Ding huizhe
The former 82nd Hospital of the Eastern Theater General Hospital
Huai An 223001
【Abstract】This paper retrospectively analyzed the successful nursing practice of a case of femoral shaft fracture complicated with deep venous thrombosis of lower limbs after operation, and summarized the experience of comprehensive nursing.
【Key words】deep venous thrombosis of lower limbs; Fracture; Nursing
Deep venous thrombosis of lower limbs is a common complication of Orthopaedic patients1. If pulmonary embolism occurs, it is easy to sudden death. Therefore, we should pay attention to the nursing of deep venous thrombosis of lower limbs. Our hospital successfully nursed a case of femoral shaft fracture complicated with lower limb deep venous thrombosis after operation. The experience is as follows.
1 Case introduction
A 62-year-old male patient with traumatic right femoral shaft fracture underwent internal fixation one day after injury. On the fourth day after the operation, the pain in the right thigh was aggravated with tightness and swelling of the right leg. Color Doppler ultrasound showed that the blood flow of the right posterior tibial vein disappeared and thrombosis formed. Laboratory report: D-dimer increased significantly. After nursing in our hospital, the patient was cured and discharged.
2 Method
2.1 Risk assessment
Including trauma, long-term bedridden, high blood coagulation after injury, it is necessary to assess the high risk of deep venous thrombosis and prepare disposal plans.
2.2 Mental nursing
Medical staff alleviate patients'fear and anxiety; inform the patient of the injury, treatment plan and prognosis; listen to the patient's feelings, give sympathy, comfort and help, and get the patient's cooperation.
2,3 functional training
After admission, the affected leg muscles were relaxed and contracted, and the “ankle pump” was performed2. Deep breathing was used to promote venous reflux by using negative pressure of thoracic cavity.
2.4 Diet nursing
Light diet, low-fat foods rich in fiber, protein and vitamins; drink more water, lower blood viscosity; keep the urine and urine smooth.
2.5 Nursing care of deep venous thrombosis of lower extremities
2.5.1 Patients need to rest in bed, brake the affected limb, prohibit massage and hot compress, prevent thrombus from falling off 3; raise the affected limb; keep the affected limb warm.
2.5.2 To monitor vital signs and dispose of possible pulmonary embolism as soon as possible according to the plan.
2.5.3 The skin temperature, color, sensation and swelling of affected limbs were observed, and the circumference of affected limbs was measured regularly. The position of lower leg was 10 cm at the lower edge of patella, and that of upper thigh was 20 cm 4 at the upper edge of patella 4.
2.5.4 Thrombolysis selects the dorsum pedis vein of the affected side; observe whether there is oozing at the puncture site, whether there is skin purpura, gums and gastrointestinal bleeding and hematuria.
2.5.6 After the thrombus was stabilized, functional exercise was continued. Medical staff guided the patients to sit on the edge of the bed gradually, and to stand and walk with walking aids.
2.6 Pain Control
Analgesic pump was used; pain was scored by NRS method; mild pain was treated by music therapy, attention transfer, reading and relaxation therapy; severe pain was treated by intravenous drip of flurbiprofen.
2.7 Discharge Guidance
To guide oral anticoagulants and prevent bleeding tendency; to learn functional exercises; to appoint a referral time; to track the rehabilitation of patients.
3 Dissusion
Lower limb fractures are prone to lower limb deep venous thrombosis, and pulmonary embolism can threaten life. We should have a good understanding of the danger of deep venous thrombosis, evaluate the risk of thrombosis and make a good disposal plan. Fully communicate between nurses and patients to obtain their understanding and cooperation. Take preventive nursing measures, pay attention to the "venous pump" function of lower limb muscles, combined with deep breathing exercise, to promote venous blood reflux of lower limbs. After the occurrence of thrombus, it is necessary to prevent thrombus from falling off, observe vital signs, and detect pulmonary embolism and hemorrhage as soon as possible. In a word, prevention-oriented and comprehensive nursing are very important.
4 Summary
In view of the lower limb deep venous thrombosis complicated by fracture, we should pay attention to prevention and take comprehensive nursing measures to reduce the incidence of deep venous thrombosis as much as possible.
【References】
1.Wang Gang.226 cases of lower extremity deep venous thrombosis after orthopaedic surgery[J].Chinese Medical Report, 2010;7(4): 31-2.
2. Chen Haijing. Effect of ankle pump exercise on prevention of deep venous thrombosis of lower extremity after lower limb bone fracture surgery[J].World's latest medical information abstract, 2019,19(29): 277+279.
3. Zhang Liuliu, Maojing. Cause analysis and nursing of deep vein thrombosis after deep vein catheterization [J]. Jiangsu Health Care, 2006 (04): 17-18.
4. Yang Aixia, Song Jinwen, Dong Zhiqiang, Yin Jianguo. Nursing care of popliteal vein puncture for deep venous thrombosis of lower extremities [J].Chinese Journal of Nursing, PLA, 2012, 29 (22): 60-61+68.