Factors of preoperative septic shock associated with urolithiasis:an analysis and nursing progress

Factors of preoperative septic shock associated with urolithiasis:an analysis and nursing progress

Li,Shenzhen,Lan,Yujie,Tang,Chao,Xian,Hongyi,Lin,Xianping

The Second Affiliated Hospital of Guangxi Medical University,Nanning Guangxi 530007,China

【Abstract】The so-called urinary stones,which result in lumpy or granular aggregates after concentration and precipitation of urine,as a more common type of disease in urology,will occur in any part of the urethra ureter,bladder,and kidney,but mainly ureteral stones as well as kidney stones are more common in the clinic.There is considerable variation in the symptoms exhibited by stones presenting at different sites,which are mainly clinical,such as pain,frequency,clouding of the urine color,and low back pain,and in severe cases may contain sand stones or blood in the urine.In the accelerated pace of people's daily life along with the change of dietary habits at the present stage,leading to the incidence of such diseases shows a yearly increasing trend,and more commonly found in the South as well as in the male population of young adults,the age of patients is mostly at the age of 20-40 years.Other than that,the associated complications of this condition are more difficult to manage clinically,so adequate awareness as well as great attention has to be paid to urinary calculi because it has a high recurrence rate and may lead to urinary obstruction,produce damage and.The patient's renal pelvis,under the influence of the stones,places them on increased pressure,and the refluxing bacteria can invade the blood to cause septic shock to occur,causing severe damage to renal function.According to the related survey research shows that urinary stones now cannot be radical,for which caregivers strengthen nursing intervention in clinical treatment,patients must actively cooperate with the development of nursing work to bed rest,thereby reducing the probability of related complications and effectively improving the quality of daily life.This article discusses in detail the factors that contribute to the development of preoperative concomitant septic shock in urolithiasis as well as nursing interventions,which are reported below.

【Key words】Urinary stones;Septic shock;Factor analysis;Nursing interventions

Preface:

At present,the improvement of people's daily life quality and the irregularity of their daily living habits,together with the environmental pollution generated in the economic development,have brought more adverse effects on people,resulting in urinary stones becoming one of the important threats to people's life and health.There are many factors contributing to the formation of stones,which are closely related to epidemiology,abnormalities in the anatomical structure of urine and urinary tract infection[1].The disease can be pided into primary urolithiasis,secondary or infectious urolithiasis and metabolic urolithiasis according to the pathogenesis.If the clinical treatment is not carried out in time,it may lead to more serious complications,such as septic shock or severe sepsis.Because of the rising mortality and incidence rate of such diseases in recent years,people have also shown a high degree of attention.

1Analysis of the factors associated with septic shock before operation of urinary calculi

Infectious shock is also called septic shock,which refers to the syndrome of sepsis accompanied by shock caused by microorganisms and related toxin products.The incidence rate of this disease in clinical practice is as high as 4.7%.As one of the more serious complications of urinary calculi,if it cannot be treated and controlled in time,it is easy to cause death[2].According to relevant research results,[3]the probability of septic shock in patients with urinary calculi is significantly higher than that reported in relevant literature.Systemic inflammatory reaction syndrome(SIRS)will occur in patients with septic shock during urine culture at the middle stage before operation,and then the related symptoms of septic shock will occur.For patients without systemic inflammatory reaction syndrome after surgery,the positive rate in urine culture before surgery was 10.7%,and for patients with systemic inflammatory reaction syndrome after surgery,the positive rate in urine culture before surgery was 66.5%.Therefore,one of the important factors for septic shock is bacterial culture.The occurrence of septic shock is closely related to the positive result in urine culture,and at the same time,it is also related to the amount of bleeding in patients during operation,whether the drainage tube remains unobstructed after operation,and the length of operation time.Relevant research data show that

[4],the probability of pathogenic factors of stones related to infectious shock in the treatment process is about 1.13%,and the highest mortality rate can reach 81%.Therefore,we should strengthen the relevant preventive measures of urinary system stones in preoperative infectious shock,early diagnosis and take corresponding intervention measures.

2 Clinical manifestations of urinary calculi and preoperative septic shock

2.1 Clinical manifestation of urinary calculus

In clinical practice,urinary calculi mainly show severe waist pain,and the onset time is relatively sudden,accompanied by pus and blood or hematuria.The pain may radiate along the ureter to the iliac fossa,scrotum and perineum.At the same time,it may also be accompanied by symptoms such as interruption of urine flow or difficulty in urination,which will cause great harm to the daily life and physical and mental health of patients.

2.2 Clinical manifestations of septic shock

In clinical practice,a few patients show warm shock,but most patients are conscious and will have symptoms such as anxiety,nervousness and irritability.In addition,it is accompanied by mild cyanosis of lips and nail bed,pale complexion and skin,cold and wet limbs,significantly faster heart rate,decreased urine volume,low blood pressure and other clinical symptoms.In the late stage of shock,it may lead to the failure of important visceral organs,and the more common ones are intractable hypotension and extensive bleeding of skin,viscera,mucosa,lumen,etc.[5].For example,acute cardiac insufficiency,brain dysfunction,acute renal failure and acute pulmonary failure are all caused by the failure of important tissues and organs caused by septic shock[6].It can be seen from this that both urinary stones and their associated complications will cause great pain to patients.Therefore,it is of great significance to strengthen the body's self-protection in daily life to effectively avoid the occurrence of related diseases.

3 Emergency treatment and nursing methods of urinary calculi and preoperative infectious shock in clinic

3.1 Nursing evaluation and basic prevention

Because of the acute onset of urinary system stones accompanied by infectious shock,the harm is greater,and the concealment is relatively strong.Therefore,after admission,patients should strictly monitor their vital signs,check their blood routine,evaluate their blood pressure and body temperature,monitor their skin,mucous membrane and urine volume every 4 hours,and at the same time,carry out bedside procalcitonin test,blood urine culture and complete set of biochemical electrolyte coagulation and other tests to timely feed back their risk assessment results,and take basic preventive measures[7].

3.2 Treatment of anti-infective shock

After admission,the relevant nursing staff should check the liver and kidney function of the patient,carry out routine monitoring of blood and urine,and select broad-spectrum antibiotics based on their retention for bedside procalcitonin test,and select vasoactive drugs or rehydration in the process of anti-shock,which should be carried out through central venous catheterization[8].Carry out urine culture and drug sensitivity tests,strictly check the vital signs of patients,and pay attention to whether there is deterioration.Relevant nursing staff carried out blood picture etiological examination for patients,monitored their urine routine and renal function,and carried out blood biochemical examination of acid-base balance,serum enzyme determination and serum electrolyte determination,so as to ensure that all examination indicators of patients meet the range of relevant indicators[9].

3.3 Nursing of acute respiratory distress syndrome

The onset of acute respiratory distress syndrome is relatively acute,and the PaO2 in the patient's body will fluctuate greatly and decrease within 3-5 hours of admission.The patient shows sweating,dying,purple and cyanotic lips and faces,and the breath sounds of both lungs will be scattered in the wheezing sounds.After the symptoms of hypoxia,there will be no significant change after using the mask for high concentration oxygen inhalation.At this time,the ventilator with endotracheal intubation should be immediately selected to assist breathing

[10].The blood gas analysis of patients should be strictly monitored,and the electrolyte imbalance and acid-base imbalance in the body should be corrected in time to control the incidence of infection.At the same time,timely supplement high protein,high calorie and high nutrient substances to make patients adapt to the state of high metabolism.

3.4 Nursing of sepsis with hypotension

Before using antibiotics for treatment,at least two blood samples and urine samples should be selected for urine culture.If the patient has symptoms related to sepsis,double-channel fluid replacement should be carried out immediately.A deep vein catheter was placed under the patient's clavicle to timely monitor the central venous pressure and adjust the infusion speed[11].The amount of dopamine should be adjusted according to the blood pressure level.After the blood pressure level remains stable,the amount of dopamine can be reduced or withdrawn directly.

3.5 Nursing of multiple organ failure

When urolithiasis is accompanied by infectious shock stress,patients may have a series of reactions such as immune state,nervous system and endocrine system.Long-term or more intense stress state will lead to the depletion of potential or the impairment of the body's adaptive ability,leading to the waterfall effect,and ultimately lead to the failure of multiple organ function and even death of patients[12].During blood gas analysis,the blood coagulation time of electrolyte is dynamically monitored,the drug use is adjusted in time,and the acid-base and water-electrolyte imbalance are adjusted.At the same time,cardiotonic drugs should be used to maintain the respiratory function and renal function of patients.Medical staff should also pay attention to the prevention and treatment of brain edema,acute respiratory distress syndrome and other auxiliary treatment[13].

3.6 Strengthen the prevention and intervention of stones

With the development of social economy,people's daily living standards are constantly improving,leading to the rising probability of stones.However,as long as we pay more attention and take corresponding measures in daily life,we can effectively avoid the occurrence of infectious shock

[14].There are two ways to prevent stones.First,life prevention.The main formation factor of urolithiasis is the infection of urinary system,which is closely related to the prevention and treatment of urolithiasis.At the same time,for patients who take traditional Chinese medicine for a long time,they should take sea gold sand and Lysimachia christinae for soaking in water at intervals to promote the excretion of small stones in the body.If conditions permit,patients can seek TCM doctors to open TCM prescriptions according to their specific conditions[15].In addition,drinking more water and exercising more can effectively prevent the occurrence of stones.Drinking more water can promote the excretion of minerals and salts from the body.Cultivating good living habits in daily life is also a manifestation of responsibility for personal health.The second is diet prevention.There is a certain relationship between the occurrence of stones and the diet structure.Reasonable adjustment of the daily diet structure can effectively prevent the occurrence of stones.In daily life,people should eat more high-fiber foods.Because the composition of urinary stones is quite different,the diet conditioning programs are also different[16-17].For example,the stone is calcium oxalate.Patients should try to avoid eating foods with high calcium oxalate in daily life,such as tomatoes,strawberries,spinach,etc;If the stone is uric acid,eat a low purine diet;Eat more meat for infection;If the stone is phosphoric acid,eat more foods with low calcium and low phosphorus[18-19].In medicine,patients with kidney stones should eat as little salt and animal protein as possible,drink more water in daily life,and keep the urine volume at 2000-3000ml,which can not only prevent the secondary recurrence of kidney stones,but also ensure the intake of calcium.Therefore,develop good habits in life and diet,take corresponding preventive and intervention measures,effectively reduce the probability of urinary stones and reduce the occurrence of infectious shock

[20].

Conclusion:

To sum up,in clinical practice,the incidence rate of infectious shock associated with urinary calculi before surgery is relatively high,and there is a high mortality rate.Therefore,people develop good habits in daily life to effectively avoid the emergence of diseases.At the same time,hospitals should improve the relevant treatment system,strengthen the monitoring of patients'vital signs,assess the risk of disease related complications,and take corresponding preventive and intervention measures,Timely control the patients with abnormal physical signs to reduce the physical and mental pain of the patients and effectively avoid the damage to the body.

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