消化道溃疡教案.docx
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消化道溃疡教案
消化道溃疡教案
前言:
NowI’mveryhappytohaveachancetostandhere,talkingaboutmyteachingdesignandcorrespondinganalysis.Mynameis***,myteammateis***,wearefromguangzhoumedicaluniversity,andnowbetheinternofdigestivedepartmeng.AndIwelcomeeverysuggestiononmyinterpretationfromyouexperts.Thetopicofmyinterpretationisxxx.
1、PepticUlcerdisease
2、Tomasterthecauseofpepticulcerclinicalmanifestationsandcomplications;
Familiarwiththekeypointsofthepathogenesisandtreatmentofpepticulcer;
Masteringthepepticulcernursinginterventionandhealtheducation;
掌握消化性溃疡临床表现和并发症的原因;
熟悉的关键点消化性溃疡的发病机理和治疗;
掌握消化性溃疡护理干预和健康教育;
3、Definition:
AcircumscribedulcerationofthegastrointestinalmucousoccurringinareasexposedtoacidandpepsinandmostoftencausedbyHelicopterpyloriinfection.(Uphold&Graham,2003)
胃肠粘膜的局限性溃疡发生地区暴露在酸和胃蛋白酶和通常由幽门螺杆菌感染引起的。
4、PepticUlcers:
(图片比较)
Gastric&Duodenal
5、PepticUlcers:
Gastric&Duodenal
(1)gastriculcer:
theulcerthatoccursinthestomachlining,someofthemmaybemalignant.
胃溃疡:
发生在胃粘膜溃疡,其中一些可能是恶性的。
(2)duodenalulcer:
mostoftenseeninfirstportionofduodenum.
十二指肠溃疡:
最常出现在第一个部分十二指肠。
6.GU(图片两张)
7.DU(图片两张)
8.消化系统图片
9.PUDDemographics(流行病学)
(1)Lifetimeprevalenceis~10%.
(2)duodenalsitesare4xascommonasgastricsites
(3)mostcommoninmiddleage
peak30-50years
(4)Maletofemaleratio—4:
1
(1)终生患病率是~10%。
(2)十二指肠溃疡4倍胃胃溃疡
(3)最常见的在中年
峰30-50年
(4)男女ratio-4:
1
10.Etiology(病因学)
(1)Helicobacterpylori(HP)
(2)nonsteriodalanti-inflammatorydrugs(NSAID)
(3)Acidandpepsin
(4)Others
(1)幽门螺杆菌(HP)
(2)nonsteriodal抗炎药(非甾体抗炎药)
(3)酸和胃蛋白酶
(4)其他
11.
12.mainsymptom
(1)abdominalpain:
theclassicsymptomofPUD.
Pain—”gnawing”,“aching”,or“burning”“hungerlike”
(钝痛、胀痛、饥饿痛或灼痛)
(2)rhythmic:
GUEating-pain-relief
DUpain-eating-relief
(3)cyclicity:
Morethanautumnorwinterofattack
Episodesofremissionandexacerbation
13、Paincharacteristicsofpepticulcer
14.Clinicalmanifestation
Othersymptomsofdigestivesystem:
(1)Nausea,vomiting,belching,dyspepsia,bloating,chestdiscomfort,anorexiamayalsooccur.
(2)nausea,vomiting,&weightlossmorecommonwithGastriculcers
(1)恶心、呕吐、嗳气,消化不良,腹胀,胸部不适,还可能出现厌食。
(2)恶心、呕吐、&减肥更常见的胃溃疡
15、Clinicalmanifestation
sign:
Gastrictenderness
16.Complications
(1)hemorrhage
(2)Perforation
(3)obstruction–pyloricstenosis
(4)Gastriccarcinoma.(notduodenalcarcinoma)
(1)出血
(2)穿孔
(3)阻塞——幽门狭窄
(4)胃癌。
(不是十二指肠癌)
17、Hemorrhage:
hematemesis,blackortarrystools
18.Gastriccarcinoma
GU1%可癌变、长期慢性GU病史、45岁以上、症状顽固不愈、持续便潜血(+)
20.PUD-Diagnosis
(1)Endoscopy
(2)Bariummeal–contrastx-ray
(3)Biopsy–bacteria&malignancy
(4)Stoolforfecaloccultblood
(5)H.Pylori:
Endoscopycytology、Biopsy–Specialstains、Culture-difficult、(13)C-ureabreathtest
(1)内窥镜检查
(2)钡餐-对比x射线
(3)活检——细菌和恶性肿瘤
(4)粪便潜血的凳子上
(5)H。
幽门:
内镜细胞学活检,细菌培养,碳呼气检查。
20、Endoscopy(图片)
21、Bariummeal–contrastx-ray(图片)
钡餐,对比x射线
22、TreatmentPlan
Medications—treatwithProtonPumpInhibitorsorH2receptorantagoniststoassistulcerhealing
(1)H2:
Tagament,Pepcid,Acid,orZantacforupto8weeks
(2)PPI:
Prilosec,Prevacid,Nexium,Protonix,orAciphexfor4-8weeks.DU:
PPI4~6w;GU:
PPI6~8w
Medications-treat与质子泵抑制剂或H2受体拮抗剂协助溃疡愈合
(1)H2:
Tagament,Acid或雷尼替丁8周
(2)PPI:
奥美拉唑、PrevacidNexiumProtonix或Aciphex4-8周。
十二指肠:
PPI4~6胃:
PPI6~8w
23、Surgery
Peoplewhodonotrespondtomedication,orwhodevelopcomplications
24、Nursingdiagnosis
(1)Painrelatedtogastricandduodenalinjury
(2)AlteredNutrition:
lessthanbodyrequirementsrelatedtoanorexia,nausea
(1)疼痛与胃和十二指肠损伤有关
(2)改变营养:
不到身体需求相关的厌食,恶心
25、nursingintervention
(1)Relievepain
(2)Medicationandcare
(3)Diet
(4)Rest
(5)Monitor
(6)Heatheducation
(7)psychotherapy
(1)减轻疼痛
(2)药物治疗和护理(3)饮食(4)休息(5)监控(6)健康教育(7)心理治疗
26、Relievepain
DU:
Eatalkalescentfoodinpainorbeforepain(suchassodabiscuit,etc.);
Thelocalhotcompress
吃碱性食物在疼痛或疼痛(如苏打饼干等);
局部热敷
27、Medicationandcare
28.Diet
(1)Eatinglittlebutoftenandregularly.
(2)Avoideatingraw,cold,hardandstrongirritantfood.
(3)Selecteasilydigestibleandnutritiousfood.Eatingpasta,adequateskimmilkduringactiveperiod(drinkingbetweentwomeals,butnotdrinks).Afterthesymptomsisalleviated,youshouldreturntonormalmealdiettimely.
(4)Nutritionmonitoring(suchas:
bodyweight,hemoglobin)
(2)避免吃生、冷、硬和强烈的刺激性食物。
(3)选择易于消化和营养食品。
吃意大利面,足够的活跃时期脱脂牛奶(两餐之间喝,但是不是饮料)。
症状缓解后,你应该及时恢复正常餐饮食。
(4)营养监测(如:
体重、血红蛋白)
29.Rest
Thelightperson:
appropriateactivitiestodistractiontheattention
Theheavyperson:
stayinbedforafewdaysto1~2weeks,relievepainsymptoms
轻者:
适当的活动来分散注意力
重者:
卧床休息几天,1~2周,缓解疼痛症状
30.Monitor
Vitalsign
Measuringweightonaregularbasis,monitoringnutritionalindexessuchasserumalbuminandhemoglobin
生命体征
定期测量体重、监测血清白蛋白和血红蛋白等营养指标
31.Healtheducation
(1)InformationabouttherelationshipbetweenpepticulcerandfactorssuchasHp,NSAIDs,smoking,alcoholintake,stress.
(2)Educationaboutboththerapeuticandpreventivestrategies.
(3)Lifestylemanagement
(4)Avoidtheuseofsteroid,caffeine,aspirinandotherNSAIDs.
(5)Instructionaboutthemedicationregimenprescribedandhowtotakethedrugs.
(6)Teachtheclientthesymptomsthatmayindicateacomplication,suchasincreasedabdominalpainordistention,vomiting,blackortarrystools,orfainting.
(1)信息消化性溃疡和惠普等因素之间的关系,非甾体类抗炎药,吸烟、饮酒、压力。
(2)教育对治疗和预防策略。
(3)生活方式管理
(4)避免使用类固醇、咖啡因、阿司匹林和其他非甾体类抗炎药。
(5)指令规定的药物疗法以及药物。
(6)教客户可能表明并发症的症状,如增加腹痛或腹胀、呕吐、黑色或迟延大便或晕倒。
29、结束