消化性溃疡课件(同名35).ppt

1、Peptic Ulcer disease(PUD)by Anrui Zhengfrom huangshi central hospital1Learning Objectives To master the cause of peptic ulcer To master the cause of peptic ulcer clinical manifestations and complications;clinical manifestations and complications;To m To master the peptic ulcer nursing aster the pept

2、ic ulcer nursing intervention and health education;intervention and health education;Be f Be familiar with the key points of the amiliar with the key points of the pathogenesis and treatment of peptic ulcer;pathogenesis and treatment of peptic ulcer;2Definition A circumscribed ulceration of the gast

3、rointestinal mucosa occurring in areas exposed to acid and pepsin and most often caused by Helicobacter pylori infection.(Uphold&Graham,2003)3Peptic Ulcers:Gastric&Dudodenal4Peptic Ulcers:Gastric&Duodenalngastric ulcer:the ulcer that occurs in the stomach lining,some of them may be malignant.nduoden

4、al ulcer:most often seen in first portion of duodenum.5GU6DU78PUD Demographics（流行病学）nLifetime prevalence is 10%.nThe incidence of duodenal is 4 times as common as gastric ulcernmost common in middle age peak 30-50 yearsnMale to female ratio4:1 9Etiology（病因学）nHelicobacter pylori（HP）10Etiology（病因学）nno

5、nsteriodal anti-inflammatory drugs(NSAID）nAcid and pepsinnOthers 11disease characteristicsChronic processperiodical attackRhythmic abdominal pain12main symptom(1)abdominal pain：the classic symptom of PUD.Pain”gnawing”,“aching”,or“burning”“hungerlike”（钝痛、胀痛、灼痛或饥饿痛）(2)rhythmicity:GU Eating-pain-relief

6、 DU pain-eating-relief(3)cyclicity：Attack more in autumn or winter 13gastric ulcerduodenal ulcertimepositionnature ruleoccurs 0.51 hour after a meal and relief until next meal,may not awaken patient from sleep.median or left of Subxiphoidburning pain or crampy painEating-pain-reliefoccurs 3-4 hours

7、after a meal and may awaken patient from sleep.Midline or right of epigastrichungerlike pain or burning painpain-eating-reliefPain characteristics of peptic ulcer14Clinical manifestationnOther symptoms of digestive system：Nausea,vomiting,belching,bloating,chest discomfort may also occur.15Clinical m

8、anifestationnsign Epigastric tenderness16Complications nhemorrhage 17Complications Perforation18Complications 19Complications 20Hemorrhage:hematemesis,black or tarry stools 21Gastric carinomauGU 1%can become cancerous GU 1%can become cancerous uA chronic,GU history A chronic,GU history u45 years of

9、age or older 45 years of age or older uThe more symptoms stubbornly The more symptoms stubbornly uContinuous and occult blood(+)Continuous and occult blood(+)22 Stool for fecal occult blood23nEndoscopy24 25Treatment PlannMedicationstreat with Proton Pump Inhibitors or H2 receptor antagonists to assi

10、st ulcer healingH2:Tagament,Pepcid,Axid,or Zantac for up to 8 weeksPPI:Prilosec,Prevacid,Nexium,Protonix,or Aciphex for 4-8 weeks.nDU：PPI 46wnGU:PPI 68w26SurgerynPeople who do not respond to medication,or who develop complications27Nursing diagnosisnPain related to gastric and duodenal injurynAltere

11、d Nutrition:less than body requirements related to nausea28nursing interventionnRelieve pain nMedication and care nDiet nRestnMonitornPsychotherapy and heath education29Relieve pain nDU:Eat alkalescent food in pain or before pain(such as soda biscuit,etc.);nThe local hot compress 30Medication and ca

12、re Antacids:should be 1h after the meal or before bed.Aluminium Hydroxide Gel:cause phosphorus deficiency,loss of appetite,weakness31Medication and care H2RA:It should be taken at meals or after meals,or at bedtime.PPI:Effective in acidic environment,take 1 hour before meal.Bismuth agent:Because it

13、works in acidity,it is taken before meal.It can make the feces black.32Diet nEating little but often and regularly.nAvoid eating raw,cold,hard and strong irritant food.nSelect easily digestible and nutritious food.Eating pasta,adequate skim milk during active period.After the symptoms is alleviated,

14、you should return to normal meal diet timely.nNutrition monitoring(such as:body weight,hemoglobin)33RestnThe light symptom:appropriate activities to distraction the attentionnThe heavy symtom:stay in bed for a few days to 1 2 weeks,relieve pain symptoms 34MonitornVital signnMeasuring weight on a reg

15、ular basis,monitoring nutritional indexes such as serum albumin and hemoglobin 35Psychotherapy and heath educationnInformation about the relationship between peptic ulcer and factors such as Hp,NSAIDs,smoking,alcohol intake,stress.36Psychotherapy and heath educationnEducation about both therapeutic

16、and preventive strategies.nLifestyle managementnAvoid the use of steroid,caffeine,aspirin and other NSAIDs.37Psychotherapy and heath educationnInstruction about the medication regimen prescribed and how to take the drugs.nTeach the client the symptoms that may indicate a complication,such as increased abdominal pain or distention,vomiting,black or tarry stools,or fainting.38QuestionnWhich type of PUD will have abdominal pain at night?nHow can we diagnosis the infection of Hp?3940