Gastroenterology is a kind of internal medicine. Do you know the nursing methods of common diseases in gastroenterology? The following is the nursing method of common diseases in gastroenterology that I brought to you. Welcome to reading.
Nursing methods of common diseases in gastroenterology Section 1 Routine nursing of diseases in gastroenterology
First, the nursing points
(1) disease observation
(1) Observe whether there are symptoms such as nausea, vomiting, warm breath, acid regurgitation, abdominal pain, abdominal distension, diarrhea, constipation, bloody stool, yellow staining of scleral skin, etc.
(2) Observe the changes of blood pressure, body temperature, pulse, breathing and consciousness according to the illness.
(3) Observe the location, nature, duration, inducement and relieving factors of pain.
(2) the implementation of treatment
(1) Carry out routine and special examinations according to the doctor's advice.
(2) Special drugs, such as somatostatin, octreotide, etc., are pumped in at a constant speed in strict accordance with the doctor's advice.
(3) Fasting and drinking water before gastroscopy. Eat food without residue two days before colonoscopy and avoid eating fruits and vegetables. /kloc-Don't eat after 0/8:00, eat a box of laxatives around 20:00, and eat two more boxes on an empty stomach at 8: 00 the next morning until you urinate and defecate three times with clear water.
(3) Nursing measures
1. Drug care
(1) Oral drugs (such as Daxi), gastric motility drugs (such as morpholine) and anticholinergic drugs (such as atropine, which is not suitable for patients with gastric ulcer and forbidden for patients with pyloric obstruction) should be taken before meals and before going to bed.
(2) Oral drugs (such as aspirin) that irritate the stomach and destroy the gastric mucosal barrier should be taken after meals.
(3) antacids (such as omeprazole) and drugs that reduce pepsin activity should be taken at 0.5 ~ 1h after meals.
(4) Acute pancreatitis patients with severe abdominal pain should not be used alone. Sedatives are forbidden in patients with hepatic coma.
(5) Patients with liver cirrhosis and esophageal varices should take drugs orally after grinding, and patients with peptic ulcer should take acid inhibitors before meals or on an empty stomach.
2. Symptom care
(1) Abdominal pain
Measure and record vital signs, and apply antispasmodics according to the doctor's advice. Acute abdomen should be fasted, without abdominal hot compress and enema, and narcotic painkillers should be banned.
(2) Abdominal distension
It is advisable to eat food without residue, which is easy to digest and does not produce gas. If necessary, vent the anus or enema to decompress the gastrointestinal tract.
(3) Diarrhea
Timely sampling for inspection, abdominal warmth, and nursing around anus.
(4) hematemesis
Accurately record the amount and vital signs of hematemesis and melena, prepare first-aid medicines and articles, and prepare blood and blood transfusion. Stay in bed.
(5) jaundice
Patients with itching can be given antipruritics or sedatives, and isolated immediately if necessary.
(6) Constipation
Take enough liquid (2000mL/d), give multi-fiber food, and don't abuse laxatives. People with severe constipation can use kaiselu and enema when necessary.
3. Special treatment and care
When abdominal puncture, liver biopsy, electronic endoscope and percutaneous liver puncture intervention are needed, preoperative preparation, intraoperative cooperation and postoperative nursing should be done well.
4. Psychological care
Psychological counseling can eliminate patients' nervousness and fear, so that patients can relax and be emotionally stable. Do a good job in comforting patients and their families, so that patients can remain optimistic and avoid the stimulation of adverse factors.
5. Skin care
When itching occurs (cholate in the blood increases), cut the nails short to prevent scratching the skin.
6. Pipeline nursing
For patients who use gastric tube, nursing should be carried out according to the operating rules of gastric tube; For patients who use three-cavity and two-sac tubes, nursing should be carried out according to relevant operating procedures. Properly fixed to prevent the pipeline from sliding.
7. Prevention of complications
Patients who stay in bed for a long time should take measures to prevent falling pneumonia, pulmonary embolism and venous thrombosis of lower limbs (turning over, patting back, taking a deep breath, coughing effectively, massaging lower limbs and avoiding infusion of lower limbs). ), pressure sores (keep the skin clean and dry, turn over and massage regularly) and constipation (eat more cellulose foods and often massage the abdomen clockwise).
(4) Rehabilitation guidance
1. Instructions for medication
Follow the doctor's advice, insist on taking medicine on time and in quantity, and don't stop taking medicine at will.
2. Dietary guidance
Used for patients with peptic ulcer, ascites due to liver cirrhosis, acute pancreatitis, ulcerative colitis, etc. Guide them to eat a diet with digestive ability, high protein, low salt or no salt, low fat and no residue. Fasting should be done during bleeding period, and a nutritious, digestible and non-irritating diet should be given during recovery period.
Rest activities
Critically ill and specially treated patients, such as upper gastrointestinal bleeding, advanced cirrhosis, hepatic coma, acute pancreatitis, etc. You should definitely stay in bed. Patients in mild and severe recovery period can exercise properly.
Second, the nursing quality standards
(1) Observe the patient's condition in time, and the nursing records are true and complete.
(2) the correct implementation of the doctor's advice, the implementation of treatment.
Nursing care of upper gastrointestinal bleeding in the second quarter
First, the nursing points
(1) disease observation
(1) Monitor the changes of consciousness and vital signs (using electrocardiogram and sphygmomanometer) during massive bleeding.
(2) Observe the amount, frequency and characteristics of urine, hematemesis and melena (when the amount of gastric bleeding reaches 250 ~ 300 ml, it can cause hematemesis; The appearance of melena suggests that the amount of bleeding is 50 ~100 ml; A positive fecal occult blood test indicates that the amount of bleeding is more than 5mL, and the amount of bleeding is more than 1000mL, which belongs to gastrointestinal bleeding, and severe cases cause hemorrhagic shock).
(3) Observe the changes of skin color and limb temperature.
(4) Be alert to the signs of rebleeding (such as dizziness, irritability, palpitation, sweating, nausea, abdominal distension, bowel movements, etc.). ).
(2) the implementation of treatment
1. Special inspection
When carrying out bedside gastroscopy and colonoscopy in an emergency, prepare a sputum aspirator and an ambulance, and cooperate with the doctor to prepare for rescue.
2. Special drugs
Use lidocaine, thrombin, somatostatin and octreotide as prescribed.
(3) Nursing measures
1. Drug care
Quickly establish two venous channels, and pump somatostatin and octreotide according to the dose. 4 ~ 8 mg of norepinephrine was added to 150mL of normal saline and injected from gastric tube several times.
2. Diet care
Fasting when bleeding, and gradually giving warm, cool, semi-liquid and digestible soft food after stopping bleeding.
3. Symptom nursing
(1) Absolute bed rest to prevent pulmonary embolism and venous thrombosis of lower limbs (massage lower limbs, avoid infusion of lower limbs, etc.). ), pressure sore (keep the skin clean and dry, turn over and massage regularly), etc. , to prevent the occurrence of adverse events such as falling and falling out of bed.
(2) hematemesis
(1) patients take lateral position or semi-supine position, coma head to one side, prepare negative pressure aspirator when necessary. (2) Blood transfusion, infusion and hemostasis according to the doctor's advice to keep the vein unobstructed.
(3) bloody stool
Wipe clean after defecation and keep the anus clean and dry. Stand slowly after defecation to prevent accidents such as falling.
(4) Pain
(1) After sclerotherapy, observe the nature and degree of pain and inform the doctor in time. ② According to the doctor's advice, give drugs such as acid inhibition and gastric mucosal protective agent.
(5) Fever
Fever may occur after sclerotherapy. Give infusion and anti-inflammatory drugs according to the doctor's advice, and observe the changes of body temperature regularly.
4. Special treatment and care
Stop bleeding under gastroscope and observe whether there is bleeding after operation, so as to deal with it in time.
5. Psychological care
Comfort and considerate patients and eliminate their tension and fear; Clean up all blood and gastrointestinal drainage in time to avoid malignant stimulation.
6. Skin care
Change positions frequently to avoid local long-term pressure. Keep the bed flat, clean and dry without wrinkles.
7. Three-cavity and two-sac tube nursing
(1) Place the test tube according to the operating procedure.
(2) Prepare a sputum aspirator during the operation to prevent a large amount of snow in the stomach from flowing back during intubation.
(3) Gas injection should start from the gastric balloon, and then inflate the esophageal balloon, and the deflation sequence is reversed.
(4) When the tube with three cavities and two sacs goes down to the pharyngeal cavity, let the patient swallow it to avoid swallowing it by mistake.
(5) The traction direction of the three-lumen tube should be along the longitudinal axis of the body and make an angle of 45 with the nose and lips to prevent erosion and necrosis of the nasal mucosa and lip skin.
(6) Bleed every 12-24 hours after tube filling 15-30 minutes. Check the airbag every 4-6 hours 1 time.
(7) Airbag compression should last for 3-5 days. After the bleeding stops for 24 hours, the bleeding can be observed for another 24 hours, and extubation can be considered when there is still no bleeding.
(8) Pay attention to observe the changes of the disease and prevent complications.
(4) Rehabilitation guidance
1. Instructions for medication
Take medicine according to the doctor's advice and avoid taking aspirin, indomethacin and hormone drugs. Don't stop taking the medicine without authorization.
2. Dietary guidance
Quit smoking and drinking; Soft food is mainly cold, light and residue-free, with rich nutrition and easy digestion; Avoid hunger and satiety; Avoid coarse, sour and spicy foods, such as vinegar, pepper, garlic and strong tea. Avoid eating food that is too cold or too hot.
Rest activities
Live a regular life, keep a good mood and optimism, and treat diseases correctly.
4. Follow-up guidance
Check regularly. If you have vomiting blood or black stool, go to the hospital immediately.
Second, the nursing quality standards
(1) Observe the condition in time and standardize the nursing records accurately.
(2) the inspection and nursing measures in place.
(3) Patients with rebleeding can see a doctor in time.
Nursing methods of common diseases in gastroenterology (Ⅱ) Liver cirrhosis
Definition Cirrhosis is a common chronic liver disease, which is caused by one or more pathogenic factors acting on the liver for a long time or repeatedly, resulting in chronic, progressive and diffuse damage to liver tissue, with portal hypertension and abnormal liver function as the main clinical manifestations.
The cause of disease
Viral hepatitis: Viral hepatitis (especially hepatitis B and C) is the main cause of liver cirrhosis in China, and most of them develop into portal cirrhosis. The persistence of the virus is the main reason for the evolution into cirrhosis. The course from viral hepatitis to cirrhosis ranges from a few months to 20-30 years.
2. Chronic alcoholism: In Europe and America, liver cirrhosis caused by alcoholic liver disease can account for 50%-90% of all liver cirrhosis. In recent years, there is an upward trend in China, accounting for about 10% of the total number of hospitalized cirrhosis in the same period. Generally speaking, drinking 50 grams of ethanol every day,15% of people over 0 years old will cause cirrhosis.
3. Cholestasis: When there is persistent extrahepatic bile duct obstruction or intrahepatic cholestasis, high concentrations of bile acids and bilirubin damage liver cells, causing degeneration and necrosis of liver cells and gradually developing into biliary cirrhosis.
4. Circulatory system diseases: Common chronic congestive heart failure, constrictive pericarditis and hepatic vein (or inferior vena cava) can cause long-term congestion, hypoxia, necrosis and proliferation of connective tissue of liver cells, and gradually develop into cardiogenic cirrhosis.
5. Chemical poisons or drugs: Long-term repeated exposure to carbon tetrachloride, phosphorus and other chemical poisons, or long-term use of methyldopa and diacetate can cause toxic hepatitis and eventually evolve into cirrhosis.
6. Nutritional disorders: chronic intestinal inflammation, lack of protein, vitamins and other substances in long-term food can cause malabsorption and malnutrition, and reduce the resistance of the liver to other harmful factors; Some metabolic disorders will lead to the deposition of metabolites in the liver, damage liver cells, and develop into cirrhosis for a long time.
7. Parasitic infection: Schistosoma infection is common in southern China, which can lead to schistosomiasis and further lead to liver fibrosis and cirrhosis. If the human body is infected with Clonorchis sinensis and is not treated in time, cirrhosis will occur.
8. Immune disorder: autoimmune hepatitis will eventually develop into cirrhosis.
The main clinical manifestations are portal hypertension and abnormal liver function.
First, the compensatory period of liver function: patients are prone to fatigue and loss of appetite, which may be accompanied by abdominal distension, nausea, dull pain in the upper abdomen and mild diarrhea.
Second, the decompensated period of liver function: manifested as abnormal liver function, portal hypertension and systemic symptoms and signs.
1, decreased liver function:
(1) General manifestations: dull complexion, listlessness, emaciation and fatigue, dry skin, low fever and edema.
(2) Manifestations of digestive system: fullness and discomfort of upper abdomen, nausea, vomiting, diarrhea, abdominal distension, jaundice, etc.
(3) Bleeding tendency and anemia: There are often nosebleeds, gingival bleeding, skin purpura, gastrointestinal bleeding tendency and anemia in different degrees.
(4) Endocrine disorder: male patients have decreased libido and alopecia, while female patients have menstrual disorder, amenorrhea and infertility. Spider nevus and liver palm appeared on the patient's face, neck, upper chest and shoulders.
2, portal hypertension:
(1) Ascites: This is the most prominent manifestation of liver cirrhosis, and more than 75% of decompensated patients have ascites.
(2) Establishment and opening of collateral circulation: Esophageal varicose veins are easy to cause massive hemorrhage of upper digestive tract, abdominal varicose veins can be seen around umbilicus and abdominal wall, and hemorrhoid varicose veins are easy to form hemorrhoid nuclei.
(3) splenomegaly: late hypersplenism with pancytopenia.
(4) Electrolyte disorder: Low potassium and sodium is a common phenomenon in patients with liver cirrhosis.
Third, complications.
(1) Upper gastrointestinal bleeding: It is the most common complication of this disease. Hematemesis and melena often appear suddenly, which can cause hemorrhagic shock or induce hepatic encephalopathy with high mortality.
(2) Infection: Because of low portal vein resistance and open collateral circulation, it is easy to be complicated with infection, such as pneumonia, Escherichia coli septicemia, biliary tract infection, spontaneous peritonitis, etc.
(3) Hepatic encephalopathy: It is the most serious complication of this disease and the most common cause of death.
(4) Primary liver cancer: If the liver is gradually enlarged, there is a lump on the surface of the liver, there is persistent pain in the liver area, ascites is increased and there is bloody and unexplained fever, primary liver cancer should be suspected.
(5) Hepatorenal syndrome: When liver cirrhosis is complicated with intractable ascites, patients may have spontaneous oliguria or anuria, azotemia, diluted hyponatremia and hyponatremia, but the kidney has no obvious organic damage, so it is also called functional renal failure.
(6) electrolyte and acid-base balance disorder: hyponatremia is common, which is related to long-term low-sodium diet, long-term diuresis or a large number of ascites; Hypokalemia, hypochloremia and metabolic alkalosis are related to insufficient intake, vomiting, diarrhea, polyuria and secondary aldosteronism.
accessory examination
1. Blood routine: the compensatory period is normal, and there are different degrees of anemia in the decompensated period. White blood cell count can increase with infection, while white blood cell and platelet count can decrease with hypersplenism.
2. Liver function test: normal or slightly abnormal in compensatory period; In the decompensated period, transaminase is often slightly or moderately increased, albumin is decreased, globulin is increased, and albumin/globulin ratio is decreased or inverted. Prothrombin time is prolonged.
2. Ascites examination: generally it is leakage. If spontaneous peritonitis, tuberculous peritonitis or canceration occur, the nature of ascites will change accordingly.
3. Imaging examination: X-ray examination of esophageal barium swallowing showed that esophageal vein was wormlike or earthworm-like filling defect, and gastric fundus vein was chrysanthemum-like filling defect. Ultrasonic imaging, CT and MRI can show morphological changes of liver and spleen and signs of ascites.
Principles of treatment Comprehensive measures should be taken in the treatment of liver cirrhosis. First of all, according to the treatment reasons, pay attention to rest and diet, so as to alleviate the illness, extend the compensatory period and maintain the labor force. Patients in compensatory period can take anti-fibrosis drugs (such as colchicine) and traditional Chinese medicine to avoid taking drugs harmful to the liver. Symptomatic treatment is the main treatment for decompensated patients to improve liver function and prevent complications. Patients with surgical indications should carefully choose the timing of surgical treatment, and liver transplantation is a new method for the treatment of advanced cirrhosis.
Nursing problems
1. Malnutrition: It is related to abnormal liver function and insufficient bile secretion.
Second, excessive body fluids: related to factors such as increased portal vein pressure and low plasma albumin.
Third, there is a risk of insufficient body fluid: it is related to diuresis, a large amount of ascites and insufficient active water intake.
4. Impaired skin integrity: related to malnutrition, systemic edema and long-term bed rest.
5. Impaired gas exchange: related to a large number of ascites and lung infections.
Potential complications: bleeding-related to esophageal varices.
Nursing measures
First, stay in bed. When there is ascites, it can help to arrange a comfortable semi-lying position. When the edema of lower limbs is serious, patients can be helped to raise their lower limbs to help the edema subside and pay attention to the safety of patients.
Second, diet care
1 For patients with no ascites and esophageal varices during the compensatory period of liver function, general foods and soft foods with high calorie, high protein and vitamins and easy digestion can be used to avoid eating irritating condiments and greasy foods. Every 4-5 meals is beneficial to improve nutritional intake.
For patients with esophageal varices, soft food with high calorie, high protein and high vitamins or soft food with little residue should be selected.
Patients with ascites should adopt a low-salt diet.
Protein food should be strictly restricted for patients with obvious decline of liver function or signs of hepatic encephalopathy.
Third, skin care
1 Keep the bed unit clean and clothes tidy, such as wearing soft underwear and avoiding tight clothes.
2 Turn over and massage on time to prevent pressure sores.
Trim the patient's nails to avoid scratching the skin.
For patients with severe itching, use antipruritic water according to the doctor's advice.
Fourth, carefully record the 24-hour inflow and outflow, measure the abdominal circumference and weight regularly, and observe the growth and decline of edema.
Fifth, strictly follow the doctor's advice to minimize the impact of drugs on the liver.
Six, closely observe the changes of vital signs and illness.
Seven, if patients with liver cirrhosis after hepatitis B are in the active stage of hepatitis at the same time, isolation measures should be implemented.
Eight, abnormal liver function or symptoms of hepatic coma, can't use sedatives.
Nine, psychological care, encourage patients to express their inner feelings and worries, increase the time to talk with patients, and give patients sincere comfort and support in spirit.
Acute pancreatitis
First, the concept of acute pancreatitis Acute pancreatitis is an inflammatory reaction that causes digestion, edema, bleeding and even necrosis of pancreatic tissue after pancreatin is activated. Clinical manifestations are acute epigastric pain, nausea, vomiting, fever, and increased blood pancreatin. The degree of pathological changes varies, with pancreatic edema as the main symptom, which is common in clinic. The condition is often self-limited and the prognosis is good. Also known as mild acute pancreatitis. A few patients with severe pancreatic hemorrhage and necrosis are often accompanied by infection, peritonitis, shock and other complications, and the mortality rate is high, which is called severe acute pancreatitis.
Two. Etiology and pathogenesis There are many causes of acute pancreatitis. Biliary diseases are the most common cause in China, while alcoholism is the most common cause in western countries.
1. Biliary system diseases It has been reported in China that more than 50% of acute pancreatitis is complicated with biliary system diseases such as gallstones, biliary tract infection or biliary ascaris, and the factors causing biliary pancreatitis may be:
① Edema and spasm of oddi sphincter caused by gallstones, infection, ascaris lumbricoides, etc., make the outlet of duodenal ampulla obstructed, the pressure in biliary tract is higher than that in pancreatic duct, and bile flows back into pancreatic duct, causing acute pancreatitis.
② When gallstones pass through the sphincter of Oddi (especially irregular in shape) and cause sphincter spasm, high-pressure bile flows back into the pancreatic duct and induces pancreatitis.
③ When the bile duct is infected, bacteria return to the pancreas through the common lymphatic vessels of bile duct and pancreas, and Oddi's sphincter is narrowed to varying degrees, thus causing pancreatitis.
2. Excessive drinking and overeating can increase the secretion of pancreatic juice, stimulate Oddi sphincter spasm and duodenal papilla edema, increase the pressure in the pancreatic duct, hinder the discharge of pancreatic juice, and cause acute pancreatitis. Protein precipitation often occurs in pancreatic juice of patients with chronic alcoholism, which forms protein suppository to block the pancreatic duct, resulting in pancreatic juice discharge disorder.
3. Others
① Surgery and trauma;
② endocrine and metabolic disorder;
③ infection;
4 drugs;
⑤ Idiopathic.
4. Pathogenesis The pathogenesis of acute pancreatitis is mainly due to the digestive effect of trypsin on the pancreas itself and its surrounding tissues, which leads to a series of organ dysfunction.
Third, clinical manifestations
1. Abdominal pain is the earliest symptom, which often occurs after overeating or extreme fatigue. Most of them are sudden attacks, located in the middle or left side of the upper abdomen. The pain is constant, like a knife cut. Pain radiates to the back and flank. Severe abdominal pain is mostly caused by pancreatic edema or inflammatory exudation to stimulate the celiac plexus. If it is hemorrhagic necrotizing pancreatitis, there will be total abdominal pain and acute abdominal distension in a short time after the onset, as if air is pumped into the abdomen. At the same time, there will be shock nausea and vomiting of different severity soon, which is the expression of vagus nerve stimulated by inflammation and has frequent attacks. At first, it will enter food bile, and the condition will gradually worsen (or hemorrhagic necrotizing pancreatitis), and soon it will enter intestinal paralysis, and the vomit will be fecal-like. A large amount of necrotic tissue accumulates in the omental sac, and a raised mass can be seen in the upper abdomen, which is soft and tender, and the boundary of the mass is often unclear. A few patients have no obvious signs such as abdominal tenderness, but they still have high fever, high white blood cells, and even frequent manifestations like "partial intestinal obstruction", often forming localized abscess in abdominal cavity or pelvic cavity. B-ultrasound examination and finger anus examination should be done.
2. After the onset, nausea, vomiting and abdominal distension often occur, mostly frequently and continuously, and food and bile are spit out. Abdominal pain does not relieve after vomiting, often accompanied by abdominal distension and even paralytic intestinal obstruction.
3. Fever Most patients have moderate fever, which usually lasts for 3-5 days. If the fever lasts for more than 65,438+0 weeks, accompanied by elevated pericytes, secondary infection, such as pancreatic abscess or biliary inflammation, should be considered.
4. The disorder of water, electrolyte and acid-base balance often includes dehydration with different degrees of severity. Frequent vomiting can lead to metabolic alkalosis, severe cases can lead to obvious dehydration and metabolic acidosis, accompanied by a decrease in blood potassium, magnesium and calcium, and some can lead to an increase in blood sugar. Occasionally, diabetic ketoacidosis or hyperosmotic coma may occur.
5. Hypotension and shock can be seen in acute necrotizing pancreatitis, and a few patients can suddenly go into shock.
Fourth, laboratory inspection.
1. White blood cell count: Many white blood cells increase, and neutrophil nuclei move to the left.
2. Determination of blood amylase Serum (pancreatic) amylase began to increase at 6 ~ 12 hours after onset, and began to decrease at 48 hours for 3 ~ 5 days, which can be diagnosed as this disease. Amylase level does not necessarily reflect the severity of the disease. The amylase value of hemorrhagic necrotizing pancreatitis can be normal or lower than normal. Other acute abdomen diseases such as peptic ulcer perforation, gallstones, cholecystitis, intestinal obstruction, etc. There may be an increase in serum amylase, but it generally does not exceed.
3. Determination of serum lipase: Serum lipase usually starts to increase 24 ~ 72 hours after onset and lasts for 7 ~ 10 days, which has diagnostic value and high specificity for patients with acute pancreatitis who come to see a doctor late after illness.
4. Amylase endogenous creatinine clearance ratio: In acute pancreatitis, glomerular permeability may be increased due to the increase of vasoactive substances, while renal creatinine clearance does not change.
5. Serum iron albumin: Hemoglobin released by red blood cells during intra-abdominal hemorrhage can be converted into hemoglobin iron by fatty acids and elastase, and the latter can combine with albumin to form iron albumin, which is often positive within a few hours of the onset of severe pancreatitis.
6. Biochemical examination: The temporary increase of blood sugar may be related to the decrease of insulin release and the increase of glucagon release. The continuous fasting blood glucose is higher than 10mmol/L, which indicates that the prognosis of pancreatic necrosis is poor. Hyperbilirubinemia can be seen in a few clinical patients, and the serum ASTLDH can be increased when it returns to normal 4-7 days after onset.
7. Abdominal X-ray plain film: Other acute abdomen diseases such as visceral perforation, "sentinel loop" and "colon incision sign" can be excluded as indirect indications of pancreatitis. Diffuse fuzzy shadows at the edge of psoas major indicate the existence of ascites, and intestinal paralysis or paralytic intestinal obstruction can be found.
8. Abdominal B-ultrasound: It should be used as a routine screening test for acute pancreatitis. B-ultrasound can show abnormal echo in and around pancreas. You can also learn about gallbladder and biliary tract; It has diagnostic significance for late abscess and pseudocyst, but abdominal distension often affects its observation.
Verb (abbreviation of verb) treatment points treatment principles: reduce pancreatic secretion, relieve pain and prevent complications.
1. Treatment points of mild acute pancreatitis
① Fasting, drinking water and gastrointestinal decompression;
② Intravenous infusion to replenish blood volume and maintain water, electrolyte and acid-base balance;
③ Pethidine can be given to patients with severe abdominal pain;
④ Anti-infection;
⑤ Acid suppression therapy: intravenous administration of H2 receptor antagonist or proton pump inhibitor.
2. The treatment points of severe acute pancreatitis should be:
① Anti-shock and correction of water-electrolyte balance disorder;
② Nutritional support;
③ Reduce the secretion of pancreatic juice and use somatostatin, glucagon and calcitonin.
3. Other treatments
① actively deal with complications;
② The curative effect of TCM is good;
③ peritoneal lavage;
④ Surgical treatment.
Six, nursing diagnosis and nursing measures
1. Pain: Abdominal pain is related to inflammation, edema, bleeding and necrosis of the front line and its surrounding tissues.
(1) posture and rest: absolute bed rest reduces the metabolic rate of the body; Assist the patient to take the lateral position with knees bent to relieve pain; Prevent patients from falling out of bed and ensure the safety of patients.
(2) No drinking, fasting and gastrointestinal decompression: most patients need to stop eating for 1-3 days, and patients with obvious abdominal distension need gastrointestinal decompression to reduce gastric acid secretion, thus reducing pancreatic secretion and relieving abdominal pain and abdominal distension; Patients can rinse their mouths or moisten their lips when they are thirsty, and do oral care well.
(3) medication care: those with severe abdominal pain can be given painkillers such as pethidine according to the doctor's advice; Observe whether the pain has been relieved before and after medication, and whether the nature and characteristics of the pain have changed.
(4) Observe and record the tail, nature and degree of abdominal pain, as well as the time and frequency of the attack.
Second, there is a risk of insufficient body fluid: it is related to the loss of water caused by massive vomiting.
(1) closely observe the patient's condition, monitor the patient's vital signs, accurately measure and record the daily intake and urine proportion; Observe whether the patient has dehydration symptoms such as weakness, thirst and unconsciousness; Dynamic observation of laboratory test results, such as monitoring blood, urine amylase, blood sugar, serum electrolyte, etc.
(2) Observation and treatment of vomiting: Observe the characteristics of patients' vomiting, and record the times of vomiting and the nature, quantity, color and smell of vomit; Give antiemetic drugs according to the doctor's advice and slowly return to normal diet and physical strength.
(3) Actively replenish water and electrolytes: The daily liquid intake of patients with fasting often needs to reach 3000ml. Even if an effective venous access is established to input fluids and electrolytes, it is necessary to maintain an effective circulating blood volume, adjust the infusion speed according to age and cardiac function, replenish fluids lost due to vomiting and fasting in time, and correct the acid-base imbalance.
(4) Prevention and treatment of hypovolemic shock: prepare rescue materials quickly; Take the supine position, keep warm and give oxygen;
Establish venous access as soon as possible, and infuse liquid, plasma or whole blood according to the doctor's advice to replenish blood volume; If circulatory failure persists, give antihypertensive drugs according to the doctor's advice.
Third, activity intolerance: related to frequent vomiting leading to water loss and electrolyte loss.
(1) life care: assist patients in their daily activities, and help them sit up or lie on their side when vomiting, with their heads tilted to one side to avoid aspiration; Keep patients' clothes clean and tidy, and remove peculiar smell.
(2) Safety nursing: inform the patient that dizziness, palpitation and other discomfort may occur when he suddenly gets up, and instruct the patient to move slowly.
Fourth, fever: high fever is related to pancreatic inflammation.
(1) Closely observe and record the changes of the patient's body temperature, and observe the patient's complexion, pulse, breathing and sweating while measuring the body temperature.
(2) promote heat dissipation, reduce body temperature, and give physical cooling according to the doctor's advice, such as alcohol bath; If necessary, give physical cooling, pay attention to prevent collapse due to excessive sweating when reducing fever, and then take your temperature half an hour later.
(3) Maintain water-electrolyte balance, even if water-electrolyte is supplemented.
(4) Promote comfort, prevent complications, do basic nursing and skin care, and prevent pressure ulcers.
5. Fear is related to severe abdominal pain and rapid progress of the disease.
(1) Encourage patients' confidence in overcoming diseases, communicate with patients more and divert their attention.
(2) Inform patients' families to communicate with patients and care about them.
(3) For example, tell patients the importance of cooperating with treatment, and tell examples of patients being discharged from hospital after treatment.
Lack of knowledge: Lack of knowledge about the cause and prevention of this disease.
1. disease knowledge guidance introduces the main inducing factors and pathogenesis of the disease to patients and their families, educates patients to actively treat biliary tract diseases, and attaches importance to the prevention and treatment of biliary ascaris.
2. Life guidance guides patients and their families to master food hygiene knowledge. Patients should develop regular eating habits and avoid overeating. After abdominal pain is relieved, a small amount of low-fat and low-sugar diet should gradually return to normal diet, avoid foods with strong irritation, high gas production, high fat and high protein, and quit smoking and drinking to prevent recurrence.
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