2020年10月24日星期六

lidocaine for hemorrhoids,Postoperative nursing care of patients with anorectal disease

    1. Postoperative nursing routine

    According to the general nursing routine of anorectal department. Give anti-infection and hemostatic treatment according to doctor's advice. Take the lateral position after surgery, do not loosen the dressing within 4 to 6 hours, and move slowly when turning over to prevent bleeding. You can get out of bed afterwards. It is not easy to do strenuous exercise, sit or squat for a long time when the wound is not healed, so as not to affect the wound healing. You can eat normally for a few hours after hemorrhoids, but you should pay attention to nutrition, eat more protein-rich and easy-to-digest foods, avoid spicy, fried, tobacco and alcohol, and eat more fiber-containing foods. Such as vegetables and fruits to facilitate bowel movements. In addition, it is necessary to prevent patients from fasting after surgery for fear of stool affecting the wound, so that wound healing is more difficult.

    2. Nursing care of postoperative urine retention

    After anal surgery, some patients will have difficulty urinating, and they will be treated with integrated Chinese and Western medicine. First of all, the medical staff should explain to the patient that this is due to surgical anesthesia, wound pain and other stimulation of anal sphincter spasm, bladder smooth muscle contraction, resulting in difficulty in defecation and urinary retention. Elderly male patients often have prostate hypertrophy, urethral stricture, and old age. Weak, further aggravating the occurrence of urinary retention. Therefore, analgesics should be used as appropriate; hot compress or massage in the lower abdomen bladder area; let him listen to the sound of running water in the toilet to form a conditioned reflex to facilitate urination; acupuncture or intramuscular injection of neostigmine 0.25 mg can also be used. The above methods still cannot urinate, and catheterization is required when the bladder is full.

    3. Nursing care of postoperative abdominal distension

    Some patients will have abdominal distension after anorectal surgery. The main reasons are: (1) Anesthesia, less local anesthesia, especially lumbar and sacral anesthesia, which appears on the day after surgery. (2) The dressing for filling the anus is too tight and the anus cannot be exhausted; (3) The postoperative bed stay is long and the bowel motility is poor; (4) Gas-producing foods such as milk and sugar have been consumed. Treatment methods can be combined with traditional Chinese and Western medicine: first apply abdominal hot compress, if it is ineffective, cooperate with acupuncture treatment, after seeking the doctor’s consent, appropriately relax the anal packing dressing, and when the dressing time is sufficient, the patient can be instructed to defecate as soon as possible. Exhaust gas, orally take Chinese and Western medicines that regulate qi to help digestion if necessary.

    4. Care of postoperative incision pain

    Postoperative incision pain mainly occurred within 24h after operation, especially around 6h after operation. After anorectal surgery, there will be burning pain, anal sphincter spasm and contraction pain, but most of them can be tolerated. If the pain is severe, acupuncture and moxibustion at auricular points, bean embedding, or oral tramadol 50mg, if ineffective, intramuscular injection of pethidine 50-100mg In order to relieve pain, after the operation, an analgesic plug is inserted into the patient's anus to relieve postoperative pain.

    5. Nursing care for postoperative perianal swelling and pain

    Postoperative perianal swelling and pain are caused by swelling of the surgical incision, friction of the incision during defecation, and internal hemorrhoids that have not fallen off. It usually occurs within 3 days after surgery. Our department adopts integrated traditional Chinese and western medicine treatment. In addition to the infusion of antibiotics, the special "cooling blood and hemostasis mixture" of our department is added orally. After 5 days, the "hemorrhoids and swelling mixture" is used to continue oral administration for 5 days, which can reduce inflammation, reduce swelling, Hemostasis, pain relief, etc., can well alleviate the pain of patients and promote the healing of incisions.

    6. Care for postoperative pain and bleeding during defecation

    Bleeding and pain during defecation are inevitable. On average, within 1 week after surgery, bleeding can last up to 2 weeks after surgery. After every bowel movement, the patients used "Kupu Cuyu Decoction" to sit in the bath and change the dressing after the bath. Physiotherapy such as infrared radiation is suitable for adjuvant treatment after anorectal surgery and can promote its healing. It is also very important to change the dressing after the operation. Normal saline is used to flush around the wound. When there is edema, use hypertonic saline to wet or trim. When there is purulent secretion, use hydrogen peroxide solution (hydrogen peroxide) to rinse (such as anal fistula). "Zicao oil gauze" is filled and drained to stimulate the growth of granulation; the wound is freshly cleaned with normal saline and then filled with "Quick-acting hemorrhoid cream + Zhichuang Ningshuan". Pay attention to gentle movements during dressing change, talk to the patient more, distract them, and use local anesthetics when the pain is unbearable.

    7. Guidance before discharge

    Adhere to hot salt water or traditional Chinese medicine bath every night, develop regular bowel habits, and treat diarrhea or constipation in time. Keep the anus clean and avoid irritation. The toilet paper should be soft, and tight pants and rough underwear should not be worn. Avoid sitting for a long time, standing for a long time or squatting for a long time. Do not sit on objects that are too hot, too cold, wet, or on the ground. Soft cushions are best. Avoid tobacco, alcohol and spicy products. Eat more fruits and foods containing more crude fiber. Don't travel far with heavy load to prevent overwork. Get proper physical exercise. Lose weight. Do levator anus exercises every day, 3 to 5 times a day (that is, contract the anus by itself for 5 seconds and then relax for 5 seconds, inhale deeply when contracting the anus, repeat this 5-10 times), if conditions permit, perform anal contraction exercises, 400~ 500 times/d, it can strengthen the anal sphincter and reduce the recurrence of hemorrhoids.

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