消化性潰瘍英文培訓(xùn)課件

1、消化性潰瘍英文消化性潰瘍英文Learning Objectives To master the cause of peptic ulcer clinical manifestations and complications; Be familiar with the key points of the pathogenesis and treatment of peptic ulcer; To master the peptic ulcer nursing intervention and health education; 2消化性潰瘍英文Learning Objectives To maD

2、efinition A circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to acid and pepsin and most often caused by Helicobacter pylori infection. (Uphold & Graham, 2003)3消化性潰瘍英文Definition A circumscribed uPeptic Ulcers: Gastric & Dudodenal4消化性潰瘍英文Peptic Ulcers: Gastric & Dudo

3、Peptic Ulcers: Gastric & Duodenalgastric ulcer : the ulcer that occurs in the stomach lining ,some of them may be malignant.duodenal ulcer : most often seen in first portion of duodenum .5消化性潰瘍英文Peptic Ulcers: Gastric & DuodGU6消化性潰瘍英文GU6消化性潰瘍英文DU7消化性潰瘍英文DU7消化性潰瘍英文8消化性潰瘍英文8消化性潰瘍英文PUD Demographics （流行

4、病學(xué)）Lifetime prevalence is 10%. The incidence of duodenal is 4 times as common as gastric ulcermost common in middle age peak 30-50 yearsMale to female ratio4:1 9消化性潰瘍英文PUD Demographics （流行病學(xué)）9消化性潰瘍英Etiology（病因?qū)W）Helicobacter pylori（HP）nonsteriodal anti-inflammatory drugs (NSAID）Acid and pepsinOthers

5、10消化性潰瘍英文Etiology（病因?qū)W）Helicobacter pylodisease characteristicsChronic processperiodical attackRhythmic abdominal pain11消化性潰瘍英文disease Chronic periodical Rhymain symptom(1)abdominal pain：the classic symptom of PUD. Pain”gnawing”, “aching”, or“burning”“hungerlike” （鈍痛、脹痛、灼痛或饑餓痛）(2)rhythmicity:GU Eatin

6、g- pain-relief DU pain-eating-relief(3)cyclicity：Attack more in autumn or winter 12消化性潰瘍英文main symptom12消化性潰瘍英文gastric ulcerduodenal ulcertimepositionnature ruleoccurs 0.51 hour after a meal and relief until next meal,may not awaken patient from sleep.median or left of Subxiphoidburning pain or cram

7、py painEating- pain-reliefoccurs 3-4 hours after a meal and may awaken patient from sleep.Midline or right of epigastrichungerlike pain or burning painpain-eating-reliefPain characteristics of peptic ulcer13消化性潰瘍英文gastric ulcerduodenal ulceroccClinical manifestationOther symptoms of digestive system

8、 ：Nausea, vomiting, belching, dyspepsia, bloating, chest discomfort, anorexia may also occur. 14消化性潰瘍英文Clinical manifestationOther syClinical manifestationsign Epigastric tenderness15消化性潰瘍英文Clinical manifestationsign 1消化性潰瘍英文培訓(xùn)課件Hemorrhage: hematemesis ,black or tarry stools 17消化性潰瘍英文Hemorrhage: hem

9、atemesis ,blacGastric carinomaGU 1% can become cancerous A chronic, GU history 45 years of age or older The more symptoms stubbornly Continuous and occult blood(+) 18消化性潰瘍英文Gastric carinoma18消化性潰瘍英文EndoscopyBarium meal contrast x-rayBiopsy bacteria & malignancyStool for fecal occult bloodH.Pylori:(1

10、3)C-urea Breath Test.PUD - Diagnosis19消化性潰瘍英文EndoscopyPUD - Diagnosis19消化性潰Endoscopy20消化性潰瘍英文Endoscopy20消化性潰瘍英文 Barium meal contrast x-ray21消化性潰瘍英文 Barium meal contrast x-rayTreatment PlanMedicationstreat with Proton Pump Inhibitors or H2 receptor antagonists to assist ulcer healingH2: Tagament, Pep

11、cid, Axid, or Zantac for up to 8 weeksPPI: Prilosec, Prevacid, Nexium, Protonix, or Aciphex for 4-8 weeks.DU：PPI 46wGU: PPI 68w22消化性潰瘍英文Treatment PlanMedicationstreaSurgeryPeople who do not respond to medication, or who develop complications23消化性潰瘍英文SurgeryPeople who do not respoNursing diagnosisPai

12、n related to gastric and duodenal injuryAltered Nutrition: less than body requirements related to anorexia, nausea24消化性潰瘍英文Nursing diagnosisPain relatnursing interventionRelieve pain Medication and care Diet RestMonitorPsychotherapy and heath education25消化性潰瘍英文nursing interventionRelieve paRelieve p

13、ain DU:Eat alkalescent food in pain or before pain (such as soda biscuit, etc.); The local hot compress 26消化性潰瘍英文Relieve pain DU:Eat alkalescenMedication and care 抗酸劑：應(yīng)在飯后或睡前1h，乳液要震動(dòng)，應(yīng)咀嚼片。不與衣服的酸 性飲料，避免與牛奶同服；氫氧化鋁凝膠：引起磷缺乏癥表現(xiàn)食欲不振、無力長期服 用引起便秘，可與氫氧化鎂交替。H2RA ：應(yīng)在餐中或餐后服，也可把一日的劑量在睡前服用 靜脈給藥應(yīng)控制速度（過快低血壓和心律失常）PP

14、I類： 可引起頭暈 硫糖鋁：在酸性環(huán)境下有效，餐前1小時(shí)服用。不能與多酶片同服， 鉍劑：因在酸性下起作用，故餐前服。可使糞便呈黑色。 27消化性潰瘍英文Medication and care 抗酸劑：應(yīng)在飯后或睡Diet Eating little but often and regularly . Avoid eating raw, cold, hard and strong irritant food.Select easily digestible and nutritious food. Eating pasta, adequate skim milk during active pe

15、riod . After the symptoms is alleviated,you should return to normal meal diet timely.Nutrition monitoring (such as :body weight, hemoglobin)28消化性潰瘍英文Diet Eating little but often RestThe light symptom: appropriate activities to distraction the attentionThe heavy symtom : stay in bed for a few days to

16、 1 2 weeks, relieve pain symptoms 29消化性潰瘍英文RestThe light symptom: approprMonitorVital signMeasuring weight on a regular basis, monitoring nutritional indexes such as serum albumin and hemoglobin 30消化性潰瘍英文MonitorVital sign30消化性潰瘍英文Psychotherapy and heath educationInformation about the relationship be

17、tween peptic ulcer and factors such as Hp, NSAIDs, smoking, alcohol intake ,stress. Education about both therapeutic and preventive strategies.Lifestyle managementAvoid the use of steroid, caffeine , aspirin and other NSAIDs .Instruction about the medication regimen prescribed and how to take the drugs. Teach the client the symptoms that may indicate a complication, such as increased abdominal pain o