1 Preoperative health education
1. 1 psychological counseling
After admission, we should warmly receive patients, introduce bed doctors and responsible nurses, introduce ward environment and department system, and eliminate patients' strangeness. Understand the patients' psychological problems and try to help solve them from family, society and economy. Organize communication with successful patients, listen to their own experiences, and enhance their confidence in surgery. Take patients to ICU to get familiar with the environment, understand the functions and sounds of ECG monitors and ventilators, so as to convince patients that they will be well monitored after operation and reduce their anxiety and fear.
1.2 disease knowledge education
Explain the etiology, pathogenesis, clinical manifestations, the purpose and necessity of operation, the general process of operation, the matters needing attention after operation, the importance of various pipelines, the types, principles and quality reliability of artificial valves in various forms to improve patients' understanding of the disease.
1.3 behavior guidance
Advise patients to quit smoking immediately after admission, and explain that the postoperative complications of smokers can reach 4 times that of non-smokers [1], which is very harmful. Strengthen warmth in winter to prevent colds and respiratory infections. It is of great significance to instruct patients to do effective cough, deep breathing and abdominal breathing three days before operation to prevent postoperative pulmonary complications [2]. Train patients to urinate and defecate in bed, determine the communication mode of tracheal intubation after operation, eliminate patients' fear and cooperate with treatment and nursing. This paper introduces the work and significance of routine preparation before operation, such as skin preparation, blood preparation, fasting, enema and dressing change.
1.4 dietary guidance
Instruct patients to adjust their diet reasonably and eat more foods with high calorie, high protein and rich vitamins, so as to enhance the body's tolerance to surgery. People with poor heart function need to limit sodium salt and eat more foods with high potassium content, such as bananas, oranges, green leafy vegetables and juice. Because patients with heart failure, long-term use of diuretics, a large number of potassium salt excretion caused by low potassium, can cause arrhythmia and other complications. Eat proper amount of crude fiber food such as vegetables and fruits to keep the stool unobstructed.
1.5 rest and activity guidance
Ensure adequate sleep and avoid heavy physical activity. The degree of activity should be limited to no chest tightness, shortness of breath, palpitations or relief after a few minutes' rest. Once you have dizziness or syncope, you should lie flat immediately and call the medical staff in time. Patients with atrial fibrillation should avoid holding their breath and coughing suddenly, so as to reduce the chance of thrombus falling off and prevent embolism.
1.6 medication guidance
Long-term use of digitalis preparation requires pulse measurement before use. If the pulse is lower than 60 beats/min, stop taking the medicine. When toxic reaction symptoms such as nausea, vomiting, abdominal pain, yellow vision, green vision and arrhythmia are found, you should immediately report to the doctor and stop taking the medicine. Long-term use of diuretics should pay attention to the electrolyte situation and supplement potassium. Aspirin should be taken after meals to avoid irritating the gastric mucosa. Stop using anticoagulants 5-7 days before operation to avoid bleeding during and after operation. Explain the function and possible reaction of preoperative medication to avoid patients and their families from being nervous.
2 postoperative health education
2. 1 psychological care
When patients wake up, they often feel scared because of the changes in ward environment, the sounds made by ventilators and monitors, the inability to speak when tracheal intubation is not pulled out, and the discomfort caused by indwelling various pipes. Medical staff should patiently explain to patients at the bedside and tell them not to move around to avoid the pipe falling off. Inform patients that if they feel unwell, they can communicate with gestures determined before operation. Pay attention to protect the patient's privacy during the exposure operation.
2.2 respiratory tract management
Explain to the patient again the importance of effective cough and expectoration after operation, the function and method of atomizing inhalation, and make it cooperate. Assist the patient to sit up every 2 hours, buckle his back correctly, encourage coughing, expectoration and deep breathing, and let the patient blow balloons or use a breathing trainer to facilitate lung recruitment and prevent lung infection.
2.3 Dietary guidance
After operation, due to the improvement of cardiac function, the decrease of interstitial water and the increase of urine volume, and the drying of airway by ventilator, patients are often thirsty and eager to drink water after tracheal intubation. Patients should be informed that only a small amount of warm water can be taken 4 hours after extubation to avoid choking and aspiration. If there is no discomfort such as nausea and vomiting, you can gradually turn light and digestible liquid or semi-liquid into general food, and eat more foods with high potassium and high protein diet to promote wound healing.
2.4 recumbent position and activity guidance
After the tracheal intubation is removed 24-48 hours after operation, the patient is informed that this position can reduce diaphragm, increase vital capacity, facilitate pericardial and mediastinal drainage and promote wound healing. Encourage patients to exercise early and stay in bed for 24-48 hours after operation. Encourage patients with good heart function to eat and wash themselves. On the third day after operation, you can get up and move around the bed, and then gradually increase the activity according to your illness, so as not to cause palpitation and shortness of breath.
2.5 Health education of anticoagulant therapy
After heart valve replacement, biological valve needs anticoagulation for 3-6 months, and mechanical valve needs anticoagulation for life. Bleeding and embolism related to anticoagulation are the most common life-threatening complications after valve replacement. Therefore, patients and their families must be aware of the importance of anticoagulant therapy in order to get cooperation. Warfarin is an anticoagulant commonly used in clinic. Anticoagulation usually begins 24-48 hours after operation. Attention should be paid when using: ① Take it according to the dosage on time in strict accordance with the doctor's advice, and monitor the dosage of PT, APTT and INR daily until PT is adjusted to 1.5-2 times the normal value, and INR is 1.5-2.0, and then measure it once a week after stability. ② Pay close attention to whether there is bleeding tendency. Once gum bleeding, nosebleed, hemoptysis, hematuria, menorrhagia, skin ecchymosis and even intracranial hemorrhage are found, you should immediately report to the doctor, see a doctor immediately after discharge, review the coagulation time, reduce the dosage of anticoagulant, and apply vitamin K treatment under the guidance of the doctor; ③ Vitamin K is the most effective antagonist of warfarin, which has blood coagulation function. During anticoagulation, you should try to avoid eating things with high vitamin K content, such as spinach, cabbage, carrots, tomatoes, potatoes, animal offal, lettuce and so on. ④ Pay attention to the influence of other drugs on anticoagulants. For example, salicylic acid, erythromycin and sulfonamides can enhance the anticoagulant effect of warfarin, while barbiturates and rifampicin can weaken the effect of warfarin. If necessary, use it under the guidance of a doctor.
3 Health guidance after discharge
Instruct patients to rest, combine work and rest, feel comfortable and avoid strenuous activities and fatigue within six months after discharge. Strengthen nutrition, but limit the intake of salt, don't overeat, and take cardiotonic, diuretic and anticoagulant according to the doctor's advice. Pay attention to the effects of valve surgery and anticoagulation on menstruation and pregnancy of women of childbearing age. Pay attention to keep warm to prevent colds. Pay attention to the change of body temperature, and seek medical advice in time if there is any abnormality. Regular review according to doctor's advice