Perioperative nursing for a patient with external auditory canal cancer and right cervical lymph node metastasis, complicated by multiple cardio‐cerebrovascular diseases and lower limb vein thrombosis
外耳道癌伴右颈转移合并心脑疾病与静脉血栓的围术期护理

摘要

总结一例外耳道癌右颈部淋巴结转移并多发心脑血管疾病及下肢静脉血栓患者，在全麻下行右侧颞骨次全切除+右外耳道成形+乳突根治+右侧颈淋巴结清扫+右侧腮腺部分切除+面神经减压+腹部脂肪转移修复术的围术期护理的护理经验。护理要点：术前组建多学科诊疗团队，积极完善相关检查及准备，保障手术安全，降低手术风险；遵医嘱及时用药，预防心脑血管并发症；重视心理护理、落实各项护理风险评估与预防策略。术后密切观察呼吸情况，预防呼吸困难；加强房颤的护理，预防心脑血管意外；做好下肢静脉血栓的护理，预防肺栓塞；抑制腺体分泌，预防涎瘘；严格防控切口感染，健全防御机制；制定出院指导，提升患者居家的护理。经过精心治疗与护理，患者术后第二十天临床康复出院，随诊患者切口愈合情况较满意，后续进一步至肿瘤科行放疗治疗。

Abstract

This case report summarizes the perioperative nursing experience of a patient with external auditory canal cancer and right cervical lymph node metastasis, complicated by multiple cardio‐cerebrovascular diseases and lower limb vein thrombosis. Under general anesthesia, the patient underwent subtotal resection of the right temporal bone, right external auditory canal reconstruction, radical mastoidectomy, right cervical lymphadenectomy, partial resection of the parotid gland, facial nerve decompression, and abdominal fat transfer. The nursing care plan mainly included assembling a multidisciplinary diagnosis and treatment team preoperatively, actively completing relevant examinations and preparations to ensure surgical safety and reduce risks, administering medications promptly as per medical orders to prevent cardio-cerebrovascular complications, emphasizing psychological care, and implementing various nursing risk assessments and preventive strategies. Postoperatively, the patient’s respiration was closely monitored to prevent respiratory distress; enhanced care for atrial fibrillation was performed to avoid cardio‐cerebrovascular accidents; thorough nursing for lower limb vein thrombosis was provided to prevent pulmonary embolism; glandular secretion suppression was required to prevent salivary fistulas; strict infection control measures were enforced to protect the surgical site; and discharge guidance was developed to improve home care for the patient. With meticulous treatment and nursing care, the patient was discharged on the 20th postoperative day with satisfactory wound healing, and follow‐ups with the oncology department were scheduled to continue radiotherapy.