Cell Biochem Biophys DOI 10.1007/s12013-014-0493-4
ORIGINAL PAPER
Nursing Care of Lower Respiratory Tract Infection After Abdominal Surgery Caixia Cao • Liying Zhang
Ó Springer Science+Business Media New York 2015
Abstract The harm, the causes, and nursing care methods of lower respiratory tract infection after abdominal operation were described in this article. Keywords Nursing care Operation Lower respiratory tract Infection
brought from oro-pharynx to the respiratory tract by invasive procedures. The disappearance of cough reflex after general anesthesia may lead to the accumulation and leakage of the secreta around the tracheal tampon, which facilitates bacteria to enter the bronchus and lungs [1]. Accumulation of Respiratory Secretions
Introduction Lower respiratory tract infection after abdominal surgery is one of the most common diseases in clinical practice and can result in severe complications with an incidence rate of 13–17.5 %. Prevention and care of respiratory tract infections are critical for a successful outcome. Here, we describe the causes of respiratory tract infections after abdominal surgery and the nursing care required for patients.
It is not easy to discharge secreta due to a decrease in respiratory tract clearing in patients who are bed ridden. Thus, the secreta is subsequently deposited in the pulmonary fundus. Another cause is that patients are unwilling to breath deeply and cough effectively from fear of pain after abdominal surgery, resulting in an absence of respiratory tract secreta discharge and subsequent deposits in the lower respiratory tract. Breathing and coughing are inhibited by the anesthetics and analgesics, thus weakening the sputum discharge. Fluid loss during surgery and fasting after surgery lead to sputum thickness, increasing the difficulty of discharging the secreta [2].
Causes of Infections Medical Devices Contamination Invasive Procedures If the respiratory tract is not sufficiently cleared, bacteria can easily invade the lower respiratory tract and cause infections, leading to disease deterioration or even death. Abundant bacteria in the oro-pharynx and nose are the main cause of iatrogenic respiratory tract infection. The bacteria may be C. Cao L. Zhang (&) Department of General Surgery, Jiangsu Jiangyin People’s Hospital, Shou Shan Road 163, Jiangyin City 214400, China e-mail: [email protected]; [email protected] C. Cao e-mail: [email protected]
Atomizing inhalation devices, oxygen tubes, humidifiers, and ventilator pipes, which are not completely disinfected or stored improperly, may lead to contamination. Thus, the absence of strict aseptic procedures during inhalation and endotracheal intubation, sputum suction, use of anesthesia machines, and an absence of strict sterilization of those devices may result in widespread contamination of bacteria, causing or aggravating the lower respiratory tract infection. Improper Use of Antibiotics Some doctors use antibiotics based on their experience, without pathogenic bacteria cultivation or drug-sensitive test.
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Moreover, long-term use of broad-spectrum antibiotics inhibits the growth of normal flora in the oro-pharynx and stomach, leading to mass propagation of opportunistic and drug-resistant bacteria. When bacteria or fungi are inhaled into lower respiratory tract, bronchial or pulmonary infection may occur.
prednisolone, and chymotrypsin could be considered 6 days post-surgery to prevent and control infection, humidify the trachea, and to dilute the sputum. Strict Aseptic Techniques Devices Disinfection
Nursing Strategies Elimination of Predisposing Factors Lower respiratory tract infection after abdominal surgery most commonly occurs amongst individuals with reduced immunity. Hence, it is important to prevent the infection before surgery. Patients must be encouraged proper food intake to ensure sufficient energy and abundant vitamins to enhance their tolerance levels. Patients are required to quit smoking and must be educated on the prevention of respiratory tract infection.
Use disposable endotracheal intubation, sputum intubation, and mask devices for one patient only. Disinfect ventilator pipes periodically and keep the fluid in the humidifiers and atomizers aseptic. Disinfect breathing machines periodically. Disinfect atomizers, oxygen humidifiers, and tubes, and keep them in a dry place to avoid bacterial growth if not being used. Perform oral care once per shift on the patients who have trans-nasal intubation and indwelling of stomach tubes to reduce formation of the oro-pharynx bacteria and the spreading of gastrointestinal bacteria into the respiratory tract to cause infection [3]. Hand Hygiene
Assisting Patients to Discharge Sputum Keeping the Airway Open Place the patient’s head in a horizontal position with the head toward one side, and clear the oral cavity. Perform suction with soft and agile movements if the endotracheal intubation is left. Then, supply patients with 3–4 L/min oxygen with a tracheal incision. Increase oxygen flow (4 L/ min) before suction and perform suction 2 min after measuring oxygen. Offer 5 L/min oxygen after the completion of suction and regulate oxygen flow after balance. Each time, the suction should be finished within 15 s.
The percentage of infection caused by bacteria transmission via the hands of medical staff reaches 30 % or so. Thus, medical staff must practice prevention by washing their hands thoroughly. Intensive washing of the hands is the most important preventative practice to avoid exogenous nosocomial infection caused by procedures carried out by medical staff. Environmental Monitoring Take the possibility of lower respiratory tract infection caused by environmental pollution into account. Keep the hospital wards clean and limit the number of visiting members.
Effective Coughing and Expectoration
Drug Use
Assist patients to stand and pat them on their back. Press the incision and the patient’s stomach to reduce pain when coughing. Encourage patients to take a deep breath and cough. Convert ineffective coughing to effective coughing, by coughing out sputum in two steps. Firstly, take 5 or 6 deep breaths at one time and keep the mouth open to proceed with another deep breath. Then cough mildly to remove sputum from the pharynx and cough out the sputum rapidly.
Follow physicians’ advice on using antibiotics, perform bacteria cultivation and drug-sensitive test, and select the third-generation antibiotics when an infection is suspected. Nurses should master the pharmacology of various antibiotics, follow physicians’ advice accurately, and observe drug response to shorten the time of drug use.
Humidifying the respiratory tract
References
Respiratory tract infection is the most common complication which occurs within 3 days after surgery, and prevention should be considered during this period. Offer the patient ultrasonic atomizing inhalation, 2–3 times per day, to humidify respiratory tract sufficiently. Gentamicin,
1. Gao, D. (2008). Nursing of surgery (2nd ed., p. 501). Beijing: People’s Medical Publishing House. 2. Wang, Z., & Zhou, L. (2009). Critical care (pp. 70–71). Beijing: People’s Military Medical Press. 3. Lou, R. (2008). The safety problems and strategies faced by nursing management. Chinese Journal of Misdiagnosis, 8, 1347.
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ORIGINAL PAPER
Nursing Care of Lower Respiratory Tract Infection After Abdominal Surgery Caixia Cao • Liying Zhang
Ó Springer Science+Business Media New York 2015
Abstract The harm, the causes, and nursing care methods of lower respiratory tract infection after abdominal operation were described in this article. Keywords Nursing care Operation Lower respiratory tract Infection
brought from oro-pharynx to the respiratory tract by invasive procedures. The disappearance of cough reflex after general anesthesia may lead to the accumulation and leakage of the secreta around the tracheal tampon, which facilitates bacteria to enter the bronchus and lungs [1]. Accumulation of Respiratory Secretions
Introduction Lower respiratory tract infection after abdominal surgery is one of the most common diseases in clinical practice and can result in severe complications with an incidence rate of 13–17.5 %. Prevention and care of respiratory tract infections are critical for a successful outcome. Here, we describe the causes of respiratory tract infections after abdominal surgery and the nursing care required for patients.
It is not easy to discharge secreta due to a decrease in respiratory tract clearing in patients who are bed ridden. Thus, the secreta is subsequently deposited in the pulmonary fundus. Another cause is that patients are unwilling to breath deeply and cough effectively from fear of pain after abdominal surgery, resulting in an absence of respiratory tract secreta discharge and subsequent deposits in the lower respiratory tract. Breathing and coughing are inhibited by the anesthetics and analgesics, thus weakening the sputum discharge. Fluid loss during surgery and fasting after surgery lead to sputum thickness, increasing the difficulty of discharging the secreta [2].
Causes of Infections Medical Devices Contamination Invasive Procedures If the respiratory tract is not sufficiently cleared, bacteria can easily invade the lower respiratory tract and cause infections, leading to disease deterioration or even death. Abundant bacteria in the oro-pharynx and nose are the main cause of iatrogenic respiratory tract infection. The bacteria may be C. Cao L. Zhang (&) Department of General Surgery, Jiangsu Jiangyin People’s Hospital, Shou Shan Road 163, Jiangyin City 214400, China e-mail: [email protected]; [email protected] C. Cao e-mail: [email protected]
Atomizing inhalation devices, oxygen tubes, humidifiers, and ventilator pipes, which are not completely disinfected or stored improperly, may lead to contamination. Thus, the absence of strict aseptic procedures during inhalation and endotracheal intubation, sputum suction, use of anesthesia machines, and an absence of strict sterilization of those devices may result in widespread contamination of bacteria, causing or aggravating the lower respiratory tract infection. Improper Use of Antibiotics Some doctors use antibiotics based on their experience, without pathogenic bacteria cultivation or drug-sensitive test.
123
Cell Biochem Biophys
Moreover, long-term use of broad-spectrum antibiotics inhibits the growth of normal flora in the oro-pharynx and stomach, leading to mass propagation of opportunistic and drug-resistant bacteria. When bacteria or fungi are inhaled into lower respiratory tract, bronchial or pulmonary infection may occur.
prednisolone, and chymotrypsin could be considered 6 days post-surgery to prevent and control infection, humidify the trachea, and to dilute the sputum. Strict Aseptic Techniques Devices Disinfection
Nursing Strategies Elimination of Predisposing Factors Lower respiratory tract infection after abdominal surgery most commonly occurs amongst individuals with reduced immunity. Hence, it is important to prevent the infection before surgery. Patients must be encouraged proper food intake to ensure sufficient energy and abundant vitamins to enhance their tolerance levels. Patients are required to quit smoking and must be educated on the prevention of respiratory tract infection.
Use disposable endotracheal intubation, sputum intubation, and mask devices for one patient only. Disinfect ventilator pipes periodically and keep the fluid in the humidifiers and atomizers aseptic. Disinfect breathing machines periodically. Disinfect atomizers, oxygen humidifiers, and tubes, and keep them in a dry place to avoid bacterial growth if not being used. Perform oral care once per shift on the patients who have trans-nasal intubation and indwelling of stomach tubes to reduce formation of the oro-pharynx bacteria and the spreading of gastrointestinal bacteria into the respiratory tract to cause infection [3]. Hand Hygiene
Assisting Patients to Discharge Sputum Keeping the Airway Open Place the patient’s head in a horizontal position with the head toward one side, and clear the oral cavity. Perform suction with soft and agile movements if the endotracheal intubation is left. Then, supply patients with 3–4 L/min oxygen with a tracheal incision. Increase oxygen flow (4 L/ min) before suction and perform suction 2 min after measuring oxygen. Offer 5 L/min oxygen after the completion of suction and regulate oxygen flow after balance. Each time, the suction should be finished within 15 s.
The percentage of infection caused by bacteria transmission via the hands of medical staff reaches 30 % or so. Thus, medical staff must practice prevention by washing their hands thoroughly. Intensive washing of the hands is the most important preventative practice to avoid exogenous nosocomial infection caused by procedures carried out by medical staff. Environmental Monitoring Take the possibility of lower respiratory tract infection caused by environmental pollution into account. Keep the hospital wards clean and limit the number of visiting members.
Effective Coughing and Expectoration
Drug Use
Assist patients to stand and pat them on their back. Press the incision and the patient’s stomach to reduce pain when coughing. Encourage patients to take a deep breath and cough. Convert ineffective coughing to effective coughing, by coughing out sputum in two steps. Firstly, take 5 or 6 deep breaths at one time and keep the mouth open to proceed with another deep breath. Then cough mildly to remove sputum from the pharynx and cough out the sputum rapidly.
Follow physicians’ advice on using antibiotics, perform bacteria cultivation and drug-sensitive test, and select the third-generation antibiotics when an infection is suspected. Nurses should master the pharmacology of various antibiotics, follow physicians’ advice accurately, and observe drug response to shorten the time of drug use.
Humidifying the respiratory tract
References
Respiratory tract infection is the most common complication which occurs within 3 days after surgery, and prevention should be considered during this period. Offer the patient ultrasonic atomizing inhalation, 2–3 times per day, to humidify respiratory tract sufficiently. Gentamicin,
1. Gao, D. (2008). Nursing of surgery (2nd ed., p. 501). Beijing: People’s Medical Publishing House. 2. Wang, Z., & Zhou, L. (2009). Critical care (pp. 70–71). Beijing: People’s Military Medical Press. 3. Lou, R. (2008). The safety problems and strategies faced by nursing management. Chinese Journal of Misdiagnosis, 8, 1347.
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