个案护理英文.docx

个案护理英文.docx

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个案护理英文

Hemorrhageof

upperdigestivetract

---onecasenursingofhemorrhageofupperdigestive

ByKelly&Mini

Directory

Thehemorrhageofupperdigestivetract----------3-4

Learningobjectives-------------------------------------4

Anatomyandphysiology------------------------------5-7

Casedescription----------------------------------------7-10

Nursing-problems-------------------------------------10-16

nursingevaluation-------------------------------------16

Summary------------------------------------------------17-19

Reference------------------------------------------------19

Ⅰ.Introduction

1.theconceptofdisease:

theuppergastrointestinalhemorrhageisreferstotheligamentofTreitzabovethedigestivetract,includingtheesophagus,stomach,duodenumbleedingorbiliousandpancreaticdisease,stomachjejunumanastomosisafterjejunalhemorrhagealsobelongstothiscategory.Massivehemorrhageisreferstowithinafewhoursofbloodlossthan1000mlorcirculatingbloodvolume20%,itsmainclinicalexpressionismetathesisand（or）blackstool,oftenaccompaniedbyareductioninbloodvolumeinducedacuteperipheralcirculatoryfailure,isacommondisease,themortalityrateisashighas8%~13.7%.

2,theepidemiologicaldata:

（1）Duodenalulcer,gastriculcer,acutegastriccolossallesions,malignanttumor,esophagealvariesChineseisthemaincauseofuppergastrointestinalhemorrhage,accountedfor31.2%,15.2%,12%,11.7%,11.3%;

（2）2000comparedto2006and2006to2011,aduodenalulcer,gastriculcer,acutegastriccolossallesion,esophagealvaries,malignanttumorratiois32.3%,15.1%,12.1%,7.2%,12.5%and29.7%,15.4%,11.1%,15.3%,10.9%;

（3）Malepatientsweremorethanfemalepatients,theratiois3.25:

1;

（4）theelderlymaincauseofuppergastrointestinalbleedingingastriculcer,cancer,acutegastritis,duodenalulcer,esophagealvaries,children'smaincauseofuppergastrointestinalhemorrhageinduodenalulcer,gastriculcer,acutegastriccolossallesion.Conclusionspepticulcer,acutegastriccolossallesion,malignanttumor,esophagealvariesChinaisthemaincauseofuppergastrointestinalhemorrhage.

Ⅱ.LearningObjective

1.Tounderstandthebasicknowledgeofupperdigestivetracthemorrhage.

2.BefamiliarwiththeIdentificationofupperdigestivetracthemorrhagetreatmentandsymptom.

3.Tograsptheupperdigestivetracthemorrhagepatientsofholisticnursingcare.

Ⅲ.AnatomyandPhysiology

1.pathologicalanatomy:

Upperdigestivetractbyoralcavity,pharynx,esophagus,stomach,duodenum.

2.etiology:

The1uppergastrointestinaldiseases:

（1）foresophagealdiseases

（2）theduodenaldiseases

（3）jejunadisease

The2portalhypertension:

（1）avarietyofcompensatelivercirrhosis.

（2）portalveinobstruction

（3）hepaticvenousobstructionsyndrome.

The3adjacentorgansortissuesofthegastrointestinaltractdisease:

（1）bilioustractbleeding

（2）uremia.

（3）withstressulcer.

3.clinicalmanifestation:

（1）hematemesisand（or）black

（2）hemorrhagicperipheralcirculatoryfailure

（3）toxemia

（4）anemiaandHemogra

4.laboratoryexamination:

1.laboratorytests

2.specialinspectionmethod

（1）endoscopy

（2）selectivearteriography

（3）X-raybariummealexamination

（4）radiosondescan

Ⅳ.Caseprofile

1.Introducingthecase

（1）Hematemesis,melenafor3days

（2）presenthistory:

onabdominaldistensionpatientsaweekoneatinghardafter,afterdefecationcanalleviatethesymptoms,notthediagnosisandtreatmentof.3daysagodefecateinsuddenfeelingnausea,vomitingCoffeelikestomachcontent1,weightabout300-400ml,followedbyredbrownbloodystoolandtarrystoolinatotalof5times,averageweightofabout200ml,withdizziness,weakness,sweating,abdominalpain,abdominaldistension,tenesmus,nochestpain,tightnessinthechest,palpitation,chills,feveranddiscomfort.Inourhospitalemergencydepartmentvisits,checkingbloodroutinetest:

WBC17.15*10^9/L,RBC3.24*10^9/L,HB101g/L,PLT221*10^9/L,totheantiinfection,antiacid,hemostatic,nutritionsupporttreatment.Sincesincetheillnessofpatients,spirit,sleepgood,poorappetite,stoollikeappeal,normalurine,recentwithoutsignificantchangesinbodyweight.

（3）History:

usuallyishealthy,deniedthe"hepatitis,tuberculosisandotherinfectiousdisease,"vaccinationhistoryisunknown."Hypertension,diabetes,coronaryheartdiseaseanddenied"andotherchronicdiseases,denyoperation,traumahistory,deniedfoodanddrugallergyhistory,denythehistoryofbloodtransfusion.

（4）socialandpsychologicalstateinpatientswithstableemotion,socialsupportofgood

（5）therelevantexamination:

a.theblood:

WBC:

9.66*10^9/L;Hb:

67g/L;PLT:

144*10^9/L;NEUT:

65.4%

b.fecalexamination:

theappearanceofredbrown

WBC:

5-10/HPF;RBC:

20-30/HPF;

ob（+）

2.treatment

（1）thegeneraltreatment:

absolutebed,oxygeninhalation,ECGandbloodpressuremonitoring,fast.

（2）drugtherapy:

acidsecretioninhibitors.Inhibitoryeffectofdrugsinhibitinggastricacidsecretionofgastricacidsecretion,increasedgastricpHvalue,isconducivetothebleedingandpreventre-bleeding.Commongastricacidsecretioninhibitorswithprotonpumpinhibitorssuchasomeprazole40mgeachtime,2timesdailyintravenousinjectionorinfusion.

（3）supplementbloodcapacity:

immediatelycheckedbloodtypeandbloodmatching,theestablishmentofaneffectivechannelintravenousinfusionassoonaspossible,supplementbloodcapacityassoonaspossible.Inthematchingprocess,tolosebalanceliquidorglucosesaline.Improvementofacutehemorrhagickeyperipheralcirculatoryfailureistobloodtransfusion,thegeneralredbloodcelltransfusionconcentration,seriousactivityhemorrhageconsiderwholebloodtransfusion.

Thefollowingconditionsforemergencybloodtransfusionindications:

a.changethepositionsyncope,decreasedbloodpressureandheartrate;

b.andhemorrhagicshock;

c.hemoglobinbelow70g/Lorhematocritislowerthan25%.Bloodtransfusionasimprovehemodynamicsandanemiapatientsaroundanddecide,urinevolumeisareferencevalue.Shouldpayattentiontoavoidtheinfusion,transfusiontoofast,toomuchandcausepulmonaryedema,theoriginalheartdiseaseorelderlypatientswhennecessary,accordingtothecentralvenouspressureadjustinginput.

（4）parenteralnutritionsupport

Ⅴ.Identificationofpatient’sproblem

1.nursingdiagnosis

（1）bodyfluiddeficiencyanduppergastrointestinalmassivehemorrhage.

（2）activityintoleranceassociatedwithhemorrhagicperipheralcirculatoryfailure.

（3）thereisriskoftrauma,injuryofasphyxia,aspirationofesophagusandfundusofstomachmucouslongtimecompression,compressionofthreecavitytubeobstructionoftheairway,bloodorsecretionsintothetrachea.

（4）thelackofknowledgerelatedtothedeficiencyofuppergastrointestinalhemorrhagecausedbydiseasesandtheirpreventionknowledge.

2.nursingobjectives:

Shorttermgoals:

（1）withnosignofrecurrenthemorrhage,insufficientbloodvolumecorrected,stablevitalsigns.

（2）getenoughrest,dizziness,weaknessofnolitigation.

（3）upperairwaypatency,noasphyxia,aspiration,esophagealandfundicmucouswasnotduetoballooninjury.

（4）patientscansignrecognitionattheonsetofthedisease.

Longtermgoals:

（1）thepatientsbloodreturntonormalrange,nohematemesis,melena.

（2）exercisetoleranceincreasedgradually,thesafepointsactivities.

（3）patientswereabletobetterunderstandthedisease,andcaneffectivelypreventtherecurrenceofthedisease

3.nursingmeasures:

A.bodyfluiddeficiency:

（1）positionandkeeptheairwaypatency:

absolutebedrest,bleedingpatientssupineandlowerlimbwillbeslightlyraised,inordertoensurethebloodsupplytothebrain.Vomitingandheadtooneside,topreventsuffocationoraspiration;whennecessary,negativepressureaspiratorforremovalofairwaysecretions,bloodorvomit,maintainairwaypatency.Giveoxygen.

（2）treatment:

immediatelyestablishveinchannel.Thestartofinfusionshouldbefast,centralvenouspressuremeasurementastheadjustmentoftheinfusionvolumeandinfusionratebasiswhennecessary.Avoidinfusion,transfusionoftoomuch,toofastandthecauseofacutepulmonaryedema,inelderlypatientswithheartandlungfunctionisnotcompletepersonespeciallyshouldpayattentionto.

（3）dietnursing:

acutemassivehemorrhagecomplicatedwithnausea,vomitingshouldfast.Asmallamountofbleedingwithoutvomiting,intothecool,bland.

（4）thepsychologicalnursing:

observationinpatientswithandwithouttension,fearorgriefandotherpsychologicalreactions.Interpretationofbedresttohemostasis,care,comfortapatient.Hematemesisormelenaafterthetimelyremovalofblood,dirt,inordertoreduceadversestimulationpatients.

（5）Observation:

a.vitalsignsobservation

b.spiritandconsciousness

c.observationofskinandnailbedcolor

d.preciseintakeandoutputrecord

e.observationofvomitandfecesnature,colorandquantityChanges

f.monitoringofserumelectrolyteandbloodgasanalysis

B.Pharmaceuticalcare

（1）NS250/500ml+somatostatin3MG,firsttosomatostatincontaining250μgintravenousinjection（10min）,followedbymaintenanceofintravenousinfusionof12-24h.Theprocessofdripinfusionpatrolstoobservetodo,noadversereactions,suchas:

vertigo,tinnitus,blush,dripexcessivenausea,vomiting,shouldstrictlycontroltheinfusionspeed.

（2）Nexiumandotherdrugscancauserecurrentvomiting,difficultyswallowing,hematemesisormelena,ifsuchasituationshouldbereportedtoadoctorimmediately,checkregularlywithoutleukemia,goodoralcare,