Perioperative General preparation It mainly includes psychological preparation and patient's physical preparation. 1. Psychological preparation (including medical staff)
(1) To enhance communication with patients and their families Condition , diagnosis, operation method, necessity of operation, effect of operation, possible complications and preventive measure The danger of the operation, the recovery process after the operation and the recovery should be clearly explained to the patients and their families to gain trust and cooperation, so that the patients can accept the operation happily. (2) Full respect Patient autonomy The choice of“ informed consent ”Take diagnosis under the premise of Treatment measures Before the patient has informed consent, it is not advisable to perform any operation or treatment with injury. 2. Physiological preparation: The patient maintains a good physiological state to pass the operation and the post operation process safely.
(1) Preoperative training: urinate in bed, cough and Expectoration Method, two weeks before operation Stop smoking 。 (2) Blood preparation and fluid infusion : Correct water and electrolyte Acid-base imbalance and anemia ； Blood group identification And crossover Cooperation test Prepare a certain amount of whole blood. (3) Prevention of infection: do not contact infected patients; No upper respiratory tract infection Of the staff entering the operating room; Preventive use Antibacterials : ① Operation involving infected focus or incision close to infected area; ② Gastrointestinal surgery; ③ Long operation time Major operation ；④ Contaminated wound, debridement time is long or it is difficult to completely debridement; ⑤ Cancer surgery; ⑥ cardiovascular Operation; ⑦ Artifacts Implantation; ⑧ viscera Transplantation 。 (4) Gastrointestinal preparation: ① For patients who are not undergoing gastrointestinal surgery, they are forbidden to eat 12 hours before surgery and water 4 hours before surgery to prevent vomiting during anesthesia or surgery. Soap water overnight before operation enema ；② Gastrointestinal (especially colon) surgery, 1-2 days before surgery Liquid diet If left colon or rectum surgery is performed Clean enema And began to take intestinal bacteriostatic drugs 2-3 days before the operation to reduce the chance of postoperative infection. (5) Heat protein And vitamins: about a week before the operation, according to different conditions, provide sufficient calories, protein and vitamins through mouth or vein. General Elective operation Patient's Rest energy consumption The value (REE) increases by about 10%. (6) Others: check the patient the day before operation or in the morning of the operation day, if any fever (above 38.5 ℃) or female patient Menstruation , delayed operation; Give it the night before the operation sedative To ensure the patient's full sleep; Empty the urine before entering the operating room, and detain the catheter if necessary; Remove movable teeth before operation. （1） Evaluation and nursing care of patients before operation
1. Key points of pre operation nursing
(1) Assess and correct physiological and Psychological problems To help patients do well in psychological and physical care. (2) Provide patients and their families with health guidance on surgery.
(3) Help develop discharge and Lifestyle Changed adaptation plan. 2. Evaluation of patients before operation
(1) General information.
（2） Past history And health status. (3) The patient's psychological condition was evaluated.
(4) Ask relatives if they support, care about and can afford the operation.
(5) Assess the patient's Tolerance 、 laboratory examination Results and important organ function. 3. Preoperative patients Nursing measures (1) Psychological preparation: The significance of preoperative psychological preparation is to reduce anxiety; Promote the stability of pulse and blood pressure after operation; Reduce intraoperative anesthetic To reduce the postoperative demand for analgesics; Increase postoperative activity of patients Initiative ； Reduce the incidence of postoperative infection; Shorten hospital stay. mental nursing The most basic measure of facing patients squarely Emotional response Encourage patients to express their anxiety, feelings or questions, and give support and guidance. Common psychological problems of preoperative patients: exaggerating the risk of surgery; Do not understand the process of anesthesia; Do not know the degree of pain; yes prognosis pessimism. The most effective way to solve these problems is to eliminate the "unknown" and enhance the patient's sense of control. Preoperative education and arranging patients to participate in recreational activities can achieve better results. (2) Environmental preparation: the temperature of the ward should be kept at 18 ℃ - 20 ℃, and the humidity should be 50% - 60%, so as to reduce nursing care. For newly admitted patients, nurses should introduce the ward environment.
(3) Physical preparation: help patients improve various examinations, nurses explain the significance of various examinations to patients, and help and urge patients to accept examinations. For the blood, urine and stool test of the retained samples, the requirements for the collection of various samples should be explained to the patient.
Skin preparation : Remove microorganisms from the skin, and reduce the chance of wound nonunion caused by infection. Skin preparation is usually carried out one day before operation. Patient cleans skin and trims Fingernail , and Skin preparation 。 The range of skin preparation shall be larger than the predetermined incision range. respiratory tract Preparation: The purpose is to improve the ventilation function and prevent postoperative complications. The main measures are smoking cessation and deep breathing, cough and expectoration training. If the patient has Respiratory diseases , should be performed before operation Postural drainage ， Atomization inhalation And apply antibiotics when necessary. Gastrointestinal preparation: the purpose is to reduce vomiting and Aspiration It can also prevent pollution during digestive tract operation. ① Fasting and drinking: fasting 12 hours before operation, and drinking water 6 hours before operation. Eat a low residue diet three days before intestinal surgery, and change it one day before surgery liquid diet ；② Enema: except Emergency operation Patients are strictly prohibited from enema. Ordinary patients should use 0.1% - 0.2% soapy water for enema once or use Kaisailu in the evening before operation. The intestinal tract should be cleaned during operation Intestinal cavity ；③ place Gastric canal Or intestinal tube, usually placed in the morning of the operation day; ④ Stool practice. Increase body Resistance Strengthen nutrition and promote rest and sleep. To adapt to the operation, the practice of postoperative changes.
(4) Morning care: Measuring vital signs Make records and note whether there is any abnormality. Check the skin and gastrointestinal preparation.
Ask the patient to urinate and decide whether to place a gastric tube and catheterize.
Remove Hairpin , dentures and body accessories. Wipe off Nail Polish , lipstick, eye shadow, etc. Accurate and timely delivery Preanesthetic medication 。 take medical record , X-ray films, special drugs used during operation, etc. shall be counted together and handed over to the operating room pickup. Write down the family name and contact information.
4. Health education for patients before operation
The skills of health education for patients are: try to use simple and understandable language for communication; Inform the patient of various matters, reasons or reasons for actions; varied Educational methods Used simultaneously. What patients should know before and after operation Basic activities Methods include: deep breathing, effective expectoration, posture change and limbs Functional exercise , urinate on the exercise bed. （2） Mid term patient assessment and nursing
1. Operating room environment: The operating room should be adjacent to the operating department and relevant departments. The operating room is divided into sterile Zone, Clean Zone ， Semi clean area and Contaminated Zone 。 The suitable temperature is 20-24 ℃, and the humidity is 50-60%. 2. Nursing care of patients during operation: including evaluation and documentation, posture preparation and observation during operation.
(1) Requirements for surgical posture: ensure the comfort and safety of patients to the greatest extent; It is beneficial to expose the operation field and facilitate the operation of the operator; Minimal effect on respiration and circulation; Do not damage the limbs due to excessive traction or compression; Limbs shall not be placed in the air and shall be supported by brackets.
Common operation positions: supine, neck supine, head down supine, prone, kidney operation and bladder Rock cutting site 。 (2) Disinfection of surgical field skin: too much disinfectant should not be used; Starting from the operation center, apply evenly and forcefully; The disinfection scope should exceed the area required for the surgical incision.
(3) Observation during operation: Itinerant nurse The patient's reaction should be closely observed, and the patient's discomfort or accident should be found in time to prevent complications and ensure the patient's safety. explain
Perioperative period accidental hypothermia (IPH, Inadvertent Periodic Hypothermia) means that the core temperature is lower than 36 ℃, and 34 ℃ - 36 ℃ is called mild in clinic Hypothermia 。 [1] On average, the patient's core temperature will drop 1-3 ℃ during the operation. Perioperative accidental hypothermia Yes anaesthesia and Surgery Common and preventable during operation complication ， incidence rate Up to 50% - 90%. Perioperative accidental hypothermia can lead to serious consequences, bringing additional trauma and economic losses to patients. Perioperative complications of accidental hypothermia
Perioperative accidental hypothermia has many adverse effects on the body clinical research confirm, [2] Even mild hypothermia can lead to many serious consequences. For example, the incidence of surgical site infection, which is widely mentioned in the study, has increased three times. The main reasons for its occurrence include three aspects: during the operation, the surgical incision exposes the body to Exogenous And endogenous pathogen Among them, the body's main defense against surgical pathogens is through Neutrophils The oxidation and killing effect of. 1. Hypothermia trigger vasoconstriction , reducing tissue oxygenation and Perfusion volume , reducing the number of neutrophils reaching the surgical incision and their hyperoxidation Free radical Generation of; two low-temperature induction Multiple anti-inflammatory cell factor and Interleukin Horizontal decline; 3. Mild low temperature increases and reduces nitrogen loss collagen protein Generation of wound healing ； Therefore, a series of factors lead to a threefold increase in the risk of surgical site infections (SSIs). Other perioperative complications of unexpected hypothermia include Myocardial ischemia Harmony Dysfunction Increased occurrence, increased and prolonged blood transfusion and infusion drug metabolism Time, disease convalescence Time extension, and shiver Thermal discomfort, etc. serious Hypothermia Will also cause immunity Damage [3] Coagulation function Exceptions ventricular fibrillation 、 Respiratory depression , airframe electrolyte and Acid base balance disorder and mortality Increased, directly threatening the treatment effect and life safety of patients. In addition, patients often complain that cold discomfort at the initial stage after surgery is one of the most painful experiences during hospitalization, sometimes even more than pain. Once a series of hypothermia complications occur, it will inevitably lead to an increase in clinical treatment costs, such as for treatment miocardial infarction . Infection at operation site, increased blood transfusion respirator Use ICU The cost of retention time, etc. Research shows that maintenance Normal body temperature Can save per capita medical expense $2500 - $7000. Therefore, early detection and timely correction during operation accidental hypothermia It can not only reduce many complications of perioperative hypothermia, greatly reduce treatment costs, but also increase patient comfort and reduce bedsore Its clinical application value is self-evident. 
