First, control the pain.
Generally speaking, western medicine does not advocate pain relief, and its function is mostly achieved by anesthetizing the nerves, treating the symptoms rather than the root cause. Some western medicines, such as Demerol, are easily addictive and produce drug resistance. It is suggested that Chinese medicine be used to treat pain by cutting off the replication function of cancer cells. Pain is the main symptom of patients with advanced lung cancer, which has a great influence on patients. To control cancer pain, we should correctly understand and apply the three-step analgesic scheme;
1, body surface analgesia: Analgesia can be achieved by stimulating the skin around the pain site or the corresponding healthy side. Stimulation methods can be massage, cold pain medication, etc. , or stimulation at various temperatures, or local hot compress with 65℃ hot water bottle on wet towel for 20 minutes each time, can achieve certain analgesic effect.
2, attention transfer analgesia method: according to the patient's hobbies, put some fast-paced music, so that patients can clap their hands while enjoying it; Or let patients watch some jokes, humorous stories, and say a cross talk to distract themselves. You can also let patients sit in a comfortable chair, close their eyes, recall interesting childhood stories, or think about whatever they want, every time 15 minutes, usually 2 hours after meals, and then sit still for 2 minutes, which can achieve the purpose of transferring pain.
3, relaxation and pain relief method: the whole body can have a faint pleasure, muscle relaxation can block the pain response. Let the patient close his eyes, sigh, breathe, etc. Then bend your hips and knees and lie flat, relax your abdominal muscles and back muscles and breathe slowly. Or let the patient close his eyes in a quiet environment, inhale and exhale slowly and deeply, and let fresh air enter the lungs to achieve the purpose of relieving pain.
Second, the nursing of lung cancer patients
(1) Daily nursing
1. Bedsore prevention: The nutritional status of patients with advanced lung cancer is generally poor, sometimes accompanied by systemic edema, which is easy to produce bedsores and difficult to cure. It is particularly important to prevent bedsores. Relieve local pressure, change body position on time, and cushion vulnerable parts of the body with balloons and soft pillows to avoid long-term pressure. Keep the skin clean, especially for patients with urinary incontinence, keep the bed clean and flat, apply baking lamps to the damaged skin, and keep it dry locally.
2. Relieve symptoms: fever is one of the main symptoms of lung cancer. Patients should be told to keep warm, prevent colds and avoid pneumonia; For irritating cough, antitussive drugs can be given; When patients have persistent cough at night, they can drink hot water to reduce the irritation to the throat; If there is hemoptysis, hemostatic drugs should be given. When there is a large amount of hemoptysis, the doctor should be informed immediately, and the patient's head should be tilted to one side, and the blood in the mouth should be removed in time to prevent suffocation and assist the doctor in rescue.
3. Observation and nursing: Patients with advanced lung cancer often have metastases from different parts of the tumor, causing different symptoms. Pay attention to observation and give corresponding care. Such as liver and brain metastasis, sudden coma, convulsion, blurred vision, etc., nurses should find it in time and give symptomatic treatment. Patients with bone metastasis should strengthen limb protection. Abdominal metastasis often leads to intestinal obstruction. Pay attention to observe whether the patient has symptoms such as abdominal distension and abdominal pain. Because of weakness, fatigue, decreased activity and other reasons, patients often have constipation, and should be given kaisai dew or laxatives in time to relieve constipation. Malnutrition and low plasma protein can cause edema. Measures such as increasing nutrition and raising the affected limb should be taken to reduce edema.
4. Psychological care: Patients with advanced lung cancer will have anxiety, fear and sadness, and often appear apathy and loneliness. We should have a high degree of sympathy and sense of responsibility, strive to create a warm and harmonious culture environment for patients, and put them in a single ward with cordial language and sincere attitude, encourage patients to express their psychological feelings, enlighten them in time, and actively introduce patients with information about their improvement. Nursing care of patients with advanced lung cancer is mainly to control symptoms, relieve patients' pain, create a comfortable culture environment and give patients the greatest spiritual support and psychological comfort. In addition, anti-cancer Chinese medicine can also be used for conditioning. Although western medicine takes effect quickly, it is extremely unstable, easy to relapse, with large side effects, easy to produce drug resistance, and it can treat the symptoms rather than the root cause.
(2) postoperative care
After lung cancer surgery, patients should be forbidden to smoke, so as not to promote recurrence. If there is pulmonary hypofunction, patients should be instructed to gradually increase exercise.
Always pay attention to the patient's recovery after operation. If there is a recurrence, you should immediately go to the hospital for a doctor's consultation and decide whether to have radiotherapy or chemotherapy.
Postoperative lung squamous cell carcinoma is easy to invade the local area and cause intrathoracic recurrence.
Lung adenocarcinoma or undifferentiated carcinoma is prone to distant metastasis, such as lymph nodes, bones, liver, brain and contralateral lung.
Always pay attention to whether the patient has fever, severe cough, blood in sputum, shortness of breath, chest pain, headache, vision change, pain in liver area, bone pain, supraclavicular lymph node enlargement, liver area enlargement, etc. If you notice the above symptoms, you should go to the hospital in time. At the same time, patients should go to the hospital regularly for chest fluoroscopy and take fresh sputum to check cancer cells. (3) Psychological nursing
1 psychological counseling
The psychophysiology of patients with advanced lung cancer is relatively fragile, especially when they are just diagnosed, which is difficult for patients and their families to accept. Nurses should take the initiative to care for and comfort patients when they are admitted to the hospital, introduce ward environment, introduce doctors and nurses in charge, eliminate patients' strangeness and nervousness, reduce patients' fear of hospitalization, help patients understand patients, guide their families to give strong support in spirit and life, and take various forms to do psychological counseling for patients in time.
Comfort patients with language art
Nurses should treat patients sincerely, talk naturally, always show concern and sympathy for patients, seek help that patients need, let patients have trust in nurses, and talk to patients about their inner changes. Nurses can capture information in time by talking with patients, give appropriate psychological care at the right time, eliminate patients' worries, stabilize patients' emotions, stimulate patients' confidence in treatment, and actively and optimistically cooperate with doctors and nurses.
1.2 Establish a good nurse-patient relationship.
Establishing a good nurse-patient relationship is the premise of timely and effective psychological consultation, so nurses should communicate with patients frequently. Close the distance with the patient through chatting, listen to the patient's complaints patiently, and use what you have learned to explain the illness properly [1], understand the feelings and emotional changes hidden in the patient's language through conversation, and take effective psychological care in time.
2 to meet the psychological needs of patients
Patients with advanced cancer have many demands, which affect their mood and behavior. Therefore, it is necessary to carefully observe the needs of patients and meet their various needs.
2. 1 survival needs
Survival is the strongest demand of cancer patients. They are eager to continue to feel the value of life and need people's understanding and support. Therefore, it is necessary to establish a good nurse-patient relationship with patients and their families, encourage their families and relatives to be considerate and take care of patients, and visit patients frequently to make them feel warm. As medical staff, especially department directors and head nurses, we should often visit patients and give them encouragement, so that patients can feel warm and caring everywhere in this extraordinary big family of the hospital, and let him firmly overcome the confidence of the disease and actively cooperate with the treatment.
2.2 Physiological needs
Patients with advanced lung cancer are characterized by dyspnea, which leads to poor quality of life. Many patients have irritability, irritability, pessimism, insomnia, and even suicidal tendencies. Nurses should keep abreast of the dynamic changes of patients' thoughts, find problems in time and give corresponding treatment. For example, a 64-year-old female patient was admitted to hospital and diagnosed with small cell lung cancer. After repeated treatment of 1 year, her condition did not improve, with consolidation of one lung and only two-thirds of the lung function on the other side, accompanied by pericardial effusion. The patient's cough, irritability, poor sleep and extremely unstable mood cannot be guaranteed. When chatting with patients, it was found that the quality of life of patients was extremely low due to repeated illness and the development of the disease, and patients lost confidence in treatment and exposed suicidal tendencies. Nurses enlighten patients in time, introduce optimistic attitude towards life to patients in the same boat, and encourage patients to give up any scruples as much as possible and seek spiritual support. Timely nursing the cause, teaching patients to master several hypnotics such as rosary and listening to light music, and giving symptomatic treatment, so that patients can get rid of the pain of insomnia, regain their spirits and actively cooperate with the treatment.
(4) Diet care
1. Patients with lung cancer should choose their food freely without swallowing difficulties. Under the condition of not affecting the treatment, we should eat more foods containing protein and rich in carbohydrates, so as to improve the diet quality and create good conditions for the operation. If the nutritional status is poor, it is difficult to tolerate surgical trauma, and the postoperative healing is slow and easy to be infected, which is not conducive to surgical rehabilitation.
2. It is required that the diet contains various nutrients necessary for the human body. When the heat supply is sufficient, it can supplement protein nutrition and promote the synthesis of muscle protein. When the heat supply is insufficient, branched-chain amino acids can also provide more heat energy. There are many kinds of essential diets, and the application should start with low concentration. If you take it orally, you should pay attention to drinking it slowly. Because the essential diet is hypertonic, if it is introduced too quickly, it will easily cause diarrhea and vomiting.
3, postoperative diet deployment: according to the condition of postoperative diet deployment. Because surgical trauma can cause dysfunction of digestive system, so don't rush to seek success in food selection and tonic. Everyone should eat more fresh vegetables and fruits. Fruits and vegetables are rich in vitamin C, which is an anticancer substance and can block the formation of cancer cells. In addition, garlic also contains anticancer substances. Develop good living and eating habits, regular physical examination, timely diagnosis and treatment.
(5) Common sense of home care for lung cancer patients
In addition, we should also observe whether the patient has cough, expectoration, hemoptysis, chest pain, chest tightness, dyspnea, fever and other abnormal conditions. Pay special attention to dysphagia, hoarseness, edema of head, neck and upper limbs or ptosis. If dysphagia occurs, it indicates that the tumor invades or oppresses the esophagus; If there is hoarseness, it suggests that the tumor directly or indirectly compresses the recurrent laryngeal nerve; If head and neck edema, chest congestion and varicose veins occur, accompanied by headache, dizziness or dizziness, it indicates that superior vena cava compression syndrome has occurred; Horner's syndrome is suggested if there are ptosis of the upper eyelid, enophthalmos, miosis, and no sweat on the forehead and upper chest on the same side as the lung tumor.
Iii. Precautions for Advanced Lung Cancer
1. The diet is rich and varied, light and nutritious, with meat porridge, fish porridge, egg porridge, glutinous rice porridge, lily porridge, wolfberry porridge and other kinds of porridge and soup as the main ingredients, with fruits and fresh vegetables.
2. Help patients who can't take care of themselves turn over, scrub and massage their hands and feet regularly every day. Safflower alcohol can be applied to the compressed part to prevent bedsore. 3. For patients with pain, we should try our best to meet their pain relief requirements and not be afraid of the addiction of narcotic analgesics to improve their quality of life.
For patients who can exercise slightly, they can walk slowly, take a walk and exercise their bones and muscles, and don't overdo it.
5. You can listen to light music, folk music and Beethoven's symphony of destiny properly to relax your body and mind and improve your quality of life.
6. Give patients more spiritual comfort, eliminate their fear of death, encourage and cultivate their spouses and relatives, caress and hug patients, speak out of turn, communicate more, express their love and nostalgia for patients, so that patients can get spiritual happiness.
7. Closely observe the changes of the patient's breathing, blood pressure, pulse, body temperature and consciousness. If there is any abnormality, report to the doctor immediately and deal with the symptoms.
8. If you cough with phlegm, encourage the patient to cough it up by himself. If you have difficulty in expectoration, pat your back to help you expectorate, use a sputum aspirator if necessary, and pay attention to tilting your head to one side during rest and sleep to prevent suffocation. If the patient is found to have sudden aphasia, face change and respiratory arrest, he must immediately report to the doctor for emergency rescue.