Nursing care for patients with pelvic fractures

Due to external factors, the integrity of the bone is destroyed and the pelvic bone structure is damaged. Clinically, this disease is called pelvic fracture. After the fracture occurs, the shape of the pelvis changes, and the patient will experience clinical manifestations such as pain in the affected area, difficulty in movement, and bruising around the urethra. It has a high mortality rate and disability rate. Affected by symptoms such as difficulty in movement and severe pain after the fracture, the patient's self-care ability is reduced and the degree of cooperation with treatment is poor. At the same time, most patients will also experience self-perception burden, which affects their confidence in treatment and has an adverse effect on the treatment of the disease and prognosis recovery. Therefore, for patients with this disease, in addition to active treatment, effective nursing intervention is crucial. When the disease occurs, we will briefly introduce how to provide correct nursing intervention and how to improve self-management ability.

1. Reasonable diet care

Reasonable diet is of vital importance to the recovery of the disease. Guiding patients to eat scientifically and making good dietary plans can not only reduce the occurrence of complications but also have a positive effect on the recovery of patients. In terms of dietary structure, the intake of nutrients such as vitamins and proteins should be increased, including the consumption of a variety of fresh fruits and vegetables, and the intake of dairy products and eggs. For patients who need long-term bed rest, give them easily digestible food intake, increase the amount of water they drink, and promote body metabolism. Avoid eating fried, spicy and irritating foods. After the patient has just finished surgical treatment, liquid foods such as lotus root powder and thick rice soup should be given first. One day after the operation, semi-liquid foods such as soup noodles and meat floss porridge can be replaced. When the patient recovers better and there are no symptoms of a series of gastrointestinal discomfort such as abdominal distension, vomiting, and nausea, they can gradually transition to a normal diet, but high-cholesterol foods are forbidden. For those who have a series of gastrointestinal discomfort symptoms such as abdominal distension or accompanied by pelvic organ damage, they should first fast and give intravenous nutrient solution. After the patient's intestinal function is restored, the diet can be gradually restored according to the above rules, and the gas discharge is often used to determine whether the intestine has recovered.

2. Correct traction care

Traction is essential for pelvic reduction. Correct traction operation helps the pelvis to return to its normal anatomical position as soon as possible. Therefore, when traction is applied to patients, attention should be paid to the control of the traction direction and the strength. Wrong traction direction will result in the failure of pelvic reduction. Too loose traction will directly affect the reduction effect, while too much traction will easily cause secondary damage to the fracture site. In addition, during the traction process of the patient, attention should be paid to the patient's limb mobility and blood circulation, and the skin color, skin surface temperature, dorsalis pedis artery pulsation and capillary filling of the limbs should be recorded and monitored. Once an abnormality is found, the traction strength should be adjusted in time. At the same time, since patients need to stay in bed for a long time during traction treatment, the frequency of mattress application and replacement should be increased to ensure that the traction belt is in a flat state to prevent the occurrence of pressure sores, and hot compresses, massages and other methods can be used to improve the blood circulation of the compressed parts. When traction is applied to the lower limbs, traction belts should be used on both sides of the pelvis at the same time to prevent pelvic tilt.

3. Complication prevention care

3.1 Prevention and care of pneumonia

In order to promote a more stable pelvic recovery, the patient needs to ensure absolute bed rest. Long-term bed rest is very likely to induce aspiration pneumonia. In order to reduce the risk of this complication, when the patient has sputum, the patient's upper body can be lifted by a traction bed and the patient's back can be tapped. If the patient is still unable to expectorate on his own, the sputum can be diluted by atomization inhalation to promote sputum discharge.

3.2 Prevention and care of urinary tract infection

Long-term bed rest will slow down the patient's metabolism. The patient needs to increase the amount of water he drinks every day, massage his abdomen to promote urination, keep a record of the amount of urine he has urinated, and ensure that the daily urine volume is not less than 1500mL to clean the bladder. Then, add metronidazole to the sodium chloride injection to flush the bladder, ensure the stability of the catheter and the filling degree of the balloon, and then dilate the patient's urethra after the catheter is removed to prevent the occurrence of urethral stenosis.

3.3 Prevention and care of venous thrombosis

Slowing of venous blood flow, blood coagulation, and blood stasis are all factors that cause venous thrombosis. Long-term bed rest will cause the patient's overall blood flow to slow down. In addition, the pelvic wall venous plexus of patients with pelvic fractures will be damaged, which will increase the risk of thrombosis. Therefore, for six hours after surgery, patients can be given an intermittent pressure pump twice a day for one hour each time to accelerate the blood circulation of the patient's limbs and reduce the occurrence of swelling. And one day after surgery, guide the patient to conduct rehabilitation training, including quadriceps contraction training and ankle flexion and extension training. At the same time, percutaneous injection of low molecular weight heparin is given twice a day. Venous thrombosis prevention is carried out through multiple routes and methods, and during treatment, the patient's bleeding tendency is monitored, including observing whether the patient has skin and mucosal bleeding.

4. Traditional Chinese medicine nursing

4.1 Massage care

Tuina is a method of balancing yin and yang, harmonizing qi and blood, relaxing muscles and activating blood circulation, and activating meridians by performing a series of operations such as patting, kneading, and massaging the human body. Tuina can relax the muscles of patients after surgery, relieve muscle tension and pain, and enhance the return of venous blood and lymph, thereby relieving congestion and edema. Tuina can also enhance the range of motion of joints and prevent contracture and stiffness. Most massages can only be performed after the fracture has recovered more stably to prevent the fracture from being repositioned and displaced, resulting in failure of repositioning. The best time for massage is one month after surgery, and professional doctors will perform massage on the abdomen, limbs and other parts of the patient.

4.2 Acupuncture Nursing

Acupuncture is a method of promoting the balance of qi, blood, yin and yang in the body by applying heat or needling corresponding acupuncture points. Acupuncture for patients with this disease can effectively solve the problem of patients' dependence on analgesics and relieve pain. At the same time, it can promote fracture healing, regulate endocrine, strengthen immunity, and reduce the risk of infection. It can also improve nerve function and prevent local paralysis and numbness caused by nerve damage. Acupuncture should be performed by a professional doctor, and the corresponding acupuncture points should be selected according to the patient's symptoms, including Quchi point, Sanyinjiao point, Xuehai point, etc.

In summary, in order to promote the recovery of patients with pelvic fractures, comprehensive and detailed nursing intervention is very important.

Author: Wang Qinying, People's Hospital of Aba Tibetan and Qiang Autonomous Prefecture