Protective medical treatment will be implemented first, and only at an appropriate time will the patient be informed of the condition and introduced to the necessity of surgery and the therapeutic effect to increase the patient’s confidence in overcoming the disease and actively cooperating with the treatment.
I. Pre-operative instruction
1.Hemoptysis and coughing up sputum should be spit into the prescribed container so as to facilitate observation of the amount and nature of hemoptysis and coughing up sputum.
2.Vigorous cough and sputum, or fever indicate combined lung infection, and the infection needs to be controlled before surgery.
3. Quit smoking and consciously train deep breathing and coughing to facilitate the recovery of lung expansion after surgery and to prevent complications such as pulmonary atelectasis.
4.Strengthen nutrition, eat a high-calorie, high-protein, vitamin-rich, easy-to-digest diet to improve the body’s resistance.
5.Drug taking, if you have daily anticoagulant and blood-activating drugs such as salvia, aspirin, bicoumarin, warfarin, or betaloc and other drugs, you need to respond to the bedside physician in time to stop or change the dosage of medication before surgery.
6. Respiratory training, practice chest deep breathing in sitting position and abdominal deep breathing in lying position, 2 or 3 times a day for about 15 min each time. Deep inhalation should be done slowly and with best effort, with 1-2 seconds of stagnation after inhalation to maximize alveolar filling and achieve lung expansion and then slow exhalation.
7. The patient should be trained to adapt to defecate and urinate in bed before surgery.
Second, postoperative guidance
1, diet: the second day after surgery, you can enter the semi-liquid, to be gradually universal food after anal venting and defecation. Take the principle of easy to digest and nutritious diet to enhance the patient’s physical fitness. Generally speaking, there is no special contraindication to the diet of lung surgery patients, all can intake high-quality protein, the intake in addition to meet the daily needs, but also to provide the necessary nutrition for tissue repair.
2, two stools: usually in the removal of the patient’s chest tube at the same time, remove the patient’s catheter, catheter placed for too long, will increase the risk of urinary tract infection, after the removal of the catheter, some patients may have difficulty urinating, should encourage patients to urinate in bed, hot towels on the lower abdomen, and give patients to listen to the sound of running water, help some patients urinate. Postoperative patients’ intestinal peristalsis is gradually recovered, generally within 3-4 days after surgery will appear anal exhaustion, defecation, if you have difficulty in defecation, do not force to reject stool, which may induce stroke, pulmonary embolism, heart attack and other disease episodes, timely notification of medical personnel, the use of appropriate drugs to improve defecation.
3.Position: lie flat for six hours after surgery, then take a slope or semi-sitting position, and sometimes head-low-foot-high position, in order to facilitate closed chest drainage and coughing and sputum excretion.
4.Chest closed drainage.
5.Health exercise instruction.
(1) on the second day after surgery, the condition allows a thick rope to be bolted at the end of the bed, the patient can practice sitting up by himself with the help of the pull of the rope to increase lung capacity, which is conducive to wound healing.
(2) After the drainage tube is removed, the patient can get out of bed to reduce pulmonary complications, and under the guidance of the physician, moderate training and early activity can reduce the occurrence of pulmonary embolism. Especially for elderly and obese patients, postoperative pulmonary embolism is prone to occur, and the latter can lead to sudden death of patients, these patients should pay more attention to early bed activity.
(3) Consciously use the upper limb of the affected side to do such actions as combing the hair, carrying a bowl, touching the opposite auricle from the top of the head, climbing the wall, etc. The purpose is to exercise the function of the pectoralis major muscle on the affected side and prevent disuse paralysis of the affected upper limb.
6.Prevention of postoperative pulmonary atelectasis
(1) The patient should do deep breathing exercises and consciously exercise the lung function.
(2) Effective coughing and sputum excretion, family members can assist the patient to sit up and pat the back, with drug nebulized inhalation to dilute sputum, which is conducive to coughing up sputum and keeping the airway open.
(3) Do balloon blowing exercise, a dozen times a day to increase lung capacity and facilitate lung expansion.