Hemorrhageofupperdigestivetract---onecasenursingofhemorrhageofupperdigestiveByKelly&Mini1

DirectoryThehemorrhageofupperdigestivetract----------3-4Learningobjectives-------------------------------------4Anatomyandphysiology------------------------------5-7Casedescription----------------------------------------7-10Nursing-problems-------------------------------------10-16nursingevaluation-------------------------------------16Summary------------------------------------------------17-19Reference------------------------------------------------192

Ⅰ.Introduction1.theconceptofdisease:theuppergastrointestinalhemorrhageisreferstotheligamentofTreitzabovethedigestivetract,includingtheesophagus,stomach,duodenumbleedingorbiliousandpancreaticdisease,stomachjejunumanastomosisafterjejunalhemorrhagealsobelongstothiscategory.Massivehemorrhageisreferstowithinafewhoursofbloodlossthan1000mlorcirculatingbloodvolume20%,itsmainclinicalexpressionismetathesisand(or)blackstool,oftenaccompaniedbyareductioninbloodvolumeinducedacuteperipheralcirculatoryfailure,isacommondisease,themortalityrateisashighas8%~13.7%.32,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,4

esophagealvariesChinaisthemaincauseofuppergastrointestinalhemorrhage.Ⅱ.LearningObjective1.Tounderstandthebasicknowledgeofupperdigestivetracthemorrhage.2.BefamiliarwiththeIdentificationofupperdigestivetracthemorrhagetreatmentandsymptom.3.Tograsptheupperdigestivetracthemorrhagepatientsofholisticnursingcare.Ⅲ.AnatomyandPhysiology1.pathologicalanatomy:Upperdigestivetractbyoralcavity,pharynx,esophagus,stomach,duodenum.5

2.etiology:The1uppergastrointestinaldiseases:(1)foresophagealdiseases(2)theduodenaldiseases(3)jejunadiseaseThe2portalhypertension:(1)avarietyofcompensatelivercirrhosis.(2)portalveinobstruction(3)hepaticvenousobstructionsyndrome.The3adjacentorgansortissuesofthegastrointestinaltractdisease:(1)bilioustractbleeding6(2)uremia.(3)withstressulcer.3.clinicalmanifestation:(1)hematemesisand(or)black(2)hemorrhagicperipheralcirculatoryfailure(3)toxemia(4)anemiaandHemogra4.laboratoryexamination:1.laboratorytests2.specialinspectionmethod(1)endoscopy(2)selectivearteriography(3)X-raybariummealexamination(4)radiosondescanⅣ.Caseprofile1.Introducingthecase(1)Hematemesis,melenafor3days7(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,deniedfoodanddrug8

allergyhistory,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:theappearanceofredbrownWBC: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,theestablishmentofan9

effectivechannelintravenousinfusionassoonaspossible,supplementbloodcapacityassoonaspossible.Inthematchingprocess,tolosebalanceliquidorglucosesaline.Improvementofacutehemorrhagickeyperipheralcirculatoryfailureistobloodtransfusion,thegeneralredbloodcelltransfusionconcentration,seriousactivityhemorrhageconsiderwholebloodtransfusion.Thefollowingconditionsforemergencybloodtransfusionindications:a.changethepositionsyncope,decreasedbloodpressureandheartrate;b.andhemorrhagicshock;c.hemoglobinbelow70g/Lorhematocritislowerthan25%.Bloodtransfusionasimprovehemodynamicsandanemiapatientsaroundanddecide,urinevolumeisareferencevalue.Shouldpayattentiontoavoidtheinfusion,transfusiontoofast,toomuchandcausepulmonaryedema,theoriginalheartdiseaseorelderlypatientswhennecessary,accordingtothecentralvenouspressureadjustinginput.(4)parenteralnutritionsupport10

Ⅴ.Identificationofpatient’sproblem1.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.11

(4)patientscansignrecognitionattheonsetofthedisease.Longtermgoals:(1)thepatientsbloodreturntonormalrange,nohematemesis,melena.(2)exercisetoleranceincreasedgradually,thesafepointsactivities.(3)patientswereabletobetterunderstandthedisease,andcaneffectivelypreventtherecurrenceofthedisease3.nursingmeasures:A.bodyfluiddeficiency:(1)positionandkeeptheairwaypatency:absolutebedrest,bleedingpatientssupineandlowerlimbwillbeslightlyraised,inordertoensurethebloodsupplytothebrain.Vomitingandheadtooneside,topreventsuffocationoraspiration;whennecessary,negativepressureaspiratorforremovalofairwaysecretions,bloodorvomit,maintainairwaypatency.Giveoxygen.(2)treatment:immediatelyestablishveinchannel.Thestartofinfusionshouldbefast,centralvenouspressuremeasurementastheadjustmentoftheinfusionvolumeandinfusionratebasiswhennecessary.Avoidinfusion,12

transfusionoftoomuch,toofastandthecauseofacutepulmonaryedema,inelderlypatientswithheartandlungfunctionisnotcompletepersonespeciallyshouldpayattentionto.(3)dietnursing:acutemassivehemorrhagecomplicatedwithnausea,vomitingshouldfast.Asmallamountofbleedingwithoutvomiting,intothecool,bland.(4)thepsychologicalnursing:observationinpatientswithandwithouttension,fearorgriefandotherpsychologicalreactions.Interpretationofbedresttohemostasis,care,comfortapatient.Hematemesisormelenaafterthetimelyremovalofblood,dirt,inordertoreduceadversestimulationpatients.(5)Observation:a.vitalsignsobservationb.spiritandconsciousnessc.observationofskinandnailbedcolord.preciseintakeandoutputrecorde.observationofvomitandfecesnature,colorandquantityChangesf.monitoringofserumelectrolyteandbloodgasanalysis13

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,topreventstomatitisandgastrointestinalcandidiasis.(3)Mucostaforgastriculcer,acuteexacerbationofgastricmucosallesionsinacutegastritis,chronicgastritis(erosion,bleeding,hyperemia,edema)improvement,payattentiontowhetherthepatientshadskinrashandotherallergicphenomenon,thereisnogeneralnausea,vomiting,abdominaldistensionorheartburn,whitebloodcellsandliverfunctionmonitoringwhennecessary.(4)OkushiYasushouldbetheintravenousdrip,once40mg,beforethe10mlspecialsolventintofreeze-driedpowder14

vial,prohibittheuseofothersolvents.Should,afterdinnerorbeforebed1H,emulsiontoshock,shouldbechew-abletablets.Acidicdrinksnotwithclothes,avoidtaketogetherwithmilk.Payattentiontotheadversereactionswereobservedwithandwithoutconstipation,nausea,vomitingandothergastrointestinaltract.C.activityintolerance(1)restandactivity:asmallamountofbleedingshouldrestinbed.Massivehemorrhageabsolutebedrest,tohelppatientstakecomfortablepositionandtimingofchangingposture,payattentiontokeepwarm.(2)patientswereinstructedtositup,standupsafetymovestoslow;dizziness,palpitation,sweatingbed-restimmediatelyandinformthenurse;nursewhenrequiredtoaccompanythetoiletorchangethetemporarybedexcretion.Severepatientsshouldpatrol,bedcolumnprotection.(3)thelifecare:patientespeciallytheelderlyandseverepatientspayattentiontothepreventionofpressureulcers;vomitingintimeafterthegargle;moreattentiontodefecationperianalskincleanandprotect.15

D.thereistheriskofinjury(1)antitrauma:avoideatingspicyfood.(2)topreventchokingandaspiration:eattakesemirecliningposition,topreventfoodaspirationandpulmonaryinfection.E.healtheducation(1)tomaintainagoodstateofmindandspiritofoptimism,correctlytreatdisease(2)payattentiontofoodhygiene,reasonablearrangementsforworkandresttime.(3)theappropriatephysicalexercise,enhancedphysique.(4)smoking,tea,Coffeehavefoodstimulationtothestomach.(5)ingoodseasonnoticedietetichygiene,payattentiontoworkandrest.(6)toinduceoraggravatethesymptomsofulcerdisease,andevencausecomplicationsofthedrugshouldavoidusingsuchassalicylicacid,reserpine,BaotaisongⅥ.nursingevaluation(1)thepatientstoppedbleeding,backtonormallifesigns;(2)adequaterestandsleep,exercisetoleranceincreased16

orrestoredtothelevelbeforebleeding.(3)whentheactivitywithoutsyncope,fallandotheraccidents;(4)noasphyxiaoraspiration,esophagealmucousnoerosion,necrosis;(5)patientswereabletorecognizesignsofdiseaseanddifferentialattack.Ⅶ.ConclusionThroughthiscasestudy,Icansystematicallyunderstandingthisdiseaseofupperdigestivetracthemorrhage,thewholenursinglevelofthesepatientsimproved.Uppergastrointestinalhemorrhageisthefourmostcommonetiology,arepepticulcer,esophagealandgastricvaricealhemorrhage,acutegastricmucosallesion(hemorrhagicerosivegastritisandgastriccancer),isoneofthemostcommondigestiveulcer.Thenreceivedapatientwithacuteuppergastrointestinalhemorrhage,our17nursingstaffhavetodoisvenouschanneltwoormorerapidestablishmentofcoarse,bloodtestsandhemostatictreatmenttocooperatewiththedoctor,readytorescue,rescueintherehydrationofmedicalstaffintheprocessofoperationshouldbequicklydetermined,emotionalcomfortofpatients.Hemostaticmeasuresusuallyuppergastrointestinalhemorrhagewithacidsuppressingmedications(protonpumpinhibitor(PPI)andH2receptorantagonist),treatment,endoscopicthreecavitytwocapsuletubecompressionhemostasis(usedforbleedingesophagealvariesinduced).Inthemedicaltreatmentprocess,weshouldpaycloseattentiontothepatient'svitalsigns,consciousness,andt