Early postoperativeinflammatoryileus (EPII) is a mechanical and dynamic intestinal obstruction caused by surgical trauma or intra-abdominal inflammation that leads to edema and exudation of the intestinal wall in the early stage of abdominal surgery (about 2 weeks), forming extensive adhesions in the abdominal cavity and inhibiting gastrointestinal function. Because of its special characteristics, improper clinical management may cause serious complications such as intestinal fistula, severe infection and short bowel syndrome. Wu Chunfu, Department of Surgery, Wuxi Hospital of Traditional Chinese Medicine, Wuxi, China Diagnosis: There was a history of recent abdominal surgery, and the abdominal plain film showed many different degrees of liquid and gas planes in the small intestine without typical mechanical complete intestinal obstruction. CT examination of the whole abdomen showed: edema and thickening of the intestinal wall, pneumatization and fluid accumulation in the intestinal cavity, and abdominal exudation.
Care 1.Psychological care After the traumatic stress of surgery, the patient’s psychological changes increase, and the sudden change of condition brings heavy psychological pressure to the patient and family members, showing different degrees of fear and anxiety, so we should patiently explain the pathological mechanism and clinical treatment of intestinal obstruction to the patient and family members in detail, and introduce the successful cases of non-surgical treatment to eliminate the fear of patients and family members about the change of condition and actively Cooperate with treatment and care.
2. Postoperative observation The responsible nurse should actively cooperate with the clinician to conduct detailed physical examination of the operated patient, especially the specialist examination and the necessary special examination, and strengthen the treatment of the patient’s underlying diseases; closely monitor the patient’s vital signs, gastrointestinal function, changes in abdominal signs, and auscultate the intestinal sounds; the patient should record the number of anal venting and the number, volume, color and nature of bowel movements in the early postoperative period when he or she has a short bowel movement. The patient should record the number of anal evacuations, the number, volume, color, nature of the bowel movements, and the recovery of bowel function. After eating, closely observe the patient’s appetite, whether there is nausea, vomiting, abdominal distension, abdominal pain, once the above symptoms appear, immediately report to the doctor. Severe compound injuries and elderly patients are not sensitive to abdominal pain after surgery, and nursing observation often shows that abdominal distension is significant, while abdominal pain and peritoneal irritation signs are not obvious.
3, gastrointestinal decompression care after the occurrence of EPII, gastrointestinal decompression is one of the key means of non-surgical treatment. Effective gastrointestinal decompression can attract gas and fluid accumulation, relieve pressure in the gastrointestinal cavity, improve blood circulation in the intestinal wall, reduce abdominal pain and abdominal distension, and facilitate the recovery of intestinal function. Close observation and accurate recording of the nature, drainage and color of gastric fluid during nursing can help the doctor to formulate the corresponding treatment plan. During the process of gastrointestinal decompression, 0.9% sodium chloride injection 150ml was routinely given to flush the gastric cavity 3 times/d to prevent the occurrence of stress ulcers. At the same time, observe the change of drainage fluid, if the drainage of coffee-colored fluid exceeds 500ml, we should pay attention to the possibility of stress ulcer or strangulated intestinal obstruction.
4.Total gastrointestinal nutrition care Patients with inflammatory bowel obstruction have poor nutritional status due to the lack of real recovery of gastrointestinal function, long fasting time, inflammatory edema of intestinal wall and continuous gastrointestinal decompression. The central venous line was placed, and a mixture of nutrient solution, vitamins and trace elements was evenly injected within 24 hours. During the drug administration, the nutritional indexes and blood biochemical indexes were observed, and the 24-hour in and out volume was recorded, and the abdominal signs and anal venting were observed. In the process of nursing, first of all, ensure that the nutrition solution and infusion bottle are clean and sterile, the nutrition solution should be configured in a sterile environment, and the infusion pump should control the infusion speed. Pay attention to the care of deep vein puncture catheter, keep the catheter unobstructed, avoid twisting and squeezing, and seal the catheter with heparin dilution at the end of infusion to prevent thrombosis. If there is redness and swelling at the puncture site or if the patient suddenly develops chills and high fever without other foci of infection, the catheter should be considered infected, and the doctor should be notified to remove it in time, and the bacterial culture at the end of the catheter should be added to the drug sensitivity test.
5, diet care Develop a progressive diet plan, during fasting, gastrointestinal decompression, suction the gastric tube several times a day to maintain patency, and observe and record the amount and nature of drainage, pay attention to the frequency of nausea, vomiting, gastric juice with yellow bile components, indicating the reflux of intestinal fluid. If the patient with continuous gastrointestinal decompression has abdominal pain relief, abdominal distension reduction, normalization of intestinal sounds, and the beginning of exhaust, it means that the obstruction is relieved, and the gastrointestinal decompression can be suspended, and the gastric tube can be left in place. After 1 d, the patient has no abdominal distension, abdominal pain and vomiting symptoms, gradually increase the amount of food and reduce the dose of intravenous nutrition drugs, gradually transition to semi-liquid to general diet.
6.Application of growth inhibitor care Inflammatory bowel obstruction patients after continuous gastrointestinal decompression and drainage of a large amount of digestive fluid loss, more likely to cause water, electrolytes and acid-base balance disorders, the intestinal wall edema aggravated is not conducive to recovery, the application of growth inhibitor can reduce digestive fluid secretion. The application of growth inhibitor can reduce the secretion of digestive fluid by inhibiting the action of gastrointestinal hormones, reducing fluid retention in the intestinal lumen, reducing ischemic edema of the intestinal wall and promoting the recovery of intestinal function.