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Nursing care of patients with chest wall and pleural diseases
This is a mind map about the care of patients with chest wall and pleural diseases. The main content includes: pleural tumors, chest wall tumors, empyema, and pectus excavatum.
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Nursing care of patients with chest wall and pleural diseases
- One Hundred Years of Solitude Character Relationship Chart
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Nursing care of patients with chest wall and pleural diseases
pectus excavatum
The most common congenital chest wall deformity refers to a scaphoid or funnel-shaped deformity in which the sternum and ribs are depressed inward and backward.
Clinical manifestations: Symptoms: thin body, immobile, prone to respiratory infections. Physical signs, thoracic deformity, hunched back, protruding abdomen
Treatment: Those with mild deformity do not need special treatment; those with severe deformity require early surgery. Generally no earlier than 3 years old, preferably between 3 and 12 years old; minimally invasive pectus excavatum correction is the first choice today.
Nursing measures: Preoperative care ① psychological care; ② preoperative preparation, ventilator exercise and bed toilet training; ③ nutritional support, guiding patients to eat high-protein, high-vitamin, high-calorie diets. Postoperative care ① Monitor vital signs, monitor ECG for 12 to 24 hours, continue low-flow oxygen inhalation, closely observe changes in blood pressure, respiratory pulse and blood oxygen saturation and make records; ② Keep the respiratory tract normal, and tilt the head of patients under general anesthesia to one direction after surgery side, give oxygen through the nasal cannula; ③ Closed chest drainage care, properly fix the catheter, maintain effective drainage, squeeze regularly to prevent tube blockage, avoid discounting, closely observe the color of the drainage fluid, and accurately record the flow rate; ④ Posture and movement, surgery After the operation, keep your back on a hard bed. Do not use soft cushions such as sponges. Use light quilts to avoid bearing weight on the chest. It is strictly forbidden to turn over and lie on your side to prevent the chest from being compressed and deformed, causing the steel plate to shift. You can get out of bed one day after the operation and keep your chest Keep your back straight ⑤ Eat and drink. You can eat after being awake for 4 to 6 hours after the anesthesia and without symptoms of abdominal distension, nausea, or vomiting. Use liquid and semi-liquid foods to gradually transition to a normal diet. ⑥ To prevent complications, the main complication is pneumothorax. Observe the respiratory pattern, frequency, and rhythm after surgery, avoid turning over, patting on the back, and closely observe the infection situation.
Empyema
Purulent exudate collects in the pleural cavity
Classification
Course: acute and purulent
Bacteria: purulent, tubercular, specific pathogenic empyema
Scope of infection: localized, total empyema
Cause
Acute empyema (common Streptococcus pneumoniae), the main primary focus of empyema is pulmonary infection
Chronic empyema: The disease lasts for more than three months ① Poor drainage of pus ② Retention of foreign bodies ③ Combined bronchial or esophageal fistula that is not treated in time ④ Chronic lesions adjacent to the pleura ⑤ Presence of special pathogenic bacteria
clinical manifestations
Symptoms: Acute empyema, high fever, pulse rate, shortness of breath, loss of appetite; chronic empyema, long-term low fever, anemia, hypoalbuminemia and other chronic systemic poisoning symptoms
Signs: Acute, weakened respiration on the affected side, full intercostal space; chronic, invagination of the chest, weakened respiratory movement, and deviation of the bronchi and mediastinum to the affected side.
Processing principles
Acute: control the primary infection and promote the rapid recovery of lung tissue
Chronic: Surgical treatment to eliminate the cause and empyema
Nursing measures
Preoperative: strengthen nutrition, skin care, relieve pain, lower body temperature, improve respiratory function, psychological care
Postoperative: Observe the condition, maintain effective breathing, keep the drainage tube unobstructed, and carry out effective rehabilitation training
health education
Prevent infection: keep warm and take active treatment
Disease awareness guidance: Take medicine on time as directed by your doctor, check your lung function regularly, and return to the clinic at any time if you feel unwell.
Rehabilitation guidance: Instruct the patient to strengthen nutrition, ensure adequate sleep, and guide the patient to do aerobic exercise.
Chest X-ray
chest wall tumors
Tumors that occur in the deep tissues of the chest wall
Primary: rare
Secondary: ribs are most common
Clinical manifestations: Chest wall mass and local pain are the most common
Auxiliary examination: Chest X
Treatment: Benign tumors may not be treated temporarily. Tumors with uncertain properties, whether benign or malignant, should be surgically removed as soon as possible.
Care: Before surgery, give effective antibiotic treatment; control infection; provide symptomatic care; make preoperative preparations; after surgery, strengthen respiratory care; encourage patients to take deep breaths to effectively eliminate phlegm, and give antibiotics as directed by the doctor.
pleural tumors
Primary: less common, with malignant pleural mesothelioma and pleural fibroma being the most common.
Secondary: accounting for 95%, often secondary to lung cancer and breast cancer
Clinical manifestations: Most patients with pleural metastasis are asymptomatic. Common symptoms include cough, dyspnea, and chest pain.
Auxiliary examination: Thoracoscopic biopsy is the best way to diagnose malignant pleural mesothelioma
Treatment: ① Secondary, for primary tumors, control pleural effusion; ② Primary, mainly treated with chemotherapy drugs, localized fibrous mesothelial tumors require surgical resection
Nursing care: ① Psychological: Provide psychological counseling; ② Pain: Give analgesics as directed by the doctor; ③ Chest closed drainage: Keep the drainage tube normal to prevent infection; ④ Nursing care of intrathoracic chemotherapy: Eat a light diet and drain the pleural effusion before injection. After injecting the drug, change positions every 30 minutes to ensure that the drug is fully and evenly distributed in the pleural cavity.