Patients with acute inferior myocardial infarction are prone to sinus bradycardia, patients with acute right ventricular infarction are prone to blood pressure drop, and patients with acute extensive anterior myocardial infarction are prone to ventricular tachycardia, ventricular fibrillation and other complications. Therefore, atropine, dopamine, lidocaine and so on. When thrombolysis, we should make preparations, prepare emergency vehicles and defibrillators, and closely observe the changes of heart rate, rhythm, blood pressure and electrocardiogram to avoid various complications during thrombolysis, which makes the rescue not timely.
Vagal reflex is easy to occur in patients with extubation after coronary stent implantation. It is necessary to closely observe whether there are complications such as nausea, vomiting, sweating and yawning. Therefore, emergency drugs such as dopamine and atropine should be prepared when extubation, and the patient's in-and-out quantity should be strictly recorded before extubation, with the intake reaching at least 1500ml and the urine volume reaching at least 800ml.
Keep the respiratory tract unobstructed
Conscious patients should be encouraged to take deep breaths or pat their backs regularly to help them cough up secretions. Coma patients often have difficulty breathing or even suffocation due to the weakening or disappearance of cough and swallowing reflex, and respiratory secretions and saliva accumulate in the larynx. Therefore, the patient's head should be tilted to one side, and respiratory secretions should be sucked out in time to keep the respiratory tract unblocked. And through respiratory cough training, lung physiotherapy cough and so on. , to prevent secretion stagnation, pneumonia and atelectasis.
Strengthen clinical nursing and passive exercise.
Eye care: those who can't close their eyes by themselves should pay attention to eye care, and can apply eye ointment or cover with oily gauze to prevent corneal dryness from causing ulcers and conjunctivitis.
Oral care: keep oral hygiene and stimulate appetite.
Skin care: critically ill patients should be diligent in observing, turning over, scrubbing, massaging, sorting and changing shifts.
When the condition is stable, the patient should be assisted in passive limb movement as soon as possible. For example, after radiofrequency ablation, the puncture site of the patient is in the right femoral vein. Because of the elastic bandage, passive massage should be done for lower limbs within 6 hours after operation, and patients should be encouraged to get out of bed after 6 hours to prevent venous thrombosis of lower limbs.
Supplementing nutrition and water
The catabolism of critically ill patients is enhanced, the consumption is high, and the demand for nutrients is increased, while the appetite of patients is poor and the digestive function is reduced. In order to ensure that patients have enough nutrition and water and maintain the balance of body fluids, we should try our best to improve patients' diet and help patients with self-care defects to eat. Those who can't eat can use nasal feeding or total parenteral nutrition. For patients with excessive water such as excessive drainage or loss of excess body fluids, attention should be paid to supplementing enough water. For example, patients after coronary artery surgery should quickly adjust the number of infusion drops and drink plenty of water, the amount should reach 1500ml to avoid vagal reflex; Patients with acute right ventricular myocardial infarction should also increase the speed of fluid replacement because of insufficient blood solubility, otherwise blood pressure will drop.
Maintain excretory function and keep all kinds of catheters unobstructed.
Assist patients to urinate, if necessary, carry out artificial defecation and catheterization under aseptic operation, and those with indwelling catheter carry out routine nursing of urinary catheter. For example, patients with myocardial infarction should keep their stools unobstructed to avoid angina pectoris caused by defecation. The urine volume after coronary stenting should be at least 800 ml. Patients have difficulty urinating or even urinary retention due to environmental changes or unaccustomed to urinating in bed. It is necessary to guide the patient's urine and keep the urine drainage unobstructed.
There are sometimes multiple drainage tubes on critically ill patients, so we should pay attention to proper fixation and safe placement to prevent distortion, extrusion, blockage and falling off, keep them unobstructed and play their due role. At the same time, pay attention to strictly maintain aseptic operation technology to prevent retrograde infection.
Ensure patient safety
For patients with delirium, restlessness and disturbance of consciousness, attention should be paid to safety and rational use of protective equipment to prevent accidents. The indoor light should be dark, and the staff should move lightly to avoid convulsions caused by external stimuli. Accurately execute the doctor's orders to ensure the medical safety of patients.
Psychological nursing
Critically ill patients often show various psychological problems, such as sudden accidents or acute onset patients often show fear, anxiety, sadness, oversensitivity and so on. Patients with aggravated chronic diseases are often negative, suspicious and desperate. Therefore, nurses should try their best to do psychological care while saving the lives of critically ill patients.