I. Routine postoperative care in thoracic surgery 1. Care according to the general postoperative and post-anesthesia care routine in surgery. 2, detailed understanding of the surgical process, including the condition, infusion, blood transfusion volume, urine volume, the amount of chest drainage fluid and the bottom of the chest drainage bottle water mark. 3.Postoperatively, give slope position, and give oxygen inhalation, receive cardiac monitoring to measure heart rate, blood pressure, respiration, blood oxygen saturation, observe the mental, pupil size and peripheral circulation, etc. 4, the patient back to the ward immediately after the measurement of body temperature, hyperthermia should actively take cooling measures, the body temperature is lower than normal, to give warmth to rewarm, if necessary, report to the doctor to deal with. 5.Keep the chest closed drainage tube open, squeeze the drainage tube regularly to prevent obstruction, observe the color, volume and nature of the drainage fluid, if the drainage flow exceeds 100 ml per hour for more than 3 hours, indicating the possibility of active bleeding, should immediately report to the doctor, prepare for surgery to stop bleeding. (See observation and care of chest drains for details.) 6. Avoid affecting the patient’s normal breathing due to pain, and pain relievers should be used promptly. 7.Encourage the patient to breathe deeply and cough. If the sputum is sticky, nebulize inhalation 2 – 3 times a day. After surgery, if the patient can eat and drink, the patient should be encouraged to drink water a few times, 30~50ml each time, once every 10~20min to increase body water and prevent airway dryness and sputum stickiness. (See postoperative respiratory management and care in thoracic surgery.) 8. After the removal of the chest drain, generally no special contraindications, patients should be encouraged to leave the bed, and appropriate for the affected shoulder, elbow joint activities. (For more details, see Limb Function Rehabilitation Activities) 9. Patients undergoing thoracic surgery, except for gastrointestinal surgery, can drink water first if there is no nausea and vomiting, abdominal distension and other gastrointestinal conditions 6 hours after surgery, and give a liquid or semi-liquid diet on the first day after surgery, or choose a diet as the patient likes. If the patient does not eat enough, report to the doctor. The purpose of early postoperative activities: – can promote the recovery of the whole body function – such as promoting deeper breathing, conducive to lung expansion and secretion discharge, to prevent pulmonary complications – promote blood circulation, conducive to wound healing, to prevent thrombosis – Promote gastrointestinal peristalsis to prevent abdominal distension and constipation – Promote the recovery of urinary function to prevent urinary retention 2. 2.1 Before the chest drain is removed or when activity is restricted for other reasons, the lower limbs should be flexed and extended in bed frequently; the upper limbs of the affected limbs can be lifted, touching the top of the head and the opposite ear, or Hold the wrist of the affected side with the healthy hand to do the upward movement. 2.2 In general, the chest drainage tube is removed 48-72 hours after surgery. After the tube is removed, the patient can leave the bed and walk slowly indoors or in the corridor, eat by himself, go to the bathroom, and move the upper limb on the operated side according to the training plan every day so that the upper limb on the operated side can recover its function as soon as possible. 3. Instruction of limb activities 3.1 Postoperative patients have limited activities of the affected limb. Under the guidance of the nurse, the affected shoulder joint can be uplifted, posteriorly extended, abducted, internally retracted, internally rotated and externally rotated, the scapula can be ascended, retracted, externally moved and rotated, and the elbow joint can be flexed and extended and rotated. 3.2 Methods of functional exercise of upper limbs ① Start to do simultaneous flexion and extension of five fingers and fist clenching exercise for 3~5 minutes each time three times a day after awakening from general anesthesia 6 hours after surgery. ② Start elbow flexion and extension exercises on the first day after surgery, hold a bowl or cup with the affected side while dining, brush teeth and wash face. ③ Start hair combing exercise on the second postoperative day, do not tilt the neck, keep the elbow elevated to maintain the natural position and comb facing the mirror, three times a day for 3~5 minutes each time. ④ On the third postoperative day, start shoulder up and down exercise. To protect the upper limb on the affected side, use the healthy side hand to support the exercise and do upward lifting over the head, three times a day for 3~5 minutes each time. ⑤ On the fourth postoperative day, start bladder root exercise, gradually place the affected hand on the occipital area, start to assist with the hand of the healthy side, and gradually move the affected hand over the head to touch the opposite ear, three times a day for 3~5 minutes each time. (6) On the fourth postoperative day, start arm swinging exercise, swinging both hands to the left and right significantly, in order to avoid the difference between the affected side and the healthy side, the joint force should be used, three times a day, 3~5 minutes each time. (7) On the fifth postoperative day, start hoop exercise, lift the affected limb up, straighten the elbow joint, and rotate the movement forward and backward with the shoulder joint as the center, and extend the exercise backward appropriately until the affected limb is lifted straight up, three times a day, 3~5 minutes each time. ⑧ On the fifth postoperative day, start fanning arm exercises, with the ten fingers of both hands superimposed behind the head and both elbows opening and closing in front of the face, keeping both elbows at the same height and spreading them widely backward, three times a day for 3~5 minutes each time. 3.3 Progressive functional exercise of the affected upper limb of open-chest patients after surgery: Progressive functional exercise of the affected upper limb of open-chest patients after surgery is very important to accelerate their recovery and improve their quality of life. It can not only prevent the occurrence of complications and postoperative scar contracture, but also improve lung capacity. The specific methods are: ① 6h after surgery (after the patient is awake from general anesthesia), start to do five fingers flexion and extension and fist clenching exercise at the same time, 3~5min each time, 3 times a day. ②The elbow flexion and extension exercise was started on the first day after surgery, and the affected hand was used to brush teeth and wash face in the morning, and the affected hand was used to hold a bowl or cup during meals. ③Start hair combing exercise on the 2nd postoperative day, do not tilt the neck, raise the elbow and keep the natural position for 3~5min each time, 3 times a day. ④Start upper arm exercise on the 3rd postoperative day: to protect the affected upper limb during the exercise, use the healthy side to drag the elbow and do the upper limb upward movement over the head, 3~5min each time, 3 times a day. ⑤ On the 4th postoperative day, shoulder exercises were started by gradually placing the affected hand on the occipital area and touching the contralateral ear. At the beginning, the affected hand was assisted by the healthy hand, and gradually the affected hand was lifted over the head to touch the contralateral ear for 3~5 min each time, 3 times a day. (6) On the 5th postoperative day, comprehensive exercises were started, including arm swinging and large movements of the right and left hands. To avoid differences between the affected side and the healthy side, joint force should be applied. Upper limb supination movement, alternate upper limb supination of both upper limbs, inciting arm movement, superimposing the ten fingers of both hands behind the head, opening and closing both elbows in front, keeping both elbows at the same height and spreading widely backward, each movement for 3~5min each time, 3 times a day.