Gwaro reNursing Mushure mekuvhiyiwa
Kuchengeta varwere mushure mekuvhiyiwa inzira dzakasiyana dzekutarisira varwere mushure mekuvhiyiwa, dzine chinangwa chekukurumidzisa kupora, kudzivirira matambudziko, kuderedza marwadzo, uye kubatsira varwere kudzokera kumabasa avo enguva dzose zvakachengeteka. Nguva yekuvhiyiwa inogona kusiyana kubva kumunhu kusvika kumunhu, zvichienderana nerudzi rwekuvhiyiwa, zera, hutano hwepamberi pekuvhiyiwa, uye kuvapo kwezvirwere zvakaita sechirwere cheshuga kana BP. Nokudaro, nyanzvi dzezvehutano, varwere, nemhuri vanofanirwa kunzwisisa nhungamiro dzekutarisira kuti vave nechokwadi chekupora kwakakwana. Chinyorwa chino chinokurukura nheyo dzakakosha dzekuchengeta varwere mushure mekuvhiyiwa, kubva pakutarisa kwekutanga kusvika pakutarisira varwere kumba.
1. Chinangwa chikuru chekuyamwisa mushure mekuvhiyiwa
Kazhinji, vanamukoti vanoitirwa mushure mekuvhiyiwa vanotarisa pazvinangwa zvikuru zvishanu. Chekutanga, kuchengetedza kushanda zvakanaka kwemhepo nekufema mushure mekubatwa nechirwere cheanesthesia. Chechipiri, kuona kuti ropa rinoyerera zvakakwana kudzivirira kuvhunduka, kubuda ropa, kana thrombosis. Chechitatu, kudzora marwadzo nekusagadzikana kuti murwere akwanise kufamba, kufema zvakanaka, uye kurara zvakakwana. Chechina, kudzivirira hutachiona uye kuona kuti ronda rinopora zvakanaka. Chechipiri, kudzorera mashandiro emuviri kuburikidza nekufamba nekukurumidza, kudya kwakakwana, uye kudzidzisa murwere asati aenda kumba.
2. Danho rekutanga: kurapwa muimba yekupora
Mushure mekuvhiyiwa, varwere vanowanzoendeswa kukamuri rekupora kana kuti PACU (Post-Anesthesia Care Unit). Munguva iyi, kutariswa kwakanyatsojeka kunodiwa nekuti murwere achiri pasi peanesthesia uye ari panjodzi yekutadza kufema zvakanaka, kusaziva zvakanyanya, kuda kurutsa, kurutsa, kana kuchinja kweBP.
Zvinhu zvinonyanya kukosheswa nevakoti zvinosanganisira:
– Kuongororwa kwemhepo inofema uye kufema: mwero wekufema, kudzika kwekufema, ruzha rwekufema, kuwanda kweokisijeni mumuviri, uye zviratidzo zvekuvharika kwemhepo inofema.
– Kuongororwa kweropa: BP, kurova kwemoyo, ruvara rweganda, tembiricha yemuviri, uye zviratidzo zvekubuda ropa.
- Kuziva: kupindura kune zvinokurudzira, kutungamirirwa, uye zviratidzo zvekuvhiringidzika.
– Marwadzo nekurutsa: kuongororwa kwehukuru hwemarwadzo uye zviratidzo zvekusvotwa kana kurutsa nekuda kweanesthesia.
– Mamiriro eronda nedhiri: tarisa kuti ronda racho rakaiswa sei, huwandu hweropa riri kubuda, kuvapo kwemvura mudhiri, uye iva nechokwadi chekuti michina yese yakaiswa zvakanaka.
Kana murwere akasimba, mashandiro ekufema akanaka, uye marwadzo akadzorwa, murwere anowanzo endeswa kuchipatara.
3. Kutarisa zviratidzo zvinokosha uye kuona matambudziko nekukurumidza
Muwadhi, zviratidzo zvehupenyu zvinoongororwa nguva nenguva. Vanamukoti vanofanira kutarisa shanduko dzinogona kuratidza matambudziko, akadai se:
– Fivha: inogona kuratidza hutachiona, atelectasis (kuputsika kwemapapu zvishoma), kana kuzvimba mushure mekuvhiyiwa.
– Kushaya simba mumuviri uye tachycardia: zvinogona kuratidza kubuda ropa, kupera mvura mumuviri, kana kuvhunduka.
– Kushaya mweya kana kudzikira kwehuwandu hwemvura: zvinogona kunge zvakabatana ne atelectasis, pneumonia, pulmonary embolism, kana mhedzisiro yemishonga inonyaradza marwadzo.
– Marwadzo akanyanya asingavandudzike: anogona kuratidza dambudziko neronda, hutachiona, kana matambudziko emukati memuviri.
Kuonekwa kwechirwere nekukurumidza kwakakosha sezvo matambudziko mushure mekuvhiyiwa anowanzo kurumidza kukura uye anoda rubatsiro rwekukurumidza.
4. Kudzora marwadzo: kiyi yekupora
Marwadzo mushure mekuvhiyiwa anowanzoitika, asi anofanira kutarisirwa zvinobudirira kuti varwere vakwanise kufema zvakadzama, kufamba-famba, uye kurara. Marwadzo anoongororwa uchishandisa chikero chenhamba (0–10) kana chimwe chikero chinoenderana nemamiriro emurwere.
Nzira dzekurapa marwadzo dzinosanganisira:
– Mishonga: mishonga inonyaradza marwadzo sezvakarairwa (semuenzaniso, paracetamol, mamwe maNSAID, kana maopioid). Vanamukoti vanoongorora migumisiro yakaipa yakadai sekusvotwa, kuvimbiwa, kudzikira kweruzivo, uye kutadza kufema zvakanaka.
– Zvisiri zvemishonga: nzira dzekuzorora, kutsausa, kuisa zvinhu panzvimbo, kudzvanya sezvakaratidzwa, uye nzvimbo yakasununguka.
– Dzidzo: Varwere vanofanira kuziva kuti kutaura nezvekurwadziwa hazvirevi kuti "havana simba," asi zvinobatsira nyanzvi dzehutano kugadzirisa marapirwo kuti vakwanise kupora nekukurumidza.
Marwadzo akadzorwa zvakanaka akaratidzwa kuti anotsigira kukurumidza kufamba uye anoderedza njodzi yematambudziko.
5. Kutarisirwa kwemaronda ekuvhiyiwa uye kudzivirira hutachiona
Kutarisirwa kwemaronda mushure mekuvhiyiwa kunovavarira kuchengetedza ronda rakachena, rakaoma, uye rakachengetedzwa. Mukoti achaongorora ronda kuti rione kana rine ruvara, kuzvimba, kutsvuka, kudziya, kunyorova kwenzvimbo, uye kuvapo kwemvura kana hwema.
Nheyo dzakakosha dzekudzivirira hutachiona dzinosanganisira:
– Geza maoko ako usati wabata ronda uye mushure mekubata.
- Nzira yekubvisa utachiona pakuchinja madhirezi.
– Tarisa zviratidzo zvehutachiona: kutsvuka kuri kupararira, kurwadziwa kuri kuwedzera, hurwa, fivha, kana maronda akavhurika.
– Kutarisira madhireni, kana aripo, kusanganisira kuyera huwandu neruvara rwemvura, kuchengetedza chibatiso, uye kuona kuti haadhonzwe kana murwere achifamba.
Varwere nemhuri vanofanirawo kudzidziswa mashandisirwo ekurapa maronda kumba, kusanganisira nguva yekudzokera kuchipatara kana paine zviratidzo zvengozi.
6. Kutarisira kufema: kudzivirira atelectasis nepneumonia
Mushure mekuvhiyiwa, kunyanya kuvhiyiwa kwemudumbu kana pachipfuva, varwere vanowanzo kufema zvisina kudzika nekuda kwekurwadziwa. Izvi zvinowedzera njodzi ye atelectasis uye pneumonia. Matanho akajairika ekuyamwisa anosanganisira:
– Kufema zvakadzama uye kukosora kunoshanda, zvichienderana nekushivirira marwadzo.
- Kushandisa spirometry yekukurudzira kana iripo.
- Nzvimbo yeSemi-Fowler kuti mapapu awedzere kukura.
- Kukurumidza kufamba kwemhepo kuti mhepo ipinde zvakanaka uye kutenderera kweropa.
- Kushanda pamwe chete mukupa okisijeni kana mvura yakawandisa.
Vanamukoti vanofanira kuongorora ruzha rwekufema, maitiro ekufema, uye kuvapo kwepundu rinonetsa kubvisa.
7. Kukurumidza kugadzwa uye kudzivirira thrombosis
Kusagona kufamba mushure mekuvhiyiwa kunogona kukonzera matambudziko akadai se deep vein thrombosis (DVT), pulmonary embolism, kuvimbiwa, uye kudzikira kwesimba retsandanyama. Saka, kufamba nekukurumidza kunokurudzirwa, zvichienderana nemamiriro emurwere uye mirairo yachiremba.
Kuedza kudzivirira thrombosis kunosanganisira:
- Kudzidzira kufamba-famba (ROM) uye kufamba-famba kwemakumbo pamubhedha.
– Famba zvishoma nezvishoma kana zvichibvumirwa, uchitanga wakagara, wakamira, wozofamba.
– Masokisi ekudzvanya kana michina yekudzvanya inopneumatic kana zvichikurudzirwa.
- Mvura yakakwana zvichienderana nemamiriro ehutano.
Zviratidzo zveDVT zvekuchenjerera zvinosanganisira kuzvimba kwegumbo rimwe chete, kurwadziwa kwemhuru, kutsvuka, uye kuwedzera kwekushisa kwemuviri.
8. Kudya kunovaka muviri, zvinwiwa, uye kubviswa kweropa
Kupora kwenyama kunoda kudya kwakakwana. Mushure mekuvhiyiwa, varwere vanowanzo shaya chekudya kana kuda kurutsa. Kudyisa kunowanzoitwa muzvikamu, kutanga nemvura yakachena, wozonwa mvura yakakwana, wozonwa mvura yakapfava, wozodya nguva dzose, zvichienderana nekuti munhu anoshivirira sei uye rudzi rwekuvhiyiwa.
Zvinhu zvakakosha zvinotariswa nevanamukoti:
– Kuenzana kwemvura: nyora pasi huwandu hwemvura inonwiwa uye inobuda mumuviri, tarisa zviratidzo zvekushaya mvura mumuviri kana mvura yakawandisa mumuviri.
– Kushanda kwenzira dzemudumbu: kurira kwemudumbu, kuzvimba, kuda kurutsa, kurutsa, kana kuzvimba kwedumbu.
– Kuzvimba: kunowanzoitika nekuda kweopioids uye kusaita maekisesaizi; kunogona kudzivirirwa nemvura yakakwana, fiber (kana zvichibvumirwa), uye kufamba kwemuviri.
– Kuchengeta weti: dzimwe nguva kunoitika mushure mekunzwa kurwadziwa; kuongorora kubuda kweweti uye kuzara kwedundira kwakakosha.
9. Rutsigiro rwepfungwa nedzidzo yevarwere
Mushure mekuvhiyiwa, varwere vanogona kunetseka, kutya maronda akazaruka, kunetseka nezvemhedzisiro, kana kunzwa kushaya simba. Rutsigiro rwepfungwa chikamu chakakosha chekuyamwisa. Vanamukoti vanogona kubatsira nekutaurirana kwakadzikama, kutsanangura maitiro, uye kubatanidzwa kwemhuri mukutarisira.
Dzidzo yekurapa usati wabuda muchipatara inosanganisira:
- Maitiro ekutora mushonga zvichienderana nenguva yakatarwa.
- Maitiro ekutarisira maronda uye nguva yekuchinja mabhandeji.
– Zvirambidzo zvemabasa (semuenzaniso kusimudza zvinorema, kutyaira, kana kuita mitambo).
– Kudya kunokurudzirwa.
- Purogiramu yekutarisa nezviratidzo zvengozi zvinofanira kugadziriswa nekukasika.
10. Zviratidzo zvengozi zvinoda kutariswa nekukasika
Varwere nemhuri vanofanira kuziva mamiriro ezvinhu anoda kutakurwa nekukurumidza kuenda kuchipatara, akadai se:
– Kubuda ropa kubva paronda kana pakusunga kunokurumidza kuzara neropa.
– Kupisa muviri zvakanyanya, kutonhora, kana kuti urwa huri kubuda kubva paronda.
– Kushaya mweya wekufema, kurwadziwa pachipfuva, kana kudzikira kweoxygen mumuviri.
– Marwadzo anowedzera uye asinganyanyi kunaka kana munhu anwa mishonga.
– Kuzvimba kana kurwadziwa kwemhuru zvinofungirwa kuti zvine chekuita neDVT.
– Kugara uchirutsa, kunetseka kudya, kana kutadza kuita weti.
Kuziva zviratidzo zvengozi nekukurumidza kunogona kudzivirira matambudziko kuti asanyanya kuipa.
Penutup
Kurapa mushure mekuvhiyiwa inzira yakazara inosanganisira kutarisa kwakanyatsojeka, kugadzirisa marwadzo, kutarisira maronda, kudzivirira hutachiona, kurovedza muviri kufema, kufambisa varwere nekukurumidza, rutsigiro rwekudya, uye kudzidzisa varwere. Kushanda pamwe chete pakati pevanamukoti, vanachiremba, varwere, nemhuri kwakakosha kuti vabudirire pakupora. Nekutarisirwa kwakakodzera uye kungwarira matambudziko, varwere vanogona kupora nekukurumidza uye zvakachengeteka, uye kudzokera kumabasa ezuva nezuva nehupenyu hwakanaka.
Kana muchida, ndinogona kugadzirisa chinyorwa chino kuti chienderane nemhando dzakasiyana dzekuvhiya (semuenzaniso, kubviswa kwepamuviri, kuvhiyiwa kwemapfupa, kuvhiyiwa kwedumbu) kana kugadzira shanduro inoshanda zvakanyanya muchimiro chekutarisa kutarisirwa kwezuva nezuva.
