Surgical nursing for bronchial lung cancer

Lung cancer is the abbreviation of primary bronchial lung cancer. In my country, lung cancer ranks fourth among common malignant tumors in men and fifth among common malignant tumors in women. However, in many large cities such as Shanghai, Beijing, Tianjin and industrial and mining areas such as Anshan, it has become the first among common malignant tumors. How should surgical care for bronchial lung cancer be done?

The treatment principle of lung cancer is mainly surgery or striving for surgery, completely removing the tumor and the lymph nodes that may metastasize in the chest cavity, preserving functional normal tissue as much as possible, and using preoperative or postoperative radiotherapy, chemotherapy and immunotherapy based on the different stages and tissue types of lung cancer, in order to achieve the purpose of radical cure. For example, small cell carcinoma should be treated with chemotherapy or radiotherapy first, and then surgical resection; non-small cell lung cancer should be treated with surgery first, and radiotherapy or chemotherapy should be used after surgery. The surgical procedures for lung cancer include: local resection (segmental or wedge resection), lobectomy and bronchoplasty (sleeve resection), pneumonectomy, and palliative resection.

(1) Preparation before surgery:

① Explain carefully to eliminate the patient’s fear of surgery.

② Provide good preoperative instruction so that patients can master effective coughing, practice urinating in bed, and perform appropriate activities to enhance cardiopulmonary function.

③ Strengthen oral hygiene and use expectorants and antibiotics for those with excessive sputum.

④ Eat a high-protein, multi-vitamin diet and pay attention to the balance of water and electrolytes.

(2) Postoperative care after general anesthesia: Closely observe changes in body temperature, pulse, respiration, and blood pressure to prevent and detect bleeding and shock early. Adequate oxygen inhalation is required within 24 to 48 hours after pneumonectomy and tracheoplasty, with an oxygen flow rate of 4 to 6 L/min.

(3) Postoperative position: Generally, the patient needs to lie flat for 6 hours after surgery, and then change to a semi-sitting position after the vital signs are stable. Tracheoplasty is to reduce the tension of the trachea, bronchi and trachea and promote anastomosis healing. After the operation, the mandibular and chest skin are sutured with thick silk thread. The pillow needs to be raised 25 to 30 degrees. The two sides of the head are fixed with sandbags, especially to prevent damage to the anastomosis due to restlessness during anesthesia recovery.

(4) Keep the airway open:

① Clear respiratory secretions promptly to prevent atelectasis and pneumonia.

② After waking up from anesthesia, encourage deep breathing and coughing up phlegm.

③ Due to the large wound and irritation of the chest drainage tube after the operation, the patient will suffer severe pain and should be injected with analgesics on time.

④ Assist the patient to turn over, move his limbs, and help the patient sit up and pat his back on time.

⑤ During surgery, nebulizer inhalation is performed three times a day, and antibiotics and chymotrypsin are added to dilute the sputum to prevent infection.

⑥ When using a nasal catheter to suction sputum after tracheoplasty, avoid causing severe coughing, and perform bronchial suction if necessary.

(5) Closed chest drainage care: After lung resection, a drainage tube is often placed in the upper and lower parts of the lungs. The upper tube is mainly used to exhaust air, and the lower tube is mainly used to drain fluid, in order to accelerate the expansion of the lungs and eliminate residual cavity. After surgery, the lower drainage tube is connected to the long glass tube of the closed chest drainage bottle. The doctor will connect the upper tube to negative pressure suction on the second day after the operation. The pressure regulating tube should be kept 12 to 16 cm below the water surface. The closed chest drainage is inserted 2 to 3 cm above the water surface. Precautions:

① The drainage rubber tube should not be too long and droop at an angle, which will affect the discharge of liquid.

② The drainage should not be raised above the level of the chest cavity, so that the liquid in the bottle will be sucked back into the chest cavity.

③ Avoid compression or bending of the drainage tube, and squeeze it frequently to prevent it from being blocked by blood clots or cellulose.

④ Observe the fluctuation of the water column at any time, the general amplitude is 4 to 6 cm; if there is no water column, check whether the drainage device is leaking or the drainage tube is dislocated into the chest wall; if the water column does not fluctuate, the drainage tube may be blocked or twisted; if the water column fluctuates too much, the upper respiratory tract may be blocked; if the water column does not fluctuate much and rises excessively, it may be atelectasis, which should be corrected in time.

⑤Observe the nature and amount of drainage fluid. It should not exceed 500ml on the first day after surgery, and gradually decrease on the second and third days after surgery. If it exceeds 100ml per hour in a short period of time, and the blood color is too dark or accompanied by blood clots, and the hemoglobin in the drainage fluid exceeds 5g%, it indicates internal bleeding and requires another thoracotomy to stop bleeding. Generally, 36 to 48 hours after surgery, if the lungs have re-expanded and the exudate has stopped, the drainage tube can be removed.

(6) Postoperative diet: After waking up from anesthesia, if there is no nausea or vomiting, you can eat liquid food and gradually return to normal diet. After tracheoplasty, fasting is required and food can be resumed on the second day.

(7) Observation of postoperative complications: Common complications after lung cancer surgery include atelectasis and pneumonia, tension pneumothorax, bronchopleural fistula, pulmonary edema, etc. Closely observe the patient for dyspnea and fever after surgery. In case of large-scale atelectasis, the trachea and heart shift to the affected side, and tension pneumothorax shifts to the opposite side. Bronchopleural fistula often occurs 7 days after surgery, and the patient has fever, irritating cough, and purulent sputum. The intravenous infusion rate after pneumonectomy should not be too fast, preferably 2 ml per minute, to avoid causing pulmonary edema.

(8) Fever care: Fever is a common symptom of lung cancer. Patients should be cared for as patients with fever. Sweaty clothes should be changed promptly. Patients should also keep warm to prevent colds. Late-stage "cancer fever" requires symptomatic treatment.