个案护理(英文)

1Hemorrhageofupperdigestivetract---onecasenursingofhemorrhageofupperdigestiveByKelly&Mini2DirectoryThehemorrhageofupperdigestivetract----------3-4Learningobjectives-------------------------------------4Anatomyandphysiology------------------------------5-7Casedescription----------------------------------------7-10Nursing-problems-------------------------------------10-16nursingevaluation-------------------------------------16Summary------------------------------------------------17-19Reference------------------------------------------------193Ⅰ.Introduction1.theconceptofdisease:theuppergastrointestinalhemorrhageisreferstotheligamentofTreitzabovethedigestivetract,includingtheesophagus,stomach,duodenumbleedingorbiliousandpancreaticdisease,stomachjejunumanastomosisafterjejunalhemorrhagealsobelongstothiscategory.Massivehemorrhageisreferstowithinafewhoursofbloodlossthan1000mlorcirculatingbloodvolume20%,itsmainclinicalexpressionismetathesisand(or)blackstool,oftenaccompaniedbyareductioninbloodvolumeinducedacuteperipheralcirculatoryfailure,isacommondisease,themortalityrateisashighas8%~13.7%.42,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,5esophagealvariesChinaisthemaincauseofuppergastrointestinalhemorrhage.Ⅱ.LearningObjective1.Tounderstandthebasicknowledgeofupperdigestivetracthemorrhage.2.BefamiliarwiththeIdentificationofupperdigestivetracthemorrhagetreatmentandsymptom.3.Tograsptheupperdigestivetracthemorrhagepatientsofholisticnursingcare.Ⅲ.AnatomyandPhysiology1.pathologicalanatomy:Upperdigestivetractbyoralcavity,pharynx,esophagus,stomach,duodenum.62.etiology:The1uppergastrointestinaldiseases:(1)foresophagealdiseases(2)theduodenaldiseases(3)jejunadiseaseThe2portalhypertension:(1)avarietyofcompensatelivercirrhosis.(2)portalveinobstruction(3)hepaticvenousobstructionsyndrome.The3adjacentorgansortissuesofthegastrointestinaltractdisease:(1)bilioustractbleeding7(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,melenafor3days8(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,deniedthehepatitis,tuberculosisandotherinfectiousdisease,vaccinationhistoryisunknown.Hypertension,diabetes,coronaryheartdiseaseanddeniedandotherchronicdiseases,denyoperation,traumahistory,deniedfoodanddrug9allergyhistory,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,theestablishmentofan10effectivechannelintravenousinfusionassoonaspossible,supplementbloodcapacityassoonaspossible.Inthematchingprocess,tolosebalanceliquidorglucosesaline.Improvementofacutehemorrhagickeyperipheralcirculatoryfailureistobloodtransfusion,thegeneralredblood