Nursing after complete lung resection

For patients with more serious lung diseases, in order to protect their life safety, a pneumonectomy is often required. After the pneumonectomy, the patient's physical condition is relatively poor at this time, and vital signs must be monitored, infusion care must be strengthened, respiratory care must be done well, etc. Only in this way can the treatment effect after the operation be guaranteed and the patient's life and safety can be extended.

1. Vital Signs Monitoring

After the operation, the patient continued to inhale low-flow oxygen at 3 L/min, and the changes in respiration, heart rate, blood pressure, blood oxygen saturation, and central venous pressure were closely observed. Deal with respiratory secretions promptly and keep them moist to avoid dryness of the respiratory tract and difficulty in expectoration so as to achieve effective oxygen delivery. Continuous ECG monitoring was performed to maintain blood pressure and heart rate within normal range. Blood oxygen saturation should be maintained above 95% and central venous pressure should be 6-12 cmH2O. Patients may have shallow and rapid breathing due to pain and other reasons after surgery, mostly between 20-35 times. If the breathing amplitude is large and rapid (>35 times/min), attention should be paid to the occurrence of respiratory failure. If the heart rate increases, the blood oxygen saturation decreases, and the trachea deviates to the healthy side after surgery, it is often caused by mediastinal compression and displacement, which should be taken seriously and treated.

After total lung resection, the total amount of infusion and the infusion rate should be strictly controlled. Generally, the 24-hour infusion volume is limited to 1000-1500 ml, and the drip rate should be 20-30 d/min. The reserve volume should be slightly larger than the intake volume. Colloid should be used first, then crystalloid. It is better to infuse less rather than more to maintain water and electrolyte balance and observe urine output. If you have a severe cough and cough up a lot of thin foamy cough, you should be alert to the occurrence of pulmonary edema and notify a doctor in time for treatment. 3 Body Position Care

After waking up from anesthesia and having stable vital signs, the patient should be placed in a semi-recumbent position. After total lung resection, the patient should be placed in a supine or 1/4 lateral position. If the patient is completely on the affected side or there is severe vibration when moving the patient, the mediastinum may move excessively and the large blood vessels may twist, causing shock. If the patient is completely on the healthy side, the only lung may be compressed, causing severe hypoxia. The patient's position should be changed every 2 hours, and skin care should be strengthened to prevent bedsores.

After complete lung resection, the pulmonary circulation blood flow is redistributed, the blood flow and pressure of the healthy lung increase, and the blood vessel wall becomes more permeable, resulting in more alveolar secretions on the healthy side. Therefore, eliminating respiratory secretions, maintaining respiratory secretions, and maintaining airway patency are important measures to ensure the success of the operation. After the patient wakes up, he/she is encouraged to cough and expectorate, and the back is patted intermittently to encourage the patient to cough. For those who are afraid of coughing due to the pain of the incision, the wound can be gently pressed, and the trachea can be pressed at the upper edge of the sternum to stimulate coughing; routine nebulization inhalation is performed after surgery. 5. Chest Drainage Tube Care

After complete removal of one lung, the purpose of leaving a drainage tube is to drain the accumulated air and fluid in the chest cavity. The placed drainage tube is clamped with a vascular clamp and opened for a short time according to the patient's intrathoracic pressure. The amount of fluid discharged at one time should not exceed 500 ml. Pay attention to observe whether there is subcutaneous emphysema or tracheal displacement to the healthy side, and observe the position of the heart. If it is confirmed that the pleural cavity pressure is increased and there is a large amount of fluid or air accumulation, the chest drainage tube should be opened to remove the accumulated air and fluid. When opening the tube, coughing should be initiated and medical staff should be on guard. 6. Pain care

After the operation, the patient is placed in a comfortable position. For patients who are sensitive to pain, a pain pump is placed after the operation. After the operation, the patient is encouraged to relax as much as possible and take painkillers when necessary. 7. Prevention of complications

The main pulmonary complication is limited respiratory movement after surgery, which is caused by the blockage of the airway by the retention of secretions in the trachea. Therefore, it is important to assist in the discharge of sputum and place a tube, and give timely back percussion, sputum suction, nebulization inhalation, and expectorant drugs when necessary. After total lung resection, the patient's vital signs are stable and there are no discomfort symptoms. The patient should be assisted to get out of bed and move around as soon as possible to increase appetite and reduce gastrointestinal flatulence that causes the diaphragm to lift, the remaining lung to be compressed, and there are phenomena such as difficulty breathing and rapid heart rate. Patients with abdominal distension should be given hot compresses and massages in the lower abdomen, and gastrointestinal decompression should be performed when necessary.