For airway and tracheostomy management, the care plan (including daily assessment of readiness to wean, strict suctioning indications, ventilator maintenance, and structured oral care to reduce VAP) aligned with current evidence syntheses and best-practice recommendations for mechanically ventilated and tracheostomized patients in the ICU, which emphasize standardized assessment, secretion management, and oral hygiene bundles to prevent respiratory complications and facilitate safe liberation from the ventilator. The tracheostomy skin and stoma care measures (daily inspection, use of foam dressings to reduce device-related pressure injury) were consistent with contemporary evidence summaries on tracheostomy care and pressure-injury prevention (11, 12).

During the patient’s ICU stay, mechanical ventilation was initiated. Proper airway management during this period was crucial for ensuring the patient’s safety, preventing ventilator-associated complications, and facilitating recovery (13). The necessity of mechanical ventilation should be assessed daily. Adjustments to ventilator modes and parameters must be made precisely based on changes in these settings and the patient’s specific clinical status, with a focus on optimizing oxygen delivery and reducing oxygen consumption to restore respiratory function effectively (1). Suctioning must be performed in strict compliance with standard protocols and procedures, with rigorous assessment of suctioning indications. Suctioning should be initiated when the patient exhibits any of the following clinical indicators: (1) Significant rhonchi or wheezing; abnormal ventilator waveforms or parameter changes; (2) Dyspnea or airway obstruction; (3) Decreased oxygen saturation or deteriorating arterial blood gas results; (4)Visible excessive secretions in the oral cavity or airway; (5) Inability to produce an effective spontaneous cough; (6) Onset of acute respiratory distress; (7) Suspected aspiration of gastric or upper airway secretions; (8) Excessive sputum volume with thick consistency, accompanied by increased respiratory rate and cyanosis. Strict adherence to these suctioning indicators is crucial to prevent airway trauma from repeated suctioning and reduce the risk of infection. If airway dryness occurs post-suctioning, nebulized therapy should be administered to liquefy sputum and alleviate airway dryness.

Ventilator maintenance should be performed as follows: the heat and moisture exchanger should be replaced every 7 days or immediately if contaminated; condensate in the ventilator circuit should be removed promptly, and the condensate collection cup must be kept at the lowest point of the circuit system. Oral colonizing bacteria, dental plaque, and poor oral hygiene are closely associated with the development of ventilator-associated pneumonia (VAP). Therefore, oral care should be conducted twice daily: teeth are brushed with Xipayi Gengyin Liquid, followed by rinsing with warm water, to reduce the incidence of VAP (14).

The patient was transferred from the ICU to a general ward with a tracheostomy tube in place. The core goals of tracheostomy care are to maintain airway patency and prevent related complications, including infection, tube obstruction, and medical device-related pressure injuries.

The skin around the tracheostomy incision should be disinfected daily with normal saline or povidone-iodine, followed by replacement of the sterile gauze dressing. During this process, the incision site should be assessed for signs of redness, swelling, exudate, or bleeding. To prevent pressure injuries on the anterior neck skin, foam dressings are recommended instead of traditional tracheostomy gauze.

The structured nutritional assessment using NRS-2002 and the combination of enteral and parenteral nutrition were planned according to international perioperative nutrition guidelines that recommend early risk screening and energy/protein targets of approximately 25–30 kcal/kg/day and 1.2–2.0 g/kg/day of protein in surgical and critically ill patients (12).

Skin management strategies (Braden-based risk assessment, frequent repositioning, air mattress, moisture control, and barrier/protective products in the context of diarrhea and incontinence) reflect evidence that fecal incontinence with loose stools and high Braden risk scores are strong predictors of incontinence-associated dermatitis and pressure injury, and that structured skin-care protocols reduce IAD severity and pressure injury risk (21, 22). The tightness of the tracheostomy ties and the skin integrity of the neck and occipital area were checked twice per shift, with no pressure injuries observed. The patient had decreased sensory perception in the right limbs. On POD 7, she developed frequent diarrhea with fecal incontinence. Her Braden Scale score was 13, indicating a high risk of skin integrity impairment and incontinence-associated dermatitis (IAD). To reduce skin pressure, an air mattress was used, and the patient was repositioned every 2 h with assistance. Family members were instructed on the proper use of the bedpan and gentle wiping of stool with wet wipes. 3 M spray film and cornstarch were applied to keep the buttocks dry. No IAD or skin integrity impairment occurred until discharge (23).

VTE prevention using the Caprini risk assessment model, low-molecular-weight heparin, and mechanical prophylaxis (intermittent pneumatic compression) is supported by validation studies and guideline-based algorithms recommending pharmacologic plus mechanical prophylaxis in high-risk surgical oncology patients. These additions clarify that the nursing interventions in this case were not solely experience-based but were deliberately selected and sequenced with reference to current evidence and consensus recommendations (24, 25).

The patient was diagnosed with endometrial cancer. Studies have shown that cancer is associated with an increased risk of VTE (26, 27). The patient had a history of stroke. Her preoperative Caprini score was 6, classifying her as a high-risk patient for VTE. Since VTE can lead to recurrent stroke or even fatal pulmonary embolism, VTE prevention is particularly important.

In accordance with guidelines (10), the patient received basic prophylaxis and pharmacological prophylaxis preoperatively. Basic prophylaxis mainly included educating the patient to increase fluid intake, performing passive limb exercises, and avoiding lower limb punctures. Pharmacological prophylaxis involved subcutaneous injection of enoxaparin sodium injection (0.4 mL: 4100 AXa IU) once daily.

Postoperatively, the patient’s Caprini score for VTE was 8. After completing bilateral lower extremity color Doppler ultrasound (with no abnormal findings), physical prophylaxis was added to the preoperative prevention regimen: bilateral lower extremity pneumatic compression devices were used continuously for 18 h daily. During hospitalization, the patient’s D-dimer (DDI) levels were continuously monitored (Figure 2). No venous thromboembolic complications occurred until discharge.

For the patient with communication barriers, healthcare providers should allow her to use various communication symbols, such as vocalizations, gestures, postures, and intonation, during health education to ensure effective communication (28, 29). Providing a communication-conducive environment, maintaining a positive attitude, and showing sufficient patience will have a positive impact on patient communication (30).

The charge nurse of each shift conducts health education using short sentences and repetitive explanations, encourages the patient to express herself, distinguishes the tone of her responses, and observes her cooperation level. These actions help assess whether the patient understands the educational content. However, healthcare providers cannot accurately and timely assess all the patient’s needs, while her primary caregiver has a better understanding of these needs. Therefore, providing health education to the primary caregiver is of great significance for the patient’s rapid postoperative recovery.

We educated the primary caregiver on the importance of tube safety and skin protection, addressed doubts about the treatment process, and guided the caregiver to assist nurses in assessing the patient’s needs. This not only helped the patient understand and cooperate with relevant medical procedures but also kept her in a good mood and actively engaged in treatment.

Prior to the patient’s discharge, health education was provided to the primary caregiver, including guidance on feeding the patient slowly to prevent choking; continuing limb rehabilitation exercises to reduce muscle atrophy; avoiding sexual activity and tub baths for 3 months; and repositioning the patient multiple times daily, plus performing back percussion to promote sputum excretion.

At discharge, the primary caregiver was assessed and confirmed competent in tracheostomy tube care, blood pressure monitoring, and oxygen saturation monitoring.

The family members may feel sad and upset, but considering that the patient’s physical condition was relatively good at the time and the cancer was in its early stages, the family members still need to have an active attitude towards treatment. Our nursing team attaches great importance to the patient, with senior nurses providing dedicated care, communicating with the patient and family members every day, guiding their recovery, and the family members cooperating well. In the case reported here, the patient was dysphasic due to her stroke. Since her family members were used to that limitation and had managed over time to establish communication with the patient, they were included in the care plan to ensure more effective communication between the patient and the healthcare professionals.

However, there are certain limitations in our care. A review of the nursing process in this case revealed that psychological care for the patient may have been insufficient. Therefore, in future clinical practice, healthcare providers should strengthen psychological assessment and intervention for such patients. In addition, no standardized neurological assessment was performed. Such an assessment could help nursing management and should be performed in similar cases.

The patient was hospitalized for 27 days and underwent follow-up 1 week after discharge. At this time, the tracheostomy tube had been removed, the patient could eat pureed food, her general condition was good, and there was no vaginal bleeding or abdominal pain.

At 3 months after discharge, the patient failed to attend the scheduled hospital review. A telephone follow-up was conducted, during which the primary caregiver stated that the patient was in good condition and could use a special wheelchair to go to the park for sun exposure.

In summary, the complex perioperative care needs of patients with endometrial cancer and post-stroke sequelae call for more effective response strategies. Specifically, conducting a comprehensive preoperative evaluation for such patients (including assessment of stroke-related motor function and cancer surgical tolerance) is of great importance. Furthermore, the MDTs can ensure the provision of high-quality diagnostic and therapeutic recommendations as well as optimal treatment plans for patients with multiple comorbidities during the perioperative period. We believe that in the future, nurses can serve as initiators of MDTs, collaborating with specialized nurses and nursing experts to deliver more comprehensive nursing care to patients with multiple comorbidities.

Notably, when highly specialized nursing issues arise in ward nursing (such as the complex perioperative care of the aforementioned patients), specialist nursing consultations also play a crucial role: they not only help resolve clinical nursing challenges but also facilitate the timely identification of problems and proactive intervention, this positive role is key to preventing the occurrence of severe complications, and further complements the collaborative support of MDTs in improving the quality of care for patients with multiple comorbidities.

First, in view of the patient’s severe post-stroke dysphagia and high aspiration risk, a nasogastric tube was placed preoperatively to secure an enteral feeding route and facilitate safer airway and nutritional management around the time of surgery. Enteral nutrition is recommended for stroke patients who cannot safely swallow, both to prevent malnutrition and to reduce complications such as aspiration pneumonia and poor functional recovery. Early initiation of enteral tube feeding (within the first few days after recognizing dysphagia or nutritional risk) is associated with improved functional outcomes and lower complication rates in stroke populations, and nasogastric feeding is widely regarded as an appropriate early route in patients with severe dysphagia. Dysphagia after stroke is highly prevalent and is strongly linked to malnutrition, dehydration, aspiration pneumonia, and worse post-stroke prognosis, supporting proactive decisions about early tube placement rather than prolonged fasting or delayed nutritional support. In the postoperative period, once intestinal function returned, enteral nutrition via the nasogastric tube was resumed promptly to avoid extended fasting, consistent with guidance that early enteral nutrition can improve neurological and overall outcomes in stroke patients. As the patient’s condition stabilized and swallowing function permitted, medications and diet were gradually transitioned from tube to oral administration, in line with evidence that recovery of safe oral intake is associated with better long-term outcomes and that tube feeding should be withdrawn as soon as adequate oral intake is feasible (31–33).

Second, considering the patient’s history of stroke and malignancy, she was classified as at high risk for perioperative venous thromboembolism, including recurrent cerebrovascular events and deep vein thrombosis or pulmonary embolism. Current gynecologic surgery and gynecologic oncology guidelines recommend systematic VTE risk assessment (e.g., Caprini) and dual prophylaxis (pharmacologic plus mechanical) for high-risk patients undergoing cancer surgery, provided that bleeding risk is acceptable. Perioperative protocols in gynecologic oncology have shown that expanded thromboprophylaxis regimens, including preoperative administration of unfractionated or low-molecular-weight heparin at the time of anesthesia induction and extended postoperative LMWH in women with malignancy, significantly reduce symptomatic VTE without increasing bleeding or infectious complications. More broadly, perioperative anticoagulant prophylaxis initiated shortly before surgery (roughly within 2 h before to 4 h after incision) is more effective at preventing postoperative VTE than regimens that omit this period, and physical measures such as intermittent pneumatic compression are an important adjunct, particularly in high-risk surgical or neurologic patients. In this case, prophylactic low-molecular-weight heparin was started in the preoperative period to address the elevated risk of recurrent thromboembolic events, and, after lower-limb deep vein thrombosis was excluded postoperatively, pharmacologic prophylaxis was complemented by continuous bilateral lower-limb intermittent pneumatic compression for most of the day. This combined pharmacologic–mechanical strategy is consistent with contemporary recommendations for high-risk gynecologic oncology patients and with evidence that appropriately prescribed VTE prophylaxis can reduce deep vein thrombosis and pulmonary embolism by more than half in hospitalized and surgical cohorts (34, 35).