Hello everyone, I am Wu Gang, chief physician of the Department of Interventional Medicine of the First Affiliated Hospital of Zhengzhou University, and today I will share with you the health knowledge of obstructive jaundice!
1. Preoperative
1. Fasting and water for 4 hours before surgery.
2. Because the bile salts in the bile stimulate the nerve endings of the skin, which can cause itching of the skin throughout the body, the patient should cut the nails short, remember not to scratch, wash and wipe the local skin with warm water, keep the skin clean, avoid alkaline irritation of the skin such as soapy water, and apply antibiotics to prevent skin infection after cleaning the skin.
2. Postoperative period
1. Lie flat for 6-8 hours after surgery, closely monitor the patient's vital signs, observe changes in blood pressure, and pay attention to whether there is bloody fluid drainage in the drainage tube.
2. After the operation, you can get out of bed and move, the elderly and infirm can turn over frequently in bed, do leg extension and flexion activities frequently, and prevent the formation of deep vein din plugs and pressure ulcers in the lower limbs.
3. Diet care: early follow the principle of a small number of meals, diet to light and easy to digest low-fat liquids, the first day after surgery advanced rice soup, vegetable juice, etc., if there is no discomfort, the second day can eat fish soup, broth, porridge, fresh juice, etc., observation for 2-3 days, if there is no bloating, abdominal pain and other discomfort, you can gradually eat low-fat soft food, after 3 weeks can gradually restore three meals a day, guide patients to eat more vitamins and high-quality protein foods, avoid high-fat diet.
Third, carry the drainage tube precautions
1. Proper fixation: The drainage tube is properly fixed to the abdominal wall by elastic bandage, and if necessary, it can be fixed with abdominal band assistance.
2. Keep the drainage tube unobstructed: avoid twisting, folding, compression and slipping of the drainage tube, squeeze from the proximal end of the drainage tube to the distal end regularly, and pin a pin to the pants when getting up and moving to prevent slippage. Apply the anti-reflux drainage bag and replace it once a week.
3. Prevent infection: The drainage bag should not be placed too low, especially not on the ground, so as not to pollute. The drainage tube should always be lower than the puncture to avoid infection caused by the reverse flow of bile.
4. Pay attention to the amount and color of bile: the normal bile color is golden yellow, thicker, clearer and without slag. Abnormal bile color, thinness, turbidity, or sediment-like bile. Normal adults secrete bile per day about 800-1200 ml, a sudden decrease or increase, indicating an abnormality, should inform the doctor. If the drainage tube is internal and external two-way drainage, start to clamp the drainage tube half an hour before the meal, and then open the drainage tube two hours after the meal.
5. Pay attention to the whole body: if there is a decrease in body temperature, the disappearance of jaundice, the deepening of fecal color, and an increase in appetite, it indicates that part of the bile has entered the intestine, indicating that the inflammation of the lower end of the bile duct has subsided, and vice versa, it indicates that the lower end of the bile duct is not smooth.
6. Protect the skin around the puncture: disinfect the skin around the puncture every day, keep the puncture clean and dry, pay attention to whether the skin is allergic to the tape, change the dressing in time, and apply zinc oxide ointment locally to reduce the irritation of bile salts to the skin and prevent dermatitis.
4. Discharge health guidance
1. Quit smoking and alcohol, reduce the intake of fatty foods, and abstain from high-fat and fried foods. Do not eat or try to eat as little fat, animal offal, egg yolks and fried foods, and should not eat all kinds of high-fat, high-calorie "fast food". cooking
Use animal oil as little as possible, and increase vegetable oil in moderation. Dishes should be steamed, stewed, cold mixed, less fried vegetables, especially to avoid spicy and irritating food, do not drink alcohol, so as to reduce the adverse stimulation of the biliary tract.
2. Gradually enhance nutrition. You can appropriately increase your protein intake, eat some foods rich in high-quality protein, such as: lean meat, aquatic products, legumes, if you can drink - a cup of milk is better. If you are not accustomed to eating milk or fish and meat, you can eat more soybean products, fungi, and mushrooms to make up for the lack of animal protein. Avoid overeating and pay attention to dietary hygiene.
3. Follow the doctor's instructions and review it regularly.
4. Teach patients to properly fix the drainage tube, talk about the harm of the drainage tube, keep the drainage tube unobstructed, keep the puncture site clean and dry, observe the bile volume, color and traits every day, and make a record.
5. If the drainage tube is accidentally removed or abdominal pain, fever, jaundice should be treated in time to the hospital.