Urgent! Nursing records of diabetic patients kneeling after laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is the first choice for the treatment of various benign gallbladder diseases. As a hepatobiliary nurse, besides being familiar with the indications and contraindications of LC, as well as preoperative nursing, the focus is on postoperative nursing of LC.

The specific measures are as follows for your reference:

1. Establish effective countermeasures

The patient felt unwell and restless in a short time after waking up from general anesthesia. Dizziness. If you don't cooperate with nursing, you should tell yourself and your family in time (due to the reaction after general anesthesia and oxygen tube). Abdominal drainage tube. Cuff of ECG monitor. Stimulation of clips and electrode pads on the body). In order to stabilize the patient's mood and obtain cooperation.

2. Nursing care of nausea and vomiting

Patients should keep their mouth clean at any time after operation to prevent vomit from entering the trachea by mistake. The nature and quantity of vomit should be observed, and the causes of vomiting should be analyzed (whether it is related to vomiting caused by vomiting center stimulated by narcotic drugs or peeling). Cholecystectomy stimulates gastrointestinal tract and interferes with gastrointestinal function. Deal with it in time according to different situations.

3. Keep the respiratory tract unobstructed

After the operation, the patient should return to the ward and lie on the pillow for 8 hours with his head tilted to one side. If the patient can't sleep for 2 hours, instruct his family to turn over and knock on his back. Even if the oral secretions are cleared, it is necessary to prevent aspiration.

4. Shoulder and back pain

If the patient's pain is aggravated when changing positions or lying on his back, explain to him, help him change comfortable positions, massage the sore parts, and tell him that the symptoms will disappear after 1-3 days.

5. Nursing care of hypertension

The causes of postoperative hypertension should be found out in time, and the factors of emotional tension, pain or dysuria should be ruled out. Patients with essential hypertension should continue to be treated with antihypertensive therapy after operation. Prevent titanium clip from falling off or abdominal bleeding caused by continuous increase of blood pressure.

6. Prevention and nursing of hypercapnia and acidosis

After operation, low-flow oxygen inhalation should be continued, and oxygen saturation should be monitored to keep the oxygen saturation above 96%. If the value is low, check whether the patient's skin temperature is too low. Whether the oxygen inhalation device is unobstructed. If the coma is due to the high PaCO2 _ 2 _ 2 caused by CO2 pneumoperitoneum during operation, the patient's breathing is shallow and slow, and the heart rate increases. Intravenous infusion of 5% NahCO _ 3 should correct electrolyte imbalance, increase oxygen partial pressure and carry out hyperbaric oxygen therapy to prevent serious consequences.

7. Nursing care of diabetes

Patients with mild diabetes underwent minor surgery, and their appetite after operation was the same as before. People who can't eat in gastrointestinal tract should continue to inject glucose solution intravenously. The daily total glucose intake is 150~250g ~ 250g, and the ratio of glucose to insulin is 3 ~ 6g:1u.. At the same time, blood sugar, urine sugar and ketone body, potassium, sodium, chlorine and so on. We should be sure. According to the inspection results, adjust the water and salt metabolism, and correct the abnormal metabolism of sugar and protein. Urine sugar and urine ketone body were measured every 2 hours during operation, and every 4 ~ 6 hours after operation 1 time as appropriate. Generally, the fasting blood glucose is kept at 83 ~11mmol/L, and urine sugar is safe at "+"and "++". After general surgery, patients should eat liquid diet 1 ~ 3 days and return to normal diet in 4 ~ 6 days. When he can ingest 1.20 g carbohydrate every day, he can stop intravenous glucose infusion and resume the preoperative diabetes treatment plan.

8. Observation and nursing of complications

(1) Intraperitoneal hemorrhage

Closely monitor the changes of blood pressure and pulse within 8 hours after operation to prevent severe vomiting and cough. If the drainage volume exceeds 50 ml within 30 minutes, you should be alert to intra-abdominal bleeding and speed up fluid replacement immediately. When the amount of bleeding exceeds 600ml, immediately report to the doctor and assist in handling. (2) Closely observe the changes of body temperature and abdominal pain of patients after biliary fistula operation. Abdominal distension and jaundice, whether there is bile outflow from indwelling abdominal drainage tube.

9. Psychological care

Encourage patients to overcome negative emotions and establish confidence in overcoming diseases.

10. Health education

Fasting should be done before intestinal function is restored. Do not drink alcohol. On the first day after the recovery of intestinal function, mainly use fat-free liquid, and then gradually transition to a diet with low fat, moderate protein, high vitamins and rich fiber, establish good eating habits (regular, moderate, light and easy to digest), quit smoking and drinking, avoid spicy and irritating things, and avoid greasy, fried, fried and fatty foods, such as fat pork, cream, butter and cakes.