How to care for a child after surgery. Postoperative period in outpatients (children). Healing after child circumcision

CARE FOR PATIENTS AFTER OPERATION.

Postoperative period begins from the moment the surgeon tied the last suture and covered the wound. The child is in the operating room for some time, and then he is transferred to the ward and placed in a fresh bed.

General issues. If an adult consciously relates to his condition after undergoing surgery, tolerates the position given to him in bed, minor pain, etc., relatively calmly, then Small child, not understanding the seriousness of the condition, is sometimes overly active and agitated, often changes position in bed and this can cause harm to his health. Therefore, we have to resort to fixing the patient, which is carried out by tying the limbs to the bed using cuffs made of bandages and cotton wool or flannel. Very restless children are additionally secured around the body with a wide soft belt. Fixation should not be rough. Cuffing your limbs too tightly can cause pain and venous stasis. Fingers should fit freely into the space between the cuff and the skin. From time to time the position of the limbs is changed. The duration of fixation depends on the age of the child and the type of anesthesia. After surgery under local anesthesia Only infants and children are recorded toddlers for 2-3 hours. However, in most cases, surgery in children is performed under anesthesia. In such cases, regardless of age, the fixation is carried out until complete awakening: during the period of awakening, the child is especially excited, his consciousness is darkened, and in this state he can tear off the sticker, damage the seams, or fall out of the bed. 4-6 hours after the operation, when the child is fully awake, a calm patient (usually older children) can be released from the cuffs and belt and allowed, in the absence of contraindications, to turn on his side and bend his legs. In young children, hand fixation is necessary for a longer period of time to avoid damage and infection of the sutures.

Vomiting often occurs during the awakening period. At this point, it is very important to prevent vomit from entering the Airways, which is dangerous due to the possibility of developing pneumonia and even asphyxia (suffocation). As soon as the nurse notices the urge to vomit, she immediately turns the child’s head to the side, and after throwing out the vomit, she carefully wipes the oral cavity with a previously prepared clean diaper. Individual observation in such cases is necessary until complete awakening and cessation of vomiting.

During the period of awakening and in the following hours, the child experiences extreme thirst and persistently asks for a drink. In this case, the nurse is guided by the doctor’s instructions and does not allow excess water intake, which can cause repeated vomiting. If not special contraindications, about which the doctor must inform the nurse, after minor operations (appendectomy, hernia repair, removal of skin tumors, etc.), as soon as the effect of anesthesia wears off and in the absence of vomiting, the patient can be given plain boiled water or sweetened tea with lemon to drink. At first, you are given no more than 2-3 teaspoons of liquid to drink every 20-30 minutes, then the dose is increased. If the water does not cause vomiting, begin feeding, the nature of which depends on surgical intervention.

Children who have undergone surgery have a high need for water, so after major operations intravenous infusion of solutions is performed. by drip. The nurse monitors the proper functioning and serviceability of the system, strictly adheres to the given regime (frequency of drops), strictly controlling the amount of liquid administered and its composition.

In children after complex interventions, increased oxygen requirement therefore, from the first minutes of the patient’s stay in the ward, he must be provided with it. Exist different ways oxygen supply, as well as special oxygen tents. The nurse must be well versed in all systems and be able to quickly set them up.

In the immediate postoperative period in children great importance It has fighting pain. If the child is restless and complains of pain in the area of ​​the surgical wound or elsewhere, the nurse immediately informs the doctor. In some cases, painkillers or sedatives (promedol, sibazon in age-appropriate dosages) are prescribed once. After large and difficult operations, they are usually prescribed systematically 4-6 times a day for 2-3 days.

Postoperative sutures usually covered with a sticker, sometimes a bandage or special pastes. While caring for the patient, the nurse monitors cleanliness of the seam area. On the neck and upper body they are protected from contamination by vomit and protected from food ingress; When performing interventions on the lower abdomen and back, the sutures protect against contamination by urine and feces.

When caring for a small child, it is necessary to take into account that such a patient, firstly, does not ask to go to the potty on his own; secondly, the number of urinations per day is increased compared to adults; bowel movements are also more frequent. Therefore, repeated monitoring of natural bowel movements throughout the day, multiple diaper changes, and perineal toileting are absolutely necessary. In some cases, stool and urine retention may occur after surgery. If there is no stool, a cleansing enema is given at the end of the 2nd or 3rd day after the operation, and if the abdomen is bloated, a gas outlet tube is used for 15-20 minutes (in consultation with the doctor). If there is urinary retention, the nurse must inform the doctor about this, since this requires taking more urgent measures.

Caring for the sick is the most difficult and responsible task. In order to ensure the most suitable conditions for their detention and the work of personnel, special departments are created in large hospitals and clinics, called intensive care units and intensive care. In the absence of an intensive care unit in children's surgical departments, postoperative wards, in which patients who need increased attention are concentrated. One of the main tasks of the nurse is constant monitoring of the patient, the ability to see signs of impending dangerous complications and provide the necessary first aid. The nurse keeps a special card for the seriously ill patient, in which every 1-2 hours she records body temperature, pulse rate and respiratory movements, blood pressure, the amount of urine excreted, the volume of fluid drunk and parenterally administered; In the same card, the nurse notes the fulfillment of the doctor’s prescriptions.

Success surgical intervention is possible only if the nurse punctually follows written orders and oral instructions from the doctor regarding the smallest details of patient care, taking into account the operation performed.

After organ surgery abdominal cavity care depends on the severity and extent of the intervention. At inguinal hernia, dropsy, cryptorchidism, etc. the next day after the operation, the child receives the same table as before the operation. For appendicitis and other diseases, when the operation is associated with intervention on the intestines, adhere to more strict diet. After surgery for pyloric stenosis in infants Feeding begins after 6 hours with expressed breast milk every 2 hours with a night break (during the first day). In the next 2-3 days the amount breast milk increase by 15-20 ml each feeding. From the 4th day, children are transferred to regular breastfeeding.

For complex surgical interventions (for example, for intestinal obstruction, Hirschsprung's disease, etc.), especially those associated with resection (removal) of part of the intestine, postoperative care requires increased attention. The patient is given a semi-sitting position, but from time to time is allowed to turn on his side. In the first 2-3 days, avoid feeding by mouth and often drinking water. The patient receives parenteral nutrition- intravenously, less often subcutaneously or rectally. In such patients, a gastric tube inserted through the nose is often left in place. The nurse monitors the nature of the discharge through the probe and records the amount of fluid released. Every 2 hours the probe is washed with a small amount saline solution to avoid blockage. The gastric tube is kept in place for 48-72 hours until the discharge of green mucus stops. With a functioning tube, you can give drinks in small portions. The doctor warns the sister about the start of oral feeding and usually prescribes a regimen as for appendicitis.

Often after operations on the abdominal organs, bloating of the intestines with gases (flatulence) is observed. Significant flatulence is accompanied by pain and difficulty breathing. In order to combat flatulence and preventively, inhaling oxygen (oxygen therapy) is useful; in consultation with the doctor, a gas outlet tube is used or a hypertensive enema is given. The sister also makes sure that the bandage that is sometimes placed on the stomach is not tight.

After surgery on the perineum, the child is most often placed in a position with his legs raised and spread apart, which are fixed with a special plaster splint-spacer or soft bandages to the crossbars attached to the top of the bed; the blanket is thrown over the crossbars, thus creating a frame. One or more light bulbs are placed inside the frame, the purpose of which is to dry the suture area and to some extent warm the patient. The child stays in this position for an average of 8-10 days, then he is transferred to his normal position.

It is especially important to monitor the condition and proper functioning of the drains (strips of rubber, gauze, tubes and catheters) that are inserted into the wound, anus, V urethra. The nurse makes sure that the child does not accidentally pull out the drainage and records the nature and amount of fluid released. The nurse should not change or remove the drainage independently, without the participation of a doctor.

From the 2nd day after the operation, the child receives the same diet as before the operation. To improve the conditions for the passage of feces, the child is given liquid by mouth. Vaseline oil 1 dessert spoon 3-4 times a day. After defecation, the nurse carefully performs a perineal toilet weak solution potassium permanganate, then dry the skin with a gauze pad. From time to time, the position of the legs is changed, and in the absence of special contraindications, the legs are freed from the fixing bandages for a while.

After the operation, performed under local anesthesia, the child is placed in a general ward. Children in the first year of life are handed over to their mothers. After the operation, performed under anesthesia, the child is placed in the intensive care unit.

To avoid hypothermia in children, the air temperature in the recovery room should be 20-22 °C. For newborns and premature babies, a special ward is allocated where the temperature is maintained at 22-26 °C, and it is better to use incubators with a temperature of 34-37 °C.

After the operation, under anesthesia, the child is laid horizontally on his back, without a pillow, with his head turned to the side. In case of vomiting, the oral cavity is treated with a cotton swab moistened aqueous solution antiseptic. In a day top part the body is raised (Fowler's position).

Special attention nurse must pay attention to monitoring bandages, drains, and indwelling catheters, since children try to get rid of them and can pull them out. For wounds on the perineum, in the lower abdomen, use special measures precautions using moisture-proof materials (oilcloth, polyvinyl chloride film) and diapers. If the dressing becomes contaminated with feces, it should be changed immediately.

To combat pain, children are prescribed droperidol in combination with non-narcotic analgesics and barbiturates in age-appropriate dosages. Narcotic analgesics used as a last resort, preference is given to dipidolor (0.1 ml per 1 year of life).

After operations under local anesthesia, children are immediately given sweet tea taking into account the nature of the surgical intervention. After anesthesia and in the absence of vomiting, drinks are prescribed after 4-6 hours.

Feeding children is allowed 6-8 hours after surgery, taking into account the nature of the disease, the type of surgery, and the age of the child.

To prevent flatulence, children are given a gas tube for several days in a row.

Hyperthermia- increase in body temperature to 40-41 ° C - feature child's body. It is observed in children even after minor operations.

Pale hyperthermia syndrome is especially dangerous. A few hours after the operation, there is a rise in temperature (40-41 °C), the face becomes pale, collapse develops, against which the child dies.

The nurse must know the basic principles of treating this condition in order to competently care for a sick child. Are used physical methods cooling: ice pack to the head, to the liver area, inguinal folds; wiping the skin with solutions of alcohol and water (1:1) or vinegar and water (1:1). A 5% glucose solution (18-20 °C) is administered internally, analgin 0.1 ml is administered intramuscularly for 1 year of life.

Convulsions - distinguishing feature operated children. The reasons for their occurrence are different: hypoxia, hypercapnia ( increased content carbon dioxide in arterial blood), novocaine overdose, fever, intracranial hemorrhage and etc.

Treatment is prescribed by the doctor depending on the cause of the seizures. Tranquilizers (seduxen) are used, as well as sodium hydroxybutyrate and sodium thiopental in doses appropriate to the child’s age.

Acute respiratory failure (ARF) occurs in children due to obstruction of the upper respiratory tract, less often - of central origin. The child is restless, lips are cyanotic, there is sweating, difficulty breathing with the participation of auxiliary muscles. Sudden cessation of breathing may occur.

To prevent ARF, the nurse must prevent aspiration of vomit, suck out mucus from the nasopharynx, supply humidified oxygen, and, if necessary, perform artificial ventilation (ALV).

Acute cardiovascular failure characterized by a progressive deterioration in the condition of the operated child. Apathy increases, interest in the environment is lost, the reaction to pain decreases, cyanosis of the nail phalanges appears, the pulse becomes thready and soft, blood pressure drops, the skin is moist, grayish, and heart sounds are muffled.

If these symptoms occur, the nurse should immediately notify the doctor; lower the child's head and raise his legs (Trandelenburg position); prepare medications (cordiamine, ephedrine); supply oxygen. In case of cardiac arrest indoor massage heart (CHS), taking into account the age of the child.

V. Dmitrieva, A. Koshelev, A. Teplova

"Postoperative care for children" and other articles from the section

General principles post-operative care looking after the children are based on strict consideration of factors influencing the course of the postoperative period. Of utmost importance are mental immaturity the child, his peculiar reaction to surgical trauma, anesthesia and an unusual hospital environment. A small child, not understanding the seriousness of his condition, is sometimes overly active, often changes position in bed, rips off bandages and can cause significant harm to himself.

Constant observation and attentive post-operative care for children, especially in the first hours after surgery, play a significant role in the successful outcome of treatment.

After the child is delivered from the operating room to the ward, he is placed in a clean bed. The most comfortable position at first is on the back without a pillow with the patient fixed in bed: the limbs are tied to the bed using cuffs made of cotton wool and bandages or flannel. In very restless children, the torso is additionally secured with a wide soft belt at the level of the lower half of the abdominal wall. Fixation should not be rough. Pulling the limbs too tightly with cuffs causes pain and venous stagnation and can lead to malnutrition of the foot or hand. Fingers should fit freely into the space between the cuff and the skin. From time to time the position of the limbs is changed.

The duration of fixation depends on the age of the child and the type of anesthesia. After operations, only infants and toddlers are fixed under local anesthesia for 2-3 hours. After operations under anesthesia, regardless of the child’s age, the fixation is carried out until complete awakening. The period of awakening requires special attention. At this time, the child is especially active, his consciousness is darkened. In this state, he can rip off the bandage, damage the stitches, and even fall out of the bed. 4-6 hours after the operation, when the child fully awakens and calms down, you can release the limbs from the cuffs, remove the belt and allow (in the absence of contraindications specified by the doctor) to turn on its side and bend its legs. However, in young children, hand fixation is necessary for a longer period of time (1-2 days) to avoid damage and infection of the sutures.

Postoperative sutures are usually closed with a sticker, sometimes a bandage or a special paste. The nurse keeps the suture area clean. For this purpose, it is best to place an additional diaper or gauze napkin on top of the sticker, which is changed as it gets dirty. If the sticker becomes dirty, it must be changed.

Vomiting often occurs during awakening from anesthesia. It is very important to prevent vomit from entering the respiratory tract, which is dangerous for subsequent development. aspiration pneumonia and even asphyxia (suffocation). As soon as the nurse notices the urge to vomit, she immediately turns the child on his side, and after vomiting, thoroughly wipes the oral cavity with a previously prepared clean diaper. Individual observation of the child is necessary until he fully awakens and stops vomiting. During the period of awakening and the following hours, the child experiences extreme thirst and persistently asks for a drink. The nurse should not allow the patient to take fluids before the prescribed time. If there are no special contraindications, about which the doctor must inform the nurse, then after minor operations (appendectomy, hernia repair, removal of skin tumors, etc.), as soon as the effect of anesthesia wears off and in the absence of vomiting, usually 3-4 hours after the operation, the patient can give boiled water or sweetened tea with lemon to drink. At first, give no more than 2-3 teaspoons of liquid every 20-30 minutes, then increase the dose. If the water does not cause vomiting, feeding begins, the nature of which, depending on the surgical intervention, is determined by the doctor.

Children who have undergone surgery have a very high need for fluid, which supports vital important functions body. After major operations, the increased need for fluid is compensated for by intravenous infusions of various solutions by drip. The nurse monitors the proper functioning and serviceability of the drip infusion system. The frequency of drops should not be too high, otherwise there is a danger of developing pulmonary and cerebral edema and death of the patient. If drops rarely enter the bloodstream, fluid administration will be insufficient and, in addition, the lumen of the vein may become clogged. The optimal frequency is 10-14 drops per minute. At drip infusion in children, in addition to fixing the needle with strips of adhesive plaster, a light plaster splint or plywood splint is applied to the corresponding limb, which is tied with ribbons to the bed.

After complex interventions, children have an increased need for oxygen, so the patient should be provided with it from the first minutes of being in the ward. For small children, it is more convenient to use special oxygen tents.

The fight against pain is of great importance in the postoperative period. If your child is restless and complains of pain in the area after surgical wound or another place, the nurse immediately informs the doctor about this. In some cases, sedatives are prescribed once, but after major and severe surgical interventions, painkillers in dosages specified by the doctor are administered systematically every 4-6 hours for 2-3 days.

At postoperative care From the very first minutes, a small child must be monitored for its natural functions and functions. Such a patient does not ask to go to the potty on his own; he urinates on himself. The number of bowel movements and urinations is increased compared to adults. In this regard, repeated active supervision by the nurse, appropriate toileting of the perineum and multiple diaper changes are necessary. In some cases, after surgery there may be retention of stool and urination. If there is no stool, a cleansing enema is given at the end of the 2nd or beginning of the 3rd day after the operation, and if the abdomen is bloated, a gas tube is inserted for 15-20 minutes. If urination is delayed, the nurse should immediately inform the doctor about this, since urinary retention may indicate impaired renal function, which requires urgent action.

Unlike an adult, a small child cannot accurately formulate his complaints, so one has to take into account the slightest deviations in his behavior or, as they say, microsymptoms. Constant monitoring of vital function is of great help. important organs and systems of the patient - respiratory, cardiovascular, digestive, excretory, central nervous, etc. For this purpose, the nurse keeps a special card for the seriously ill patient, in which every 1-2 hours he records body temperature, pulse rate and respiratory movements, blood pressure, amount of administered into the body of fluid and excreted urine, etc. In the same card, she notes the fulfillment of the doctor’s prescriptions.

The anatomical and physiological characteristics of the child’s body determine the need for special postoperative care. The nurse must know the age standards for basic physiological indicators, the nature of children’s nutrition, various age groups, as well as a clear understanding of the pathology and principle of surgical intervention. Among the factors influencing the course of the postoperative period in children and determining the need for special care for them are: vital importance the patient has mental immaturity and a peculiar reaction of the body to surgical trauma.

General principles of postoperative care for children

After the child is delivered from the operating room to the ward, he is placed in a clean bed. The most comfortable position at first is on your back without a pillow. Small children, not understanding the seriousness of the condition, are overly active and often change position in bed, so they have to resort to fixing the patient by tying the limbs to the bed with cuffs. In very restless children, the torso is additionally fixed. Fixation should not be rough. Pulling the limbs too tightly with cuffs causes pain and venous congestion and can cause malnutrition of the foot or hand, including necrosis. Fingers should fit freely into the space between the cuff and the skin. The duration of fixation depends on the age of the child and the type of anesthesia.

During the period of awakening from anesthesia, vomiting often occurs, so it is important to prevent aspiration of vomit to avoid aspiration pneumonia and asphyxia. As soon as the nurse notices the urge to vomit, she immediately turns the child’s head to the side, and after vomiting, carefully wipes the child’s mouth with a clean diaper. During the period of awakening and the following hours, the child experiences extreme thirst and persistently asks for a drink. In this case, the nurse strictly follows the doctor’s instructions and does not allow excess water intake, which can cause repeated vomiting.

In the immediate postoperative period in children, pain control is of great importance. If the child is restless and complains of pain in the area of ​​the postoperative wound or other place, the nurse immediately informs the doctor about this. Usually in such cases, sedative painkillers are prescribed. Doses medications only a doctor.

Postoperative sutures are usually closed with aseptic tape. While caring for the patient, the nurse ensures that the dressing around the stitches is clean.

In the postoperative period, most often observed the following complications:

§ Hyperthermia develops mainly in infants and is expressed in an increase in body temperature to 39°C and above, often accompanied convulsive syndrome. Apply ice packs to the area great vessels(femoral arteries), the child is exposed, the skin is wiped with alcohol. As prescribed by the doctor, antipyretic drugs are administered orally or parenterally

§ Respiratory failure is expressed in shortness of breath, bluish coloration of the lips or general cyanosis, shallow breathing. Sudden cessation of breathing may occur. The complication develops suddenly and gradually. The role of the sister in prevention is especially important respiratory failure(prevention of aspiration by vomit, regular suction of mucus from the nasopharynx). In life-threatening conditions, the nurse provides first aid, providing the child with oxygen (oxygen therapy, mechanical ventilation).

§ Bleeding can be external or internal and is manifested by direct or indirect signs. Direct signs are bleeding from a postoperative wound, vomiting blood, and blood in the urine or feces. TO indirect signs include pallor skin and visible mucous membranes, cold sweat, tachycardia, decreased blood pressure. In any case, the nurse reports any signs of bleeding she notices.

§ Oliguria, anuria - reduction or cessation of urine output. A sharp decrease in the amount of urine indicates either a pronounced decrease in blood volume or kidney damage. In any case, the nurse should inform the doctor about changes in the patient’s diuresis that she notices.

Nutritional Features

For the first days after surgery on the stomach and intestines, diet No. 0 is prescribed. The food consists of liquid and jelly-like dishes. Allowed: tea with sugar, fruit and berry jelly, jelly, rosehip decoction with sugar, juices fresh berries and fruits, diluted sweet water, weak broth, congee. Food is given in small, frequent doses throughout the day. The diet is prescribed for no more than 2-3 days.

Features of nutrition after appendectomy

1st day - fasting

· 2nd day - mineral water without gases, rosehip decoction, dried fruit compote

Over the next three days:

All dishes are liquid and puree

· Frequent fractional meals in small portions

· Tea with sugar, rose hip decoction, compote

· Low-fat chicken broth

· Jelly, fruit and berry jelly

Before eating, 20-30 minutes before eating a glass of warm boiled water, and 1 glass 1.5 hours after

The postoperative diet involves avoiding:

fatty, floury, salty foods and smoked foods.

Features of nutrition after cholecystectomy

Approximate daily diet

First breakfast

A glass of rosehip broth, low-fat cottage cheese with a small amount of sour cream, carrot puree.

Lunch

A glass of tea with blackcurrant jam or lemon with white crackers.

Potato soup with carrot roots; boiled lean fish, boiled chicken or steamed beef cutlet; a glass of dried fruit compote.

A glass of milk and cookies.

Steam egg white omelette, mashed potatoes, semolina, rice, or well mashed buckwheat with milk.

Before bedtime

A glass of warm jelly with white day-old bread or crackers.

A glass of warm dried fruit compote.

Steam omelette or soft-boiled egg, steam cutlet, with carrot, potato or beetroot puree. A glass of tea.

Lunch

Compote, milk, or one-day yogurt, white bread, a slice of boiled fish.

Plate vegetable soup, mashed potatoes with meat pate or fish, tea with milk.

Tea with lemon and cookies.

Boiled beets, with a small amount of low-fat sour cream, a slice of bread, jelly.

Before bedtime

Steamed egg white omelet.

At night when waking up

A glass of fruit juice diluted with water.

Thus, the fractional balanced diet, physiotherapy as prescribed by a doctor, regular walks on fresh air, and good mood and an optimistic attitude are the key to successfully preventing unwanted complications after surgery

Features of nutrition after hemorrhoidectomy

After hemorrhoidectomy, as well as after any other operation on the digestive organs, a diet is prescribed.

In the postoperative period, days 1-2 are fasting. On the 2-3rd day - liquid and jelly-like dishes; 200ml low-fat meat or chicken broth, weak sweetened tea, rosehip infusion, fruit jelly. On the 3-4th day - add a soft-boiled egg, a steamed protein omelette, and low-fat cream. On the 5-6th day, the diet includes pureed milk porridge, mashed potatoes, and cream of vegetable soup. Meals should be divided up to 5-6 times a day, in small portions. Boiled and mashed food. Recommended vegetables: beets, carrots, zucchini, pumpkin, cauliflower. All vegetables should be consumed boiled.

From fruits: bananas, peeled apples (preferably baked), plums, apricots (can be replaced with prunes and dried apricots).

Exclude:

· Alcohol

Prevention of complications of postoperative wounds

The wound after surgery is almost sterile. Caring for such a wound comes down to keeping the dressing clean and creating peace. Several times a day you need to monitor its condition, ensuring the comfort, safety of the dressing, its cleanliness and getting wet. If the wound is sutured tightly, the bandage should be dry. If the wound gets slightly wet, the top layers of the dressing should be changed using sterile material, without exposing the wound in any way. There should be no redness, swelling, infiltration, or any discharge in the area of ​​the postoperative wound. The nurse must inform the doctor about the appearance of signs of inflammation.