Table of Content

10 January 2022, Volume 3 Issue 1 Previous Issue    Next Issue

Research Paper

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A study on the risk assessment method of critical condition in patients with chronic obstructive pulmonary disease LI Caijuan, JIN Peiying, ZHOU Qing, XUN Hui, XIANG Qin 2022, 3 (1):  10-15.  doi: 10.3761/j.issn.2096-7446.2022.01.001 Abstract ( )   PDF (871KB) ( )   Save Objective To investigate the clinical effect of modified early warning score（MEWS） combined with end-expiratory carbon dioxide（PetCO2） in predicting the risk of critical condition in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods Convenient sampling method was used to select AECOPD patients admitted to the emergency room of a class A hospital in Zhejiang Province from April 2019 to February 2021 as the study subjects. MEWS score and PetCO2 value were used to evaluate. Bayes discriminant analysis was used to evaluate the accuracy of the risk of critical condition in emergency AECOPD patients,and the prediction value of the two combined assessments on the risk of critical condition in emergency AECOPD patients was compared by receiver operator characteristic（ROC） curve. Results A total of 151 AECOPD patients were enrolled,including 66 cases（43.7%） in the critical group and 85 cases（56.3%） in the stable group. MEWS score and PetCO2 value in critical group were [7.0（7.0,9.0）] and [49.5（39.8,68.5）] mmHg,respectively,which was higher than the MEWS score [6.0（4.0,8.0）] and PetCO2 value [40.0（36.0,48.0）] mmHg in the stable group,and the differences were statistically significant（P<0.05）. The predictive probability（PRE_1） of MEWS score combined with PetCO2 value was 0.795[95%CI（0.722,0.856）],the sensitivity was 0.621,and the specificity was 0.835. The area under ROC curve of MEWS score,PetCO2 value and PRE_1 were compared,and the differences were statistically significant（P<0.05）. Conclusion Both MEWS score and PetCO2 value can be used as effective indicators to evaluate the risk of critical condition in emergency AECOPD patients,and their combined application can help emergency medical staff distinguish critically ill patients more scientifically. References | Related Articles | Metrics

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Application of prehospital home-based pulmonary rehabilitation in patients with lung cancer combined with chronic obstructive pulmonary disease HAN Nafei, HE Hong, JIN Yaojuan, HU Xiaomin, LIU Jinkai, SHEN Tao 2022, 3 (1):  16-23.  doi: 10.3761/j.issn.2096-7446.2022.01.002 Abstract ( )   PDF (1142KB) ( )   Save Objective To explore the effect of prehospital home-based pulmonary rehabilitation training on enhanced recovery after surgery（ERAS） in patients with lung cancer combined with chronic obstructive pulmonary disease（COPD）. Methods From December 2019 to December 2020,130 patients with lung cancer combined with COPD were divided into experimental group and control group according to random number table. The experimental group received prehospital pulmonary rehabilitation training intervention on the basis of the ERAS program,and the control group was provided with the ERAS program. The patients received surgery at the second day after admission and the ERAS program was performed through the entire process. Lung function,6-minute walk test,peak flow rate,self-management score,incidence of postoperative complications,duration of antibiotic use,length of hospital stay,and hospitalization cost were compared between the two groups. Results In the process of implementation,2 cases were dropped out in the experimental group. Finally we had 67 cases in the experimental group and 61 cases in the control group. Compared with the control group,the duration of antibiotic use in the experimental group for patients with moderate COPD after surgery was shorter（Z=-2.408,P=0.016）. The mean daily peak velocity was significantly increased（F=152.870,P<0.001). The total score of self-management was increased（Z=-6.795,P<0.001). The incidence of postoperative complications,length of hospital stay and hospitalization cost were decreased（P<0.05）. Preoperative lung function of patients with moderate COPD was improved after intervention and the difference was statistically significant（P<0.05）. However the difference in the 6-minute walk test was not statistically significant（P>0.05）. Conclusion Prehospital home-based pulmonary rehabilitation training can improve patients' lung function,increase peak flow rate,improve patient self-management ability and reduce antibiotic use time. It is more effective in patients with lung cancer and moderate COPD. Furthermore,it can also help reduce the incidence of postoperative complications,shorten the length of hospital stay,thereby reduce the cost of hospitalization. References | Related Articles | Metrics

Special Planning—Nursing Care of Critically Ill Children and Newborns

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Construction and validation of a prediction model for iatrogenic withdrawal syndrome in critically ill children HUANG Hun, CHUN Xiao, MA Jingxiang, ZHONG Yongmei, ZHAI Zhihui, LI Ming 2022, 3 (1):  24-29.  doi: 10.3761/j.issn.2096-7446.2022.01.003 Abstract ( )   PDF (962KB) ( )   Save Objective To investigate the risk factors and establish a risk prediction model for iatrogenic withdrawal syndrome in critically ill children. Methods The convenient sampling was used to enroll children with analgesic and sedative drugs in the pediatric intensive care unit of a third-level A children's specialist hospital in Guangzhou from June 2019 to February 2020. The univariate analysis and multivariate logistic regression analysis were used to analyze risk factors of iatrogenic withdrawal syndrome,and the prediction model was established. Results A total of 110 critically ill children were enrolled in this study. The incidence of iatrogenic withdrawal syndrome in critically ill children was 42.7%. Multivariate logistic regression analysis showed that the independent risk factors of iatrogenic withdrawal syndrome were daily cumulative dose of midazolam and fentanyl. The area under the ROC curve was 0.761[95%CI（0.671,0.851）],and the test result of Hosmer-Lemeshow showed that P=0.662 and the test result of Omnibus showed that P< 0.001. Conclusion The incidence of iatrogenic withdrawal syndrome in critically ill children is in high level. The children with higher daily cumulative dose of midazolam and fentanylmay have higher risk of iatrogenic withdrawal syndrome. The prediction model constructed in this study can help medical staff to identify iatrogenic withdrawal syndrome early and manage analgesia and sedation scientifically and effectively. References | Related Articles | Metrics

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Summary of the best evidence for fluid management in very low and extremely low birth weight infants WU Qian, YU Xiaoman, YU Rong, LI Qianqian, WEI Lili 2022, 3 (1):  30-35.  doi: 10.3761/j.issn.2096-7446.2022.01.004 Abstract ( )   PDF (945KB) ( )   Save Objective To search and evaluate the evidence of fluid management in very low birth weight and extremely low birth weight infants,and then form the best evidence. Methods We searched the literature from BMJ Best Practice, UpToDate, Cochrane Library, Joanna Briggs Institute（JBI）, Scottish Intercollegiate Guidelines Network（SIGNP）, CINAHL, PubMed, Embase, CBM, CNKI, Wanfang to collect relevant guidelines,systematic reviews,best practice information sheets,evidence summaries,expert consensuses and original studies. The retrieval period was from the inception of databases to March 2021. Results A total of 9 literatures were enrolled,including 2 guidelines,1 clinical decision-making,2 systematic reviews,3 evidence summaries and 1 randomized controlled trial. Totally 16 pieces of best evidence were summarized from 4 aspects,fluid evaluation,calculation,prevention and management,monitoring. Conclusion This study summarized the best evidence of fluid management of very low and extremely low birth weight infants,which can provide evidence-based basis for clinical staff. References | Related Articles | Metrics

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A review of neonatal enterostomy nursing JIN Ting, XU Hongzhen, TANG Fang, LOU Jia 2022, 3 (1):  36-40.  doi: 10.3761/j.issn.2096-7446.2022.01.005 Abstract ( )   PDF (922KB) ( )   Save This article summarized characteristics and types of neonatal enterostomy,the best site of the stomy,choice of stomy products and nursing skills,types and management of complications,and challenges of neonatal enterostomy care. It provided reference for clinical nursing practice of neonatal enterostomy. References | Related Articles | Metrics

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Application of multidisciplinary collaboration in the care of children with spinal muscular dystrophy DENG Haiying, HU Jun, HUANG Liqin, LIU Minzhen, LIN Xiaoxia, LIN Lizhen 2022, 3 (1):  41-43.  doi: 10.3761/j.issn.2096-7446.2022.01.006 Abstract ( )   PDF (719KB) ( )   Save To summarize the nursing experience of multidisciplinary cooperation in 5 children with spinal muscular atrophy. Under the leadership of charge nurses for pediatric patients with spinal muscular dystrophy,cooperation of full-time nurses who are matched with medical professional groups of neurology,respiratory,rehabilitation and nutrition departments,and the participation of doctors of nutrition department and rehabilitation department,the respiratory tract management,nursing care of intrathecal injection of Nosephase sodium,nutrition management of gastrostomy,home rescue skills training and rehabilitation training,discharge follow-up were carried out for the children. Five children were successfully discharged from hospital with good treatment effect. References | Related Articles | Metrics

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The nursing of a newborn underwent diaphragmatic hernia repair and pulmonary cystadenoma resection under complete placental circulation support WANG Shanshan, XU Hongyan, ZHAO Tingting, FENG Suwen 2022, 3 (1):  44-46.  doi: 10.3761/j.issn.2096-7446.2022.01.007 Abstract ( )   PDF (871KB) ( )   Save One of double-chorionic double-amniotic sac twin pregnancy was underwent diaphragmatic hernia repair and pulmonary cystadenoma resection during cesarean section in the condition of complete placental circulation. The nursing key points were summarized as follow：preoperative multidisciplinary joint simulation exercises,placental circulation maintaining under precise uterine cavity pressure control using a self-made intrauterine perfusion system,newborn resuscitation with visualized technology assistance,operational safety assurance with personalized maternal-fetal monitoring and refined management. The operational time was 78 minutes. Newborn with congenital diaphragmatic hernia was born with Apgar score of 3-4-8 at 1-5-10 minute. The newborn with diaphragmatic hernia was discharged after 13 days of treatment and nursing in NICU. The healthy newborn's Apgar score was 2-5-8 at 1-5-10 minute after birth. The healthy newborn was discharged after 6 days of general care. The parturient was discharged 6 days after the cesarean section. After 4 months of follow-up,the parturient and newborn babies were all in good condition and had no complications. References | Related Articles | Metrics

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Application of positioning aids in positioning the tip of PICC in neonates ZHOU Lianjuan, ZHU Jihua, ZHOU Hongqin, LOU Xiaofang, ZHU Haihong, YUAN Tianming, PAN Jiarong, XU Hongzhen 2022, 3 (1):  47-51.  doi: 10.3761/j.issn.2096-7446.2022.01.008 Abstract ( )   PDF (771KB) ( )   Save Objective To evaluate the application effect of self-designed positioning aids in neonatal PICC tip localization. Methods 247 neonates with PICC catheterize from January 2018 to December 2020 in the neonatal department of a tertiary hospital in Zhejiang Province were selected as the experimental group,and 180 neonates with PICC catheterize from January 2016 to December 2017 were selected as the control group. During PICC puncture,intravenous electrocardiogram was used to guide tip positioning in both groups,and the position of the tip was verified by X-ray after successful fixation. During positioning,positioning aids were used in the experimental group to fix the position,and the standard neonatal position was used in the control group. The success rate of the first tip localization,the time of catheterization localization and the incidence of ectopic in X-ray verification were compared between the two groups. Results In the experimental group,232 cases（93.9%） were successfully located for the first time,which was significantly higher than 144 cases（80.0%） in the control group. The positioning time of the expe-rimental group was （3.06± 0.31） min,which was lower than that of the control group （5.33± 1.23） min,and the difference was statistically significant（P< 0.05）. The incidence of ectopic location in experimental group（5.67%） was significantly lower than that in control group（13.89%）. Conclusion The use of positioning aids can improve the accuracy of ECG positioning and X-ray positioning results,improve the work efficiency of nurses,and reduce PICC ectopic and X-ray exposure in children. References | Related Articles | Metrics

Clinical Research

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Study on the variability of blood pressure in inpatients with aortic dissection and influencing factors WANG Simeng, HAN Xiujuan, LONG Yan, HUANG Sufang 2022, 3 (1):  51-56.  doi: 10.3761/j.issn.2096-7446.2022.01.009 Abstract ( )   PDF (718KB) ( )   Save Objective To investigate the variability of blood pressure in hospitalized patients with aortic dissection and explore its influencing factors. Methods We collected the data of 346 patients with aortic dissection admitted to a tertiary first-class hospital in Wuhan city from January 2019 to June 2020. The related factors that may affect the variability of blood pressure were analyzed by multiple linear regression. Results The variability of systolic blood pressure in inpatients with aortic dissection was （11.65± 3.60） mmHg（1 mmHg=0.133 kPa）,the varia-bility of diastolic blood pressure was （8.03± 1.98） mmHg. Gender,age,history of hypertension,smoking his-tory,alcohol drinking history,first admission blood pressure and types of antihypertensive drugs were the main influencing factors of blood pressure variability（P< 0.05）. Conclusion Blood pressure in patients with aortic dissec-tion fluctuated to a certain extent during hospitalization. It is suggested that medical staff should reduce the fluctuation of blood pressure while controlling the blood pressure of patients,so as to reduce the risk of deterioration and death,and improve the prognosis of patients. References | Related Articles | Metrics

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The application of patient-centered emergency treatment management strategy in batches of patients with severe burn and blast combined injuries ZENG Fei, LAN Meijuan, LIANG Jiangshuyuan, JIN Xiaojuan 2022, 3 (1):  57-60.  doi: 10.3761/j.issn.2096-7446.2022.01.010 Abstract ( )   PDF (673KB) ( )   Save According to the treatment characteristics of patients with severe burn and blast combined injuries caused by tanker truck explosions,we summarized nursing management experience in the treatment of public health emergency. Nursing management points included：establishing a nursing team with patient-centered and subspecialized nursing as basic unit,and a team leader as the core,namely "one patient,one team"; implementing a positive and negative two-way quality management model based on a three-level quality management system. Through the implementation of individualized and precise emergency treatment management strategy,the 30-day survival rate of patients reached 100%,and the 90-day survival rate reached 60.0%. There were no adverse effects during the period. References | Related Articles | Metrics

Quality and Safety

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Research on the allocation of nursing manpower in emergency room based on epidemiological investigation and working hour determination CAI Mengxin, YUN Hui, CHEN Jing, SU Meng, ZHOU Wenhua 2022, 3 (1):  61-66.  doi: 10.3761/j.issn.2096-7446.2022.01.011 Abstract ( )   PDF (824KB) ( )   Save Objective To explore how to allocate the nursing manpower resources reasonably by calculating nursing workload in emergency room through epidemiological investigation and working hour determination. Methods A retrospective analysis was made on the patients in the emergency room from January 2017 to December 2019. We designed the observation table of nursing items and trained the observers to measure average working hours and the total nursing workload of each nursing operation,then allocated the nursing human resources reasonably. Results 9 735 patients were treated in emergency room from 2017 to 2019,mostly aged 60 to 70（23.4%）. Diseases were mostly circulatory diseases（34.2%）. The patient's median stay length in the emergency room was 0.94 days,and the peak treatment time was 12：00— 17：59 and 21：00— 23：59. The emergency department involved 85 items of direct nursing procedures and 18 items of indirect nursing procedures. On average,the total work time of nursing care for each patient was 411.13 min per 24 h,the theoretical bed-nurse ratio was 1∶ 1.69,and the nurse-patient ratio was 1.54∶ 1. Conclusion Nursing workload was heavy and manpower was insufficient in emergency room. According to the characteristics of the patient,nursing managers should strengthen nurse' theoretical training,increase staffing,dynamically replenish manpower,optimize team structure,improve hospital support system and improve the work efficiency in emergency room. References | Related Articles | Metrics

Evidence Synthesis and Practice

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Visualization analysis of research hotpots in midline catheter SUN Songwei, GAO Yufang, WANG Gang, ZHAO Lin, ZHOU Yinghao, WU Yu, YANG Rui, JI Zitong 2022, 3 (1):  67-72.  doi: 10.3761/j.issn.2096-7446.2022.01.012 Abstract ( )   PDF (1029KB) ( )   Save Objective To explore the research hotpots and development trend of midline catheter（MC）. Methods The Chinese literature on midline catheter collected in CNKI and Wanfang,the English literature collected in Web of Science from 2011 to 2020 was received,and a bibliometrics tool Citespace 5.7R2 was used for literature analysis. Results A total of 154 articles in Chinese and 79 articles in English related to MC were retrieved. In 2017,the number of articles published in English decreased slightly,and the number of English articles published the same as Chinese articles in 2018,and then they have been continuing to grow. Through the co-occurrence analysis of key words,it was found that the research hotpots focused on complications,intensive care unit（ICU）,children,indwelling time and so on. Through cluster analysis,there were six significant clusters in Chinese literature（intravenous treatment/thrombosis/catheterization technology/nursing/midline catheter/cost）; six significant clus-ters were formed in English literature（ultrasonography/midline catheter/health care-associated infection/catheter-based interventions/central venous catheterisation/catheter-associated complications）. Conclusion Scholars have paid increasing attention to midline catheter nowadays,focusing on catheterization technology of midline catheter and incidence rate of complications,ect. However,due to the lack of research,the research theme and research variable setting relatively were simple. In the future,more studies can be carried out on nursing technology of midline catheter. References | Related Articles | Metrics

Review

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Research progress of pain management in patients with intraosseous infusion ZHAN Yue, YANG Minfei, GU Xinping, YAO Xiaoyue 2022, 3 (1):  73-77.  doi: 10.3761/j.issn.2096-7446.2022.01.013 Abstract ( )   PDF (736KB) ( )   Save This paper reviewed the research progress of pain management related to intraosseous infusion,including pain mechanism,incidence,influencing factors,analgesia timing and methods. We aimed to provide theoretical support for improving the pain management of intraosseous infusion and promote the standardized development of intraosseous infusion in China. References | Related Articles | Metrics

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Review on surrogate decision-making for incapacitated patients in ICU ZHANG Jiajia, CHEN Feng, GONG Xiaoyan, ZHOU Yuzi, ZHUANG Yiyu 2022, 3 (1):  78-82.  doi: 10.3761/j.issn.2096-7446.2022.01.014 Abstract ( )   PDF (723KB) ( )   Save Incapacitated patients in ICU are unable to make treatment decisions due to critically ill condition or deep sedation,and their choice of medical decisions is a difficult point in clinical practice. This paper introduces the concept,main body and contents of surrogate decision-making,analyzes the factors affecting surrogate decision-making,and proposed four guiding strategies of surrogate decision-making including strengthening the education of surrogate decision makers and medical staff,strengthening communication and decision aids. It can provide some reference for surrogate decision maker to make the optimal choice and the related research development of surrogate decision. References | Related Articles | Metrics

Clinical Practice

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Emergency nursing of a patient with extremely severe hydrofluoric acid burn LU Fuchang, XIA Yilan, CHEN Huaqing, SHAO Huawei 2022, 3 (1):  83-85.  doi: 10.3761/j.issn.2096-7446.2022.01.015 Abstract ( )   PDF (568KB) ( )   Save To summarize the nursing experience of a patient with severe hydrofluoric acid burn. Responding to the high corrosiveness and high permeability of hydrofluoric acid,the nurses assisted the doctor to remove wound blisters as soon as possible after the exposure history was confirmed in the emergency department,and implemented calcium supplementation by two ways to prevent further damage of hydrofluoric acid. We implemented the goal-oriented fluid management in the early stage of burns to reduce the toxic effects on the heart,closely monitored the levels of free calcium and fluoride,and combined with bedside continuous renal replacement therapy to promote the excretion of fluoride from the body. At the same time,in view of the characteristics of progressive tissue necrosis of hydrofluoric acid burns,the wound debridement and repairing operation were performed as soon as possible,and the perioperative wound management was implemented. As the patient had ICU delirium,the cluster management strategy was implemented. On the 18th day of admission,the patient was in a stable condition and transferred to a general ward to continue turning frame and dressing changing treatment. On the 32th day,the wound was healed and he was discharged. References | Related Articles | Metrics

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Nursing care of negative pressure wound treatment for a patient with acute necrotizing fasciitis with septic shock ZENG Ying, WANG Wei, HUANG Xuye, CHEN Wenbin 2022, 3 (1):  86-88.  doi: 10.3761/j.issn.2096-7446.2022.01.016 Abstract ( )   PDF (572KB) ( )   Save To summarize the nursing care of negative pressure wound therapy（NPWT） for a case of massive acute necrotizing fasciitis with septic shock and mucocutaneous separation of the stoma. Wound management involved doctors,nurses,stoma therapists,and dietitians jointly to formulate the plan. After comprehensive assessment of the patient's condition,a special care plan was adopted for removing the cause of infection,including modified and sustainable NPWT wound treatment care,stoma feces management,wound care after free skin transplantation with hair follicles and whole-process nutritional management. The patient recovered and was discharged 86 days later. References | Related Articles | Metrics

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Nursing care of a patient treated by extracorporeal membrane oxygenation combined with continuous renal replacement therapy JIA Xueping, ZENG Lei, YANG Hongxiao, LI Guifang 2022, 3 (1):  89-91.  doi: 10.3761/j.issn.2096-7446.2022.01.017 Abstract ( )   PDF (548KB) ( )   Save To summarize the nursing experience of a patient with multiple injury complicated with multiple organ dysfunction syndrome who underwent extracorporeal membrane oxygenation combined with continuous renal replacement therapy. Conventional nursing measures were adjusted for safety problems such as pipeline fixation of extracorporeal membrane lung oxygenation,coagulation monitoring,hemodynamic disorders. Thoracic closed drainage combined with mechanical ventilation nursing and pressure injury prevention were given. According to patients' consciousness and ICU activity score,early graded rehabilitation activity program led by nurses was given,among which physical function exercise,combination of active and passive activities,and activity safety were the difficulties and key points of nursing. After 26 days of treatment and nursing,the patient's condition was improved and he was discharged. He was in good condition after 2 months of follow-up. References | Related Articles | Metrics

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Nursing care of a patient with contrast-induced encephalopathy after total cerebrovascular angiography FENG Fang, LIU Qian, LIANG Lijie, ZHAO Xuehong 2022, 3 (1):  92-94.  doi: 10.3761/j.issn.2096-7446.2022.01.018 Abstract ( )   PDF (416KB) ( )   Save To summarize the nursing experience of a case of contrast-induced encephalopathy after total cerebrovascular angiography. Emergency procedures were started,then symptom monitoring and emergency treatment were carried out,and patient safety protection was implemented. During the nurse-led sedation and analgesia management,excessive sedation and drug-related complications were prevented by dynamic evaluation of sedation degree. Volume monitoring was used to ensure the effectiveness of individualized hydration therapy and promote contrast excretion. After the above nursing,the patient's symptoms disappeared 12 hours later and recovered well. References | Related Articles | Metrics

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Nursing care of a child with Kabuki syndrome and cleft soft palate YU Luyan, DAI Yefeng 2022, 3 (1):  94-96.  doi: 10.3761/j.issn.2096-7446.2022.01.019 Abstract ( )   PDF (532KB) ( )   Save Kabuki syndrome is a rare multiple malformation syndrome,and few nursing reports were published. This paper summarized the experience of nursing care of a child with Kabuki syndrome and soft palate cleft. The main points of nursing care included formulating strategies to prevent hypoglycemia before operation,choosing appropriate spoons and correct feeding methods,actively prevention of infection and suffocation. The child was successfully discharged after 11 days of admission. Six weeks of outpatient follow-up showed that he recovered well. References | Related Articles | Metrics