個案護理(英文)

1、 Hemorrhage of upper digestive tract -one case nursing of hemorrhage of upper digestiveBy Kelly&Mini 19DirectoryThe hemorrhage of upper digestive tract-3-4Learning objectives-4Anatomy and physiology-5-7Case description-7-10Nursing-problems-10-16nursing evaluation-16Summary-17-19Reference-19.Introduc

2、tion1. the concept of disease: the upper gastrointestinal hemorrhage is refers to the ligament of Treitz above the digestive tract, including the esophagus, stomach, duodenum bleeding or bilious and pancreatic disease, stomach jejunum anastomosis after jejunal hemorrhage also belongs to this categor

3、y. Massive hemorrhage is refers to within a few hours of blood loss than 1000ml or circulating blood volume 20%, its main clinical expression is metathesis and (or) black stool, often accompanied by a reduction in blood volume induced acute peripheral circulatory failure, is a common disease, the mo

4、rtality rate is as high as 8% 13.7%.2, the epidemiological data: (1) Duodenal ulcer, gastric ulcer, acute gastric colossal lesions, malignant tumor, esophageal varies Chinese is the main cause of upper gastrointestinal hemorrhage, accounted for 31.2%, 15.2%, 12%, 11.7%, 11.3%; (2) 2000 compared to 2

5、006 and 2006 to 2011, a duodenal ulcer, gastric ulcer, acute gastric colossal lesion, esophageal varies, malignant tumor ratio is 32.3%, 15.1%, 12.1%, 7.2%, 12.5% and 29.7%, 15.4%, 11.1%, 15.3%, 10.9%; (3) Male patients were more than female patients, the ratio is 3.25:1; (4) the elderly main cause

6、of upper gastrointestinal bleeding in gastric ulcer, cancer, acute gastritis, duodenal ulcer, esophageal varies, childrens main cause of upper gastrointestinal hemorrhage in duodenal ulcer, gastric ulcer, acute gastric colossal lesion. Conclusions peptic ulcer, acute gastric colossal lesion, maligna

7、nt tumor, esophageal varies China is the main cause of upper gastrointestinal hemorrhage.Learning Objective 1.To understand the basic knowledge of upper digestive tract hemorrhage. 2.Be familiar with the Identification of upper digestive tract hemorrhage treatment and symptom. 3.To grasp the upper d

8、igestive tract hemorrhage patients of holistic nursing care.Anatomy and Physiology1. pathological anatomy:Upper digestive tract by oral cavity, pharynx, esophagus, stomach, duodenum.2.etiology:The 1 upper gastrointestinal diseases:(1) for esophageal diseases(2) the duodenal diseases(3) jejuna diseas

9、eThe 2 portal hypertension:(1) a variety of compensate liver cirrhosis.(2) portal vein obstruction(3) hepatic venous obstruction syndrome.The 3 adjacent organs or tissues of the gastrointestinal tract disease:(1) bilious tract bleeding(2) uremia.(3) with stress ulcer.3. clinical manifestation:(1)hem

10、atemesis and (or) black(2)hemorrhagic peripheral circulatory failure(3)toxemia(4)anemia and Hemogra4.laboratory examination:1. laboratory tests2. special inspection method(1) endoscopy(2) selective arteriography(3) X-ray barium meal examination(4) radiosonde scan.Case profile 1.Introducing the case

11、(1) Hematemesis, melena for 3 days (2) present history: on abdominal distension patients a week on eating hard after, after defecation can alleviate the symptoms, not the diagnosis and treatment of. 3 days ago defecate in sudden feeling nausea, vomiting Coffee like stomach content 1, weight about 30

12、0-400ml, followed by red brown bloody stool and tarry stool in a total of 5 times, average weight of about 200ml, with dizziness, weakness, sweating, abdominal pain, abdominal distension, tenesmus, no chest pain, tightness in the chest, palpitation, chills, fever and discomfort. In our hospital emer

13、gency department visits, checking blood routine test: WBC 17.15*109/L, RBC 3.24*109/L, HB 101g/L, PLT 221*109/L, to the anti infection, anti acid, hemostatic, nutrition support treatment. Since since the illness of patients, spirit, sleep good, poor appetite, stool like appeal, normal urine, recent

14、without significant changes in body weight. (3) History: usually is healthy, denied the hepatitis, tuberculosis and other infectious disease, vaccination history is unknown. Hypertension, diabetes, coronary heart disease and denied and other chronic diseases, deny operation, trauma history, denied f

15、ood and drug allergy history, deny the history of blood transfusion. (4) social and psychological state in patients with stable emotion, social support of good (5) the relevant examination:a. the blood: WBC:9.66*109/L; Hb:67g/L; PLT:144*109/L; NEUT:65.4%b.fecal examination:the appearance of red brow

16、nWBC:5-10 /HPF; RBC:20-30 /HPF;ob (+)2.treatment (1) the general treatment: absolute bed, oxygen inhalation, ECG and blood pressure monitoring, fast. (2)drug therapy: acid secretion inhibitors. Inhibitory effect of drugs inhibiting gastric acid secretion of gastric acid secretion, increased gastric

17、pH value, is conducive to the bleeding and prevent re-bleeding. Common gastric acid secretion inhibitors with proton pump inhibitors such as omeprazole 40 mg each time, 2 times daily intravenous injection or infusion. (3) supplement blood capacity: immediately checked blood type and blood matching,

18、the establishment of an effective channel intravenous infusion as soon as possible, supplement blood capacity as soon as possible. In the matching process, to lose balance liquid or glucose saline. Improvement of acute hemorrhagic key peripheral circulatory failure is to blood transfusion, the gener

19、al red blood cell transfusion concentration, serious activity hemorrhage consider whole blood transfusion. The following conditions for emergency blood transfusion indications:a. change the position syncope, decreased blood pressure and heart rate;b. and hemorrhagic shock;c. hemoglobin below 70g/L o

20、r hematocrit is lower than 25%. Blood transfusion as improve hemodynamics and anemia patients around and decide, urine volume is a reference value. Should pay attention to avoid the infusion, transfusion too fast, too much and cause pulmonary edema, the original heart disease or elderly patients whe

21、n necessary, according to the central venous pressure adjusting input.(4) parenteral nutrition support.Identification of patients problem1.nursing diagnosis(1) body fluid deficiency and upper gastrointestinal massive hemorrhage.(2) activity intolerance associated with hemorrhagic peripheral circulat

22、ory failure.(3) there is risk of trauma, injury of asphyxia, aspiration of esophagus and fundus of stomach mucous long time compression, compression of three cavity tube obstruction of the airway, blood or secretions into the trachea.(4) the lack of knowledge related to the deficiency of upper gastr

23、ointestinal hemorrhage caused by diseases and their prevention knowledge.2.nursing objectives:Short term goals: (1) with no sign of recurrent hemorrhage, insufficient blood volume corrected, stable vital signs.(2) get enough rest, dizziness, weakness of no litigation.(3) upper airway patency, no asp

24、hyxia, aspiration, esophageal and fundic mucous was not due to balloon injury.(4) patients can sign recognition at the onset of the disease.Long term goals:(1) the patients blood return to normal range, no hematemesis, melena.(2) exercise tolerance increased gradually, the safe points activities.(3)

25、 patients were able to better understand the disease, and can effectively prevent the recurrence of the disease3. nursing measures: A.body fluid deficiency: (1) position and keep the airway patency: absolute bed rest, bleeding patients supine and lower limb will be slightly raised, in order to ensur

26、e the blood supply to the brain. Vomiting and head to one side, to prevent suffocation or aspiration; when necessary, negative pressure aspirator for removal of airway secretions, blood or vomit, maintain airway patency. Give oxygen. (2) treatment: immediately establish vein channel. The start of in

27、fusion should be fast, central venous pressure measurement as the adjustment of the infusion volume and infusion rate basis when necessary. Avoid infusion, transfusion of too much, too fast and the cause of acute pulmonary edema, in elderly patients with heart and lung function is not complete perso

28、n especially should pay attention to. (3) diet nursing: acute massive hemorrhage complicated with nausea, vomiting should fast. A small amount of bleeding without vomiting, into the cool, bland. (4) the psychological nursing: observation in patients with and without tension, fear or grief and other

29、psychological reactions. Interpretation of bed rest to hemostasis, care, comfort a patient. Hematemesis or melena after the timely removal of blood, dirt, in order to reduce adverse stimulation patients. (5)Observation:a.vital signs observationb. spirit and consciousnessc. observation of skin and na

30、il bed colord. precise intake and output recorde. observation of vomit and feces nature, color and quantity Changes f.monitoring of serum electrolyte and blood gas analysisB.Pharmaceutical care(1) NS250/500ml+ somatostatin 3MG, first to somatostatin containing 250 g intravenous injection (10min), fo

31、llowed by maintenance of intravenous infusion of 12-24h. The process of drip infusion patrols to observe to do, no adverse reactions, such as: vertigo, tinnitus, blush, drip excessive nausea, vomiting, should strictly control the infusion speed.(2) Nexium and other drugs can cause recurrent vomiting

32、, difficulty swallowing, hematemesis or melena, if such a situation should be reported to a doctor immediately, check regularly without leukemia, good oral care, to prevent stomatitis and gastrointestinal candidiasis.(3) Mucosta for gastric ulcer, acute exacerbation of gastric mucosal lesions in acu

33、te gastritis, chronic gastritis (erosion, bleeding, hyperemia, edema) improvement, pay attention to whether the patients had skin rash and other allergic phenomenon, there is no general nausea, vomiting, abdominal distension or heartburn, white blood cells and liver function monitoring when necessar

34、y.(4)Okushi Yasu should be the intravenous drip, once 40mg, before the 10ml special solvent into freeze-dried powder vial, prohibit the use of other solvents. Should, after dinner or before bed 1H, emulsion to shock, should be chew-able tablets. Acidic drinks not with clothes, avoid take together wi

35、th milk. Pay attention to the adverse reactions were observed with and without constipation, nausea, vomiting and other gastrointestinal tract.C.activity intolerance(1) rest and activity: a small amount of bleeding should rest in bed. Massive hemorrhage absolute bed rest, to help patients take comfo

36、rtable position and timing of changing posture, pay attention to keep warm.(2) patients were instructed to sit up, stand up safety moves to slow; dizziness, palpitation, sweating bed-rest immediately and inform the nurse; nurse when required to accompany the toilet or change the temporary bed excret

37、ion. Severe patients should patrol, bed column protection.(3) the life care: patient especially the elderly and severe patients pay attention to the prevention of pressure ulcers; vomiting in time after the gargle; more attention to defecation perianal skin clean and protect.D. there is the risk of

38、injury(1) anti trauma: avoid eating spicy food.(2) to prevent choking and aspiration: eat take semi reclining position, to prevent food aspiration and pulmonary infection.E.health education(1) to maintain a good state of mind and spirit of optimism, correctly treat disease(2) pay attention to food h

39、ygiene, reasonable arrangements for work and rest time.(3) the appropriate physical exercise, enhanced physique.(4) smoking, tea, Coffee have food stimulation to the stomach.(5) in good season notice dietetic hygiene, pay attention to work and rest.(6) to induce or aggravate the symptoms of ulcer di

40、sease, and even cause complications of the drug should avoid using such as salicylic acid, reserpine, Baotaisong.nursing evaluation(1) the patient stopped bleeding, back to normal life signs;(2) adequate rest and sleep, exercise tolerance increased or restored to the level before bleeding.(3) when t

41、he activity without syncope, fall and other accidents;(4) no asphyxia or aspiration, esophageal mucous no erosion, necrosis;(5) patients were able to recognize signs of disease and differential attack.Conclusion Through this case study, I can systematically understanding this disease of upper digest

42、ive tract hemorrhage, the whole nursing level of these patients improved. Upper gastrointestinal hemorrhage is the four most common etiology, are peptic ulcer, esophageal and gastric variceal hemorrhage, acute gastric mucosal lesion (hemorrhagic erosive gastritis and gastric cancer), is one of the m

43、ost common digestive ulcer. Then received a patient with acute upper gastrointestinal hemorrhage, our nursing staff have to do is venous channel two or more rapid establishment of coarse, blood tests and hemostatic treatment to cooperate with the doctor, ready to rescue, rescue in the rehydration of

44、 medical staff in the process of operation should be quickly determined, emotional comfort of patients. Hemostatic measures usually upper gastrointestinal hemorrhage with acid suppressing medications (proton pump inhibitor (PPI) and H2 receptor antagonist), treatment, endoscopic three cavity two capsule tube compression hemostasis (used for bleeding esophageal varies induced). In the medical treatment process, we should pay close attention to the patients vital signs, consciousness, and the indexes of volume, and increase the non