个案护理英文.docx

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

2、oduction1.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 cate

3、gory. 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

4、 mortality 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 t

5、o 2006 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 cau

6、se 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, mali

7、gnant 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 uppe

8、r digestive 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 dis

9、easeThe 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)

10、hematemesis 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 ca

11、se (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

12、 300-400ml, 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 e

13、mergency 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, rece

14、nt 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, denie

15、d food 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

16、brown WBC: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 ga

17、stric 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 matc

18、hing, 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

19、 general 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 7

20、0g/L or 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 patien

21、ts when 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 ci

22、rculatory 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

23、 gastrointestinal 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,

24、no asphyxia, 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 activiti

25、es.(3) 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

26、 ensure 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

27、 of infusion 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

28、 person 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

29、other 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

30、and nail 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

31、), followed 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, difficulty swallowing, hematemesis or melena, if such a situation should be reported to a doctor immediately, check regularly without leukemia, good oral care,