Huashan Perioperative Nursing Program for Stroke Patients Undergoing Contralateral Seventh Cervical Nerve Transfer

Huashan Perioperative Nursing Program for Stroke Patients Undergoing Contralateral Seventh Cervical Nerve Transfer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Methodology Huashan Perioperative Nursing Program for Stroke Patients Undergoing Contralateral Seventh Cervical Nerve Transfer Fan Su, Xiaoqian Wang, Ye Xu, Yiqun Zhou, Wendong Xu, Jinyao Zhang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-245379/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Apr, 2022 Read the published version in Perioperative Medicine → Version 1 posted 10 You are reading this latest preprint version Abstract Background: The previous investigation regarding contralateral seventh cervical nerve transfer (CC7) revealed a novel and effective approach to improve arm function in patients with chronic spastic paralysis. The patients who underwent both CC7 and standard rehabilitation showed greater functional improvements and spasticity reductions than did the control group who underwent rehabilitation only. Additional efforts are needed to maximize the benefits in patients and establishing a supporting nursing program is a promising way of achieving this goal. Methods: The present Huashan nursing program was established in consideration of the following elements, that were the routine perioperative care, ensuring surgical safety and improving patient cooperation. Before surgery, psychiatric nursing, health education and risk control were stressed. After surgery, in addition to routine nursing and positioning, special attention was needed for the targeted nursing of postoperative adverse events. In addition, we performed descriptive statistical analysis on the clinical data of patients receiving the Huashan nursing program, focusing on postoperative adverse events. Totally 85 patients were included in the study, and postoperative adverse events occurred in 10 patients, including severe pain (5, 5.88%), neck hematoma (2, 2.35%), dyspnea (2, 2.35%) and hoarseness (1, 1.18%). The above adverse events were alleviated under the targeted nursing guided by the Huashan program. Discussion: This article introduces the Huashan nursing program, which is based on preoperative evaluations, educational sessions, postoperative monitoring and targeted nursing, for patients undergoing CC7. The present nursing program helped the promotion and provided the opportunity to maximize the benefits of CC7. Internal Medicine stroke contralateral seventh cervical nerve transfer evaluation and education postoperative monitoring targeted nursing Figures Figure 1 Figure 2 1. BACKGROUND Stroke causes various types of functional impairments, which persist years following stroke onset and may even be permanent. Despite advances in medicine, the overall stroke burden has been reported to continuously increase in recent years [1, 2]. Urgent demands for stroke recovery have been proposed, and the study on the contralateral seventh cervical nerve transfer (CC7), provided new insights into the treatment of chronic stroke. By transferring the C7 nerve, the functional connection between the spastic arm and ipsilateral hemisphere was established, and the healthy hemisphere could gain control over the paralyzed arm [3]. As reported in our recent trial, CC7 surgery in combination with rehabilitation led to an average 17.7-point increase in the Fugl-Meyer score, massively exceeding the magnitude of improvement in the control group who underwent rehabilitation only [4]. In addition to improvements in arm motor function, spasticity and difficulties performing activities of daily living were also ameliorated [4]. CC7 surgery is an entirely novel approach for stroke recovery, and much more effort should be made to promote CC7. Considering the essential roles of nursing in all medical treatments, establishing a standard perioperative nursing program may be a promising approach. The nursing program was mainly developed on the basis of the following two aspects: patient characteristics and CC7-related side effects. The former aspect mainly includes advanced ages and basic diseases, which require detailed preoperative assessments and education [5]. Moreover, because most stroke survivors have difficulties performing activities of daily living, the nursing program also focuses on providing assistance in daily activities and preventing accidental injuries (such as falls) [6]. The injuries include hematoma and injuries of surrounding nerves (e.g., the superior laryngeal nerve, the recurrent laryngeal nerve and the phrenic nerve), which may lead to hoarseness and dyspnea. Additionally, paraesthesia is usually reported after nerve transfer [7], and the management of paraesthesia, especially in the presence of severe pain, is also a topic of concern. Targeted care for the above side effects is essential for recovery. In view of this, this paper proposes a perioperative nursing plan for contralateral seventh cervical nerve transfer: the Huashan nursing program. The key points in nursing work were addressed to ensure patient safety and successful surgery and reduce adverse events. Moreover, we performed descriptive statistical analyses on the clinical data of 85 patients admitted to our center to expound the clinical outcomes of the Huashan nursing program intervention. 2. METHODS 2.1. Participants A total of 85 participants were included in the study, and they underwent CC7 surgery in Huashan Hospital from June 2015 to June 2018. The inclusion and exclusion criteria were similar to those in our previous study [4] . 2.2. The Huashan nursing program The Huashan program was illustrated in Figure 1, and the detials were elaborated as following [8, 9]. A. Preoperative nursing Psychiatric Nursing: All patients were educated in a routine manner after admission to hospital, mainly on CC7-realted principles, possible complications and reasonable postoperative expectations. In addition, the hospital anxiety and depression scale (HADS) was used to assess the psychological states of the patients, and special attention was given to the patients with a score ≥ 8 [10]. We encouraged communication among patients to eliminate negative emotions and build patients' confidence in treatment, and multimedia materials were also used to share information on CC7. Clinical Path in Health Education: We outlined the entire track a patient is expected to follow throughout the course of the treatment. Both orderliness and timeliness were stressed, and education was scheduled in phases [11]. The path will lead to a better understanding and the cooperation of patients and promote efficient and orderly operations for nursing work. Surgical Risk Assessment: The assessment is essential, as most stroke survivors are characterized by an advanced age and many basic diseases [5]. Special effort should be made to prevent pulmonary embolism, pulmonary infection and stroke recurrence. Details regarding the preoperative examinations were listed in Table 1. The patient's medical history and physical signs are of great significance, and examinations should be performed appropriately to minimize risk. Preoperative Preparation: Routine preparation includes stopping taking antiplatelet and anticoagulant drugs 5 days before surgery; water and food fasting for 6 hours before surgery; removing the denture; training for cough and sputum excretion; and preparing the skin of both armpits, the jaw and the uninjured limb (for the preparation of a sural nerve graft). B. The routine postoperative nursing The patients took a supine position after surgery. Two negative pressure drainage tubes were used, and the color, quality and quantity of drainage fluid were monitored. Generally, the drainage tubes were removed when the color of the drainage fluid turned faint yellow and the volume collected over 24 hours was less than 20-30 ml. When the volume increased suddenly or the color turned bright red, we checked for active bleeding and reported it in a timely manner. In contrast, when the volume decreased suddenly, an obstruction could have occurred, and we needed to identify and resolve the problem. Meanwhile, sandbags were placed over the bilateral clavicle for 48 hours to reduce bleeding and the incidence of hematoma. The patient's state, particularly regarding complaints of chest tightness, difficulty breathing and neck swelling, was closely monitored. ECG monitoring and oxygen inhalation were performed for 4-6 hours after surgery. Blood pressure management is essential for the prevention of cerebrovascular accidents. We instructed the patients with hypertension to continue antihypertensive therapy as usual. A low ambient temperature, anxiety, pain and sleep disturbances can increase blood pressure, and the impact of these factors should be minimized as much as possible (details provided in the next section). Esophageal edema may occur due to the stimulation or pulling of the esophagus during the operation; thus, postoperative dietary guidance is required to protect the esophagus. A liquid diet was allowed 6 hours after surgery, and a semiliquid diet was provided on postoperative day 2. From postoperative day 3 onward, the patients consumed a soft diet, and after 1 month, the patients consumed a general diet. For the prevention of lung infection, early out-of-bed activity was encouraged, and the range and intensity of activity was gradually increased. For the prevention of lower extremity deep venous thrombosis, air pressure treatment can be utilized. C. The position and immobilization To reduce the magnitude of traction on the transferred C7 nerve, a neck collar and bandage were used to reduce the movement of the head and the paralyzed arm, respectively, for 4 weeks after surgery [12]. The shoulder on the paralyzed side was kept in an adducted position, and we helped the patients hold a towel with the paralyzed hand to relieve spasticity. D. Targeted nursing for adverse events As shown in Table 2, adverse events occurred in 10 patients after surgery. Targeted nursing for the above adverse events played essential roles in recovery, and the details are as follows (also seen in Figure 2). Neck Hematoma. Attention should be paid to the self-reported symptoms of patients and the quality and quantity of the drainage liquid. When the amount of drainage liquid increased and the color turned dark, we needed to remove the neck collar, watch the color of the neck, observe whether the neck widened, and palpate the neck to assess muscle tension. Neck hematoma is usually caused by poor drainage and the use of anticoagulant drugs. For obstructed drainage, the tubes were repositioned. For the patients with a medical history of anticoagulant drugs, pressure dressings were effective, and drainage tubes were not removed unless the situation improved. Hoarseness. Injuries of the recurrent laryngeal nerve can lead to hoarseness, which is generally caused by excessive traction during surgery or neck hematoma compression [13]. Attention should be paid to monitor whether there is a change in voice or coughing when drinking, especially in patients with neck hematoma. For patients suffering from nerve traction, hoarseness spontaneously resolves within approximately one week, and we should increase doctor-patient communication and relieve the anxiety of patients during the nursing process. Regarding patients with neck hematoma, treatments of the primary disease should be stressed, and the details are listed above. For nerve traction, hoarseness spontaneously resolves, but attention should be paid to patient comfort and communication with nurses so that the patients consistently maintain a positive mood. Severe Pain. Pain and numbness of the arm were the most common adverse events after surgery [4]. In severe cases, sleep disorders, anxiety and depression, and fluctuations in blood pressure and blood glucose levels can occur, which ultimately negatively impact recovery. The face rating scale (FRS) was utilized to assess the severity of pain [14]. For patients with a score less than 5, the preferred treatment was physical therapy. For the patients with a score between 5 and 7, imagery therapy was added, and the patients were asked to relax their minds and imagine good things, which attenuated sympathetic activation to relieve pain. For the patients with an score higher than 7, sleep disorders can occur, and drug therapy is often necessary. Painkillers (i.e., gabapentin and pregabalin) and sleeping pills were used as needed. Dyspnea. Phrenic nerve injury can lead to dyspnea [15], which is usually caused by excessive traction or accidental injury when the scalenus is cut anteriorly. We closely monitored the patients’ self-reported symptoms, respiratory frequency and oxygen saturation. When dyspnea occurred, a high concentration of oxygen was used, and emergent blood gas analysis and chest CT scans were performed to determine the severity. Afterwards, patients were asked to enhance thoracic breathing. The exercise was performed three times on the first day for ten minutes each time. Then, the duration and intensity of breathing exercise improved gradually. To prevent lung infection, the head of the bed was raised to 30°, the patient was assisted in turning over, the back of the patient was patted, and atomization inhalation was performed [16, 17]. 3. Discussion Presently, we proposed the perioperative nursing program for stroke patients undergoing CC7, the Huashan program. Further, the preliminary study enrolling 85 patients suggested its’ feasibility and effectiveness. Before surgery, nurses focused on performing a comprehensive examination, which was established based on the complex conditions of stroke patients. The risk assessment of complications represents an essential step to ensure surgical safety. Moreover, the clinical path for health education was key in reducing patient’s worries and building their confidence [18, 19]. Regarding postsurgical nursing, attention should be paid to the management of surgery-related complications, especially neck hematoma, hoarseness, severe pain and dyspnea [4]. In addition to the early discovery and timely treatment of complications, the prevention of accidents and treatment of basic diseases by nurses must also be stressed. To conclude, CC7 is a novel and effective treatment approach for patients with spastic arm paralysis in the chronic stage. Based on the patients’ characteristics and surgery-related side effects, the present program provided the feasible template. The Huashan nursing program helps maximize the benefits of CC7. Moreover, it can also provide novel perspectives of nursing for patients with brain injury and patients undergoing nerve transfer. abbreviations CC7, contralateral seventh cervical nerve transfer; HADS, the hospital anxiety and depression scale; FRS, face rating scale. Declarations Ethics approval and consent to participate The institutional review board of Huashan Hospital approved the study, and each participant provided written informed consent. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding This paper was partly supported by the Fosun Nursing Research Fund Project of Fundan University (FNF201918), Special Foundation for Nursing in Health Research Project in Jing 'an District, Shanghai (2019HL01), First-class Nursing Discipline Construction Project of Fudan University (FNSYL202006) Authors' contributions Fan Su and Xiaoqian Wang collected the data and wrote the paper. Ying Liu, Wendong Xu and Jinyao Zhang designed the program and directed the study. Ye Xu and Yiqun Zhou assistted in program design and paper writing . Acknowledgements Not applicable. References Feigin VL, Norrving B, Mensah GA: Global Burden of Stroke . Circ Res 2017, 120 (3):439-448. Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, Moran AE, Sacco RL, Anderson L, Truelsen T et al : Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010 . Lancet 2014, 383 (9913):245-254. Hua XY, Qiu YQ, Li T, Zheng MX, Shen YD, Jiang S, Xu JG, Gu YD, Xu WD: Contralateral peripheral neurotization for hemiplegic upper extremity after central neurologic injury . Neurosurgery 2015, 76 (2):187-195; discussion 195. Zheng MX, Hua XY, Feng JT, Li T, Lu YC, Shen YD, Cao XH, Zhao NQ, Lyu JY, Xu JG et al : Trial of Contralateral Seventh Cervical Nerve Transfer for Spastic Arm Paralysis . N Engl J Med 2018, 378 (1):22-34. Writing Group M, Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Despres JP et al : Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association . Circulation 2016, 133 (4):e38-360. Quigley PA: Redesigned Fall and Injury Management of Patients With Stroke . Stroke 2016, 47 (6):e92-94. Wang GB, Yu AP, Ng CY, Lei GW, Wang XM, Qiu YQ, Feng JT, Li T, Chen QZ, He QR et al : Contralateral C7 to C7 nerve root transfer in reconstruction for treatment of total brachial plexus palsy: anatomical basis and preliminary clinical results . J Neurosurg Spine 2018, 29 (5):491-499. Levett DZ, Edwards M, Grocott M, Mythen M: Preparing the patient for surgery to improve outcomes . Best Pract Res Clin Anaesthesiol 2016, 30 (2):145-157. Roulin D, Najjar P, Demartines N: Enhanced Recovery After Surgery Implementation: From Planning to Success . J Laparoendosc Adv Surg Tech A 2017, 27 (9):876-879. Snaith RP: The Hospital Anxiety And Depression Scale . Health Qual Life Outcomes 2003, 1 :29. Liu J, Yan J, Ye Q, Ming Y, Cheng K, Liu L, Yang L, Wang Y: [Effect of clinical pathway of health education in patients with kidney transplantation] . Zhong Nan Da Xue Xue Bao Yi Xue Ban 2014, 39 (1):78-83. Li J, Ying Y, Su F, Chen L, Yang J, Jia J, Jia X, Xu W: The Hua-Shan rehabilitation program after contralateral seventh cervical nerve transfer for spastic arm paralysis . Disabil Rehabil 2020:1-8. Myssiorek D: Recurrent laryngeal nerve paralysis: anatomy and etiology . Otolaryngol Clin North Am 2004, 37 (1):25-44, v. Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B: The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement . Pain 2001, 93 (2):173-183. Kokatnur L, Rudrappa M: Diaphragmatic Palsy . Diseases 2018, 6 (1). Gohl O, Walker DJ, Walterspacher S, Langer D, Spengler CM, Wanke T, Petrovic M, Zwick RH, Stieglitz S, Glockl R et al : [Respiratory Muscle Training: State of the Art] . Pneumologie 2016, 70 (1):37-48. Takemura H: [Perioperative Management for Cardiovascular Surgery on the Patients with Pulmonary Dysfunction] . Kyobu Geka 2020, 73 (10):764-769. Hofmann PA: Critical path method: an important tool for coordinating clinical care . Jt Comm J Qual Improv 1993, 19 (7):235-246. King AB, Alvis BD, McEvoy MD: Enhanced recovery after surgery, perioperative medicine, and the perioperative surgical home: current state and future implications for education and training . Curr Opin Anaesthesiol 2016, 29 (6):727-732. Tables Table 1. The examinations before CC7 surgery Examination program Examination purpose Basic Examination Blood routine analysis, coagulation function test, electrocardiogram, tests of viral hepatitis, syphilis and HIV Routine preoperative assessment Specific Examination echocardiography Whether cardiopulmonary function is capable of surgery; whether mural thrombus occur pulmonary function test carotid artery ultrasound Whether severe vascular stenosis or unstable plaques exist head CT angiography lower limbs deep vein ultrasound Whether deep vein thrombosis exist brachial plexus MRI Whether there is anatomic variation brain functional MRI Access brain plasticity Table 2. The demographic data and adverse events no. (%) Gender male 74 (87.06%) female 11 (12.94%) Side of paralyzed hand left 45 (52.94%) right 40 (47.06%) Cause of injury cerebral hemorrhage 48 (56.47%) cerebral infarction 37 (43.53%) Adverse events Neck Hematoma 2 (2.35%) Hoarseness 1 (1.18%) Severe Pain 5 (5.88%) Dyspnea 2 (2.35%) Cite Share Download PDF Status: Published Journal Publication published 07 Apr, 2022 Read the published version in Perioperative Medicine → Version 1 posted Review # 2 received at journal 05 Oct, 2021 Editorial decision: Minor revision 05 Oct, 2021 Reviewer # 2 agreed at journal 18 Sep, 2021 Review # 1 received at journal 29 Aug, 2021 Reviewer # 1 agreed at journal 22 Aug, 2021 Reviewers invited by journal 04 Mar, 2021 Editor assigned by journal 28 Feb, 2021 Editor invited by journal 28 Feb, 2021 Submission checks completed at journal 16 Feb, 2021 First submitted to journal 13 Feb, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-245379","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Methodology","associatedPublications":[],"authors":[{"id":12096771,"identity":"cad210e4-20fb-40d3-9725-0e9a97204392","order_by":0,"name":"Fan Su","email":"","orcid":"","institution":"Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Fan","middleName":"","lastName":"Su","suffix":""},{"id":12096772,"identity":"e538f148-4b8f-4592-a158-3a36b636a374","order_by":1,"name":"Xiaoqian Wang","email":"","orcid":"","institution":"Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoqian","middleName":"","lastName":"Wang","suffix":""},{"id":12096773,"identity":"2bd35ade-3e7e-4d68-9409-806a9ff7f6cb","order_by":2,"name":"Ye Xu","email":"","orcid":"","institution":"Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Ye","middleName":"","lastName":"Xu","suffix":""},{"id":12096774,"identity":"35354d82-ea5a-490a-b724-ab9017d43620","order_by":3,"name":"Yiqun Zhou","email":"","orcid":"","institution":"Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Yiqun","middleName":"","lastName":"Zhou","suffix":""},{"id":12096775,"identity":"130a8f01-2ac6-4d22-bf38-14d693c2ba3a","order_by":4,"name":"Wendong Xu","email":"","orcid":"","institution":"Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Wendong","middleName":"","lastName":"Xu","suffix":""},{"id":12096776,"identity":"ea4df0ce-9278-4871-89f1-f0c9a375c626","order_by":5,"name":"Jinyao Zhang","email":"","orcid":"","institution":"Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Jinyao","middleName":"","lastName":"Zhang","suffix":""},{"id":12096777,"identity":"e8da6a04-f710-48f0-98ef-e1c1e79300e3","order_by":6,"name":"Ying Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYBACeWbmAwc+GPyX42dvPkCcFsP2tsSDMwqYjSV7jiUQac2ZM8qHeT4wJ26Y4WNAnA7GGTkMh3kM2BI3SPB8vPGGwU5Ot4GAFnaJ3AMH5xjwGG+X7t1sOYch2djsAEFb8hIOvDGQkN055+w2aR6GA4nbCGlhuJFjcIDHwIBxw42cZ0RqOXPG4CCPQYIiUAsbcVqAgZxwcIbBAVAgG1vOMSDCL8CoPPzhw58DoKh8eONNhZ0cQS0oQIKHyKhB1kKqjlEwCkbBKBgRAAAGcUp/tFjOmQAAAABJRU5ErkJggg==","orcid":"","institution":"Fudan University","correspondingAuthor":true,"prefix":"","firstName":"Ying","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2021-02-16 16:57:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-245379/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-245379/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13741-022-00245-4","type":"published","date":"2022-04-07T23:49:31+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":6279025,"identity":"f4c734f6-864e-4b9d-b4a0-da0b398b3e7f","added_by":"auto","created_at":"2021-02-23 21:47:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":513593,"visible":true,"origin":"","legend":"Illustration of the Huashan nursing program for stroke patients undergoing contralateral seventh cervical nerve transfer. Preoperative care mainly included psychiatric nursing, health education, risk control and general preoperative preparation, while postperative nursing main consisted of rountine nursing, position and target nursing for adverse events. ","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-245379/v1/1017a70510c9d571268f68f8.png"},{"id":6278655,"identity":"259cd8ef-d7d2-4731-9ad7-ddb08857b531","added_by":"auto","created_at":"2021-02-23 21:44:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":548821,"visible":true,"origin":"","legend":"CC7-related adverse events and the targeted nursing program. The occurance and manifestation of postperative adverse events were illustrated. The targeted nursing program was proposed for pain relief, hematoma clearance, breathing recovery and hoarseness recovery. ","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-245379/v1/cfad2fc95507b18bba37ed96.png"},{"id":20042377,"identity":"3d44cad4-4075-4d15-8c21-1c31278bc134","added_by":"auto","created_at":"2022-04-06 23:49:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1157435,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-245379/v1/b1838229-1a95-43ca-a8d9-f0c1b4b1eaa4.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eHuashan Perioperative Nursing Program for Stroke Patients Undergoing Contralateral Seventh Cervical Nerve Transfer\u003c/p\u003e","fulltext":[{"header":"1. BACKGROUND","content":"\u003cp\u003eStroke causes various types of functional impairments, which persist years following stroke onset and may even be permanent. Despite advances in medicine, the overall stroke burden has been reported to continuously increase in recent years [1, 2]. Urgent demands for stroke recovery have been proposed, and the study on the contralateral seventh cervical nerve transfer (CC7), provided new insights into the treatment of chronic stroke. By transferring the C7 nerve, the functional connection between the spastic arm and ipsilateral hemisphere was established, and the healthy hemisphere could gain control over the paralyzed arm [3]. As reported in our recent trial, CC7 surgery in combination with rehabilitation led to an average 17.7-point increase in the Fugl-Meyer score, massively exceeding the magnitude of improvement in the control group who underwent rehabilitation only [4]. In addition to improvements in arm motor function, spasticity and difficulties performing activities of daily living were also ameliorated [4]. CC7 surgery is an entirely novel approach for stroke recovery, and much more effort should be made to promote CC7. Considering the essential roles of nursing in all medical treatments, establishing a standard perioperative nursing program may be a promising approach.\u003c/p\u003e\n\u003cp\u003eThe nursing program was mainly developed on the basis of the following two aspects: patient characteristics and CC7-related side effects. The former aspect mainly includes advanced ages and basic diseases, which require detailed preoperative assessments and education [5]. Moreover, because most stroke survivors have difficulties performing activities of daily living, the nursing program also focuses on providing assistance in daily activities and preventing accidental injuries (such as falls) [6]. The injuries include hematoma and injuries of surrounding nerves (e.g., the superior laryngeal nerve, the recurrent laryngeal nerve and the phrenic nerve), which may lead to hoarseness and dyspnea. Additionally, paraesthesia is usually reported after nerve transfer [7], and the management of paraesthesia, especially in the presence of severe pain, is also a topic of concern. Targeted care for the above side effects is essential for recovery.\u003c/p\u003e\n\u003cp\u003eIn view of this, this paper proposes a perioperative nursing plan for contralateral seventh cervical nerve transfer: the Huashan nursing program. The key points in nursing work were addressed to ensure patient safety and successful surgery and reduce adverse events. Moreover, we performed descriptive statistical analyses on the clinical data of 85 patients admitted to our center to expound the clinical outcomes of the Huashan nursing program intervention.\u003c/p\u003e"},{"header":"2. METHODS","content":"\u003cp\u003e\u003cstrong\u003e2.1. Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 85 participants were included in the study, and they underwent CC7 surgery in Huashan Hospital from June 2015 to June 2018. The inclusion and exclusion criteria were similar to those in our previous study [4] .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. The Huashan nursing program\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Huashan program was illustrated in Figure 1, and the detials were elaborated as following [8, 9].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eA. Preoperative nursing\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePsychiatric Nursing: \u003c/strong\u003eAll patients were educated in a routine manner after admission to hospital, mainly on CC7-realted principles, possible complications and reasonable postoperative expectations. In addition, the hospital anxiety and depression scale (HADS) was used to assess the psychological states of the patients, and special attention was given to the patients with a score \u0026ge; 8 [10]. We encouraged communication among patients to eliminate negative emotions and build patients' confidence in treatment, and multimedia materials were also used to share information on CC7.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Path in Health Education: \u003c/strong\u003eWe outlined the entire track a patient is expected to follow throughout the course of the treatment. Both orderliness and timeliness were stressed, and education was scheduled in phases [11]. The path will lead to a better understanding and the cooperation of patients and promote efficient and orderly operations for nursing work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical Risk Assessment: \u003c/strong\u003eThe assessment is essential, as most stroke survivors are characterized by an advanced age and many basic diseases [5]. Special effort should be made to prevent pulmonary embolism, pulmonary infection and stroke recurrence. Details regarding the preoperative examinations were listed in Table 1. The patient's medical history and physical signs are of great significance, and examinations should be performed appropriately to minimize risk.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePreoperative Preparation: \u003c/strong\u003eRoutine preparation includes stopping taking antiplatelet and anticoagulant drugs 5 days before surgery; water and food fasting for 6 hours before surgery; removing the denture; training for cough and sputum excretion; and preparing the skin of both armpits, the jaw and the uninjured limb (for the preparation of a sural nerve graft).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eB. The routine postoperative nursing\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patients took a supine position after surgery. Two negative pressure drainage tubes were used, and the color, quality and quantity of drainage fluid were monitored. Generally, the drainage tubes were removed when the color of the drainage fluid turned faint yellow and the volume collected over 24 hours was less than 20-30 ml. When the volume increased suddenly or the color turned bright red, we checked for active bleeding and reported it in a timely manner. In contrast, when the volume decreased suddenly, an obstruction could have occurred, and we needed to identify and resolve the problem. Meanwhile, sandbags were placed over the bilateral clavicle for 48 hours to reduce bleeding and the incidence of hematoma. The patient's state, particularly regarding complaints of chest tightness, difficulty breathing and neck swelling, was closely monitored.\u003c/p\u003e\n\u003cp\u003eECG monitoring and oxygen inhalation were performed for 4-6 hours after surgery. Blood pressure management is essential for the prevention of cerebrovascular accidents. We instructed the patients with hypertension to continue antihypertensive therapy as usual. A low ambient temperature, anxiety, pain and sleep disturbances can increase blood pressure, and the impact of these factors should be minimized as much as possible (details provided in the next section). Esophageal edema may occur due to the stimulation or pulling of the esophagus during the operation; thus, postoperative dietary guidance is required to protect the esophagus. A liquid diet was allowed 6 hours after surgery, and a semiliquid diet was provided on postoperative day 2. From postoperative day 3 onward, the patients consumed a soft diet, and after 1 month, the patients consumed a general diet. For the prevention of lung infection, early out-of-bed activity was encouraged, and the range and intensity of activity was gradually increased. For the prevention of lower extremity deep venous thrombosis, air pressure treatment can be utilized.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eC. The position and immobilization\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo reduce the magnitude of traction on the transferred C7 nerve, a neck collar and bandage were used to reduce the movement of the head and the paralyzed arm, respectively, for 4 weeks after surgery [12]. The shoulder on the paralyzed side was kept in an adducted position, and we helped the patients hold a towel with the paralyzed hand to relieve spasticity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eD. Targeted nursing for adverse events\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Table 2, adverse events occurred in 10 patients after surgery. Targeted nursing for the above adverse events played essential roles in recovery, and the details are as follows (also seen in Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNeck Hematoma. \u003c/strong\u003eAttention should be paid to the self-reported symptoms of patients and the quality and quantity of the drainage liquid. When the amount of drainage liquid increased and the color turned dark, we needed to remove the neck collar, watch the color of the neck, observe whether the neck widened, and palpate the neck to assess muscle tension. Neck hematoma is usually caused by poor drainage and the use of anticoagulant drugs. For obstructed drainage, the tubes were repositioned. For the patients with a medical history of anticoagulant drugs, pressure dressings were effective, and drainage tubes were not removed unless the situation improved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHoarseness. \u003c/strong\u003eInjuries of the recurrent laryngeal nerve can lead to hoarseness, which is generally caused by excessive traction during surgery or neck hematoma compression [13]. Attention should be paid to monitor whether there is a change in voice or coughing when drinking, especially in patients with neck hematoma. For patients suffering from nerve traction, hoarseness spontaneously resolves within approximately one week, and we should increase doctor-patient communication and relieve the anxiety of patients during the nursing process. Regarding patients with neck hematoma, treatments of the primary disease should be stressed, and the details are listed above. For nerve traction, hoarseness spontaneously resolves, but attention should be paid to patient comfort and communication with nurses so that the patients consistently maintain a positive mood.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSevere Pain. \u003c/strong\u003ePain and numbness of the arm were the most common adverse events after surgery [4]. In severe cases, sleep disorders, anxiety and depression, and fluctuations in blood pressure and blood glucose levels can occur, which ultimately negatively impact recovery. The face rating scale (FRS) was utilized to assess the severity of pain [14]. For patients with a score less than 5, the preferred treatment was physical therapy. For the patients with a score between 5 and 7, imagery therapy was added, and the patients were asked to relax their minds and imagine good things, which attenuated sympathetic activation to relieve pain. For the patients with an score higher than 7, sleep disorders can occur, and drug therapy is often necessary. Painkillers (i.e., gabapentin and pregabalin) and sleeping pills were used as needed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDyspnea. \u003c/strong\u003ePhrenic nerve injury can lead to dyspnea [15], which is usually caused by excessive traction or accidental injury when the scalenus is cut anteriorly. We closely monitored the patients\u0026rsquo; self-reported symptoms, respiratory frequency and oxygen saturation. When dyspnea occurred, a high concentration of oxygen was used, and emergent blood gas analysis and chest CT scans were performed to determine the severity. Afterwards, patients were asked to enhance thoracic breathing. The exercise was performed three times on the first day for ten minutes each time. Then, the duration and intensity of breathing exercise improved gradually. To prevent lung infection, the head of the bed was raised to 30\u0026deg;, the patient was assisted in turning over, the back of the patient was patted, and atomization inhalation was performed [16, 17].\u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003ePresently, we proposed the perioperative nursing program for stroke patients undergoing CC7, the Huashan program. Further, the preliminary study enrolling 85 patients suggested its\u0026rsquo; feasibility and effectiveness.\u003c/p\u003e\n\u003cp\u003eBefore surgery, nurses focused on performing a comprehensive examination, which was established based on the complex conditions of stroke patients. The risk assessment of complications represents an essential step to ensure surgical safety. Moreover, the clinical path for health education was key in reducing patient\u0026rsquo;s worries and building their confidence [18, 19]. Regarding postsurgical nursing, attention should be paid to the management of surgery-related complications, especially neck hematoma, hoarseness, severe pain and dyspnea [4]. In addition to the early discovery and timely treatment of complications, the prevention of accidents and treatment of basic diseases by nurses must also be stressed.\u003c/p\u003e\n\u003cp\u003eTo conclude, CC7 is a novel and effective treatment approach for patients with spastic arm paralysis in the chronic stage. Based on the patients\u0026rsquo; characteristics and surgery-related side effects, the present program provided the feasible template. The Huashan nursing program helps maximize the benefits of CC7. Moreover, it can also provide novel perspectives of nursing for patients with brain injury and patients undergoing nerve transfer.\u003c/p\u003e"},{"header":"abbreviations","content":"\u003cp\u003eCC7, contralateral seventh cervical nerve transfer;\u003c/p\u003e\n\u003cp\u003eHADS, the hospital anxiety and depression scale;\u003c/p\u003e\n\u003cp\u003eFRS, face rating scale.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe institutional review board of Huashan Hospital approved the study, and each participant provided written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis paper was partly supported by the Fosun Nursing Research Fund Project of Fundan University (FNF201918), Special Foundation for Nursing in Health Research Project in Jing 'an District, Shanghai (2019HL01), First-class Nursing Discipline Construction Project of Fudan University (FNSYL202006)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFan Su and Xiaoqian Wang collected the data and wrote the paper. Ying Liu, Wendong Xu and Jinyao Zhang designed the program and directed the study. Ye Xu and Yiqun Zhou assistted in program design and paper writing\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFeigin VL, Norrving B, Mensah GA: \u003cstrong\u003eGlobal Burden of Stroke\u003c/strong\u003e. \u003cem\u003eCirc Res \u003c/em\u003e2017, \u003cstrong\u003e120\u003c/strong\u003e(3):439-448.\u003c/li\u003e\n\u003cli\u003eFeigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, Moran AE, Sacco RL, Anderson L, Truelsen T\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eGlobal and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010\u003c/strong\u003e. \u003cem\u003eLancet \u003c/em\u003e2014, \u003cstrong\u003e383\u003c/strong\u003e(9913):245-254.\u003c/li\u003e\n\u003cli\u003eHua XY, Qiu YQ, Li T, Zheng MX, Shen YD, Jiang S, Xu JG, Gu YD, Xu WD: \u003cstrong\u003eContralateral peripheral neurotization for hemiplegic upper extremity after central neurologic injury\u003c/strong\u003e. \u003cem\u003eNeurosurgery \u003c/em\u003e2015, \u003cstrong\u003e76\u003c/strong\u003e(2):187-195; discussion 195.\u003c/li\u003e\n\u003cli\u003eZheng MX, Hua XY, Feng JT, Li T, Lu YC, Shen YD, Cao XH, Zhao NQ, Lyu JY, Xu JG\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eTrial of Contralateral Seventh Cervical Nerve Transfer for Spastic Arm Paralysis\u003c/strong\u003e. \u003cem\u003eN Engl J Med \u003c/em\u003e2018, \u003cstrong\u003e378\u003c/strong\u003e(1):22-34.\u003c/li\u003e\n\u003cli\u003eWriting Group M, Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Despres JP\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eHeart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association\u003c/strong\u003e. \u003cem\u003eCirculation 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\u003cstrong\u003e30\u003c/strong\u003e(2):145-157.\u003c/li\u003e\n\u003cli\u003eRoulin D, Najjar P, Demartines N: \u003cstrong\u003eEnhanced Recovery After Surgery Implementation: From Planning to Success\u003c/strong\u003e. \u003cem\u003eJ Laparoendosc Adv Surg Tech A \u003c/em\u003e2017, \u003cstrong\u003e27\u003c/strong\u003e(9):876-879.\u003c/li\u003e\n\u003cli\u003eSnaith RP: \u003cstrong\u003eThe Hospital Anxiety And Depression Scale\u003c/strong\u003e. \u003cem\u003eHealth Qual Life Outcomes \u003c/em\u003e2003, \u003cstrong\u003e1\u003c/strong\u003e:29.\u003c/li\u003e\n\u003cli\u003eLiu J, Yan J, Ye Q, Ming Y, Cheng K, Liu L, Yang L, Wang Y: \u003cstrong\u003e[Effect of clinical pathway of health education in patients with kidney transplantation]\u003c/strong\u003e. \u003cem\u003eZhong Nan Da Xue Xue Bao Yi Xue Ban \u003c/em\u003e2014, \u003cstrong\u003e39\u003c/strong\u003e(1):78-83.\u003c/li\u003e\n\u003cli\u003eLi J, Ying Y, Su F, Chen L, Yang J, Jia J, Jia X, Xu W: \u003cstrong\u003eThe Hua-Shan rehabilitation program after contralateral seventh cervical nerve transfer for spastic arm paralysis\u003c/strong\u003e. \u003cem\u003eDisabil Rehabil \u003c/em\u003e2020:1-8.\u003c/li\u003e\n\u003cli\u003eMyssiorek D: \u003cstrong\u003eRecurrent laryngeal nerve paralysis: anatomy and etiology\u003c/strong\u003e. \u003cem\u003eOtolaryngol Clin North Am \u003c/em\u003e2004, \u003cstrong\u003e37\u003c/strong\u003e(1):25-44, v.\u003c/li\u003e\n\u003cli\u003eHicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B: \u003cstrong\u003eThe Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement\u003c/strong\u003e. \u003cem\u003ePain \u003c/em\u003e2001, \u003cstrong\u003e93\u003c/strong\u003e(2):173-183.\u003c/li\u003e\n\u003cli\u003eKokatnur L, Rudrappa M: \u003cstrong\u003eDiaphragmatic Palsy\u003c/strong\u003e. \u003cem\u003eDiseases \u003c/em\u003e2018, \u003cstrong\u003e6\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eGohl O, Walker DJ, Walterspacher S, Langer D, Spengler CM, Wanke T, Petrovic M, Zwick RH, Stieglitz S, Glockl R\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003e[Respiratory Muscle Training: State of the Art]\u003c/strong\u003e. \u003cem\u003ePneumologie \u003c/em\u003e2016, \u003cstrong\u003e70\u003c/strong\u003e(1):37-48.\u003c/li\u003e\n\u003cli\u003eTakemura H: \u003cstrong\u003e[Perioperative Management for Cardiovascular Surgery on the Patients with Pulmonary Dysfunction]\u003c/strong\u003e. \u003cem\u003eKyobu Geka \u003c/em\u003e2020, \u003cstrong\u003e73\u003c/strong\u003e(10):764-769.\u003c/li\u003e\n\u003cli\u003eHofmann PA: \u003cstrong\u003eCritical path method: an important tool for coordinating clinical care\u003c/strong\u003e. \u003cem\u003eJt Comm J Qual Improv \u003c/em\u003e1993, \u003cstrong\u003e19\u003c/strong\u003e(7):235-246.\u003c/li\u003e\n\u003cli\u003eKing AB, Alvis BD, McEvoy MD: \u003cstrong\u003eEnhanced recovery after surgery, perioperative medicine, and the perioperative surgical home: current state and future implications for education and training\u003c/strong\u003e. \u003cem\u003eCurr Opin Anaesthesiol \u003c/em\u003e2016, \u003cstrong\u003e29\u003c/strong\u003e(6):727-732.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. The examinations before CC7 surgery \u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"102\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"216\"\u003e\n\u003cp\u003e\u003cstrong\u003eExamination program\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"245\"\u003e\n\u003cp\u003e\u003cstrong\u003eExamination purpose\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 61px;\"\u003e\n\u003ctd style=\"height: 61px;\" width=\"102\"\u003e\n\u003cp\u003e\u003cstrong\u003eBasic Examination\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 61px;\" width=\"216\"\u003e\n\u003cp\u003eBlood routine analysis, coagulation function test, electrocardiogram, tests of viral hepatitis, syphilis and HIV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 61px;\" width=\"245\"\u003e\n\u003cp\u003eRoutine preoperative assessment\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 245px;\" rowspan=\"7\" width=\"102\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Specific Examination\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"216\"\u003e\n\u003cp\u003eechocardiography\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 70px;\" rowspan=\"2\" width=\"245\"\u003e\n\u003cp\u003eWhether cardiopulmonary function is capable of surgery;\u003c/p\u003e\n\u003cp\u003ewhether mural thrombus occur\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"216\"\u003e\n\u003cp\u003epulmonary function test\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"216\"\u003e\n\u003cp\u003ecarotid artery ultrasound\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 70px;\" rowspan=\"2\" width=\"245\"\u003e\n\u003cp\u003eWhether severe vascular stenosis or unstable plaques exist\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"216\"\u003e\n\u003cp\u003ehead CT angiography\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"216\"\u003e\n\u003cp\u003elower limbs deep vein ultrasound\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"245\"\u003e\n\u003cp\u003eWhether deep vein thrombosis exist\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"216\"\u003e\n\u003cp\u003ebrachial\u0026nbsp;plexus\u0026nbsp;MRI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"245\"\u003e\n\u003cp\u003eWhether there is anatomic variation\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr style=\"height: 35px;\"\u003e\n\u003ctd style=\"height: 35px;\" width=\"216\"\u003e\n\u003cp\u003ebrain functional MRI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"height: 35px;\" width=\"245\"\u003e\n\u003cp\u003eAccess brain plasticity\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. The demographic data and adverse events\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"157\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"204\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e\u003cstrong\u003eno. (%)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"157\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"204\"\u003e\n\u003cp\u003emale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e74 (87.06%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"204\"\u003e\n\u003cp\u003efemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e11 (12.94%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"157\"\u003e\n\u003cp\u003eSide of paralyzed hand\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"204\"\u003e\n\u003cp\u003eleft\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e45 (52.94%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"204\"\u003e\n\u003cp\u003eright\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e40 (47.06%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"157\"\u003e\n\u003cp\u003eCause of injury\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"204\"\u003e\n\u003cp\u003ecerebral hemorrhage\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e48 (56.47%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"204\"\u003e\n\u003cp\u003ecerebral infarction\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e37 (43.53%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"157\"\u003e\n\u003cp\u003eAdverse events\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"204\"\u003e\n\u003cp\u003eNeck Hematoma\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e2 (2.35%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"204\"\u003e\n\u003cp\u003eHoarseness\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e1 (1.18%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"204\"\u003e\n\u003cp\u003eSevere Pain\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e5 (5.88%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"204\"\u003e\n\u003cp\u003eDyspnea\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e2 (2.35%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"perioperative-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"peri","sideBox":"Learn more about [Perioperative Medicine](http://perioperativemedicinejournal.biomedcentral.com)","snPcode":"13741","submissionUrl":"https://submission.nature.com/new-submission/13741/3","title":"Perioperative Medicine","twitterHandle":"@EMSurgeryBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"stroke, contralateral seventh cervical nerve transfer, evaluation and education, postoperative monitoring, targeted nursing","lastPublishedDoi":"10.21203/rs.3.rs-245379/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-245379/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe previous investigation regarding contralateral seventh cervical nerve transfer (CC7) revealed a novel and effective approach to improve arm function in patients with chronic spastic paralysis. The patients who underwent both CC7 and standard rehabilitation showed greater functional improvements and spasticity reductions than did the control group who underwent rehabilitation only. Additional efforts are needed to maximize the benefits in patients and establishing a supporting nursing program is a promising way of achieving this goal.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThe present Huashan nursing program was established in consideration of the following elements, that were the routine perioperative care, ensuring surgical safety and improving patient cooperation. Before surgery, psychiatric nursing, health education and risk control were stressed. After surgery, in addition to routine nursing and positioning, special attention was needed for the targeted nursing of postoperative adverse events. In addition, we performed descriptive statistical analysis on the clinical data of patients receiving the Huashan nursing program, focusing on postoperative adverse events. Totally 85 patients were included in the study, and postoperative adverse events occurred in 10 patients, including severe pain (5, 5.88%), neck hematoma\u0026nbsp;\u0026nbsp;(2, 2.35%), dyspnea\u0026nbsp;(2, 2.35%) and hoarseness (1, 1.18%). The above adverse events were alleviated under the targeted nursing guided by the Huashan program.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDiscussion: \u003c/strong\u003eThis article introduces the Huashan nursing program, which is based on preoperative evaluations, educational sessions, postoperative monitoring and targeted nursing, for patients undergoing CC7. The present nursing program helped the promotion and provided the opportunity to maximize the benefits of CC7.\u003c/p\u003e","manuscriptTitle":"Huashan Perioperative Nursing Program for Stroke Patients Undergoing Contralateral Seventh Cervical Nerve Transfer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-02-23 21:44:53","doi":"10.21203/rs.3.rs-245379/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2021-10-06T00:00:00+00:00","index":2,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"decision","content":"Minor revision","date":"2021-10-06T00:00:00+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2021-09-19T00:00:00+00:00","index":2,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-08-30T00:00:00+00:00","index":1,"fulltext":"Recommendation: Reviewer's comments unavailable due to the journal's policy.\n"},{"type":"reviewerAgreed","content":"","date":"2021-08-23T00:00:00+00:00","index":1,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-03-05T00:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2021-03-01T00:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-02-28T23:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-02-16T16:57:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2021-02-14T00:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"perioperative-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"peri","sideBox":"Learn more about [Perioperative Medicine](http://perioperativemedicinejournal.biomedcentral.com)","snPcode":"13741","submissionUrl":"https://submission.nature.com/new-submission/13741/3","title":"Perioperative Medicine","twitterHandle":"@EMSurgeryBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"49461998-fade-46a7-9afd-f71ef19f1245","owner":[],"postedDate":"February 23rd, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":2552328,"name":"Internal Medicine"}],"tags":[],"updatedAt":"2022-04-06T23:49:31+00:00","versionOfRecord":{"articleIdentity":"rs-245379","link":"https://doi.org/10.1186/s13741-022-00245-4","journal":{"identity":"perioperative-medicine","isVorOnly":false,"title":"Perioperative Medicine"},"publishedOn":"2022-04-07 23:49:31","publishedOnDateReadable":"April 7th, 2022"},"versionCreatedAt":"2021-02-23 21:44:53","video":"","vorDoi":"10.1186/s13741-022-00245-4","vorDoiUrl":"https://doi.org/10.1186/s13741-022-00245-4","workflowStages":[]},"version":"v1","identity":"rs-245379","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-245379","identity":"rs-245379","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}