Nursing experience of dynamic hip screw in the treatment of intertrochanteric fractures of the femur Niu Lihua femoral intertrochanteric fracture is one of the most common fractures of the hip joint. Improper treatment often left hip varus, external rotation and shortening deformity of the lower extremities. Since 1997, 52 cases of femoral intertrochanteric fractures have been treated in our hospital. Among them, 32 cases were treated with dynamic hip screw (DHS), and satisfactory results were obtained. It is summarized as follows.
1 Clinical data car injury in 18 cases, 14 cases of falls. 11 cases on the left and 21 cases on the right. There were 24 stable cases, 8 unstable cases, 3 cases with chest and abdominal organ injury, and 1 case with craniocerebral injury. The above cases were treated promptly and correctly, active and thoughtful care, and the follow-up results were satisfactory.
2 Nursing methods and experience 2.1 psychological nursing intertrochanteric fractures, mostly due to accidental trauma or car accidents, the patient's thought changes are more complicated, they suddenly move from bed to bed, from healthy people to patients' roles And a series of reasons for the lack of a correct understanding of the disease, it is easy to produce nervous fear. Therefore, psychological care is very important. First of all, we must patiently explain the disease and promote its recovery, because good language expression can inspire, encourage and deepen the feelings of patients.
First of all, we often tell patients about the bone injury, help them overcome psychological barriers, let them feel the importance of society, and thus establish the best psychological state of treatment. Secondly, it is very important for the newly admitted patients to arrange a comfortable environment. When moving the patient, the movement should be gentle. During the conversation (non-treatment time), appropriate titles should be given to make them feel kind and remove the mentality. The strangeness of the above makes them build confidence in the fight against disease. In addition, improving the quality of business and technical level will also make patients feel psychologically safe and satisfied with each care work.
2.2 Postoperative care Postoperative care is very important. Because of the end of the operation, we routinely leave the rubber drainage tube. Therefore, the patient raises the affected limb after surgery to facilitate drainage and observe the amount of drainage, nature and color, such as drainage fluid. Significantly increased in a short period of time, there may be bleeding within the wound, should be promptly reported to the competent doctor. It is necessary to closely observe whether the patient's respiratory tract is unobstructed, whether there are abnormalities of cardiopulmonary function, shock, excessive bleeding, etc., especially in elderly patients, most of them have different degrees of cardiovascular disease. Therefore, this type of patient strictly follows the myocardial "oxygen supply" and The principle of "aerobic" phase balance prevents preload increase and tachycardia, and corrects hypovolemia and electrolyte imbalance. Some patients were treated with ECG for close observation and appropriate treatment.
2.3 Functional exercise Because DHS has the function of sliding pressure, the fracture can achieve firm internal fixation, promote the rapid healing of the fracture, and make the patient bear the weight in the early stage. Therefore, the patient can encourage and guide the early painless and active functional exercise after surgery: 1) 24 to 48 hours after operation, the patient has the isometric contraction of the quadriceps of the affected limb and the extension and flexion of the ankle joint to promote the vein. Reflux and prevent deep vein thrombosis. 2) After the drainage tube is removed from 24 to 48 hours, the flexion of the hip and knee joints can be practiced on the bed, and the amplitude gradually increases from small to small. 3) 1 week after surgery, you can get out of bed activities, in addition to continuing functional exercise content, you can increase the sitting position, standing position functional exercise, and help the staff to get out of bed activities (for elderly patients with osteoporosis, you can postpone getting out of bed Time), but don't bear the weight. 4) 2 to 3 weeks after surgery, the patient can be helped to do some weight-bearing exercises, and then gradually exercise, until no pain can be abandoned.
In short, the DHS internal fixation treatment and nursing of the intertrochanteric fracture are inseparable, the two are indispensable, requiring the doctor, the nurse, the patient to cooperate with each other, especially the postoperative observation and nursing early correct functional exercise for the rehabilitation of the patient At the same time, it is also an important aspect that can not be ignored. It is only in this way that the occurrence of complications can be significantly reduced, and the cure and improvement rate can be improved.
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