Craniocerebral trauma is an injury caused by external force acting directly or indirectly on the head. According to whether the injured brain tissue is the same as the outside world, it can be divided into open injury and closed injury. Common brain injuries include scalp laceration, scalp avulsion, scalp hematoma, skull fracture, concussion, brain contusion and laceration, intracranial hematoma, etc. After the injury, there were different degrees of headache, vomiting, papilla edema and obstacles in consciousness, thinking, feeling and movement. The condition of craniocerebral trauma is complex and changes rapidly, which is easy to cause adverse consequences. Some patients need surgery. Because of the correct guidance, teach patients the following knowledge.
Psychological guidance eliminates fear and tension. Unexpected injury, painful stimulation and the threat of disability or even death after injury make patients feel nervous and afraid. Psychological comfort and encouragement should be given to ensure adequate sleep and improve physical resistance.
Preoperative guidance
1, diet:
(1) Those who are awake after injury and have no surgical indications: (1) They should eat foods with high calorie, high protein, high vitamins and easy digestion to ensure adequate nutrition supply and promote the repair of injuries. (2) 24 hours after continuous coma, liquid should be fed by nose to ensure nutritional supply. For details, please refer to "Knowledge Education of Intracranial Tumors". (3) When gastrointestinal bleeding occurs, you should temporarily fast, stop bleeding and then eat to avoid spicy stimulation, so as not to aggravate gastrointestinal bleeding.
⑵ When hematoma is removed by operation or fracture reduction is needed, fasting 10~ 12 hours before operation and drinking water for 6~8 hours to avoid food reflux and aspiration after anesthesia.
2. Body position: rest in bed, and raise the bedside 15 ~ 30 to facilitate intracranial venous return.
3, to prevent falling out of bed: patients with mental symptoms or restlessness, out of control of consciousness and thinking, should add guardrails to restrain limbs to prevent falling out of bed.
4. Examination guidance: Patients with traumatic subarachnoid hemorrhage need repeated lumbar puncture, with the purpose of excluding bloody cerebrospinal fluid and understanding the prognosis of hemorrhage. When puncturing, you should lie on your side, bend your knees, keep your thighs close to the abdominal wall, bend your head to your chest, bend your back as much as possible, and don't change your position at will to prevent accidental injury. After puncture, you should lie flat on your pillow for 4~6 hours to prevent headache caused by changes in cerebrospinal fluid pressure.
5. The patient has disturbance of consciousness, dyspnea, headache and vomiting, and may have increased intracranial pressure and brain crisis. , should immediately report to the medical staff.
6. Prevention of complications:
(1) Patients with cerebrospinal fluid otorrhea and nasal feeding should pay attention to: (1) Avoid coughing hard, and do not wash or stuff locally. (2) look up, at any time with sterile cotton ball to dry the external auditory canal and nasal cerebrospinal fluid, keep the mouth, nose and ears clean. ③ Liquid nasal feeding should be postponed to 4-5 days after injury to prevent retrograde infection.
(2) If the sensory function of limbs is weakened or disappeared after injury, ice should be applied to cool down in case of high fever, and the ice bag should be wrapped with cloth and cotton pad to avoid frostbite; When the weather is cold, it is not advisable to keep warm with a hot water bottle to prevent burns.
7. After the surgeon shaves his head, rinse it with soapy water and hot water to avoid postoperative wound or intracranial infection; When it is cold, wear a hat after skin preparation to prevent catching a cold.
Postoperative guidance
1, diet
(1) Six hours after anesthesia, a small amount of liquid diet is enough without swallowing difficulties, and then gradually change to soft food.
(2) Patients who are unconscious and have difficulty swallowing within 24 hours after operation should be fed with liquid by nose. Attention should be paid to when feeding liquid by nose: ① Take a small amount of meals, no more than 200ml each time, with an interval of more than 2 hours to prevent indigestion. 2 Eat a high-calorie, high-protein and nutritious diet to ensure the supply of nutrition. ③ The temperature is 38 ~ 40℃ to prevent scalding patients. ④ Bedside elevation 15 ~ 30. Do not change the patient's position within half an hour after feeding to prevent food reflux. ⑤ Prevent gastric tube from prolapse. Eating when the gastric tube is pulled out will cause food to enter the respiratory tract and cause suffocation, so it should be properly fixed, and it is not allowed to pull out the tube by itself. 6. Before feeding, be sure to confirm whether the nasal feeding tube is in the stomach, so as to prevent food from entering the respiratory tract and causing suffocation. The common inspection method is: suck out the gastric juice with a perfusion device, indicating that it is in the stomach. Once gastric tube prolapse occurs, medical staff should be reported.
(3) When the gastrointestinal function is not fully recovered in the early postoperative period, try to eat less milk and sugary food to prevent flatulence caused by excessive gas generated after digestion; When brown liquid is drawn from the stomach tube, even bloody stool appears, indicating that there is stress ulcer in the digestive tract. You should temporarily fast or inject ice liquid before eating.
2. Body position:
(1) Before anesthesia, lie on the pillow with your head tilted to the healthy side to prevent vomit from being inhaled into the respiratory tract by mistake.
(2) After waking up, if the blood pressure is stable, raise the bedside by 15 ~ 30 to facilitate intracranial venous return.
(3) When there is a large cavity in the local area after the resection of large diseased tissue, it is forbidden to lie on the side to prevent brain tissue displacement and brain edema. When the condition changes, report it to the medical staff immediately.
3. Nursing methods of various drainage tubes: After intracranial tumor surgery, drainage tubes are often placed outside the dura mater for a short time according to specific conditions. It should be pointed out that:
(1) The opening in the drainage bag is lower than the outlet of the drainage tube to avoid retrograde infection.
(2) Prevent the drainage tube from twisting and coming out, and report to the medical staff in time when the color of drainage fluid changes from shallow to deep.
(3) When delivering oxygen, don't pull out the oxygen pipe.
4. Prevention of complications:
(1) Prevention of pulmonary complications: ① Encourage patients to cough and expectorate, so as to increase their vital capacity, remove oral and nasal secretions at any time, protect airway patency and prevent pulmonary complications. ② Patients whose cough reflex is weakened or disappeared and whose sputum is too thick to be sucked out should undergo tracheotomy. Tracheotomy nursing refers to "Tracheotomy Nursing Guide for Traumatic Brain Injury".
(2) If the patient has consciousness change, headache or vomiting, and may have brain edema or secondary intracranial hemorrhage, he should inform the medical staff in time for treatment.
(3) When the urine volume increases to about 300ml/ hour or the patient has dehydration symptoms such as thirst and irritability, it may be diabetes insipidus. In addition to telling the medical staff to handle it, we should also pay attention to drinking more water and replenishing water to prevent polyuria and dehydration.
(4) Prevention of bedsore: Long-term compression of local tissues and physical stimulation such as dampness and friction make local neurotrophic disorders, which can lead to bedsore ① turning over every 1 ~ 2 hours/time to avoid skin damage. ② Change wet and polluted sheets at any time and scrub the whole body skin twice a day.
(5) Keep the mouth clean and prevent oral infection: After operation, the body's resistance is low, and the food residue left in the mouth after eating is beneficial to the reproduction of oral bacteria and causes oral infection. Rinse your mouth after every meal to remove food residue and prevent oral infection.
(6) Prevention of exposure keratitis: Coma patients after operation, whose corneal reflex is weakened or disappeared, and whose eyelids are not closed properly, are prone to corneal ulcer. Cover your eyes with eye pads to prevent foreign bodies and flying dust from entering your eyes, causing corneal damage and infection.
2. Nursing guidance after tracheotomy: Patients with persistent coma, weakened or disappeared cough reflex after brain injury should undergo tracheotomy due to excessive respiratory secretions, and attention should be paid to tracheotomy:
(1) Keep the respiratory tract unobstructed: (1) Avoid foreign bodies from entering the tracheal catheter, so as not to stimulate the tracheal mucosa and cause cough and aspiration pneumonia. (2) Don't cover the tracheal catheter with towels and other items, so as not to cause artificial blockage of the catheter, which may lead to dyspnea. ③ The endotracheal tube is boiled and disinfected four times a day, in order to eliminate the secretions in the endotracheal tube, prevent the secretions from scabbing and blocking the inner tube, and prevent the incision and lung infection.
⑵ Patients who are delirious and unconscious under general anesthesia should be supervised by special personnel to prevent tracheal collapse and airway obstruction caused by extubation, which is life-threatening.
(3) In case of shortness of breath, irritability, tracheotomy while studying abroad, obvious swelling of neck and chest, distorted pronunciation, tracheal cannula prolapse, etc. You should tell the medical staff to deal with it at once.
⑷ Obstruction: Instructions for extubation: ① When dyspnea is relieved and the sputum is obviously reduced, try to block the endotracheal tube for 24~48 hours to find out whether breathing is stable and whether the sputum can be coughed up by itself. If you breathe smoothly at night and fall asleep quietly, it means that the airway obstruction has been lifted and you can extubate; If there is shortness of breath, irritability and cold sweat, it means that there is still airway obstruction and the endotracheal tube cannot be pulled out temporarily. (2) After the endotracheal tube is pulled out, we should still pay attention to the breathing situation.
5. Language communication: When the pronunciation is affected before the tracheal catheter is removed, for those who are conscious, they can gently press their fingers on the tracheal catheter to form a temporary blockage, and then simply speak and express their feelings.
Knowledge education on surgical treatment of cerebrovascular diseases
Cerebrovascular diseases refer to intracranial vascular malformation, cystic bulging, sclerosis and thrombosis caused by congenital abnormal development of cerebrovascular or acquired vascular injury. Common intracranial aneurysms, cerebrovascular malformations, hypertensive cerebral hemorrhage or ischemic cerebrovascular diseases. Its morbidity and mortality are high. The clinical manifestations are headache, vomiting, epilepsy, hemiplegia, aphasia and change of consciousness. Sudden increase of blood pressure, emotional excitement, physical activity and forced defecation can all induce cerebral hemorrhage. , even life-threatening. Surgical methods are usually used to remove diseased blood vessels or hematoma or clamp aneurysms. In order to make patients cooperate with treatment, patients should be guided from the following aspects.
Psychological guidance should avoid emotional excitement. When emotional, sympathetic nerve will be excited, causing arteriole spasm, leading to high blood pressure, which can induce cerebral hemorrhage and even endanger life.
Preoperative guidance
1, diet:
(1) Eat a light diet with high protein, high calorie, rich nutrition and easy digestion to improve the body's resistance and postoperative tissue repair ability.
(2) Quit smoking and drinking 2 weeks before operation, so as not to stimulate respiratory mucosa, cause upper respiratory tract infection and increase respiratory secretions, and affect surgery and anesthesia.
(3) Fasting 10 ~ 12 hours before general anesthesia and drinking water for 6 ~ 8 hours to avoid aspiration caused by vomiting after anesthesia.
2. Rest and posture:
(1) Adequate sleep should be ensured before operation, which is beneficial to stimulate appetite, restore physical strength and enhance the body's resistance. Patients should try to reduce medical visits during sleep and rest.
(2) When lying in bed, raise the head of the bed by 15 ~ 30, so as to facilitate intracranial venous return and reduce intracranial pressure.
3. Patients with a history of epileptic seizures should not interrupt treatment, so as not to induce grand mal.
4. Avoid causing increased intracranial pressure. Increased intracranial pressure will aggravate headache and even cause brain crisis. Factors such as cough, difficulty in defecation and emotional excitement should be avoided. If there are symptoms such as consciousness change and headache aggravation, you should report to the medical staff immediately.
5, try not to go out, if you need someone to accompany you. Because patients with intracranial tumors have different degrees of intracranial hypertension symptoms and signs, they are easy to fall and get injured when they go out; Physical activity and emotional changes when going out will also make increased intracranial pressure.
6, training in bed defecation, avoid postoperative not accustomed to bed defecation caused by constipation, urinary retention.
7. Skin preparation: After the surgeon shaves his head, rinse it with soapy water and hot water to avoid postoperative wound or intracranial infection; When it is cold, wear a hat after skin preparation to prevent catching a cold.
8. Avoid inducing cerebral hemorrhage.
(1) Keep defecation unobstructed. Don't urinate hard; Patients with habitual constipation were treated with laxatives and low-pressure enema.
⑵ Keep a calm mind, get enough sleep, keep the ward quiet, avoid too many visitors, and avoid talking about topics that excite patients.
(3) Don't go out alone, mainly stay in bed, and definitely stay in bed for cerebral hemorrhage; Restless patients tend to restrain their limbs and calm down when necessary to prevent increased intracranial pressure and induce cerebral hemorrhage.
(4) Patients with hypertension should insist on taking medicine. Don't miss or stop taking antihypertensive drugs at will, because when blood pressure rises, it can lead to the rupture of diseased blood vessels.
9. Special examination guidance: In order to understand the nature of hemangioma and the distribution of blood vessels on the tumor, the location, size, shape, number, starting point and cerebral circulation of vascular lesions, cerebral angiography should be performed. Matters needing attention in cerebral angiography: ① Transient fever during angiography is caused by the stimulation of blood vessels by contrast agent, so there is no need to be nervous. ② Pay attention to whether the puncture site is swollen after angiography, and use sandbags or 500g plastic bags to add salt to compress the puncture site. Patients with femoral artery angiography should stay in bed as much as possible 1 day to avoid bleeding and subcutaneous swelling at the puncture site.
Postoperative guidance
1, diet
(1) Six hours after anesthesia, a small amount of liquid diet is enough without swallowing difficulties, and then gradually change to soft food.
(2) Patients who are unconscious and have difficulty swallowing within 24 hours after operation should be fed with liquid by nose. Attention should be paid to when feeding liquid by nose: ① Take a small amount of meals, no more than 200ml each time, with an interval of more than 2 hours to prevent indigestion. 2 Eat a high-calorie, high-protein and nutritious diet to ensure the supply of nutrition. ③ The temperature is 38 ~ 40℃ to prevent scalding patients. ④ Bedside elevation 15 ~ 30. Do not change the patient's position within half an hour after feeding to prevent food reflux. ⑤ Prevent gastric tube from prolapse. Eating when the gastric tube is pulled out will cause food to enter the respiratory tract and cause suffocation, so it should be properly fixed, and it is not allowed to pull out the tube by itself. 6. Before feeding, be sure to confirm whether the nasal feeding tube is in the stomach, so as to prevent food from entering the respiratory tract and causing suffocation. The common inspection method is: use a perfusion device to suck and extract gastric juice, indicating that it is in the stomach. Once gastric tube prolapse occurs, medical staff should be reported.
(3) When the gastrointestinal function is not fully recovered in the early postoperative period, try to eat less milk and sugary food to prevent flatulence caused by excessive gas generated after digestion; When brown liquid is drawn from the stomach tube, even bloody stool appears, indicating that there is stress ulcer in the digestive tract. You should temporarily fast or inject ice liquid before eating.
2. Body position:
(1) Before anesthesia, lie on the pillow with your head tilted to the healthy side to prevent vomit from being inhaled into the respiratory tract by mistake.
(2) After waking up, if the blood pressure is stable, raise the bedside by 15 ~ 30 to facilitate intracranial venous return.
(3) When there is a large cavity in the local area after the resection of large diseased tissue, it is forbidden to lie on the side to prevent brain tissue displacement and brain edema. When the condition changes, report it to the medical staff immediately.
3. Nursing methods of various drainage tubes: After intracranial tumor surgery, drainage tubes are often placed outside the dura mater for a short time according to specific conditions. It should be pointed out that:
(1) The opening in the drainage bag is lower than the outlet of the drainage tube to avoid retrograde infection.
(2) Prevent the drainage tube from twisting and coming out, and report to the medical staff in time when the color of drainage fluid changes from shallow to deep.
(3) When delivering oxygen, don't pull out the oxygen pipe.
4. Prevention of complications:
(1) Prevention of pulmonary complications: ① Encourage patients to cough and eliminate phlegm, so as to increase their vital capacity, remove oral and nasal secretions at any time, protect airway patency and prevent pulmonary complications. ② Patients whose cough reflex is weakened or disappeared and whose sputum is too thick to be sucked out should undergo tracheotomy. Tracheotomy nursing (1) to keep the respiratory tract unobstructed: (1) to avoid foreign bodies entering the tracheal catheter, so as not to stimulate the tracheal mucosa and cause cough and aspiration pneumonia. (2) Don't cover the tracheal catheter with towels and other items, so as not to cause artificial blockage of the catheter, which may lead to dyspnea. ③ The endotracheal tube is boiled and disinfected four times a day, in order to eliminate the secretions in the endotracheal tube, prevent the secretions from scabbing and blocking the inner tube, and prevent the incision and lung infection.
⑵ Patients who are delirious and unconscious under general anesthesia should be supervised by special personnel to prevent tracheal collapse and airway obstruction caused by extubation, which is life-threatening.
(3) In case of shortness of breath, irritability, tracheotomy while studying abroad, obvious swelling of neck and chest, distorted pronunciation, tracheal cannula prolapse, etc. You should tell the medical staff to deal with it at once.
⑷ Obstruction: Instructions for extubation: ① When dyspnea is relieved and the sputum is obviously reduced, try to block the endotracheal tube for 24~48 hours to find out whether breathing is stable and whether the sputum can be coughed up by itself. If you breathe smoothly at night and fall asleep quietly, it means that the airway obstruction has been lifted and you can extubate; If there is shortness of breath, irritability and cold sweat, it means that there is still airway obstruction and the endotracheal tube cannot be pulled out temporarily. (2) After the endotracheal tube is pulled out, we should still pay attention to the breathing situation.
5. Language communication: When the pronunciation is affected before the tracheal catheter is removed, for those who are conscious, they can gently press their fingers on the tracheal catheter to form a temporary blockage, and then simply speak and express their feelings.
(2) If the patient has consciousness change, headache or vomiting, and may have brain edema or secondary intracranial hemorrhage, he should inform the medical staff in time for treatment.
(3) When the urine volume increases to about 300ml/ hour or the patient has dehydration symptoms such as thirst and irritability, it may be diabetes insipidus. In addition to telling the medical staff to handle it, we should also pay attention to drinking more water and replenishing water to prevent polyuria and dehydration.
(4) Prevention of bedsore: Long-term compression of local tissues and physical stimulation such as dampness and friction make local neurotrophic disorders, which can lead to bedsore ① turning over every 1 ~ 2 hours/time to avoid skin damage. ② Change wet and polluted sheets at any time and scrub the whole body skin twice a day.
(5) Keep the mouth clean and prevent oral infection: After operation, the body's resistance is low, and the food residue left in the mouth after eating is beneficial to the reproduction of oral bacteria and causes oral infection. Rinse your mouth after every meal to remove food residue and prevent oral infection.
(6) Prevention of exposure keratitis: Coma patients after operation, whose corneal reflex is weakened or disappeared, and whose eyelids are not closed properly, are prone to corneal ulcer. Cover your eyes with eye pads to prevent foreign bodies and flying dust from entering your eyes, causing corneal damage and infection.
5. Keep blood pressure stable: postoperative blood pressure should be controlled at the patient's basic blood pressure level, and it is not allowed to adjust the speed of intravenous antihypertensive drugs at will. Hypertension can lead to blood vessel rupture and bleeding at the surgical site; Hypotension can cause cerebral ischemia and cerebral infarction.
6. Avoid inducing an increase in intracranial pressure: the eating speed should not be too fast to prevent coughing; Keep defecation unobstructed, and don't have high-pressure enema when constipation occurs; Keep quiet and avoid emotional excitement, etc.
Discharge guidance
1, reasonable nutrition, keep the stool unobstructed; Diet should be light and easy to digest, rich in crude fiber to prevent constipation.
2, patients with hypertension, insist on taking medicine under the guidance of a doctor. Don't change the dosage or stop taking medicine at will, so as to avoid blood pressure rising and bleeding.
3. Rehabilitation treatment (1) Hemiplegia: (1) Take drugs beneficial to tissue repair under the guidance of doctors, and cooperate with hyperbaric oxygen, physiotherapy and acupuncture to promote the recovery of brain function. ② Massage the paralyzed limbs 6 ~ 10 times every day regularly to promote local blood circulation. ③ Carry out passive movement of paralyzed limbs and active movement of healthy limbs to prevent muscle atrophy. (4) keep the limb functional position. Fix ankle joint with L-shaped splint to prevent foot drop.
⑵ Pronunciation guidance for aphasic patients: ① From pronouncing monosyllabic sounds to teaching patients to speak everyday language, thus training motor language functions. ② Let patients listen to the familiar songs and favorite programs in the past by listening to the radio and broadcasting, and train their auditory language function. ③ From teaching patients to read their own names and simplified Chinese characters, train their visual language ability.
(3) Patients with secondary epilepsy should be prevented. Don't go out alone, don't climb mountains, don't ride a bike, don't swim, etc. Carry the disease certificate with you and insist on taking antiepileptic drugs for 3~5 years.