甲状腺癌的护理.ppt

甲状腺癌的护理,内 容,甲状腺癌的诊断与临床 表现,术前护理及术后护理,健 康 教 育,4,1,2,3,解剖与功能,我们每个人的颈部（脖子）下方，长着像蝴蝶（又像古代战争中的防御盾牌，呈H或U型）一样的组织，叫做甲状腺（如图）,1.位于气管两侧的左右侧叶和中间的峡部组成。平均重量成大约20-25g，女性略大略重。甲状腺后面有甲状旁腺4枚及喉神经。 2.血液供应有上下左右四条动脉，所以甲 状腺血供较丰富。 3.腺体受颈交感神经节的交感神经和迷走神经支配它是人体最大的内分泌器官。,、,Description of the contents,甲状腺的主要功能是摄取、贮存碘， 合成和分泌甲状腺激素。甲状腺激素 主要有甲状腺素（四碘甲腺原氨酸， T4）和三碘甲腺原氨酸（T3）。,甲状腺疾病在普外科中是一种常见 的疾病，尤其是甲状腺腺瘤、结节 性甲状腺肿较为多见。甲状腺疾患包括 甲状腺肿、甲状腺良恶性肿瘤、甲状腺 功能亢进等。,甲状腺癌是头颈部常见恶性肿瘤之 ，约占全身恶性肿瘤的1%，女性发病率高于男性 发病初期 无明显症状，仅在颈部出现单 、质地硬而固定、表面不光滑，随吞咽上下移动的肿块。晚期癌肿除伴颈部淋巴结肿 外，常因喉返神经、气管或食管受压而出现声音嘶哑、呼吸困难或吞咽困难等。手术切除是各型甲状腺癌的基本治疗方式,甲状腺癌术应行颈淋巴结清扫，手 术创伤大，术后易出现并发症。制订有 效的护理计划，充分做好术 后护理， 术后严密观察病情，严防并发症的发生 是手术成功的关键。现将甲状腺癌术后的护理总结如下,术前护理 一. 一般护理 指导病人进行手术体位的适应性 1.训练（头颈过伸体位），即将软枕垫于肩部，保持 2.头低、颈过伸位，以利于术中手术野的暴露。同时 3.指导病人深呼吸和有效咳嗽的方法；强调戒烟的特 殊意义，鼓励病人戒烟。注意保暖，避免着凉。,二. 术前准备 保证病人术前晚充分休息和睡眠, 术前晚给予镇静安眠类药物,保证病人身心处于最 佳状态。术前一日帮助病人剃除颈部及耳后毛发， 并清洗干净。,三. 心理护理 针对病人及其家属对所患甲状腺 肿瘤性质的了解程度,有针对性地讲解有关知识,说 明手术的必要性、手术方法、术后恢复过程及预后 情况。通过心理护理使病人在坦然、平静、树立 胜疾病的良好心理状态下接受手术。,术后护理 一. 一般护理 1. 体位护理 病人麻醉清醒、血压平稳后给 予半卧位，鼓励床上活动。保证病人充足的休息和 睡眠，适当应用镇静止痛剂。 2. 饮食护理 术后6h病情平稳后,可少量饮水 若病人无不适可进少量温凉或冷流质，逐步过渡 半流质饮食及软食。,二. 心理护理 根据病人术后病理结果,指导病人调整心态,配合后续治疗。 1. 病情观察 密切观察病人生命体征、呼吸发音、吞咽、精神状况，判断有无声音嘶哑或音调降低误咽及呛咳等症状。 2.保持创面敷料清洁无渗出，及时 换潮湿敷料，并估计渗血量。 3.妥善固定颈部引流管,保持畅通，观察并记录引流液的量、颜色及性状。若有异常，及时通知医生。,三.保持呼吸道通畅 1.患者床旁必须备气管切开包、氧气、拆线缝合包等急救物品。 2.注意避免因引流管阻塞导致颈部积血、积液、压迫气管而引起呼吸不畅；鼓励和协助病人进行深呼吸和有效咳嗽必要时行超声雾化吸入，以助痰液及时排出； 3.遵医嘱给予适量镇静剂，以减轻病人因切口疼痛而不敢或不愿意咳嗽、排痰，以保持呼吸道通畅和预防肺部感染并发症。,四. 防治并发症 一. 呼吸困难和窒息 术后呼吸困难和窒息是最严重并发症，多发生于术后48h内。 1.严密观察呼吸、脉搏、血压及切口渗血情况，若发现病人有颈部紧压感、呼吸困难、烦躁、发绀等，应立即检查切口和通知医生，积极配合抢救。 2.对于血肿引起压迫的及时清除血肿；喉头水肿引起的迅速遵医嘱应用大剂量激素。 3.经处理后病人呼吸仍无改善，应果断行气管切开和吸氧；必要时送手术室做进一步检查、止血和其他处理。,二. 喉返神经和喉上神经损伤 密切 观察患者有无声音嘶哑、饮水呛咳等现象。如出现上述症状应关心安慰病人，告诉病人 这 些现象多为暂时性，可以通过理疗等处理后自行恢复。发生误咽和呛咳时指导病人坐起进食，并鼓励其半流质或固体类食物。,三. 手足抽搐 1.手术时甲状旁腺误切、挫伤或血供受累，引起甲状旁腺功能低下，出现低血钙引起手足抽搐，多发生于术后13 天，病人自觉面部、口唇周围和手、足针刺感、麻木或强直感。 2.指导病人限制含磷较高的食物，如牛奶、瘦肉、蛋黄、鱼类等。 3.可口服葡萄糖酸钙，重者遵医嘱静脉注射10%葡萄糖酸钙等。,四. 甲状腺危象 1.临床表现为术后1236h内患者出现高热、脉快而弱、大汗、烦躁不安、谵妄甚至昏迷，常伴有呕吐、腹泻。 2.应立即给予患者降温、吸氧。 3.静脉输入大量葡萄糖溶液，口服或静脉滴注碘剂、氢化可的松，使用镇静剂等。,健康教育 1. 心理调适 甲状腺癌病人术后存有不同程度的心理问题，指导病人调整心态，正确面对现实，积极配合治疗。 2. 功能锻炼 指导病人头颈部制动一段时间后,开始逐步练习活动,促进颈部的功能恢复，防止切口粘连及瘢痕收缩，直至出院后3个月。,出院指导 1.教会病人颈部自行体检的方法，若发现结节、肿 块或异常应及时就诊 2.练习颈部运动，防止颈部瘢痕 3遵医嘱口服甲状腺素片，定期复查血象，不适随诊 4如有声音嘶哑，音调变低者出院后应继续行理疗,针灸，以促进恢复 5指导患者了解甲状腺功能减退的临床表现 6指导患者多吃含碘量高的食物：海带、紫菜等， 忌烟、酒,学习目的： 甲状腺癌术后并发症的护理,谢 谢！,Click to edit title style,Description of the contents,ThemeGallery is a Design Digital Content & Contents mall developed by Guild Design Inc.,ThemeGallery is a Design Digital Content & Contents mall developed by Guild Design Inc.,ThemeGallery is a Design Digital Content & Contents mall developed by Guild Design Inc.,Title in here,Title in here,Title in here,Click to edit title style,Text in here,Text in here,Text in here,Text in here,Text in here,Text in here,Text in here,Text in here,Contents,Contents,Contents,Contents,Contents,ThemeGallery is a Design Digital Content & Contents mall developed by Guild Design Inc.,Click to edit title 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