Grouping
thrombosis, bleeding, ’ high blood pressure, dyspnea, urinary tract infections, fever, anxiety, numb, pain, neurological deficit, infection, lower extremity arterial thrombosis, venous thrombosis
THROMBOSIS, BLEEDING, SENSORY DISTURBANCE, URINARY TRACT INFECTIONS, ALLERGIC REACTION, DEEP VEIN THROMBOSIS, SWALLOWING DISORDER, INFECTION, PATHOGENESIS, REMISSION, BRAIN HEMORRHAGE, VENOUS THROMBOSIS, ADVERSE DRUG REACTIONS, ALLERGIC REACTIONS
The patient allocation sequence was generated using a complete randomization procedure. The random number and the associated allocated treatment were kept in sequentially numbered sealed opaque envelopes.Patients in the control group received traditional usual care in accordance with our hospital's usual care process:Sign monitoring: After the patient is admitted to the hospital, the patient's physiological signs, such as blood pressure, heart rate, respiratory rate and other indicators should be regularly monitored every day, and the patient's specific condition should be evaluated. If the patient has symptoms such as increased blood pressure, dyspnea, infection, thrombosis, etc., the attending doctor should be notified in time and corresponding treatment measures should be taken.Routine nursing: During the patient's bedridden period, the patient's body position should be changed regularly, the respiratory secretions should be cleaned up in time, and the breathing should be kept smooth. The patients should be told to drink more water and eat more food rich in protein and vitamins. If the patient has difficulty urinating, a catheter can be placed to assist in urination.Health education: Patients should be taught disease‐related knowledge, such as pathogenesis, treatment methods, treatment precautions, and common adverse drug reactions. The patient's psychological mood should be paid attention to, and patients with psychological abnormality should be counseled in time. Nursing should be closely communicated with family members to encourage family members to support and encourage and to reduce the psychological burden of patients.Rehabilitation training: Before being discharged from the hospital, the patients were assisted to complete the rehabilitation training, and were given discharge guidance and rehabilitation guidance. The patient could be discharged from the hospital after he/she could complete the training independently.Follow‐up: The patients were followed up by telephone every month after discharge to investigate the recovery of the patients.The predictive nursing intervention group implements predictive care on basis of usual care in the control group, including the following:Predictive nursing for allergic reactions: The dose of alteplase was precisely configured before thrombolysis, and the infusion rate was adjusted as required by the doctor. Symptoms and vital signs during thrombolysis should be closely observed. If the patient has an allergic reaction, the infusion of alteplase should be stopped, the doctor should be informed in time, and professional treatment should be carried out with antihistamines, glucocorticoids, etc. as prescribed by the doctor.Predictive nursing of bleeding: The bleeding risk of patients should be assessed before thrombolysis to understand the degree of risk. For patients with higher risk, the thrombolysis time should be shortened as appropriate. During thrombolysis, the patient's blood pressure should be monitored dynamically. If systolic blood pressure > 185 mmHg, diastolic blood pressure > 110 mmHg, the thrombolysis should be suspended. Two hours after thrombolysis, the patient should be instructed to stay in bed absolutely, pay attention to the gentleness and flexibility of the movements when changing the position, avoid sharp turning of the head, and strengthen respiratory care to ensure that it is in a smooth state.Predictive nursing for reperfusion brain injury: Within 24 h after thrombolysis, the patient's consciousness, blood pressure, breathing and other indicators should be closely monitored. On the basis of objectively assessing the remission of the patient's original condition, the 24‐h intake and output were accurately recorded, and diet and drinking instructions were given to maintain a balance of the 24‐h intake and output. In addition, if the patient has fever symptoms, it is necessary to inform the doctor in time, and cooperate with the doctor to cool down through physical methods.Predictive nursing for vascular reocclusion: During the thrombolysis process, the patient's neurological deficit dynamic score was given, a complete set of coagulation and blood routine review was performed every 6 h, and platelets and clotting time were regularly monitored to determine whether the patient has vascular reocclusion risk, and aspirin intervention should be prescribed.Psychological predictive nursing: After admission, patients and their families are prone to anxiety, tension, and fear. Therefore, nursing staff should actively introduce the hospital environment, attending doctors, and bed nurses to patients and their families, and help patients to do inspections and assessments. Nursing staff should fully understand the patient's family background, cultural background, economic status, main manifestations before and after the illness, and reevaluate according to their psychological state. Nursing staff should explain the main methods, importance and significance of thrombolytic therapy to patients, relieve patients’ anxiety and tension after admission, and at the same time enhance patients’ confidence in thrombolytic therapy, so as to relieve patients’ high blood pressure caused by emotional changes and prevent the occurrence of brain hemorrhage.Predictive nursing for deep vein thrombosis of lower extremities: due to factors such as bed rest and slow blood flow after surgery, venous thrombosis of lower extremities may be caused. Therefore, after thrombolytic therapy, it is necessary to observe whether the dorsal foot artery of the patient is weakened or disappeared, whether the skin color and skin temperature of the lower extremity are normal, and ask whether the patient has pain and sensory disturbance in the lower extremity. At the same time, nursing staff should pay attention to the fact that the puncture site should not be bandaged too tightly to prevent the arterial blood supply from being affected. Once the limbs are pale, the calf is numb, pain, the skin color turns black, and the dorsal artery pulse disappears, it indicates that the patient may have lower extremity arterial thrombosis. Nursing staff should immediately contact the bed doctor, do blood vessel color Doppler ultrasound, and carry out follow‐up treatment according to the diagnosis results.Predictive nursing of infection: For patients who need to indwelling catheters, nursing staff should choose appropriate catheters, strictly perform aseptic operations during indwelling, replace urine collection bags in time, and disinfect catheter openings every day to prevent urinary tract infections happened. Nursing staff should strengthen the patient's oral care, instruct the patient to rinse the mouth after eating, and do a good job of oral hygiene every day. If there is a swallowing disorder, the nursing staff should instruct the patient to sit as much as possible when eating, take a liquid diet, and eat small and frequent meals to prevent the occurrence of aspiration.