Psychological nursing is of positive significance for invigorating the spirit and maintaining the normal function of the body. Nurses should give full play to the independent function of nursing work and conscientiously do the following work:
(1) Eliminate patients' fear.
Cancer patients often have different degrees of fear, a lot of worries, often lose confidence in treatment, despair, and even want to commit suicide. These bad emotions have an inhibitory effect on the immune function of the body and worsen the condition. Therefore, nurses should have a high degree of sympathy and responsibility, respect patients, show enthusiastic concern, establish good relations with patients, try their best to eliminate bad stimuli, obtain close cooperation from family members, and meet patients' emotional needs.
② Stabilize patients' anxiety.
According to the specific situation of patients, such as cultural literacy, personality characteristics, mental endurance, etc., take appropriate ways to let patients know their diagnosis. Cancer is a great blow to patients, but through careful behavior induction, patients' emotions can gradually stabilize, face reality and cooperate with treatment.
③ Reduce the mental burden of patients.
For patients with recurrence and metastasis, patients should not know the exact development of the disease. Doctors and nurses should give consistent explanations to patients, be good at guiding and give spiritual support.
(4) Care about the mental life of patients.
In order to provide a comfortable living environment for tumor patients, the tumor ward should prevent the boring atmosphere, actively recuperate, organize recreational activities and talk about tumor knowledge, please heal the patient's appearance, keep books, newspapers and recreational supplies in the recreation room, organize patients to do what they can and distract their attention.
⑤ Instruct patients to carry out appropriate activities.
Let patients get up and move as much as possible, take care of themselves or part of them, prevent premature bed rest, and guide patients to rearrange their work.
⑥ Relieve patients' physical and mental pain.
Medical staff must eliminate the influence of "intractable diseases", and are not allowed to use irritating language to avoid adverse effects on patients. Careful nursing can alleviate the pain of patients.
● Nursing before radiotherapy
Nurses should first understand the patient's treatment time and course of treatment, the type of radiation, the irradiation site, the patient's physiological condition and the expected effect of radiotherapy. , and grasp the patient's ideological trends, make targeted preparations.
Before radiotherapy, most patients lack a correct understanding of "radiotherapy". Before treatment, patients and their families should be briefly introduced to radiotherapy, possible side effects in radiotherapy and matters needing cooperation. In clinics and wards, there are easy-to-understand and illustrated radiotherapy education manuals for patients to read. Before starting the treatment, accompany the patient to visit the radiotherapy department, and explain the reasons why the staff can't stay indoors during radiotherapy, but they can still be monitored at the operation desk, so that the patient can eliminate the fear and actively cooperate with the treatment.
(1) Explain the harm of smoking before, during and after radiotherapy, prevent oral mucosal reaction, and quit smoking and drinking.
② Understand the patient's physical condition and nutritional status, give a high-protein and high-vitamin diet, enhance physical fitness, and check blood picture and liver and kidney function.
③ When head and neck diseases occur, especially when the irradiation field passes through the oral cavity, oral hygiene should be done well, such as cleaning teeth and gargling with Dobby's solution. Dental caries should be pulled out first, and patients with periodontitis or gingivitis should be treated accordingly before radiotherapy.
(4) If there is a wound on the skin in the irradiated area, the wound should be properly treated and healed before receiving irradiation. If there is infection, radiotherapy should be carried out after the infection is controlled.
● Nursing during radiotherapy
① Nursing care of irradiated wild skin
Before irradiation, the importance of protecting the skin in the irradiated area to prevent radiation dermatitis should be explained to the patient. If you choose cotton soft underwear, avoid the friction of rough clothes; Irradiated fields can be lightly soaked with warm water and soft towels, and soap scrubbing or hot water bathing is prohibited locally; Irritating disinfectants such as iodized oil and alcohol are prohibited for local skin to avoid cold and hot stimulation such as hot compress and ice pack; It is forbidden to use the skin in the irradiated area as an injection point; Don't use cosmetics for external use, and don't stick tape. Because zinc oxide is a heavy metal, it will produce secondary rays, which will aggravate the radiation damage of the skin. It is forbidden to apply zinc oxide to the skin in the irradiated area, and it is also forbidden to shave. It is advisable to use an electric shaver to prevent skin damage and infection.
② Nutrition and diet nursing
Radiotherapy not only kills tumor cells, but also causes different degrees of damage to normal tissues. Strengthening nutrition plays a very important role in promoting tissue repair, improving therapeutic effect and reducing side effects. In the preparation of food, we should pay attention to color, aroma and taste, and eat more in small quantities to create a clean and comfortable eating environment for patients. Strengthen the education of nutrition knowledge for patients and their families or advocate "super-food therapy", that is, give concentrated high-quality protein and other necessary nutrients during the intermission of radiotherapy to quickly make up for the nutritional consumption of patients. During radiotherapy, patients are encouraged to drink more water, 3000ml per day, to increase urine output, so that the toxins released by a large number of tumor cells caused by radiotherapy are excreted; Reduce the reaction of whole body radiotherapy.
③ Radiological nursing care of head and neck tumor.
In order to improve radiation sensitivity and prevent infection, the irradiation area should be kept clean. Antibiotics can be dripped into eyes, ears and nose, and the eyes or external auditory canal can be washed if necessary. Eye drops containing metal should not be used to avoid aggravating conjunctival reaction. Patients with nasopharyngeal carcinoma should wash their nasal cavity with normal saline 1-2 times a day. If the nasal cavity is dry, it can be moistened with paraffin oil, and ephedrine can be dripped into the nasal congestion. Dentures and gold teeth should be removed in advance to reduce oral mucosal reaction. After oral mucosa is irradiated, saliva secretion decreases, which leads to an increase in the incidence of dental caries. Patients should be instructed to use fluoride toothpaste, gargle with 1% licorice water for dry mouth, or make tea with Ophiopogon japonicus and honeysuckle, and do mouth opening exercises to prevent mouth opening difficulties. Patients with laryngeal cancer are advised to spit out sputum and exfoliated necrotic tissue as much as possible to prevent pulmonary complications from being attracted by mistake. Closely observe the changes of the condition and report to the doctor in time, pay attention to the changes of blood pressure, pulse and breathing, keep the patient calm, establish venous access and match blood if necessary.
④ Nursing care of esophageal cancer after radiotherapy.
After radiotherapy for esophageal cancer 1-2 weeks, esophageal mucosa congestion and edema, local pain, dysphagia, mucus increase and so on appeared. It is necessary to do a good job in explaining that the tissue edema does not increase after irradiation, so as to alleviate the anxiety of patients, it is necessary to give a light and digestible diet, and it is forbidden to eat irritating food and cigarettes. For those with severe dysphagia, vomiting after meals or accompanied by vomiting, rehydration should be done in time according to the doctor's advice. Observe the nature and vital signs of patients' pain and cough at any time, so as to find esophageal perforation and bleeding in time, and immediately stop drinking water and report to the doctor.
⑤ Radiological nursing care of lung cancer
Fever is one of the main symptoms of lung cancer, so patients with fever should be cared for and kept warm. For irritating cough, antitussive drugs can be given. If the patient coughs up blood, he should keep calm, report to the doctor in time, give hemostatic according to the doctor's advice, tilt his head to one side, and suck out the blood in his mouth in time to prevent suffocation. And pay attention to the occurrence of tension pneumothorax, if there are acute chest pain, chest tightness, shortness of breath, cyanosis and other manifestations, you should report to the doctor in time. Always prepare a closed thoracic drainage device for emergency use.
⑥ Abdominal and pelvic irradiation nursing
Urine should be emptied before abdominal and pelvic irradiation to reduce bladder reaction. Small intestine is sensitive to radiation, which often leads to intestinal stenosis, mucosal ulcer, bleeding and even necrosis. Patients should be closely observed for abdominal pain, diarrhea, intestinal spasm and shock. Radiation proctitis may occur after pelvic irradiation. Pay attention to whether there is bloody mucus stool, acute internal emergency and then severe symptoms. After bladder irradiation, serious bladder contraction and capillary dilatation bleeding may occur. Pay attention to the occurrence of radiation cystitis such as urgency, frequent urination and hematuria. During radiotherapy for cervical cancer, observe whether there is bleeding in vagina. For female patients with pelvic irradiation, the contraceptive ring should be removed and the possibility of amenorrhea after irradiation should be explained to the patients and their families.
⑦ Precautions for radiotherapy: Radiotherapy patients should not bring metal objects, such as watches, pens, necklaces, earrings, dentures, keys, etc. When entering the radiotherapy room, so as not to increase radiation absorption and aggravate skin damage.
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