Thesis keywords Diabetic orthopedic surgical care
Thesis abstract With the improvement of people's living standards, the incidence of diabetes is increasing year by year, and more and more fracture patients are complicated by diabetes. Because diabetic patients have low resistance, they are often complicated by systemic microvascular and neurological diseases. The risk of surgery is high and there are many postoperative complications. The incidence rate is about 17.2. Therefore, it is very important to strengthen perioperative care for patients with diabetes. From January 2006 to December 2009, our department performed surgical treatment on 34 patients with fractures and diabetes. Due to the emphasis on preoperative and postoperative care, satisfactory results were achieved, and no complications occurred. The report is as follows:
1Clinical data
1.1 General information
Among the 34 patients, there were 18 males and 16 females, aged 40-98 years old, with an average age of 62 years old. There were 18 cases of femoral head and neck fractures, 8 cases of thoracolumbar fractures, and 8 cases of diabetic foot combined with ulcers. All have type 2 diabetes.
1.2 Treatment methods
Before surgery, regular oral hypoglycemic drugs or subcutaneous insulin injections were used. Blood glucose was measured after three meals to control fasting blood glucose below 7.8mmo/L. The blood sugar is controlled below 9.4mmo/L, and surgical treatment is performed when the whole body is in good condition. Surgical methods: 18 cases of total hip replacement, 6 cases of open reduction and internal fixation of fractures, 12 cases of posterior thoracolumbar incision, bone grafting, fusion and internal fixation, and 8 cases of diabetic foot wound debridement and suturing. After surgery, all patients were given anti-infection treatment, strengthened wound dressing changes, attention to diet, and blood sugar control.
1.3 Results
All 34 patients in this group had primary postoperative incision healing, and no complications occurred during hospitalization.
2 Nursing Measures
2.1 Psychological Nursing Due to the long duration of the disease, patients with diabetes have a certain understanding of diabetes-related knowledge, but they have insufficient understanding of surgery, heavy psychological burden, and lack of confidence in the prognosis. , mostly manifested as depression, pessimism, fear, etc. Therefore, nursing staff should proactively and enthusiastically care about patients, and at the same time do a good job in ideological work of family members to obtain family support. Patiently and carefully explain the necessity of surgical treatment to patients and their families, and introduce in detail the preoperative preparation, intraoperative cooperation, and possible postoperative discomforts and precautions, so that patients can have a more comprehensive understanding of the surgery, so as to reduce or eliminate them. Stress and fear, stabilize emotions, and actively cooperate with treatment and care.
2.2 Health Education
2.2.1 Diet Education Diabetes is an endocrine and metabolic disorder, and trauma will cause a large amount of energy consumption, which can easily form a negative nitrogen balance. Therefore, after surgery, diabetic patients must strictly control their diet to stabilize blood sugar levels and increase nutrition to promote wound healing. After consultation with a nutritionist, recipes and total calorie distribution for each meal will be formulated. According to the total daily calories required = standard body weight? The calories required per kilogram of body weight, the dietary principles are: protein 15, fat 25, carbohydrate 60, fasting high sugar, starch, animal offal and fat. 1/5 for breakfast, 2/5 for lunch, and 2/5 for dinner. And coincide with the insulin injection time. Responsible nurses strengthen patrols in the wards during meal times to understand patients' eating conditions and supervise the normal implementation of dietary plans.
2.2.2 Specialist education in the perioperative period guides patients to effectively cough and expel sputum, do deep breathing exercises, drink more water, and perform early functional exercises to prevent lung infection and venous thrombosis of the lower limbs.
2.3 Condition observation: Closely observe the changes in consciousness, vital signs and peripheral blood circulation after surgery, and observe whether there are symptoms of cardiovascular and cerebrovascular diseases. If any abnormality is found, report it to the doctor immediately for timely treatment. Observe the bleeding situation of the wound and the limb movements, sensations and blood supply. Pay attention to observe whether there is any hypoglycemic reaction and prevent the occurrence of ketoacidosis.
2.4 Wound care Due to various factors such as weakened immune function and metabolic disorders in diabetic patients, wounds are prone to infection, and it is difficult to control factors such as surgical incisions, bed rest, and various drainage tubes that increase infection. Therefore preventing infection is the key to treatment. The skin must be carefully prepared before surgery and shaved carefully to prevent scratching the skin and increasing the risk of infection. Strict aseptic operation is required when changing dressings after surgery, and attention should be paid to keeping the wound dressing dry to avoid contamination of urine and feces. When using tape to fix, pay attention to whether there is any allergic reaction to the tape to avoid allergic blisters, which may lead to skin infection and ulcers.
2.5 Blood sugar control
During trauma and surgery, factors such as the increase in insulin resistance, anti-infection, and the release of inflammatory cytokines cause insulin deficiency in diabetic patients. Diabetes specialist consultation and formulation of treatment plan. Patients in this group were treated with regular oral hypoglycemic drugs or subcutaneous insulin injections before surgery. Blood glucose was measured after three meals, and fasting blood glucose was controlled below 7.8mmo/L, and postprandial blood sugar was controlled below 9.4mmo/L. The dosage of insulin must be accurate, and the doctor's instructions should be carefully checked before aspiration to obtain an accurate dosage. The injection site should be changed frequently, because multiple injections of the same site can cause subcutaneous induration, even ulceration, and abscess formation.
2.6 Skin care Diabetic patients have poor skin resistance, postoperative incision pain, and need to limit limb activities. The patient is unwilling to change positions, which can easily cause long-term local skin pressure, ischemia, and hypoxia, resulting in Skin ulceration and soft tissue necrosis, so preventing bedsores is the key and difficult point in caring for diabetic surgery patients. The bed should be kept clean, dry, and tidy, the patient should be assisted to turn over regularly, and the skin of the pressured area should be massaged frequently. Pay attention to the cleanliness of the skin of the perineum and buttock cleft area to avoid skin eczema and ulcers caused by secretions, urine or sweat. Use a skin protective film to protect the buttock cleft area when necessary. In summer, a water pad is given to reduce the temperature and pressure of the skin in the stressed area. A towel should be placed on the water pad, and the water pad and towel should be replaced every 2 hours. For those who require leather sheath traction after total hip replacement, attention should be paid to protecting the ankle skin and avoiding direct contact with the skin at the edge of the leather sheath. A large cotton pad should be placed on the ankle, and regular checks should be made to see if the skin is compressed. Pay attention to the traction weight. Too heavy to avoid straining the skin.
2.7 Preventing complications: Due to the decline in immune function and resistance of diabetic patients, and the trauma of surgery, the body is in a state of stress, which further reduces the body’s disease resistance and is prone to complications. Nursing care Pay high attention to it. For long-term bedridden patients, help them turn over and knock on their backs once every 2 hours, guide them to take deep breaths, cough effectively and expectorate sputum, and pay attention to keeping warm to prevent lung infection. Those who have an indwelling urinary catheter after surgery should keep the drainage tube unobstructed, change the drainage bag once a day, scrub the urethral opening twice to prevent urinary tract infection, and regularly clamp and open the urinary catheter to train bladder function. For patients with preoperative hypertension, arteriosclerosis and cardiac insufficiency, changes in vital signs should be closely observed to be alert to the occurrence of myocardial infarction or cerebrovascular accident.
3 Summary
People with diabetes have low resistance, many complications, and high surgical risks. This requires us to have a high sense of responsibility and rich professionalism in clinical nursing work. Knowledge and related knowledge, be able to foresee common complications, and detect changes in the condition in a timely manner. Develop accurate and effective nursing plans, manage the patient's blood sugar well, and pay attention to wound care and skin care to avoid complications.
References
Lu Renhe, Diagnosis and Treatment of Diabetes and Its Complications with Traditional Chinese and Western Medicine [M]: People's Medical Publishing House, 1997.
Tian Hui, Surgery Adjustment of diabetes treatment plan during trauma [J]: Diabetes Friends 2009, 11.
Huang Qiaoping, Zheng Hui, Wang Liai, Nursing experience of hip fracture in elderly patients with diabetes [J]: Nursing practice and research 2009, 6(14).