Overview
Peripelvic cancer refers to tumors occurring near the end of common bile duct and duodenal papilla, which mainly refers to carcinoma of jugular abdomen, carcinoma of the lower end of common bile duct and duodenal carcinoma, and its malignancy is obviously lower than that of cancer of the head of pancreas, and surgery is the preferred treatment method. Its surgical resection rate and 5-year survival rate are significantly higher than that of pancreatic head cancer, but the surgery is traumatic, with many complications, and the patients suffer from great psychological and physiological blows. Therefore, in order to make patients recover as soon as possible, clinical nursing is crucial.
Main nursing problems
1. Pain.
2.Anxiety.
3. Nutritional disorders.
4. potential complications such as biliary tract infection, biliary fistula, pancreatic fistula, bleeding.
Nursing measures
1. Preoperative care
(1) Psychological care Most patients have different degrees of fear and anxiety. Nursing staff should communicate with patients to understand their psychological state, introduce patients to the treatment of the disease and knowledge related to the surgery, so as to relieve their nervousness and enhance their confidence in overcoming the disease, so that they can actively cooperate with the treatment and care.
(2) Pain care: Instruct patients to take a comfortable lying position to reduce the pressure of cancer on the local area, so as to relieve the pain in the upper abdomen. Give patients pain relievers as prescribed by doctors.
(3) Skin care When itchy skin appears, instruct patients not to scratch the skin and avoid scratching. Take a bath or shower with warm water and avoid using rough towels and irritating soaps.
(4) Nutritional support In order to enhance the patient’s tolerance of surgery, a high protein, high calorie, low fat diet should be given before surgery, supplemented with a large amount of vitamins, and intravenous supplementation of vitamin K for those with jaundice.
(5) Intestinal preparation Patients should be given oral antibiotics 3 days before operation to prevent infection. Fluid diet is given 2 days before operation, and clean enema is given in the night before operation to reduce postoperative abdominal distension and complications.
(6) Preoperative preparation Improve all routine examinations before operation, and instruct to practice effective coughing and sputum, lying down for urination and defecation.
2. Postoperative care
(1) Position and activity Before the patient is fully awake, the patient should be placed in a decubitus position with the head tilted to one side. After the patient is awake and vital signs are stable, change to semi-recumbent position to facilitate drainage. Assist the patient to turn over at intervals to prevent the occurrence of pressure ulcers. Strive to get out of bed as soon as possible to prevent deep vein thrombosis of the lower limbs. (2) Condition observation Closely monitor and record the changes of vital signs of the patient, connect cardiac monitoring, observe urine output, central venous pressure and peripheral blood circulation.
(3) Drainage tube care Correctly connect and properly fix the drainage tube, avoid pressure, folding and twisting of the drainage tube, and keep the drainage smooth. Observe and record the amount, color and nature of drainage fluid, so as to find out the abnormality in time.
(4) Dietary care After operation, fasting and water should be prohibited, and enteral nutritional support can be given. When the gastrointestinal function is recovered and the gastric tube is removed, a liquid diet should be given for 1~2 days, and if the patient has no symptoms such as abdominal distension, abdominal pain, nausea, etc., then the patient should be gradually transitioned to a semi-liquid diet for 2-3 days, and be given high-protein, high-vitamin, low-fat and easy-to-digest food, with small and frequent meals, avoiding oily and greasy food.
(5) Complications care ① Bleeding, if the wound oozes blood, there is bloody fluid coming out of the drainage tube, and the patient has sweating, accelerated pulse and decreased blood pressure, it suggests that there is active bleeding, and the doctor should be notified immediately for treatment. ② Fistula, common biliary fistula, pancreatic fistula and intestinal fistula, of which pancreatic fistula is a potentially fatal serious complication, mostly occurring 5 to 7 days after surgery. When pancreatic fistula occurs, the doctor should be notified immediately and be prepared for resuscitation. (iii) Infection, if there are symptoms such as fever, worsening of localized itching of the incision, purulent and bloody ooze, localized redness and swelling, it should be considered as an incision infection. Early removal of several stitches, placing drainage strips, diligent change of medicine, to promote early healing of the incision.
3.Nursing care of radiotherapy
Closely observe the patient’s reaction after radiotherapy, for serious vomiting, diarrhea should follow the doctor’s instructions to be supplemented with water and electrolytes, regular review of blood routine. Immediately report changes in condition to the doctor.
Health education
1. Eat small, frequent and balanced meals.
2. Take medication as prescribed by the doctor and have regular checkups.
3. Maintain a happy mood and take appropriate sports and physical exercise to enhance physical fitness.
4. Regularly carry out radiotherapy and chemotherapy according to the plan. 5. Promptly follow up if there are symptoms such as progressive weight loss, anemia, fatigue, fever, and so on.