Overview of cholangiocarcinoma
Cholangiocarcinoma is a malignant tumor that occurs in the extrahepatic bile ducts, i.e., the left and right hepatic ducts to the lower end of the common bile duct. With the improvement of diagnosis, this disease has become common. Progressive obstructive jaundice is the main clinical manifestation. Cholangiocarcinoma resection requires careful observation and meticulous nursing care because of the complex surgical approach, large traumatic area, and the many complications associated with the placement of postoperative drains.
Main nursing problems
1. Pain.
2.Anxiety.
3. Nutritional disorders.
4. potential complications, such as bile leakage, biliary hemorrhage, biliary peritonitis, acute hepatic failure, pulmonary infection.
5. Symptomatic treatment of itchy skin and the possibility of damage to the skin by patient scratching.
6. lack of knowledge about cholangiocarcinoma treatment, nursing care and rehabilitation.
Nursing measures
1. Psychological care
Cholangiocarcinoma patients are in serious condition, once they are accused of needing surgical treatment, they will worry about the prognosis of the surgery and have tensions of fear and anxiety, which will lead to accelerated heart rate and elevated blood pressure, and in serious cases, the smooth progress of the surgery will be affected. Therefore, nursing staff should patiently answer all kinds of questions raised by the patients, cite previous successful cases, eliminate their tension and fear, so that they can maintain a good psychological state and actively cooperate with the treatment.
2.Nutritional support nursing
(1) For those who can eat before surgery, patients can be given high-calorie, vitamin-rich, low-fat, easy-to-digest diets, and those with better liver function can be given high-protein diets. If the patients can not eat or eat too little, intravenous nutritional support can be given.
(2) Intravenous nutritional support should be given within 24 hours after the operation, and enteral nutritional support can be implemented for those who have jejunostomy tubes placed during the operation. After the gastrointestinal function is restored and the gastric tube is removed, the patient can gradually transition to liquid food, semi-liquid food or general food, and the diet should be light and easy to be digested.
3.Skin care
When jaundice is deep, bile stimulation can cause skin itching, patients should be instructed to avoid scratching and assisted to trim nails. Wash with lukewarm water or wipe with glycerite lotion to stop itching, and apply antihistamine.
4. Drainage tube care
Patients are often placed with multiple drainage tubes (such as oxygen tube, gastric tube, urinary catheter, abdominal drainage tube, etc.), after returning to the ward, all kinds of drainage devices should be connected and properly fixed, to keep the drainage tube fixed and smooth, to prevent the drainage tube from twisting and pressure and pulling off when turning over, and the drainage fluid should not flow backward, so as to avoid abdominal cavity infection, marking and recording the amount, nature and color of all kinds of drainage, and find that the drainage tube is out of place, should be treated promptly. The drainage tube should be detached and treated in time.
5. Complications
The drainage of hemorrhagic bile or fresh blood from the T-tube suggests biliary bleeding. If the amount of bile drainage becomes small and the patient complains of abdominal pain, it suggests that biliary peritonitis may occur. If the patient has a persistent high fever and worsening cough, it suggests a pulmonary infection. If there is a deepening of jaundice, delirium, coma, serum aminotransferases continue to rise and other manifestations may be acute liver failure. When the above situation occurs, the doctor should be notified immediately for timely treatment.
6. Nursing care of chemotherapy
Closely observe the patient’s reaction after chemotherapy, for severe vomiting, diarrhea should follow the doctor’s instructions to provide water electrolyte supplementation, regular recheck blood routine and so on. Immediately report to the doctor for any changes in the patient’s condition.
Health promotion
1. Adopt good dietary habits and eat small meals. Eat light, easy-to-digest food and less greasy food.
2. Take appropriate physical exercise and avoid exertion and exposure to cold.
3. Follow the doctor’s instructions for regular follow-up, and consult the doctor in time if symptoms such as abdominal pain, nausea, vomiting, and redness, swelling, heat and pain of the wound occur.