First, psychological guidance.
1. Patients caused by drugs or stress have a serious illness, sudden hematemesis and black stool, which can cause negative emotions such as panic, anxiety and tension. Instruct patients to take a deep breath, stabilize their emotions, keep the room quiet and reduce irritation.
2. Acute gastritis is reversible and can be cured through treatment, indicating cured cases and enhancing confidence in overcoming the disease.
Second, dietary guidance.
1. Patients with acute massive hemorrhage, epigastric pain and vomiting are temporarily fasted. After the symptoms are relieved, it is cold or slag-free semi-liquid. After a small amount of bleeding or hemostasis, eating rice soup to neutralize gastric acid is beneficial to mucosal repair.
2. Stop all diets or drugs that stimulate the stomach, avoid contact with the smell that causes nausea and vomiting, and pay attention to personal hygiene habits.
3. Establish good eating habits and negotiate an effective abstinence plan with patients.
Third, rest posture guidance
1, patients with severe bleeding should definitely stay in bed.
2, nausea, vomiting, take a seat or the head of a bed up 30-40o, turn your head to one side, keep the respiratory tract unobstructed.
Fourth, medication guidance.
1, guide the correct method and time of medication, and achieve good therapeutic effect.
2. Those who take non-steroidal anti-inflammatory drugs for a long time should take gastric mucosal protective agents or drugs that inhibit gastric acid secretion.
3, observation of adverse drug reactions, such as metoclopramide can cause dizziness, drowsiness, constipation; Spastic painkillers often have adverse reactions such as dry mouth, palpitation, constipation and skin flushing, such as 654-2; Aluminum hydroxide can cause constipation.
Five, health education guidance
1. To understand the inducing factors, duration and severity of symptoms such as nausea and vomiting.
2, establish a good lifestyle, alcoholics should give up drinking.
3. Patients who are highly suspected of acute gastric mucosal injury should take preventive drugs that inhibit gastric acid secretion.
4, found symptoms, timely treatment and care, to prevent the development of chronic gastritis.
Chronic gastritis Chronic gastritis refers to chronic inflammation of gastric mucosa caused by different reasons, which can be divided into chronic superficial gastritis and chronic atrophic gastritis.
First, psychological guidance.
The course of chronic gastritis is prolonged. Once the symptoms are obvious and cannot be cured for a long time, patients are prone to impatience, doubt, pessimism, depression and other emotions. Nurses should understand the cognitive degree and psychological reaction of patients and their families to diseases, give psychological care to patients, communicate effectively, encourage patients to express their psychological feelings of depression and trouble, try their best to meet the requirements, and guide self-relaxation training therapy.
Second, dietary guidance.
1, hyperacidity, eating bread, alkaline steamed bread, soybean milk, starch, milk, etc.
2. Anemic people eat fresh vegetables, such as animal liver, kidney, eggs, eggplant and tomatoes.
3. Avoid cold, overheated, hot and sour food; Eat less pickled, stale and smoked food; Avoid eating gas-producing foods, such as soda, beer, beans, potatoes and carrots.
4, guide patients to develop good eating habits, eating rules, eat less and eat more meals, food should be soft and easy to digest, chew slowly, so as not to feel full after meals.
5. Quit smoking and drinking, and avoid taking drugs that stimulate gastric mucosa.
Third, rest posture guidance
1, it is advisable for patients to stay in bed when they have an acute attack.
2, usually pay attention to the combination of work and rest, life rules.
3, abdominal distension, encourage walking after meals, moderate activities, and promote intestinal peristalsis.
Fourth, medication guidance.
1, master relevant pharmacological knowledge, and inform patients of the significance of cooperative combined medication.
2. Master the dosage, concentration, use and taking method of drugs, so as to achieve effective therapeutic effect.
1) colloidal bismuth: take it half an hour before meals. When taking it, suck it into the root of the tongue with a straw to avoid contact with teeth, and rinse your mouth with warm water after taking it.
2) The antacid should be taken half an hour to two hours after meals, and the tablets should be chewed.
3) Drugs for protecting gastric mucosa should be taken before meals 1 hour.
4) Drugs to promote gastric emptying should be taken before meals.
3. Observe the improvement of abdominal distension, nausea, vomiting, belching and other symptoms after medication.
Five, health education guidance
1, to help patients and their families understand the causes and symptoms.
2. Emphasize the importance of establishing good eating habits for patients.
3, prohibit the abuse of gastric irritant drugs, guide patients to master the time and method of taking drugs.
4. Regular follow-up and active treatment.
Peptic ulcer Peptic ulcer mainly refers to chronic ulcer of stomach and duodenum. The incidence of ulcer is seasonal and long-term.
Periodicity and rhythm. The diagnosis of peptic ulcer needs X-ray gastrointestinal barium meal examination or fibergastroscopy. Ulcers can be complicated.
Upper gastrointestinal bleeding, perforation, pyloric obstruction and canceration, among which massive bleeding and acute perforation are the main causes of death.
First, psychological guidance.
Peptic ulcer is one of typical psychosomatic diseases. Repeated attacks of diseases make patients fidgety, anxious or worried about cancer, resulting in fear, anxiety and excessive mental stress. Excessive work and life pressure and bad mood will aggravate the occurrence and development of ulcer disease. Patients should be encouraged to remain optimistic, pay attention to mental health care, live a regular life, pay attention to the combination of work and rest, and adjust their physical and mental strength.
Second, dietary guidance.
1, balanced nutrition, giving a light diet with high nutrition, high calorie, low sugar, low fat and easy digestion.
2. In terms of diet, avoid overeating and don't be too full; Encourage patients to chew slowly and avoid eating in a hurry; Cooking methods such as boiling, steaming, stewing and stewing should be adopted in diet; Avoid coffee, strong tea, thick soup, sour fruit and spicy food; Eat less or not eat fried food; Avoid alcohol and tobacco.
Third, rest posture guidance
1. Patients with active ulcer and fecal occult blood test are instructed to stay in bed.
2. Patients with ulcers are generally required to avoid excessive fatigue and pay attention to the combination of work and rest.
Fourth, pain relief guidance.
1, avoiding inducing factors.
2, rhythmic pain, guide patients to take acid-fast food before pain, to prevent pain.
3, guide patients to use relaxation therapy, such as deep breathing, whole body muscle relaxation, listening to music, etc.
4. Local hot compress.
Five, medication guidance
1, drugs for reducing gastric acid:
1)H2 receptor antagonists should be used before going to bed. Smoking will affect the effect and you should give up smoking.
2) Proton pump inhibitors should be swallowed before breakfast, not chewed, and the contents of capsules should not be poured out.
3) Alkaline antacid: When oral tablets are taken, they should be chewed or crushed and washed with water, and cannot be swallowed as a whole. It should be taken after meals 1h or half an hour before rhythmic pain, that is, Du should take it between meals and Gu should take it after meals1/2 ~1h. Taking it before going to bed can neutralize gastric acid secreted at night.
2, mucosal protection drugs: take it alone one hour before meals.
3, eradication of HP therapeutic drugs: triple therapy is anti-inflammatory, acid suppression, gastric mucosal protection treatment.
4, gastric motility drugs: take it half an hour before meals or before going to bed.
5. Avoid using drugs that are irritating to gastric mucosa, such as aspirin and indomethacin. When needed, instruct patients to choose enteric-coated or small-dose interval use, and take antacids and corresponding gastric mucosal protective drugs.
6. In order to eradicate Hp, patients often need to take drugs orally for a period of time, and guide patients to understand the importance of taking drugs to reduce the recurrence of ulcers and improve the compliance of taking drugs.
Six, health education guidance
1, to understand the causes of ulcer disease, such as bad eating habits, irregular life, overwork stress, etc.
2. Understand the occurrence process of abdominal pain and pantothenic acid symptoms.
3. Understand the importance of activities and rest, and avoid overwork.
4. Establish good eating habits, develop a regular lifestyle and keep healthy.
5, correct medication, regular follow-up, to overcome the reasons for poor medication compliance, prevention and treatment of ulcer recurrence and complications.
Cirrhosis Cirrhosis is a chronic progressive diffuse liver disease caused by different causes. Pathological features are extensive degeneration and necrosis of hepatocytes, nodular regeneration, connective tissue hyperplasia, fibrosis and pseudolobular formation, with liver function damage and portal hypertension as the main manifestations.
First, psychological guidance.
Understand patients' pain, listen to patients' dissatisfaction and anxiety, patiently comfort patients, relieve their psychological problems, encourage and guide patients to learn health education about diseases properly, and help patients to participate in self-care appropriately. Advocate a regular life, participate in collective labor, and maintain a good mood and emotional stability.
Second, dietary guidance.
Generally speaking, it is recommended to give priority to foods with high calorie, high protein, rich in vitamins and easy to digest, and alcohol is strictly prohibited.
1) In the late stage of liver cirrhosis, give appropriate protein and calories, and the diet is light and easy to digest; Eat more fresh fruits and vegetables and supplement vitamins; Small amount and multiple meals, balanced nutrition.
2) Those with obvious liver function damage, high blood ammonia and signs of hepatic encephalopathy should restrict or fast protein, and gradually resume protein intake after the condition improves, mainly plant protein, such as bean products.
3) Patients with esophageal and gastric varices mainly eat soft food, so they should chew slowly when eating, and should not eat fiber, fried or greasy food.
Third, rest posture guidance
1. During the compensatory time off, pay attention to the combination of work and rest, engage in lighter work, and take no fatigue as the activity principle.
2. It is advisable to stay in bed during decompensation. Reclining can reduce physical exertion and is beneficial to the repair of liver cells.
Fourth, medication guidance.
Guide patients and their families to understand the methods and time of taking various drugs, with the principle of using less drugs and necessary drugs, and should not
Abuse a wide variety of "liver-protecting drugs" to avoid increasing the burden on the liver and ban them;
Five, health education guidance;
1, to help patients and their families understand the symptoms, signs and complications of the disease;
2. Help patients understand the related risk factors to avoid diseases;
3. Ensure physical and mental rest and reasonable diet;
4, guide to understand the internal and surgical treatment methods, reduce mental tension, anxiety and anxiety;
5, patients and their families to master the rational use of drugs, observation of drug efficacy, adverse reactions; Upper gastrointestinal bleeding; Upper gastrointestinal bleeding refers to gastrointestinal bleeding above flexor ligament, including esophagus; The heart abuses a wide variety of "liver-protecting drugs" to avoid increasing the burden on the liver and prohibit drugs that damage the liver.
Upper gastrointestinal bleeding Upper gastrointestinal bleeding refers to gastrointestinal bleeding above flexor ligament, including bleeding caused by diseases such as esophagus, stomach, duodenum, pancreaticobiliary, and jejunal bleeding after gastrojejunostomy.
First, psychological guidance.
Timely consultation, explanation and support can improve patients' cognitive level and reduce their mental stress, depression and fear. Keep calm and deal with vomit and excrement as soon as possible to avoid adverse stimulation to patients. If you are accidentally seen, you should explain and comfort the patient and tell him that he seems to be bleeding heavily because of gastric juice, mucus or feces. Three-lumen balloon catheter compression hemostasis will cause discomfort. Nurses patiently explain the process, importance and precautions of balloon compression, comfort and encourage patients, and establish confidence in overcoming diseases.
Second, dietary guidance.
1, shock state, acute massive hemorrhage, accompanied by obvious nausea and vomiting should be fasted, and fluid can be ingested when it is confirmed that bleeding has stopped or there is no persistent bleeding or vomiting.
1) After the bleeding of esophageal varices in liver cirrhosis stops for 2-3 days, give high calorie and vitamins, limit the liquid of protein and sodium salt, and avoid hard or prickly food.
2) When the bleeding of peptic ulcer stops 12-24 hours, the liquid can enter.
2, for a small amount of bleeding, no vomiting or only black feces, no obvious active bleeding, give light and non-irritating cold liquid, give semi-liquid after hemostasis, gradually change to soft food with easy digestion, rich nutrition and less crude fiber, and then transition to normal diet. Eat less and eat more meals, and do not eat raw vegetables and irritating foods, including wine, coffee, strong tea and too sweet and sour drinks.
Third, rest posture guidance
1. In severe cases, stay in bed to keep warm.
2, take the supine position to raise the lower limbs, avoid the bow position, affect the respiratory function, and take oxygen when necessary.
Fourth, medication guidance.
Hemostatic drugs for upper gastrointestinal bleeding caused by varicose veins. Mainly drugs to reduce portal vein pressure.
1) vasopressin: It reduces portal vein pressure and blood flow, and has hemostatic effect on esophageal and gastric variceal bleeding. Observe dizziness, chest tightness, nausea, pale face, diarrhea and other adverse reactions. At the same time, pay attention to the dropping speed should not be too fast, so as not to cause hypertension, arrhythmia and myocardial ischemia.
2) somatostatin: reduce the venous pressure of peptides, closely observe the frequency, nature and fecal blood volume of hematemesis, and observe vital signs, urine volume and dripping speed; 50 mg/min can cause nausea and vomiting, and it is not allowed to adjust the dropping speed without authorization to avoid accidents.
Five, health education guidance
1. Help family members to understand the etiology, inducement and prevention knowledge of the disease, so as to reduce the risk of rebleeding and relieve patients' mental and psychological anxiety and fear.
2. Guiding reasonable diet is an important link to avoid inducing upper gastrointestinal bleeding. We should follow food hygiene and food rules, avoid overeating or overeating, and avoid eating rough and irritating foods or foods and drinks that are too cold, too hot and produce too much gas.
3, daily life should be regular, work and rest should be combined, be optimistic, and ensure physical and mental rest.
You should quit smoking and drinking, and take medicine under the guidance of a doctor to avoid long-term mental stress and overwork.
4, guide family members and patients to learn early identification of bleeding signs and emergency measures:
1) Stay in bed immediately when hematemesis or melena occurs, keep quiet and reduce physical activity; 2) Take a lateral position when vomiting to avoid aspiration.
3) Send to the hospital for treatment immediately.
5, correct medication, regular review.
Ulcerative colitis Ulcerative colitis is a chronic inflammatory disease of rectum and colon with unknown etiology. Pathological manifestations were chronic inflammatory cell infiltration and multiple ulcers in colonic mucosa and submucosa.
First, psychological guidance.
The disease has a tendency of family aggregation, which is closely related to mental and neurological factors, allergies and oxygen free radical damage. About 3% of patients may have mental symptoms such as depression, insomnia, autonomic nerve dysfunction, etc. These symptoms can tell patients successful cases, reduce their mental burden, and establish confidence in overcoming diseases.
Second, dietary guidance.
1, to guide the consumption of soft, digestible, low-cellulose, nutritious food, high-calorie, high-protein, low-residue diet is appropriate.
2, a small number of meals, avoid cold, hard and irritating food, reduce mucosal inflammation, prevent intestinal bleeding and other complications.
3. People with serious illness should fast and have high nutrition in veins.
4. Observe the eating situation, measure the weight, observe the changes of hemoglobin and plasma albumin, and understand the nutritional improvement.
Third, rest posture guidance
During acute attack or serious illness, you should stay in bed to ensure sleep. Rest properly during the remission period, and pay attention to the combination of work and rest.
Fourth, medication guidance.
Principle: Control acute attack, relieve illness, reduce recurrence and prevent complications. Take medicine according to the doctor's advice and pay attention to adverse drug reactions.
1, use sulfasalazine, and pay attention to whether there are nausea, vomiting, rash, leukopenia and joint pain.
2, the application of 5-aminosalicylic acid enema, use now, to prevent the decline of efficacy.
3. Use glucocorticoids, pay attention to hormone dosage, and gradually stop taking drugs to prevent rebound.
Five, health education guidance
1, guide reasonable rest, treat diseases correctly, maintain emotional stability, and establish confidence in overcoming diseases.
2, intake of adequate nutrition, avoid fiber and irritating food, avoid cold food.
3, adhere to the treatment, found adverse drug reactions, do not change medicine or stop medicine at will, drink plenty of water during medication, regular review and follow-up.
Colonic polyp Colonic polyp refers to a protuberant lesion that occurs on the surface of colonic mucosa, but it is generally called polyp, which is only a local protrusion of mucosa. There is no histological significance. Polyps are benign lesions, which are generally not life-threatening.
First, psychological guidance.
Intestinal polyps are mostly caused by chronic inflammatory stimuli, and patients are prone to doubt and pessimism, and worry about the nature of the disease, which leads to depression. Nurses should understand the cognitive degree and psychological reaction of patients and their families to the disease, and introduce the relevant knowledge of the disease, so that patients and their families can correctly understand the disease, actively cooperate with the treatment, and eliminate bad emotions.
Second, dietary guidance.
1, avoid drinking and eating spicy food.
2. Avoid fried, cold, high-fat, high-calorie foods.
3. Increase the intake of fruits and vegetables.
Third, surgical guidance.
1, actively do a good job of preoperative examination and preoperative preparation.
2. patiently explain the advantages of surgical methods, approaches and minimally invasive surgery, encourage and comfort patients, and eliminate patients' tension and anxiety.
3. Instruct patients to quit smoking, keep warm, and prevent colds, so as not to affect the therapeutic effect by coughing during treatment.
4, do a good job of intraoperative and postoperative nursing guidance.
Third, rest posture guidance
Stay in bed properly, and stay in bed strictly for 2-3 days after operation to reduce activities.
Fourth, health education guidance.
1. Review time: Colonic polyps are prone to relapse and may become malignant. Colonoscopy should be performed within one year after operation. When no polyps are found, colonoscopy should be performed again two years later to help patients improve their self-care ability.
2. Stay optimistic, live a regular life, develop good living habits, have a light diet and eat more dietary fiber.
Acute pancreatitis Acute pancreatitis refers to chemical inflammation in which the pancreas and its surrounding tissues are digested by digestive enzymes secreted by the pancreas. The clinical manifestations are acute abdominal pain, fever with nausea, vomiting, and increased amylase in blood and urine.
First, psychological guidance.
Comfort and considerate patients, reduce patients' tension and fear, and guide patients to relieve abdominal pain. Such as relaxation therapy, skin stimulation therapy, etc., to meet the needs of patients and assist life care.
Second, dietary guidance.
Strictly forbid patients to eat 1-3 days, and explain the significance of the ban to patients. Patients with obvious abdominal distension should undergo gastrointestinal decompression to prevent eating from stimulating gastric acid secretion, stimulating pancreas to secrete digestive enzymes and aggravating symptoms.
Third, rest posture guidance
1, absolutely stay in bed to ensure sleep and quiet environment.
2, help to choose a comfortable position, such as bending, supine, encourage patients to turn over.
3. Those who are fidgeting in bed due to severe pain should prevent from falling off the bed, and there should be no dangerous goods around. If necessary, add a bed block to ensure safety.
Fourth, medication guidance.
1, inhibiting or reducing pancreatic secretion: somatostatin: decreasing speed >; Nausea and vomiting may occur at 50 mg/min. Do not adjust the descending speed without authorization to avoid accidents. -
2, antispasmodic analgesics: morphine is prohibited, so as not to cause Oddi sphincter contraction.
3.H2 receptor antagonists or pump inhibitors can reduce pancreatic secretion and prevent upper gastrointestinal bleeding.
Five, health education guidance
1, to help patients and their families understand the inducing factors and disease process.
2. Acute pancreatitis is mostly caused by biliary tract diseases. Patients with biliary tract diseases and duodenal diseases should be actively treated to prevent ascaris infection.
3, guide to master the knowledge of food hygiene, diet, should be low-fat, non-irritating food, quit smoking and drinking, to prevent recurrence.
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