Patients with lumbar disc herniation on clinical care path

[Abstract] Objective To investigate the clinical care pathway in patients with lumbar disc herniation surgery applications. Way to our department on 2009 -2010 .3 .5 on 80 cases of lumbar disc herniation surgery care and implementation of clinical care path. Results The clinical care path, can reduce the suffering of patients and reduce the economic burden, improve the quality of medical and nursing Conclusion In patients with lumbar disc herniation can be applied to improve clinical care path patient cognitive ability, shorter hospital stays, lower medical costs reduce the incidence of complications.

[Keywords:] lumbar disc herniation; clinical care path

Clinical care path is a model of care during hospitalization, is a planned, purposeful, anticipatory care is to provide patients with high-quality, high efficiency, low-cost health services model. Its function is to provide patients with the most effective care, to treatment, care and order, reducing the missing items, shorten patient length of stay, improve quality of care we choose the surgical treatment of lumbar disc herniation were included in the clinical path received good results, are as follows:
1 Clinical data
This group of patients 80 cases, including 52 males and 28 females, aged 20-50 years old, by CT or MRI diagnosed lumbar disc herniation were treated surgically. 1-6 month postoperative follow-up, 76 patients with low back pain completely remission, 4 patients with lumbar pain.

2 implementation methods
2.1 the first day of admission: before the burglary, the main classes of nurses receiving patients, arrange beds, bed unit and the responsibility of nurses to prepare oxygen devices, burglary, measuring vital signs after the responsibility of nurses, good patient assessment, such as the general condition of patients, trauma history, past history, medication history, location and extent of low back pain, tenderness and local availability of mass, waist movement, lower extremity sensory, motor and reflex of the patient walking posture, gait, self-care ability and degree of urine out of control and whether the phenomenon of sexual dysfunction , admission to do missionary work, such as hospitals and departments described the environment, introduction of a competent physician, the nurse in charge, the class teacher, nurse and name, the church specimens from patients with urine samples checked the correct implementation of secondary care, good food guide, inform patients into high-calorie high-nutrition food vitamins digestible crude fiber, respect for your doctor to do routine checks, such as ECG, X-ray, CT, MRI, check for positive outcome, good psychological care, stable patients with mood, eliminate fear, getting enough rest, sleep at night patrol the situation of patients.

2.2 hospital the next day: early morning fasting blood test liver and kidney function, electrolytes, blood. Blood sugar, blood set, snow cross and urine testing, perform routine surgical care and secondary care, toilet training the patient in bed solution, guiding the patient the right to use the potty, encourage patients to eat more foods rich in dietary fiber digestion, drink plenty of water and more soup, the prevention of postoperative constipation and urinary retention.

2.3 Admission Day (the day before surgery perform routine surgical care and secondary care, prescribed by a doctor to do procaine penicillin skin test and intraoperative medication, antibiotics, skin test, do the psychological care and guide the patient to relax or imagined, can also be allow patients to listen to music, reads the newspaper or chatting with people to inform our department successfully treated many cases of the same type of cases, enhance the confidence of patients overcome the disease and reduce the fear, the doctor's advice for cleaning enema 20:00, 22:00 this fast, 24:00 start forbidden to drink, nursing and go to bed early, adequate sleep beneficial surgery tomorrow. Links to free download http://www.hi138.com 2.4 the fourth day of admission (the day of surgery, vital signs measured early in the morning before surgery 30 minutes prescribed for premedication, intraoperative medication preparation, surgery to understand the extent of surgery and surgery patients, postoperative care and routine care according to anesthesia, supine pillow after 6 hours, then cut the tension for the minimum position, mostly Lying to the pillow on a hard Banchuang, turning every 2 hours to give the axis of time, observe the surgical incision, with or without penetration dressing, exudation volume and color, the incision site with or without swelling, bleeding and dressing are replaced, attention to aseptic technique, compliance orders were given intravenous administration, surgery late psychological care, fails to give analgesics prescribed, patients with sleep at night patrol.

2.5 the fifth day of admission - discharge (after the first day - hospital care and perform routine surgical secondary care, guidance of patients after the first day of the systolic and diastolic quadriceps and straight leg raising exercises, 2 times per minute, lift put the same time, gradually increase the rate of leg, in order to prevent nerve root adhesions, encourage patients to enter dietary fiber and protein, vitamin-rich foods, drink plenty of water and more soup, postprandial 30-minute massage the abdomen to promote bowel movements, stool favorable to prevent constipation and urinary retention, time measuring vital signs, observe the situation of the incision, wound exudate and timely replacement, to ensure that intravenous administration.

2.6 after the seventh day: patients with low back muscle exercise guide, first swallow type, and then use five-point support method, 1-2 weeks to three-point support method, 3-4 times a day, every 5 , the step by step, gradually increase the number to increase back muscle strength, prevent muscle atrophy and enhance spinal stability, observe the incision, according to the disease stopped intravenous drug use, was discharged after suture removal 12-14 days after discharge, the patient guidance of 3 - 4 weeks out of bed wearing a waist should not be active for too long, and wearing a waist 3-6 months, lumbar spine flexion and rotation to avoid distortion, avoid prolonged sitting, standing, waist within 6 months to avoid weight-bearing after 6 - a If you must carry a heavy load on, you should take the appropriate position, looking for better support and the planned line of back muscle exercise, nursing and lying Banchuang, wear flat heeled shoes, the doctor and hospital phone numbers, after discharge if the sense of increased waist and lower limbs pain, sensory-motor abnormalities promptly contact your doctor, hospital after 1 month, 3 months, 6 months, hospital review, follow-up.

3 Results
Path through clinical care, so care is no longer a doctor's advice blindly, but a planned and predictable for care, patients also understand their care plan goals, active participation in care processes, and enhance patient self-care awareness and capability to meet the Best nursing Care, reduce patient pain, reduce complications, reduce hospitalization, reduce the economic burden on patients and society, from the long-term goal to see that it will promote the rapid development of nursing science.

4 Discussion
The implementation of clinical care path, so that nurses from the patients point of view, optimizing the hospitalization process, standardized care procedures, so that patients do not interrupt the whole process of medical treatment, the average length of stay was significantly shorter, reducing hospital costs, help to improve services quality and effectiveness, and can fully mobilize the initiative of patients, to actively participate in rehabilitation programs. patients know in advance to receive care in advance about the problems of pain, what with the medical staff with their own, effectively reducing the patient's anxiety, also get high-quality and safe services, nurses take the initiative to communicate with patients, patients to master functional exercise, significantly reduced complications in the implementation of the care path process, has received significant social and economic benefits. Links to free download http://www.hi138.com