消化性潰瘍英文修改版Definition

AcircumscribedulcerationofthegastrointestinalmucosaoccurringinareasexposedtoacidandpepsinandmostoftencausedbyHelicobacterpyloriinfection.(Uphold&Graham,2003)PepticUlcers:

Gastric&DudodenalPepticUlcers:

Gastric&Duodenalgastriculcer:theulcerthatoccursinthestomachlining,someofthemmaybemalignant.duodenalulcer:mostoftenseeninfirstportionofduodenum.GUDUPUDDemographics（流行病學）Lifetimeprevalenceis~10%.Theincidenceofduodenalis4timesascommonasgastriculcermostcommoninmiddleagepeak30-50yearsMaletofemaleratio—4:1Etiology（病因?qū)W）Helicobacterpylori（HP）nonsteriodalanti-inflammatorydrugs(NSAID）AcidandpepsinOthersmainsymptom(1)abdominalpain：theclassicsymptomofPUD.

Pain—”gnawing”,“aching”,or“burning”“hungerlike”

（鈍痛、脹痛、灼痛或饑餓痛）(2)rhythmicity:GUEating-pain-reliefDUpain-eating-relief(3)cyclicity：Attackmoreinautumnorwinter

gastriculcerduodenalulcertimepositionnatureruleoccurs0.5~1hour

afteramealandreliefuntilnextmeal,maynotawakenpatientfromsleep.medianorleftofSubxiphoidburningpainorcrampypainEating-pain-reliefoccurs3-4hoursafteramealandmayawakenpatientfromsleep.Midlineorrightofepigastrichungerlikepainorburningpainpain-eating-reliefPaincharacteristicsofpepticulcerClinicalmanifestationOthersymptomsofdigestivesystem：Nausea,vomiting,belching,dyspepsia,bloating,chestdiscomfort,anorexiamayalsooccur.

Clinicalmanifestation

sign

EpigastrictendernessComplicationshemorrhage

Perforationobstruction–pyloricstenosisGastriccarcinoma.(notduodenalcarcinoma)Hemorrhage:

hematemesis,blackortarrystools

GastriccarinomaGU1%canbecomecancerousAchronic,GUhistory45yearsofageorolderThemoresymptomsstubbornlyContinuousandoccultblood(+)EndoscopyBariummeal–contrastx-rayBiopsy–bacteria&malignancyStoolforfecaloccultbloodH.Pylori:(13)C-ureaBreathTest.PUD-DiagnosisEndoscopy

Bariummeal–contrastx-rayTreatmentPlanMedications—treatwithProtonPumpInhibitorsorH2receptorantagoniststoassistulcerhealingH2:Tagament,Pepcid,Axid,orZantacforupto8weeksPPI:Prilosec,Prevacid,Nexium,Protonix,orAciphexfor4-8weeks.DU：PPI4~6wGU:PPI6~8wSurgeryPeoplewhodonotrespondtomedication,orwhodevelopcomplicationsNursingdiagnosisPain

relatedtogastricandduodenalinjuryAlteredNutrition:lessthanbodyrequirements

relatedtoanorexia,nauseanursinginterventionRelievepainMedicationandcareDietRestMonitorPsychotherapyandheatheducationRelievepain

DU:Eatalkalescentfoodinpainorbeforepain(suchassodabiscuit,etc.);ThelocalhotcompressMedicationandcare抗酸劑：應(yīng)在飯后或睡前1h，乳液要震動，應(yīng)咀嚼片。不與衣服的酸

性飲料，避免與牛奶同服；氫氧化鋁凝膠：引起磷缺乏癥表現(xiàn)食欲不振、無力長期服用引起便秘，可與氫氧化鎂交替。H2RA：應(yīng)在餐中或餐后服，也可把一日的劑量在睡前服用靜脈給藥應(yīng)控制速度（過快低血壓和心律失常）PPI類：可引起頭暈硫糖鋁：在酸性環(huán)境下有效，餐前1小時服用。不能與多酶片同服，鉍劑：因在酸性下起作用，故餐前服?？墒辜S便呈黑色。Diet

Eatinglittlebutoftenandregularly

.Avoideatingraw,cold,hardandstrongirritantfood.Selecteasilydigestibleandnutritiousfood.Eatingpasta,adequateskimmilkduringactiveperiod.After

thesymptomsisalleviated,youshouldreturntonormalmealdiettimely.Nutritionmonitoring(suchas:bodyweight,hemoglobin)RestThelightsymptom:appropriateactivitiestodistractiontheattentionTheheavysymtom:stayinbedforafewdaysto1~2weeks,relievepainsymptomsMonitorVitalsignMeasuringweightonaregularbasis,monitoringnutritionalindexessuchasserumalbuminandhemoglobin

Psychotherapyandheatheducation

InformationabouttherelationshipbetweenpepticulcerandfactorssuchasHp,NSAIDs,smoking,alcoholintake,stress.Educationaboutboththerapeuticandpreventivestrategies.LifestylemanagementAvoidtheuseofsteroid,caffeine,aspirinandotherNSAIDs.Instructionaboutthemedicationregimenprescribedandhowtotakethedrugs.Teachtheclientthesymptomsthatmayindicateacomplication,suchasincreasedabdomi