1、消化性溃疡英文消化性溃疡英文Learning Objectives To master the cause of peptic ulcer To master the cause of peptic ulcer clinical manifestations and complications;clinical manifestations and complications;Be f Be familiar with the key points of the amiliar with the key points of the pathogenesis and treatment of p
2、eptic ulcer;pathogenesis and treatment of peptic ulcer;To m To master the peptic ulcer nursing aster the peptic ulcer nursing intervention and health education;intervention and health education;2消化性溃疡英文Definition A circumscribed ulceration of the gastrointestinal mucosa occurring in areas exposed to
3、 acid and pepsin and most often caused by Helicobacter pylori infection.(Uphold&Graham,2003)3消化性溃疡英文Peptic Ulcers:Gastric&Dudodenal4消化性溃疡英文Peptic Ulcers:Gastric&Duodenalngastric ulcer:the ulcer that occurs in the stomach lining,some of them may be malignant.nduodenal ulcer:most often seen in first p
4、ortion of duodenum.5消化性溃疡英文GU6消化性溃疡英文DU7消化性溃疡英文8消化性溃疡英文PUD 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 9消化性溃疡英文Etiology（病因学）nHelicobacter pylori（HP）nnonsteriodal anti
5、-inflammatory drugs(NSAID）nAcid and pepsinnOthers 10消化性溃疡英文disease characteristicsChronic processperiodical attackRhythmic abdominal pain11消化性溃疡英文main 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 12消化性溃疡英文gastric 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
7、hours after a meal and may awaken patient from sleep.Midline or right of epigastrichungerlike pain or burning painpain-eating-reliefPain characteristics of peptic ulcer13消化性溃疡英文Clinical manifestationnOther symptoms of digestive system：Nausea,vomiting,belching,dyspepsia,bloating,chest discomfort,anor
8、exia may also occur.14消化性溃疡英文Clinical manifestationnsign Epigastric tenderness15消化性溃疡英文Hemorrhage:hematemesis,black or tarry stools 17消化性溃疡英文Gastric carinomauGU 1%can become cancerous GU 1%can become cancerous uA chronic,GU history A chronic,GU history u45 years of age or older 45 years of age or ol
9、der uThe more symptoms stubbornly The more symptoms stubbornly uContinuous and occult blood(+)Continuous and occult blood(+)18消化性溃疡英文 Stool for fecal occult blood19消化性溃疡英文nEndoscopy20消化性溃疡英文 21消化性溃疡英文Treatment PlannMedicationstreat with Proton Pump Inhibitors or H2 receptor antagonists to assist ulc
10、er 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 68w22消化性溃疡英文SurgerynPeople who do not respond to medication,or who develop complications23消化性溃疡英文Nursing diagnosisnPain related to gastric and duodenal injur
11、ynAltered Nutrition:less than body requirements related to anorexia,nausea24消化性溃疡英文nursing interventionnRelieve pain nMedication and care nDiet nRestnMonitornPsychotherapy and heath education25消化性溃疡英文Relieve pain nDU:Eat alkalescent food in pain or before pain(such as soda biscuit,etc.);nThe local h
12、ot compress 26消化性溃疡英文Medication and care 抗酸剂抗酸剂：应在饭后或睡前：应在饭后或睡前1h1h，乳液要震动，应咀嚼片。不与衣服的酸，乳液要震动，应咀嚼片。不与衣服的酸 性饮料，避免与牛奶同服；性饮料，避免与牛奶同服；氢氧化铝凝胶氢氧化铝凝胶：引起：引起磷缺乏症磷缺乏症表现食欲不振、无力长期服表现食欲不振、无力长期服 用引起便秘，可与氢氧化镁交替。用引起便秘，可与氢氧化镁交替。H H2 2RARA ：应在：应在餐中或餐后服，餐中或餐后服，也可把一日的剂量在睡前服用也可把一日的剂量在睡前服用 静脉给药应控制速度（过快低血压和心律失常）静脉给药应控制速度（过快
13、低血压和心律失常）PPIPPI类类：可引起头晕可引起头晕 硫糖铝硫糖铝：在酸性环境下有效，餐前：在酸性环境下有效，餐前1 1小时服用。不能与多酶片同服，小时服用。不能与多酶片同服，铋剂：铋剂：因在酸性下起作用，故因在酸性下起作用，故餐前服餐前服。可使粪便呈黑色。可使粪便呈黑色。27消化性溃疡英文Diet nEating little but often and regularly.nAvoid eating raw,cold,hard and strong irritant food.nSelect easily digestible and nutritious food.Eating pa
14、sta,adequate skim milk during active period.After the symptoms is alleviated,you should return to normal meal diet timely.nNutrition monitoring(such as:body weight,hemoglobin)28消化性溃疡英文RestnThe light symptom:appropriate activities to distraction the attentionnThe heavy symtom:stay in bed for a few da
15、ys to 1 2 weeks,relieve pain symptoms 29消化性溃疡英文MonitornVital signnMeasuring weight on a regular basis,monitoring nutritional indexes such as serum albumin and hemoglobin 30消化性溃疡英文Psychotherapy and heath educationnInformation about the relationship between peptic ulcer and factors such as Hp,NSAIDs,s
16、moking,alcohol intake,stress.nEducation about both therapeutic and preventive strategies.nLifestyle managementnAvoid the use of steroid,caffeine,aspirin and other NSAIDs.nInstruction 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.31消化性溃疡英文QuestionnWhich type of PUD will have abdominal pain at night?nHow can we diagnosis the infection of Hp?32消化性溃疡英文33消化性溃疡英文
