prostatic hyperplasia?

Oh yes. -~ ~ ~ Benign prostatic hyperplasia (BPH) is one of the common diseases in elderly men. At present, it is considered that age and testicular function are two important factors in the pathogenesis of BPH. After 50 years old, most of them have clinical symptoms, mainly manifested as frequent urination, especially nocturia, dysuria, urinary retention and renal insufficiency. Surgical treatment is an important part of prostate treatment. 1. Preoperative care 2. 1. 1 Psychological care Perioperative psychological care includes introducing hospitals, explaining relevant disease knowledge, and familiarizing patients with the environment, medical staff, routine diagnosis and treatment plans and preoperative preparation. Patiently explain the pathogenesis and treatment of BPH to patients, and introduce some cure methods of similar diseases, so that patients can eliminate anxiety, establish confidence in healing, gain cooperation and trust, and actively cooperate with treatment and nursing. 2. 1.2 preoperative preparation: eat high-protein, high-vitamin, digestible food before operation to enhance the patient's physique and improve the patient's tolerance to surgery. Quit smoking and drinking before operation 1 ~ 2 weeks. Improve various examinations and understand the general situation of patients. If complicated with diabetes and hypertension, it is necessary to control blood sugar and blood pressure within a certain range; Patients with poor cardiopulmonary function need medical treatment and can be operated after their condition improves; If long-term urinary retention affects renal function, indwelling catheter should be used for more than 2 weeks before operation to improve renal function; Patients with urinary tract infection should first control the infection. Fasting 12 h before operation, drinking water for 6 h, and cleaning enema at night before operation. 2.2 postoperative nursing 2.2. 1 general nursing (1) strictly observe vital signs and pay attention to the state of consciousness. Because of the patient's age, many complications, poor resistance and compensatory ability, combined with surgical trauma, bleeding and other incentives, the condition changes rapidly, so it should be closely observed after operation. (2) Monitor blood sugar and electrolyte. Elderly patients often have complications, eat late, and are prone to hypokalemia, hyponatremia and hypoglycemia. Patients with TURP are prone to hyperglycemia and diluted hyponatremia during and after operation, which need timely correction and treatment. (3) Patients with hypertension and diabetes need to continue preoperative treatment in due course. (4) Dietary guidance: After the recovery of intestinal peristalsis after operation, give high-protein, high-vitamin and digestible food to keep the stool unobstructed and prevent constipation. 2.2.2 After bladder irrigation and catheter care, bladder irrigation should be continued for 5 ~ 7 d through a three-lumen catheter, and the bladder neck should be released after 24~48 h of compression, or the bladder should be placed in the prostatic fossa for 24 ~ 48 h ... After 3 ~ 5 days of operation, the drainage volume is less than 10 ml/d, and the posterior pubic drainage tube should be removed. (1) postoperative catheter drainage should be ensured. If the catheter is compressed, twisted or blocked by blood clots, it will lead to poor drainage, induce bladder spasm and aggravate bleeding. It is necessary to remove the blocking factors by hand rubbing or manual washing in time to ensure the patency of the drainage tube. (2) Carefully observe the color of the rinsing liquid. If it turns red and deep, quickly adjust the irrigation speed. If necessary, pull the three-lumen balloon catheter to compress the bladder neck to stop bleeding. The catheter can be fixed on the inner thigh, or the urethral orifice can be tied tightly with gauze for traction and compression. At the same time, patients are required to stay in bed to avoid increasing abdominal pressure. (3) The urine bag replacement and various operations should be strictly sterile, and the urine bag should be placed under the bladder and properly fixed. Scrub the urethral orifice with iodophor cotton balls every day, and don't disassemble the interface at will. 2.2.3 Nursing care of bladder spasm After prostate surgery, the bladder neck was compressed by surgical trauma, and the catheter and balloon were pulled. Bladder irrigation solution repeatedly stimulated the bladder and bladder neck triangle, which enhanced bladder sensitivity and caused paroxysmal spasmodic contraction of the bladder [1]. Cystic spasm not only brings pain to patients, but also causes secondary bleeding and catheter blockage, which affects postoperative recovery. Therefore, effective measures should be taken to prevent and reduce the occurrence of bladder spasm: (1) properly place a washing liquid bag 60 cm above the bed surface to avoid high-pressure washing. (2) Adjust the flushing speed according to the color of urine, and the flushing speed should be consistent with that of drainage fluid. (3) Adjust the irrigation temperature. Improper temperature of irrigation solution will aggravate bladder spasm, cause bladder bleeding and bring great pain to patients [2]. Preheat the rinsing liquid before rinsing, so as to keep the temperature of the rinsing liquid at 32℃ ~ 35℃ in autumn and winter and 22℃ ~ 25℃ in spring and summer. (4) In the flushing process, the catheter should be squeezed frequently to prevent the catheter from being twisted and blocked. (5) Strengthen psychological care, once there are signs, immediately conduct psychological counseling for patients, distract attention and eliminate tension. (6) Drug treatment: According to the doctor's advice, lidocaine can be infused into bladder, indomethacin and anisodamine can be injected into muscle, and diclofenac sodium suppository can be given to rectum. 2.2.4 Observation and nursing care of complications (1) bleeding. Bleeding usually occurs within 24 hours after operation. Closely observe the color of the drainage fluid, the patient's blood pressure and pulse, and judge the bleeding situation. If the color of drainage fluid is deep red, blood pressure drops, pulse is accelerated, or even shock occurs, consider bleeding, and immediately report to the doctor, speed up infusion, use hemostatic correctly, check whether the catheter water sac is damaged, refill the balloon or pull out the catheter to stop bleeding. If the above treatment fails, another operation is needed to stop bleeding. Secondary bleeding mostly occurs in 7 ~ 8 days after operation, which is mostly caused by poor continuous irrigation and drainage of bladder after operation, infection of necrotic coagulation layer during exfoliation or exertion of urination and defecation. Once it happens, infusion should be given in time, report to the doctor, speed up bladder irrigation, keep the catheter unobstructed, prevent blood clots from blocking the catheter, and pull out the catheter to stop bleeding if necessary. (2) Transurethral resection of prostate syndrome (TURS) is a serious complication after TURP, which is mainly caused by rapid absorption of irrigation solution during operation, resulting in hypervolemia and hyponatremia. During the period of indwelling catheter, keep the catheter unobstructed and the perineum clean, do a good job of urethral orifice nursing, and keep the daily drinking water above 2 500 ml. 2.2.2 Correct posture after prosthesis dislocation is an important nursing measure to prevent complications. When transporting the patient across the bed, the whole hip joint should be lifted, and the abduction neutral position should be maintained at the same time, and the affected limb should not be pulled alone to avoid external rotation and adduction of the hip joint. When turning over to the healthy side, put a soft pillow with a thickness of 5.0 ~ 10 cm between your knees, keep your feet parallel to your hips, and pay attention to the shoulders, hips and legs rolling to one side at the same time. When doing various operations, the hips should be lifted horizontally, not pulled, and the movements should be light, steady and accurate to prevent dislocation of the hip joint. Postoperative functional exercise should be gradual, and hip flexion should be less than 90 degrees. 2.2.3 Vein wall injury, slow blood flow, hypercoagulability and long-term bed rest are the main factors of deep vein thrombosis. Once the thrombus forms and falls off, it may cause pulmonary embolism and endanger life [1]. All 25 cases in this group are elderly patients, and most of them are complicated with physiological degeneration and/or organic diseases of multiple system organs, which makes the blood in hypercoagulable state. At the same time, these patients are lying in bed and braking their lower limbs before operation. Long-term passive posture during operation, tourniquet use during operation, excessive rotation and traction of lower limbs and other injuries indirectly damage adjacent blood vessels; After operation, due to incision pain, anesthesia and other reasons, the activity of lower limbs was obviously limited. These factors make the blood flow of lower limbs in a relatively slow state and induce thrombosis. Therefore, (1) it is necessary to do a good job in patients' health education, encourage patients to do passive and active physical exercise, and increase the amount of bed activity. (2) Instruct patients to do isometric contraction of quadriceps femoris at an early stage, actively move ankles and toes, massage affected limbs, avoid bending knees, keep hip joint drainage unobstructed and avoid blood stasis. (3) Avoid repeated puncture of ipsilateral lower limbs, and try to avoid intravenous infusion and intravenous injection of irritant drugs. (4) If deep vein thrombosis occurs in lower limbs, massage should be avoided, and the knee joint should not be actively flexed to prevent thrombosis from falling off and causing pulmonary and other organ embolism. 2.2.4 Due to the aging of skin in the elderly, the number of blood vessels in subcutaneous tissue is reduced, collagen fibers and elastic fibers are degenerated, and the regeneration ability of connective tissue is weakened. In addition, postoperative pain does not dare to move, leading to posture exertion, which is easy to cause pressure ulcers [4]. Keep the bed flat, dry and clean, and change the wet sheets at any time; On the premise of immobility of limbs, hip support should be carried out regularly to relieve sacrococcygeal compression, each time 1 time/2h; Guide and assist the patient to grasp the handle of the fixed ring with both hands, pedal the bed on the healthy side of the limbs, and lift the buttocks forcibly to prevent the skin of the buttocks from forming pressure sores due to long-term compression; When turning over, under the premise of braking the affected limb, lift the whole hip joint and the affected limb, so that the buttocks leave the bed surface and relieve the sacrococcygeal compression. Massage the skin of the sacrococcygeal part and the compressed part every 1 time/2 h. 2.2.5 Patients with constipation and traumatic fracture are affected by many factors, and constipation often occurs during hospitalization, leading to abdominal distension, abdominal pain and other symptoms, which has adverse effects on patients' diet, sleep and disease rehabilitation [6]. It is necessary to relieve the patient's worries, let the patient adapt to the ward environment and get used to defecating in bed. It is necessary to teach and explain the importance of a reasonable diet to patients, eat more foods rich in vitamins and cellulose, drink more water, guide and help patients to do abdominal massage, promote intestinal peristalsis, and keep defecation smooth. If constipation occurs, you can choose a mild laxative to promote defecation. 3 Functional Exercise Early functional exercise after artificial femoral head replacement is the key to successful operation and functional reconstruction of hip joint. Because exercise can reduce tissue adhesion, maintain muscle tension, reduce local tissue edema, increase the discharge of local metabolites, which is conducive to wound healing; Exercise can also promote venous return of lower limbs, which has a positive effect on preventing postoperative deep venous thrombosis and pulmonary embolism [7]. Therefore, take a combination of active and passive, step by step method to help patients with functional exercise. Static isometric contraction of quadriceps femoris began 24 hours after operation. Instruct patients to practice active dorsiflexion and plantarflexion of ankle and toe joints of affected limbs, so as to promote blood return of lower limbs and prevent deep vein thrombosis, and pay attention to observing the pulsation of dorsalis pedis artery, skin color and temperature of limbs, and whether there are abnormal feelings such as swelling and numbness. On the second day after operation, the patient was instructed to take active functional exercise: (1) ankle flexion and extension. (2) Isometric contraction of gluteus maximus and gluteus medius. (3) deep breathing exercise. (4) contraction of quadriceps femoris. 6 ~ 14 d after operation, straight leg lifting training; After operation 14 d, patients were encouraged to do standing exercise. First, the legs are healthy, the weight falls to the ground, and the affected limbs touch the ground without weight. 4 discharge rehabilitation guidance Because it takes a long time to recover the function of the affected limb after surgery, you must teach exercise methods and precautions at home when you leave the hospital. Avoid lateral position within 3 months; Avoid adduction and pronation of the affected limb within 6 months. The affected limb is not loaded and walks with crutches. Three months after operation, the affected limb can gradually bear the load, from double crutch to single crutch and then to abandon crutch, but the squat movement of the affected hip should be avoided. Try not to move alone with crutches; Using crutches instead of crutches when going out is self-protection on the one hand, and a hint to people around you on the other hand to prevent accidents. When doing all activities, we should try our best to reduce the weight of the affected hip joint and the stress on both sides, and don't give up crutches prematurely. Only when the fracture is confirmed by clinic and X-ray can crutches be abandoned.