I. Pre-operative guidance
1. Do patient ideological work to make them establish confidence in overcoming the disease and actively cooperate with treatment and care. Especially for those who need artificial anus, get the patient’s cooperation and understanding.
2.The purpose and method of intestinal preparation.
Purpose: To clean the intestine, reduce the number of intestinal bacteria, prevent postoperative abdominal and incisional infections, and reduce the occurrence of anastomotic fistula.
Methods: Including three aspects of diet control, intestinal cleansing, and drug use.
(1) Control diet: eat a high protein, high calorie, high vitamin, easy to digest, less residue diet one week before surgery, enter a liquid diet 2-3 days before surgery, those with intestinal obstruction should be fasted and rehydrated.
(2) Clean intestine: give oral laxative or general enema 2-3 days before surgery, make clean enema 1 night before surgery and morning of surgery day or take oral whole intestine enema 1 day before surgery.
(3) Drug use: give oral antibiotics that are not easily absorbed by the intestine, such as streptomycin, metronidazole, etc., 2-3 days before surgery, and supplement with vitamin K at the same time.
(3) Leave a urinary catheter in the morning of the surgery day, because colorectal surgery has the possibility of damaging ureter and bladder, and rectal resection can easily lead to urinary retention.
II. Postoperative guidance
1. Take a semi-recumbent position after general anesthesia awake and stable vital signs after surgery to facilitate abdominal drainage.
2, postoperative fasting, intravenous rehydration, until the anal venting or colostomy opening can be removed from the gastric tube, into the liquid food, such as warm water, vegetable soup, rice soup, etc., 1 week after the gradual transition to soft food, and choose an easily digestible diet with less residue.
3. Encourage early bed activity, and gradually get out of bed 1 day after surgery according to the situation, and master the appropriate intensity of activity to avoid increasing abdominal pressure to cause mucosal prolapse of intestinal tube.
4. After radical rectal cancer surgery, it is easy to damage sacral nerve or cause posterior bladder tilt, which may lead to urinary retention, so urinary catheter should be placed after surgery. Pay attention to the training of bladder diastolic function, i.e., to clamp the catheter and open it every 2-3 hours or according to the urinary intention to prevent the dysfunction of urination. The urinary catheter can be removed 7-10 days after surgery.
6. See “Health education for stoma patients” for care of colostomy.
Discharge instruction
1.For patients with artificial anus, encourage them to adapt to the new defecation method, live a regular life and control the activity level appropriately.
2.Eat regularly, pay attention to dietary hygiene, avoid cold, spicy and other stimulating food; avoid foods that easily cause constipation, such as corn, walnuts and fried food; avoid foods that easily cause diarrhea, such as green beans and beer; avoid foods that easily cause gas production, such as onions, beans and beer.
3, master the intensity of activities to avoid excessive increase in intra-abdominal pressure and cause the colonic mucosa at the stoma to prolapse.
4.Dilate the stoma regularly to prevent stoma stenosis. If stoma stenosis or defecation difficulty is found, come to the hospital for consultation in time.