消化溃疡(英文)PPT课件.ppt

PepticUlcerdisease PUD byAnruiZhengfromhuangshicentralhospital 1 LearningObjectives Tomasterthecauseofpepticulcerclinicalmanifestationsandcomplications Tomasterthepepticulcernursinginterventionandhealtheducation Befamiliarwiththekeypointsofthepathogenesisandtreatmentofpepticulcer 2 Definition AcircumscribedulcerationofthegastrointestinalmucosaoccurringinareasexposedtoacidandpepsinandmostoftencausedbyHelicobacterpyloriinfection Uphold Graham 2003 3 PepticUlcers Gastric Dudodenal 4 PepticUlcers Gastric Duodenal gastriculcer theulcerthatoccursinthestomachlining someofthemmaybemalignant duodenalulcer mostoftenseeninfirstportionofduodenum 5 GU 6 DU 7 8 PUDDemographics 流行病学 Lifetimeprevalenceis 10 Theincidenceofduodenalis4timesascommonasgastriculcermostcommoninmiddleagepeak30 50yearsMaletofemaleratio 4 1 9 Etiology 病因学 Helicobacterpylori HP 10 Etiology 病因学 nonsteriodalanti inflammatorydrugs NSAID AcidandpepsinOthers 11 12 mainsymptom 1 abdominalpain theclassicsymptomofPUD Pain gnawing aching or burning hungerlike 钝痛 胀痛 灼痛或饥饿痛 2 rhythmicity GUEating pain reliefDUpain eating relief 3 cyclicity Attackmoreinautumnorwinter 13 Paincharacteristicsofpepticulcer 14 Clinicalmanifestation Othersymptomsofdigestivesystem Nausea vomiting belching bloating chestdiscomfortmayalsooccur 15 Clinicalmanifestation signEpigastrictenderness 16 Complications hemorrhage 17 Complications Perforation 18 Complications obstruction pyloricstenosis 19 Complications Gastriccarcinoma notduodenalcarcinoma 20 Hemorrhage hematemesis blackortarrystools 21 Gastriccarinoma GU1 canbecomecancerousAchronic GUhistory45yearsofageorolderThemoresymptomsstubbornlyContinuousandoccultblood 22 EndoscopyBariummeal contrastx rayBiopsy bacteria malignancyStoolforfecaloccultbloodH Pylori 13 C ureaBreathTest PUD Diagnosis 23 Endoscopy 24 Bariummeal contrastx ray 25 TreatmentPlan Medications treatwithProtonPumpInhibitorsorH2receptorantagoniststoassistulcerhealingH2 Tagament Pepcid Axid orZantacforupto8weeksPPI Prilosec Prevacid Nexium Protonix orAciphexfor4 8weeks DU PPI4 6wGU PPI6 8w 26 Surgery Peoplewhodonotrespondtomedication orwhodevelopcomplications 27 Nursingdiagnosis PainrelatedtogastricandduodenalinjuryAlteredNutrition lessthanbodyrequirementsrelatedtonausea 28 nursingintervention RelievepainMedicationandcareDietRestMonitorPsychotherapyandheatheducation 29 Relievepain DU Eatalkalescentfoodinpainorbeforepain suchassodabiscuit etc Thelocalhotcompress 30 Medicationandcare Antacids shouldbe1hafterthemealorbeforebed AluminiumHydroxideGel causephosphorusdeficiency lossofappetite weakness 31 Medicationandcare H2RA Itshouldbetakenatmealsoraftermeals oratbedtime PPI Effectiveinacidicenvironment take1hourbeforemeal Bismuthagent Becauseitworksinacidity itistakenbeforemeal Itcanmakethefecesblack 32 Diet Eatinglittlebutoftenandregularly Avoideatingraw cold hardandstrongirritantfood Selecteasilydigestibleandnutritiousfood Eatingpasta adequateskimmilkduringactiveperiod Afterthesymptomsisalleviated youshouldreturntonormalmealdiettimely Nutritionmonitoring suchas bodyweight hemoglobin 33 Rest Thelightsymptom appropriateactivitiestodistractiontheattentionTheheavysymtom stayinbedforafewdaysto1 2weeks relievepainsymptoms 34 Monitor VitalsignMeasuringweightonaregularbasis monitoringnutritionalindexessuchasserumalbuminandhemoglobin 35 Psychotherapyandheatheducation InformationabouttherelationshipbetweenpepticulcerandfactorssuchasHp NSAIDs smoking alcoholintake stress 36 Psychotherapyandheatheducation Educationaboutboththerapeuticandpreventivestrategies LifestylemanagementAvoidtheuseofsteroid caffeine aspirinandotherNSAIDs 37 Psychotherapyandheatheducation Instructionaboutthemedicationregimenprescribedandhowtotakethedrugs Teachtheclientthesymptomsthatmayindicateacomp