I. Patient education
Patient education is one of the important contents of clinical nursing. As a new diagnosis and treatment technology, vascular interventional therapy has not been generally recognized, and most patients lack understanding of disease treatment, rehabilitation process and prognosis, which will lead to various psychological problems and affect the confidence and effect of treatment. Patient education can effectively alleviate patients' psychological problems before operation, promote postoperative rehabilitation and reduce the occurrence of postoperative adverse reactions.
Psychological consultation
Correctly evaluating patients' psychology is the premise of implementing individualized patient education plan. Common psychological problems of patients include: anxiety, fear, depression, paranoia, high expectations for surgery, etc. These psychological problems lead patients to pay too much attention to the safety and effectiveness of surgery before operation. Once they feel uncomfortable or have complications after operation, they will doubt the treatment effect and aggravate their discomfort. In order to achieve good results, the operation needs the close cooperation and active participation of patients. Therefore, nurses should attach importance to patients' psychological counseling and eliminate various psychological problems in order to strive for patients' active cooperation.
(b) The content and time of patient education
1 Disease-related knowledge: etiology, prognosis and necessity of operation, (the second day after admission).
Dietary guidance: Dietary requirements for anemia and advanced malignant tumor, (the day after admission), and dietary requirements before and after operation. (two days before the operation)
3. Laboratory examination guidance: instruct patients to cooperate with nurses to take various laboratory specimens, and pay attention before pelvic B-ultrasound, ct or MR examination. The purpose of explaining various laboratory tests is to let doctors fully understand the preoperative and postoperative indexes of patients, so as to provide basis for surgery and curative effect evaluation.
4 preoperative preparation guidance: explain related matters. (the day before the operation)
5. Introduce the operation process: let the patient make full psychological preparation and overcome the psychological fear of the operation. (the day before the operation)
6. Explain the precautions after operation: Pay special attention to the requirements on the day after operation, including limb immobilization, pain assessment, and precautions for using patient-controlled analgesia devices. (the day before the operation)
7 Self-care knowledge in rehabilitation period: (the second day after operation)
8 Discharge instruction: (1) Avoid overwork within one month; (2) Abstinence within 65,438+0 months after interventional therapy for gynecological tumors and within 3 months after postpartum hemorrhage; (3) After discharge, they went back to the hospital for reexamination at 1 month, 3 months, 6 months, 9 months and 12 months respectively, which was not suitable for follow-up.
The above educational content should be based on the individual differences of patients, and different ways and opportunities should be chosen.
2. Preparation before operation
(1) patient preparation
1 Understand the condition in detail, comprehensively evaluate their mental health status, and formulate personalized nursing plan.
Monitor the patient's temperature, pulse and respiration, three times a day before operation and once in the morning during operation, so as to understand the clinical examination and imaging examination data of patients and provide basis for arterial interventional therapy and curative effect evaluation. If the body temperature is ≥37.5℃ or the bleeding and clotting time is abnormal, WBC
3. Skin preparation for operation field: from navel to thigh, 1/3, including vulva. Pay special attention to whether there are skin diseases, injuries and infections at bilateral inguinal puncture sites, and at the same time, check the pulsation of the distal artery at the puncture site and make a good mark to facilitate intraoperative and postoperative comparison.
4 Procaine and iodine allergy tests were carried out the day before drug allergy test, and the test results were accurately observed and recorded. Because both ionic and nonionic contrast agents used at present can cause side effects, it is necessary to know in detail whether patients have risk factors for side effects before iodine allergy test, including renal insufficiency, diabetes, asthma, urticaria, eczema, heart disease, contrast agent allergy history, other allergic diseases or drug allergy history. For patients with risk factors, we should be careful to do allergy tests. If you have skin flushing, headache, nausea, vomiting, urticaria, etc. , is a positive result of the test, should report to the doctor in time.
Enters the digestible food 0-2 days before the gastrointestinal tract is ready for interventional therapy, and the residue is less 1, so as to prevent postoperative constipation and forced defecation from causing bleeding at the puncture site. Fasting for 4-6 hours before operation can reduce the gastrointestinal burden and avoid aspiration caused by vomiting during anesthesia or operation. Take 9 grams of senna one day before operation or clean enema at night before operation, and empty the bowel before operation to keep the intestine clean, so as to avoid the illusion caused by intestinal contents during operation and blur the vision. 6. Use drugs according to the doctor's advice before operation.
(2) Preparation of articles
1 Instruments: catheter, guide wire, vascular sheath, microcatheter. Drugs: The correct cooperation of nursing staff in three operations, such as contrast agent, embolic agent, antibiotics, chemotherapy drugs, first aid drugs, antiallergic drugs and antiemetic drugs, is an important link to ensure the smooth operation. In the interventional therapy of obstetrics and gynecology, some complications may occur, causing harm to patients. Therefore, nurses should cooperate with doctors to do the following work. (1) The patient lies on his back, his hands are naturally placed on the bedside, the arm on the infusion side of the patient is supported by a bracket, and his body is relatively braked to prevent the catheter from coming out, which will affect the screen image monitoring. (two) the correct preparation of chemotherapy drugs and antibiotics, to ensure accurate dosage and usage. Check again whether the catheter, guide wire and embolic agent are correct and intact. (3) Closely observe the changes of illness 1 Closely monitor the changes of patients' vital signs (monitored by ECG), consciousness and urine volume.
2. Observe the occurrence of cardiovascular complications. Due to the stimulation of interventional procedures, patients may have cardiovascular complications, such as chest tightness, dyspnea, hypotension or arrhythmia, and should immediately report to the doctor and take corresponding measures. Nurses should be familiar with the placement and use of first-aid equipment and first-aid drugs in the intervention room in order to cooperate with the rescue.