Overview of Gallstone Disease
Cholelithiasis is a common digestive disease, which is a general term for a type of stone disease occurring in the biliary system, including gallbladder stones and bile duct stones, usually closely related to poor diet and lifestyle habits, and can be secondary to biliary tract infections, jaundice, pancreatitis, etc., and may even lead to cancer, so it is important to treat it in time. Currently, there is a lack of effective non-surgical treatment for cholelithiasis, and most patients need to undergo surgery. According to the psychological, physiological, dietary, rest and activity characteristics of cholelithiasis patients, it is of great significance to formulate a perfect nursing plan for their treatment and improve their prognosis.
Main nursing problems
1.Pain.
2.Fever.
3.Nutritional disorders.
4. potential complications, such as bleeding, anastomotic fistula, infectious shock.
Nursing measures
1.Preoperative care
(1) Psychological care Patients with cholelithiasis are generally apprehensive about surgical treatment and are prone to fear, tension, anxiety and other emotions. Therefore, nursing staff should patiently introduce the general knowledge of cholelithiasis to the patients, so as to eliminate their worries, enhance their confidence in overcoming the disease, and make them cooperate with the treatment more actively.
(2) Nutritional supportive care Instruct patients to eat high-calorie, low-fat, low-slag, vitamin-rich, easy-to-digest food, and for those with good liver function, they can eat a high-protein diet with fewer and more frequent meals. If patients eat too little or have biliary tract infection or cholecystitis attack, intravenous nutritional support can be given.
(3) Pain care If the patient has biliary colic, antispasmodic and analgesic drugs can be given as prescribed by the doctor.
(4) Fever care If the patient’s body temperature is too high, physical cooling or medication can be given according to the situation.
(5) Jaundice care If the patient has jaundice, laboratory examination of the coagulation system should be carried out, and vitamin K1 should be given intravenously or intramuscularly, and attention should be paid to skin care.
(6) Infection care If the patient has biliary tract infection, give anti-infection treatment as prescribed by doctor.
2. Postoperative care
(1) Dietary care The patient should be fasted with water on the day of operation, and be given intravenous nutritional support according to doctor’s instruction, and then gradually transitioned to fluids, semi-fluids or general food, and the diet should be light and easy to be digested.
(2) Pain care Evaluate the cause, degree and nature of postoperative pain of the patient, and instruct the patient to use analgesic pump correctly or give analgesic drugs as prescribed by doctor.
(3) Condition observation Closely observe the patient’s vital signs, pay attention to whether there is any abnormal heart rate and rhythm, whether there is any cyanosis, and the change of hourly urine output, and do electrocardiogram, blood gas analysis and renal function test if necessary.
(4) Nursing care for complications ① Biliary tract bleeding, which can occur from a few hours to 2 weeks after surgery, manifested by fresh blood, vomited blood or black stools drawn from the drainage tube, the doctor should be notified immediately and active rescue should be carried out. ② Jaundice, preoperative impaired liver function, bile duct stenosis, infection, surgical damage to the bile duct or intraoperative multiple cholangiography, can cause postoperative jaundice, all liver-protecting measures should be taken. ③Anastomotic fistula, often appearing in 4-6 days after operation, manifested by right upper abdominal pain, abdominal distension, fever, peritoneal irritation signs, etc., should pay attention to the changes of body temperature and abdominal pain, and notify the doctor immediately if any abnormality occurs, and give appropriate treatment. ④ Infectious shock, if the patient has elevated body temperature, rapid pulse rate, decreased blood pressure, shortness of breath and impaired consciousness, it is necessary to be alert to infectious shock. Rehydration and anti-infection treatment should be given.
(5) Prevention of T-tube prolapse after surgery
If the T-tube is open for drainage, the drainage should be kept unobstructed to prevent pressure, twisting and folding. The drainage bag should be changed regularly every day, and aseptic operation should be paid attention to when changing the drainage bag, observing and recording the color, amount and character of the drainage fluid. Pay attention to whether there is blood seepage and oozing from the drain port, keep the dressing clean and dry, and protect the skin around the drain port to prevent dermatitis.
Health promotion
1. Patients should develop good dietary habits, eat small meals, eat low-fat, easy-to-digest food. Avoid fried food, spicy and fatty food, animal offal, crab roe and other food with high cholesterol.
2. Try to wear loose clothing, avoid lifting heavy objects and excessive activities.
3. In general, return to the hospital 6 weeks after surgery for T-tube imaging. Follow the doctor’s instructions for regular rechecks.
4. If abnormal symptoms such as abdominal pain, discomfort in the liver area, jaundice, etc. occur, consult the doctor promptly.