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Hemorrhageofupperdigestivetract---onecasenursingofhemorrhageofupperdigestiveByKelly&MiniDirectoryTOC\o"1-5"\h\z\o"CurrentDocument"Thehemorrhageofupperdigestivetract3-4\o"CurrentDocument"Learningobjectives4\o"CurrentDocument"Anatomyandphysiology5-7Casedescription7-10Nursing-problems10-16\o"CurrentDocument"nursingevaluation16Summary17-19\o"CurrentDocument"Reference19Introductiontheconceptofdisease:theuppergastrointestinalhemorrhageisreferstotheligamentofTreitzabovethedigestivetract,includingtheesophagus,stomach,duodenumbleedingorbiliousandpancreaticdisease,stomachjejunumanastomosisafterjejunalhemorrhagealsobelongstothiscategory.Massivehemorrhageisreferstowithinafewhoursofbloodlossthan1000mlorcirculatingbloodvolume20%,itsmainclinicalexpressionismetathesisand(or)blackstool,oftenaccompaniedbyareductioninbloodvolumeinducedacuteperipheralcirculatoryfailure,isacommondisease,themortalityrateisashighas8%~13.7%.theepidemiologicaldata:Duodenalulcer,gastriculcer,acutegastriccolossallesions,malignanttumor,esophagealvariesChineseisthemaincauseofuppergastrointestinalhemorrhage,accountedfor31.2%,15.2%,12%,11.7%,11.3%;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%;Malepatientsweremorethanfemalepatients,theratiois3.25:1;theelderlymaincauseofuppergastrointestinalbleedingingastriculcer,cancer,acutegastritis,duodenalulcer,esophagealvaries,children'smaincauseofuppergastrointestinalhemorrhageinduodenalulcer,gastriculcer,acutegastriccolossallesion.Conclusionspepticulcer,acutegastriccolossallesion,malignanttumor,esophagealvariesChinaisthemaincauseofuppergastrointestinalhemorrhage.II.LearningObjectiveTounderstandthebasicknowledgeofupperdigestivetracthemorrhage.BefamiliarwiththeIdentificationofupperdigestivetracthemorrhagetreatmentandsymptom.Tograsptheupperdigestivetracthemorrhagepatientsofholisticnursingcare.ffl.AnatomyandPhysiology1.pathologicalanatomy:Upperdigestivetractbyoralcavity,pharynx,esophagus,stomach,duodenum.犬结月希空觞筮等阁向叶一函门匚I..目夷十二指肠空膨曲「奎吉犬结月希空觞筮等阁向叶一函门匚I..目夷十二指肠空膨曲「奎吉月君左曲--4黄结脱R翠色吉月而G且民月泉—苦下腺T下颌下月泉#中Pffi.□月空「一-月琴者_命?「嘛玉"因■_喉食笛回盲瓣一一.白—阑尾人兴密■旦畦---月旦忌管十二手旨月而结月动右曲F土升结睇2.etiology:The1uppergastrointestinaldiseases:foresophagealdiseasestheduodenaldiseasesjejunadiseaseThe2portalhypertension:avarietyofcompensatelivercirrhosis.portalveinobstructionhepaticvenousobstructionsyndrome.The3adjacentorgansortissuesofthegastrointestinaltractdisease:bilioustractbleedinguremia.withstressulcer.3.clinicalmanifestation:hematemesisand(or)blackhemorrhagicperipheralcirculatoryfailuretoxemiaanemiaandHemogra4.laboratoryexamination:laboratorytestsspecialinspectionmethodendoscopyselectivearteriographyX-raybariummealexaminationradiosondescanIV.Caseprofilel.IntroducingthecaseIV.CaseprofileHematemesis,melenafor3dayspresenthistory:onabdominaldistensionpatientsaweekoneatinghardafter,afterdefecationcanalleviatethesymptoms,notthediagnosisandtreatmentof.3daysagodefecateinsuddenfeelingnausea,vomitingCoffeelikestomachcontent1,weightabout300-400ml,followedbyredbrownbloodystoolandtarrystoolinatotalof5times,averageweightofabout200ml,withdizziness,weakness,sweating,abdominalpain,abdominaldistension,tenesmus,nochestpain,tightnessinthechest,palpitation,chills,feveranddiscomfort.Inourhospitalemergencydepartmentvisits,checkingbloodroutinetest:WBC17.15*10A9/L,RBC3.24*10A9/L,HB101g/L,PLT221*10A9/L,totheantiinfection,antiacid,hemostatic,nutritionsupporttreatment.Sincesincetheillnessofpatients,spirit,sleepgood,poorappetite,stoollikeappeal,normalurine,recentwithoutsignificantchangesinbodyweight.History:usuallyishealthy,deniedthe"hepatitis,tuberculosisandotherinfectiousdisease,"vaccinationhistoryisunknown."Hypertension,diabetes,coronaryheartdiseaseanddenied"andotherchronicdiseases,denyoperation,traumahistory,deniedfoodanddrugallergyhistory,denythehistoryofbloodtransfusion.socialandpsychologicalstateinpatientswithstableemotion,socialsupportofgoodtherelevantexamination:theblood:WBC:9.66*10A9/L;Hb:67g/L;PLT:144*10A9/L;NEUT:65.4%fecalexamination:theappearanceofredbrownWBC:5-10/HPF;RBC:20-30/HPF;ob(+)2.treatmentthegeneraltreatment:absolutebed,oxygeninhalation,ECGandbloodpressuremonitoring,fast.drugtherapy:acidsecretioninhibitors.Inhibitoryeffectofdrugsinhibitinggastricacidsecretionofgastricacidsecretion,increasedgastricpHvalue,isconducivetothebleedingandpreventre-bleeding.Commongastricacidsecretioninhibitorswithprotonpumpinhibitorssuchasomeprazole40mgeachtime,2timesdailyintravenousinjectionorinfusion.supplementbloodcapacity:immediatelycheckedbloodtypeandbloodmatching,theestablishmentofaneffectivechannelintravenousinfusionassoonaspossible,supplementbloodcapacityassoonaspossible.Inthematchingprocess,tolosebalanceliquidorglucosesaline.Improvementofacutehemorrhagickeyperipheralcirculatoryfailureistobloodtransfusion,thegeneralredbloodcelltransfusionconcentration,seriousactivityhemorrhageconsiderwholebloodtransfusion.Thefollowingconditionsforemergencybloodtransfusionindications:changethepositionsyncope,decreasedbloodpressureandheartrate;andhemorrhagicshock;hemoglobinbelow70g/Lorhematocritislowerthan25%.Bloodtransfusionasimprovehemodynamicsandanemiapatientsaroundanddecide,urinevolumeisareferencevalue.Shouldpayattentiontoavoidtheinfusion,transfusiontoofast,toomuchandcausepulmonaryedema,theoriginalheartdiseaseorelderlypatientswhennecessary,accordingtothecentralvenouspressureadjustinginput.parenteralnutritionsupportV.Identificationofpatient’sproblemnursingdiagnosisbodyfluiddeficiencyanduppergastrointestinalmassivehemorrhage.activityintoleranceassociatedwithhemorrhagicperipheralcirculatoryfailure.thereisriskoftrauma,injuryofasphyxia,aspirationofesophagusandfundusofstomachmucouslongtimecompression,compressionofthreecavitytubeobstructionoftheairway,bloodorsecretionsintothetrachea.thelackofknowledgerelatedtothedeficiencyofuppergastrointestinalhemorrhagecausedbydiseasesandtheirpreventionknowledge.nursingobjectives:Shorttermgoals:withnosignofrecurrenthemorrhage,insufficientbloodvolumecorrected,stablevitalsigns.getenoughrest,dizziness,weaknessofnolitigation.upperairwaypatency,noasphyxia,aspiration,esophagealandfundicmucouswasnotduetoballooninjury.patientscansignrecognitionattheonsetofthedisease.Longtermgoals:thepatientsbloodreturntonormalrange,nohematemesis,melena.exercisetoleranceincreasedgradually,thesafepointsactivities.patientswereabletobetterunderstandthedisease,andcaneffectivelypreventtherecurrenceofthedisease3.nursingmeasures:A.bodyfluiddeficiency:positionandkeeptheairwaypatency:absolutebedrest,bleedingpatientssupineandlowerlimbwillbeslightlyraised,inordertoensurethebloodsupplytothebrain.Vomitingandheadtooneside,topreventsuffocationoraspiration;whennecessary,negativepressureaspiratorforremovalofairwaysecretions,bloodorvomit,maintainairwaypatency.Giveoxygen.treatment:immediatelyestablishveinchannel.Thestartofinfusionshouldbefast,centralvenouspressuremeasurementastheadjustmentoftheinfusionvolumeandinfusionratebasiswhennecessary.Avoidinfusion,transfusionoftoomuch,toofastandthecauseofacutepulmonaryedema,inelderlypatientswithheartandlungfunctionisnotcompletepersonespeciallyshouldpayattentionto.dietnursing:acutemassivehemorrhagecomplicatedwithnausea,vomitingshouldfast.Asmallamountofbleedingwithoutvomiting,intothecool,bland.thepsychologicalnursing:observationinpatientswithandwithouttension,fearorgriefandotherpsychologicalreactions.Interpretationofbedresttohemostasis,care,comfortapatient.Hematemesisormelenaafterthetimelyremovalofblood,dirt,inordertoreduceadversestimulationpatients.Observation:vitalsignsobservationspiritandconsciousnessobservationofskinandnailbedcolorpreciseintakeandoutputrecordobservationofvomitandfecesnature,colorandquantityChangesmonitoringofserumelectrolyteandbloodgasanalysisB.PharmaceuticalcareNS250/500ml+somatostatin3MG,firsttosomatostatincontaining250mgintravenousinjection(10min),followedbymaintenanceofintravenousinfusionof12-24h.Theprocessofdripinfusionpatrolstoobservetodo,noadversereactions,suchas:vertigo,tinnitus,blush,dripexcessivenausea,vomiting,shouldstrictlycontroltheinfusionspeed.Nexiumandotherdrugscancauserecurrentvomiting,difficultyswallowing,hematemesisormelena,ifsuchasituationshouldbereportedtoadoctorimmediately,checkregularlywithoutleukemia,goodoralcare,topreventstomatitisandgastrointestinalcandidiasis.Mucostaforgastriculcer,acuteexacerbationofgastricmucosallesionsinacutegastritis,chronicgastritis(erosion,bleeding,hyperemia,edema)improvement,payattentiontowhetherthepatientshadskinrashandotherallergicphenomenon,thereisnogeneralnausea,vomiting,abdominaldistensionorheartburn,whitebloodcellsandliverfunctionmonitoringwhennecessary.OkushiYasushouldbetheintravenousdrip,once40mg,beforethe10mlspecialsolventintofreeze-driedpowdervial,prohibittheuseofothersolvents.Should,afterdinnerorbeforebed1H,emulsiontoshock,shouldbechew-abletablets.Acidicdrinksnotwithclothes,avoidtaketogetherwithmilk.Payattentiontotheadversereactionswereobservedwithandwithoutconstipation,nausea,vomitingandothergastrointestinaltract.□.activityintolerancerestandactivity:asmallamountofbleedingshouldrestinbed.Massivehemorrhageabsolutebedrest,tohelppatientstakecomfortablepositionandtimingofchangingposture,payattentiontokeepwarm.patientswereinstructedtositup,standupsafetymovestoslow;dizziness,palpitation,sweatingbed-restimmediatelyandinformthenurse;nursewhenrequiredtoaccompanythetoiletorchangethetemporarybedexcretion.Severepatientsshouldpatrol,bedcolumnprotection.thelifecare:patientespeciallytheelderlyandseverepatientspayattentiontothepreventionofpressureulcers;vomitingintimeafterthegargle;moreattentiontodefecationperianalskincleanandprotect.thereistheriskofinjuryantitrauma:avoideatingspicyfood.topreventchokingandaspiration:eattakesemirecliningposition,topreventfoodaspirationandpulmonaryinfection.healtheducationtomaintainagoodstateofmindandspiritofoptimism,correctlytreatdiseasepayattentiontofoodhygiene,reasonablearrangementsforworkandresttime.theappropriatephysicalexercise,enhancedphysique.smoking,tea,Coffeehavefoodstimulationtothestomach.ingoodseasonnoticedietetichygiene,payattentiontoworkandrest.toinduceoraggravatethesymptomsofulcerdisease,andevencausecomplicationsofthedrugshouldavoidusingsuchassalicylicacid,reserpine,Baotaisong帆.nursingevaluationthepatientstoppedbleeding,backtonormallifesigns;adequaterestandsleep,exercisetoleranceincreasedorrestoredtothelevelbeforebleeding.whentheactivitywithoutsyncope,fallandotheraccidents;noasphyxiaoraspiration,esophagealmucousnoerosion,necrosis;patientswereabletorecognizesignsofdiseaseanddifferentialattack.VO.ConclusionVO.ConclusionThroughthiscasestudy,Icansystematicallyunderstandingthisdiseaseofupperdigestivetracthemorrhage,thewholenursinglevelofthesepatientsimproved.Uppergastrointestinalhemorrhageisthefourmostcommonetiology,arepepticulcer,esophagealandgastricvaricealhemorrhage,acutegastricmucosallesion(hemorrhagicerosivegastritisandgastriccancer),isoneofthemostcommondigestiveulcer.Thenreceivedapatientwithacuteuppergastrointestinalhemorrhage,ournursingstaffhavetodoisvenouschanneltwoormorerapidestablishmentofcoarse,bloodtestsandhemostatictreatmenttocooperatewiththedoctor,readytorescue,rescueintherehydrationofmedicalstaffintheprocessofoperationshouldbequicklydetermined,emotionalcomfortofpatients.Hemostaticmeasuresusuallyuppergastrointestinalhemorrhagewithacidsuppressingmedications(protonpumpinhibitor(PPI)andH2receptorantagonist),treatment,endoscopicthreecavitytwocapsuletubecompressionhemostasis(usedforbleedingesophagealvariesinduced).Inthemedicaltreatmentprocess,weshouldpaycloseattentiontothepatient'svitalsigns,consciousness,and