Overview.
Intestinal fistula is an abnormal passage between the intestine and other organs, or between the intestine and the abdominal cavity, outside the abdominal wall, the former is called internal fistula, the latter is external fistula. Intestinal fistula causes the intestinal contents to flow out of the intestinal lumen, resulting in a series of pathophysiologic changes such as infection, fluid loss, malnutrition, and organ dysfunction. The disease is complex and has many complications, seriously affecting the quality of life of patients. Therefore, the treatment and care of patients with intestinal fistula is particularly important.
The main nursing problems
1. pain.
2. Nutritional disorders.
3. Impaired skin integrity.
4. potential complications such as infection, pneumonia, abdominal abscess, sepsis, etc.
Nursing measures
1. Psychological care
The condition of intestinal fistula is complex, the course of the disease is long, the patient suffers from physical and mental pain, and is prone to anxiety, tension, fear, depression and other adverse emotions. Therefore, nursing staff should communicate with patients in a timely manner, care for patients, patiently listen to patients’ questions, and give comfort, explanation, in order to alleviate their anxiety, pessimism, depression and other emotions, increase patients’ confidence in overcoming the disease, so that they actively cooperate with the treatment.
2.Nutritional support nursing
At present, for patients who need nutritional support treatment for enterocutaneous fistula, enteral nutrition support is preferred, strict aseptic operation, nutritional solution should be fresh, ready to use, to prevent hypertonic or hypotonic discomfort. Enteral nutrition to the extent that the patient tolerates, step by step. During the infusion process, patients should be observed for abdominal pain, diarrhea, abdominal distension, nausea, vomiting, etc., and attention should be paid to maintaining the water-electrolyte balance.
3. Skin care
The leakage of intestinal fluid should be removed in a timely manner, to keep the skin around the fistula clean and dry, to avoid spillage of fistula fluid erosion of the surrounding skin. Keep the fistula drainage tube open, the skin around the fistula every day in a timely manner to change the seepage of wet dressings, with zinc oxide cream or anti-leakage cream coated with protection.
4. Complication care
Changes in the patient’s vital signs, changes in abdominal signs, and incision dressings should be closely observed. Pay attention to whether the patient has fever, abdominal pain, incision pain, peritoneal irritation signs and other symptoms, and be alert to the occurrence of postoperative incision infection, abdominal infection and re-fistula.
5. Drainage tube care
Fix the drainage tube properly, keep the connection tight, avoid twisting and falling off. Squeeze the drainage tube regularly to avoid blockage. Observe the nature and amount of drainage fluid.
Health promotion
1. Maintain a comfortable mood and avoid emotional tension.
2. Reasonable diet, early to moderate protein, high carbohydrate, low residue, low fat food, with the recovery of intestinal function, can gradually increase the protein and fat content.
3. Appropriate physical exercise to enhance physical fitness.
4. Instruct patients to deal with the skin around the intestinal fistula, keep the skin clean and dry.