What are the nursing methods for advanced liver cancer? Comprehensive nursing methods for advanced liver cancer

Primary liver cancer is a common disease in my country and Asia. Many (primary) liver cancers are already in the middle or late stages or complicated by other diseases (such as cirrhosis) when they are discovered, making them unsuitable for surgical treatment. Transcatheter hepatic artery infusion chemoembolization can effectively control the growth of cancer cells in the treatment of middle and late stage liver cancer. It has become a common method for middle and late stage liver cancer that cannot be surgically removed, and it is effective for both primary liver cancer and metastatic liver cancer. In clinical practice, attention should be paid to clinical observation and enhanced nursing care for patients undergoing interventional treatment for middle and late stage liver cancer. The key points of nursing care are introduced as follows:

1 Preoperative Care

1.1 Basic care

Patients should pay attention to nutritional supplementation before surgery. Patients are encouraged to take easily digestible high-nutrition, high-vitamin, low-fat diets and get enough sleep. Preoperative surgical field skin preparation, iodine allergy test, and fasting for 4 hours before surgery. Complete various preoperative examinations. After admission, the patient is in charge of the responsible nurse. In order to ensure that the interventional treatment can be carried out safely and smoothly and reduce toxic side effects, the responsible nurse must master the relevant information of the patient before treatment, such as the patient's condition and psychological state; the development of the disease and treatment; the patient's understanding of the current treatment plan, etc. At the same time, the patient's physical condition should be evaluated, including nutritional status, physical examination and laboratory tests. For those with poor physical condition, such as extreme emaciation, anemia, platelets and white blood cells below normal values, supportive therapy should be strengthened first, and this treatment should be carried out after the physical condition improves.

1.2 Preoperative care

(1) Knowledge education: Provide patients and their families with disease treatment, rehabilitation knowledge and professional nursing guidance. Guide patients to perform self-care based on relevant nursing issues, help them establish an effective knowledge system and master self-care skills.

(2) Health education: Most patients with advanced lung cancer have psychological barriers to varying degrees, lack confidence in interventional treatment, and show doubts, fear, and tension. The responsible nurse must patiently and meticulously provide psychological counseling and explanations, explain in detail the basic principles and processes of interventional treatment, care for patients and relieve their pain in a timely manner, so that patients can receive treatment in the best condition. The nurse must also explain to patients and their families the importance and necessity of bed rest and immobilization of the limbs after surgery, and train patients on how to urinate and defecate in bed.

(3) Routine preparation before surgery: Liver and kidney function, blood routine and prothrombin time should be checked before surgery. No food or water should be taken for 6 hours before surgery. The patient should be asked to wash the skin at the puncture site and prepare the skin on both sides of the groin area. Allergy tests for iodine, penicillin and procaine should be performed according to the doctor's instructions.

1.3 Psychological care

Most patients undergoing interventional therapy are irritable, fearful, anxious, pessimistic, and skeptical about treatment, or have too high expectations for treatment. If health education and psychological care before surgery are not in place, the treatment effect will be seriously affected. Moreover, most patients with liver cancer do not know their condition. Therefore, medical staff should communicate more with patients and their families, understand patients' understanding of the disease and their psychological reactions, carry out psychological care in a targeted manner, and formulate effective health education plans based on individual teaching. For patients who are mentally healthy, cheerful and optimistic, and aware of the disease, nurses should give more encouragement, patiently and carefully explain the process of interventional treatment, possible side effects and treatment principles, increase patients' confidence in overcoming the disease, and improve their self-protection ability. For patients who are psychologically fragile and unaware of the disease, nurses should be cautious, tactful, and optimistic in their communication with them, mobilize the enthusiasm of patients, convey to patients a positive mental state, and improve patients' psychological defense ability. At the same time, they should communicate more with their families, obtain their cooperation, and establish a mutually involved nurse-patient relationship, thereby improving the treatment effect.

2. Intraoperative Care

During the interventional treatment, in addition to providing psychological care for the patients, the nurses should also closely observe the injection of drugs and the operation of embolic agents, and avoid reflux of embolic agents into non-target vessels; closely observe changes in the patient's vital signs, and immediately increase the oxygen flow and concentration if there are symptoms such as irritability, chills, cyanosis, etc., and be prepared for first aid; observe for sputum and sputum secretions at any time, and deal with them in a timely manner.

3. Postoperative Care

3.1 Care of the puncture site

The patient must stay in bed for 24 hours, and a pressurized salt bag should be placed on the puncture site for 6 hours to prevent wound infection caused by dust leakage from the sandbag. The patient should be instructed to straighten the limb on the surgical side and immobilize for 8 hours. Closely observe the skin temperature, dorsalis pedis artery pulsation and skin color of the limb on the surgical side, observe whether there is congestion or hematoma on the skin at the puncture site, whether the dressing is contaminated, and whether the salt bag is displaced. If abnormal, handle it in time.

3.2 Postoperative Care

(1) Care of the puncture site: The most common complication of interventional therapy is hematoma at the puncture site. Therefore, after the operation, the puncture site is compressed for 15 minutes and then a roll of bandage is used to compress the puncture site. The limb on the side of the surgery is immobilized in the straight position for 8 hours, and the patient stays in bed for 12 hours. The puncture site should be closely observed for bleeding and subcutaneous hematoma. If there is bleeding, the dressing should be changed in time to keep the puncture site dry to prevent infection.

(2) Closely observe changes in the patient's vital signs: After surgery, pay attention to changes in the patient's body temperature, pulse, blood pressure, and limb color, especially the pulsation of the dorsalis pedis artery on the surgical side, peripheral blood circulation, and skin temperature.

(3) Hydration care: Since local infusion of large doses of anticancer drugs has obvious toxic and side effects, hydration therapy is particularly important. Within 3 days after surgery, intravenous infusion is performed at 2500-3000 ml per day. The drip rate is adjusted according to the patient's condition, 60-80 drops/min. For the elderly or patients with heart and kidney dysfunction, the drip rate can be reduced. Patients are encouraged to drink more water, no less than 2500 ml per day, and urinate more than 3000 ml, so that the drug toxins can be excreted through the kidneys as soon as possible.

(4) Monitoring of body temperature: Closely observe changes in body temperature, and provide timely physical cooling according to the patient's condition. If necessary, use medication to cool the patient down. When sweating a lot, change the patient's bed sheets, blankets, and clothes in time, and provide good oral and skin care.

(5) Nursing for gastrointestinal reactions: Patients should fast for 4 to 6 hours after surgery. The adverse reactions of chemotherapy drugs may cause nausea and vomiting. Explanation should be given during nursing care, and injections of metoclopramide and sutoflavone should be given to alleviate gastrointestinal reactions. The diet should be light, with small and frequent meals. Oral care should be strengthened to reduce adverse stimulation and promote toxin excretion.

(6) Pain care: Within 2 to 3 days of interventional treatment, pain may occur in the tumor area due to tumor tissue necrosis. While strengthening observation of the patient's condition, nurses should also do a good job of comforting the patient. When the pain is intolerable, the location, nature, and degree of the pain should be closely observed to distinguish it from pain caused by other complications. If necessary, painkillers should be used as prescribed by the doctor.

3.3 Observation and care of complications

Post-embolization syndrome is a common complication after embolization therapy, mainly manifested as fever, abdominal pain, nausea, vomiting and paralytic intestinal distension. Nurses should closely observe changes in the patient's vital signs, patrol the ward once every 30 minutes, and measure the body temperature once every 4 hours. Fever after embolization therapy usually does not exceed 38.5℃ and can gradually return to normal within 1 week. If the body temperature is too high, give alcohol baths and ice compresses in time, and give drugs to cool down when necessary. Pay attention to keeping warm, prevent cold, and replenish water in time to avoid excessive cooling and collapse. To prevent infection, antibiotics can be used before and after surgery. When the pain in the right upper abdomen is severe, analgesics should be used. Pay close attention to whether there is dyspnea, sputum, cyanosis, respiratory rate, heart rate, and heart rhythm changes, and give timely treatment when abnormal.