Bladder cancer is the most common malignant tumor in urinary tract, accounting for 4% of all visceral cancers, and it is the most common among men aged 50-69. The main clinical manifestations are painless gross hematuria, bladder irritation (frequent urination, urgency, etc. ) and dysuria, and advanced lesions can also lead to upper urinary tract obstruction. Clinical examination of exfoliated cells in urine and cystoscopy are helpful for diagnosis.
In treatment, early bladder cancer can be treated by electrocautery or surgical resection, and chemical drugs can be given at the same time; If the tumor invades the bladder on a large scale, radical cystectomy is needed. In this operation, in order to make the patient still have urination function after operation, doctors usually do enterobladder replacement, that is, cut a section of the patient's small intestine (ileum) to make an artificial bladder, connect the ureter to one end of the artificial bladder, and the other end opens to the abdominal wall. This is also called "urostomy", and urine is excreted through this passage.
The surgical design of ileal bladder replacement has brought great changes to the patient's body, changed the normal urination mode of the patient, caused inconvenience in daily life and had many negative effects on the patient's psychology. Some people adapt to this change quickly, some people need a long time to adapt, and for others, there will always be some degree of regret and loss. Most patients will naturally worry about how to deal with the hygiene and cleanliness of stoma, how to minimize the overflow of urine after stoma, and the spouse's reaction to stoma. It takes patients at least several months, even more than half a year, to adapt to the change of urination mode and learn the sanitary treatment of urostomy. At this stage of learning and training, if we don't master the treatment methods of excreta, urine overflow may occur in the urine flow channel during sleep and sexual life, which makes patients and their families feel at a loss and in a state of panic.
Therefore, patients should try to learn some basic knowledge about bladder cancer before operation, understand the main treatment methods of bladder cancer and the problems to be solved after operation. Make necessary psychological preparation, actively cooperate with medical staff for treatment, grasp the treatment methods of postoperative problems in time, receive correct rehabilitation guidance, reduce the inconvenience caused by stoma itself, make patients recover their functions to the maximum extent, restore their confidence and dignity, and help improve their quality of life and promote their physical and mental health.
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Talking about postoperative nursing care of patients with bladder cancer
Bladder tumor is a common tumor in urinary system, accounting for the first place in urinary system tumor, which is more common in people aged 50 ~ 70. From June 2004 to June 2005, 5 cases of bladder cancer/KLOC-0 were treated surgically in our department, and good results were achieved.
Clinical data of 1
In this group, there were 15 cases, including male 10 cases and female 5 cases, aged 46-86 years. All of them underwent partial cystectomy, with an average hospitalization of 15 days and a clinical cure rate of 100% (all recovered and discharged).
2. Implement health education
(1) Implementation method: According to the specific situation of patients, explain the disease-related contents to patients in stages and in a targeted manner. (2) Do a good job in admission education: introduce doctors, nurses, ward environment and related systems to patients in detail, so that patients can adapt to the hospitalization environment as soon as possible and gain the trust of patients and their families. (3) Explain to the patient the purpose of preoperative examination, the operation mode and the approximate time required for the operation, so that the patient can perform the operation in the best condition. (4) Health guidance on diet and rest: the diet should be light and moderate, not overeating, avoiding spicy food, and quitting smoking and drinking. Training patients to defecate in bed before operation, avoiding the difficulty of defecation after operation because they are not used to defecation in bed, and keeping defecation unobstructed are important measures to prevent postoperative bleeding. (5) It is advisable to stay in bed after operation. After the vital signs are stable, you can change your posture, turn over every 2 hours/kloc-0 times, and exercise your hands and feet at the same time. In our department, YQ-PB fluctuating air cushion bed was used for bedsore medical treatment to prevent bedsore, and good results were achieved. No case was complicated with bedsore. (6) Bladder irrigation is needed after operation, so that the blood oozing from the bladder can be diluted with normal saline and drained in time to avoid blocking the urethra by coagulation. (7) to guide patients and their families to observe bleeding. It is usually bright red on the day of operation, and then it gradually turns light and yellow. On the day after operation, the irrigation speed is 120 ~ 160 drops/minute, so that the blood can be diluted and pumped out, and the dripping speed can be adjusted according to the color of drainage fluid in the future. The drainage liquid is light yellow, and intermittent washing is feasible. The irrigation tube can be removed 3 ~ 4 days after operation. After the indwelling catheter stops flushing, the patient should be instructed to drink more water, more than 2000ml per day, in order to achieve the purpose of flushing. (8) Bladder spasm can occur during bladder irrigation, and drugs can be given to slow down and relieve the spasm. (9) Instruct patients to have regular examinations (every 1 to February in the first half of the year 1 time, and every three months in the second half of the year 1 time). If they feel unwell, they can go to the hospital at any time, such as ① gross hematuria; ② Frequent urination, urgency or dysuria; ③ Pubic pain or palpable mass in the lower abdomen. If these problems occur, you should go to the hospital for review in time. (10) Anti-infection treatment: rational use of antibiotics, prevention of wound infection, observation of wound dressing change at any time, timely dressing change if there is infiltration, and keeping the skin at the incision clean and dry.
Three results
Through the health guidance for patients, the satisfaction of patients and their families with nursing is improved, so that patients can treat diseases correctly and actively cooperate with treatment, and at the same time, a good nurse-patient relationship is established, which lays a good foundation for holistic nursing.
4 discussion
Although the etiology of bladder cancer is not clear, it has been confirmed that β-naphthylamine, benzidine, α-aniline and 4-aminobiphenyl are carcinogens of the disease, and the incubation period can reach 15 ~ 40 years. Implementing correct health guidance for patients is the primary task of nursing work. Therefore, nurses are required to have comprehensive professional knowledge and practical operation ability, as well as certain knowledge of sociology and psychology, and establish a more reliable nurse-patient relationship through psychological nursing to promote patients' early recovery, which is the purpose of holistic nursing.
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