[Peptic ulcer].
I. Concept
Peptic ulcers are chronic ulcers that occur in the stomach and duodenum, namely gastric ulcers and duodenal ulcers. The turn of autumn and winter is the good season for this disease.
Second, care measures
1. Do psychological care, maintain optimism, avoid excessive stress and exertion.
Rest: bed rest during the acute period, maintain a regular life, pay attention to the combination of work and rest.
2, diet care.
Eat less and more meals, eat regularly, pay attention to chewing and swallowing when eating.
Eat a nutritious, non-stimulating and easily digestible diet, mainly pasta, those who are not used to pasta can use soft rice or porridge instead. Milk is best to use skim milk, but should not drink a lot of it. Avoid stimulating food, such as raw, cold, hard, crude fiber vegetables and fruits, as well as alcohol, coffee, strong tea, spicy food.
Observation: Observe the patient’s vital signs and changes in abdominal signs, pay attention to the location, nature and pattern of abdominal pain, observe the color, nature and amount of vomit and stool, and detect complications early.
4.Medication instruction
Acid-control drugs should be taken half an hour to two hours after meals.
Anticholinergic drugs should be taken one hour before meals and before bedtime.
Gastrofacial morpholine should be taken before meals and should not be paired with antacid drugs.
Tablets should be chewed and taken.
III. Health education
1, usually eat regularly, the diet is easy to digest, rich in nutrients, non-irritating food is appropriate.
2.Eat regularly, eat less and more often, do not overeat, especially dinner should not be too full.
3.Avoid too hot, too cold, rough, fried, spicy food and strong tea, coffee and other beverages.
4.For those with little bleeding and no violent vomiting, try to enter a small amount of liquid diet.
5.In case of hemorrhage, fasting should be given. After 24-48h of fasting, if there is no continued bleeding, liquid can be improved.
6.Guide the patient to pay attention to the combination of work and rest in life and work, avoid excessive mental tension and work strain; keep optimistic mood.
7.For fecal occult blood test, it is recommended to abstain from eating meat and other blood-containing foods for 2-3d before the test, so as not to affect the test results.
Upper gastrointestinal bleeding]
I. Concept
Upper gastrointestinal bleeding refers to bleeding caused by lesions in the gastrointestinal tract above the Treitz ligament, including the esophagus, stomach, duodenum, pancreas and bile duct, as well as bleeding from jejunal lesions after gastrointestinal anastomosis.
II. Clinical features
Vomiting of blood and black stools, often accompanied by acute peripheral circulatory collapse due to blood volume reduction. When the blood loss exceeds 25% of the total body volume in a short period of time, there will be rapid heartbeat, drop in blood pressure, causing dizziness, panic, cold sweat, thirst, depression, blurred consciousness and even shock symptoms due to insufficient perfusion.
Third, care measures
1, active bleeding period absolute bed rest, keep quiet, vomiting blood is serious, go to the pillow lying flat head to the side, to ensure smooth airway, prevent mis-aspiration.
2, do a good job of psychological care, relieve tension, if necessary, follow medical advice to give sedatives as appropriate.
3, immediately establish intravenous access, cooperate with doctors to quickly and accurately implement rescue measures, closely observe the effect of treatment and adverse reactions.
4. Observe the condition: closely monitor the changes in the child’s mental state, heart rate, blood pressure and respiration, and give cardiac monitoring if necessary. Accurately record the in and out volume. If symptoms of shock such as irritability, pallor, blood pressure drop, wet and cold skin, cold limbs, etc. appear, report to the doctor in time to deal with them actively and take care of them according to the shock care routine. Record the color, nature and amount of vomit and stool of the child, and assess whether there are signs of active bleeding and rebleeding.
5. Dietary care: fasting during the bleeding period, and cold or warm fluids 8-12 hours after the bleeding stops. A small amount of fluid can be given as appropriate in ulcer disease with little bleeding.
Nutritious, easy to digest, non-irritating semi-liquid food, soft food, a small number of meals, and gradually transition to a normal diet.
6, life care: timely change of bed sheets yuan, keep clean, flat; strengthen oral care, keep the mouth clean, after vomiting need to gargle; good skin care, diligent scrubbing, keep the perianal clean.
7. Prepare hemostatic emergency medicine and master the precautions for the use of various hemostatic drugs.
IV. Health education
1.People with bleeding symptoms should fast temporarily and eat easily digestible liquid or semi-liquid as prescribed by the doctor when replenishing fluid from the vein, and gradually return to normal diet.
2, maintain a happy mood, regular life, avoid excessive tension and exertion. Eat regularly, eat little or no snacks, and do not add meals before bedtime.
3, gastric mucosa protective drugs such as sparse sugar aluminum tablets should be taken before meals on an empty stomach or before bedtime.
4, do not take aspirin and non-steroidal anti-inflammatory drugs such as Protaxon.
5.Avoid hard, rough and coarse fiber food.
6, more food value of protein (fish, poultry, eggs, milk) and vegetables with color (carrots, tomatoes, green vegetables).
7, using steam, boiling, braising, stewing, blanching and other cooking methods.
【Pediatric diarrhea】
I. Care measures
1, adjust the diet
Children with diarrhea and dehydration should continue to eat, except for those with severe vomiting who are temporarily fasted for 4-6h (not water), in order to relieve the condition, shorten the course of the disease and promote recovery. Breastfeeders continue to breastfeed and suspend complementary foods; artificial feeders dilute milk or give skim milk; viral enteritis, lactose intolerant people can be fed with soy milk substitute or lactose-free milk powder; weaned people give nutritious, light and easy to digest diet, eat less and more meals; as the condition stabilizes and gets better, gradually transition to a normal diet.
Correction of water and electrolyte disorders and acid-base imbalance
ORS is used to prevent dehydration and correct mild to moderate dehydration during diarrhea. Intravenous rehydration is used for children with moderate to severe dehydration or severe vomiting and diarrhea or abdominal distension. Keep the intravenous channels open, implement the rehydration plan according to the doctor’s prescription, master the rehydration speed and rehydration principles (rehydration principles: salt first, then sugar, concentrated first, then light, fast, then slow, potassium in urine, calcium in shock). Observe the effect of rehydration, and contact with the doctor in time.
3. Observe skin elasticity, finger-end temperature, urine volume, etc., and record 24-hour in and out volume if necessary. Observe the number, amount and nature of stools, and the presence of low potassium, low calcium, metabolic acidosis and other manifestations of electrolyte and acid-base balance disorders.
4. Control infection Strictly implement the disinfection and isolation system, and do bedside isolation for infectious diarrhea to prevent cross-infection. Dedicate food utensils, wash hands before and after meals, and do not urinate and defecate anywhere.
5.Keep the buttocks clean and dry, change diapers regularly, and apply medicine as prescribed by the doctor.
6. Collect stool and urine specimens correctly.
Health education
1. Guide reasonable feeding: feed correctly, encourage breastfeeding, and avoid weaning in summer. Add complementary foods gradually and on time, do not add several complementary foods at the same time, prevent overeating, partial eating and sudden changes in diet structure.
2. Pay attention to dietary hygiene and cultivate good hygienic habits: pay attention to fresh food, cleanliness and disinfection of food utensils to avoid intestinal infections. Teach children to wash their hands before and after meals and to cut their nails regularly.
3.Enhance physical fitness: treat malnutrition and rickets as early as possible, and do appropriate outdoor activities.
4.Pay attention to climate change: prevent from getting cold or overheating, pay attention to keeping warm in winter, and drink more water in summer.
5, the reasonable use of antibiotics, to avoid long-term oral broad-spectrum antibiotics and cause intestinal flora imbalance.
Pediatric stomatitis】
I. Care measures
1, oral care
Ulcerative stomatitis with 3% hydrogen peroxide solution or 0.1% Levanox solution to clean the ulcerated surface, older children available gargle. Encourage more water, rinse the mouth after eating, keep the oral mucosa moist and clean, reduce oral bacterial reproduction. For those who salivate, remove the effluent in time and keep the skin dry and clean to avoid causing skin eczema and erosion.
2, correct drug application
Before applying the medicine, place gauze or dry cotton balls at the mouth of the buccal mucosa parotid duct or both sides of the tongue ligament, and then wash the mucosal surface of the lesion before applying the medicine. After applying the medication, the child should close the mouth for 10 minutes and then remove the gauze or cotton ball and not rinse the mouth, drink or eat immediately.
3. Dietary care
For those whose pain affects eating, apply 2% lidocaine before eating and avoid irritating food. Those who cannot eat should be given parenteral nutrition.
4.Food utensils should be sterilized by boiling or pressure sterilization.
5.Monitor the body temperature If the body temperature exceeds 38.5℃, give physical cooling, and if necessary, medication to lower the temperature. At the same time, take good care of the skin.
Health education
Explain to parents the causes, influencing factors and care of stomatitis. Instruct parents to use food utensils exclusively and to clean and disinfect them properly. Correct children’s bad habits such as finger sucking and not brushing teeth, and cultivate the hygiene habit of rinsing mouth after eating. Publicize the importance of balanced nutrition to improve body resistance, avoid partial and picky eating, and cultivate good eating habits.
Acute pancreatitis]
I. Concept
Acute pancreatitis is a chemical inflammation caused by the digestive enzymes secreted by the pancreas to the pancreatic own tissue and its own digestion. The main clinical manifestations are: acute epigastric pain, fever, nausea, vomiting, increased blood and urine amylase, severe cases with peritonitis, shock and other complications.
Second, clinical characteristics
Characterized by acute abdominal pain, fever with nausea, vomiting and increased blood amylase, it is one of the common gastrointestinal emergencies and is divided into two types of acute edematous pancreatitis and acute hemorrhagic necrotizing pancreatitis depending on the severity of the lesion.
Third, care measures
1, absolute bed rest, semi-recumbent position.
2, fasting and drinking to reduce pancreatic secretion, critical patients, in addition to fasting and drinking need to perform gastrointestinal decompression, to be improved, blood, urine amylase back to normal after gradually eating liquid, semi-liquid, and then transition to the general diet, prohibit high-fat diet, avoid overeating.
3, follow the doctor’s instructions to give antacid, antispasmodic, analgesic drugs, prohibit morphine pain relief, so as not to cause sphincter of Oddi spasm.
4.Observation of condition.
1) Observe the changes of vital signs and abdominal signs, pay attention to the nature and degree of abdominal pain and the presence of concomitant symptoms.
2) Observe and record the color, nature and amount of vomitus and stool.
5. Care of gastrointestinal decompression: keep the gastrointestinal decompression tube unobstructed, observe the color, nature and amount of drainage fluid, and accurately record the in and out volume.
6.Keep intravenous fluids open, maintain water and electrolyte balance.
7, oral care, keep the mouth clean, rinse the mouth regularly.
8.Strengthen health education, avoid overeating to prevent disease recurrence.
IV. Health education
1.Prohibit high-fat diet and avoid overeating to prevent disease recurrence. Eat an easy-to-digest, light diet, and eat less and more meals.
2. Pay attention to rest, avoid exertion, emotional strain and tension.
3. Regular outpatient review, abdominal pain and abdominal distension should be promptly seen.
6. Chronic gastritis
Disease summary: Chronic gastritis refers to chronic inflammatory lesions of the gastric mucosa caused by different etiologies. It is usually divided into superficial gastritis, atrophic gastritis and hypertrophic gastritis. Chronic gastritis has a prolonged course and mostly presents with indigestion symptoms such as postprandial fullness, acidity, belching, and irregular abdominal pain. The diagnosis of chronic gastritis depends mainly on gastroscopy and gastric mucosal biopsy.
Treatment principle: symptomatic treatment is the main focus.
Health education prescription.
1, diet should be regular, regular and quantitative, avoid overeating. Avoid hard, spicy, salty, hot, coarse and stimulating food and drinks such as tea and coffee. For those who lack stomach acid, acidic foods and fruits are preferred. People with atrophic gastritis should not eat more fat. During meals and 2-3 hours after meals should drink as little water as possible, eat less indigestible, easily flatulent food, excessive stomach acid should avoid eating food that can stimulate the secretion of gastric acid. Do not smoke and drink less alcohol.
2, regularize life, pay attention to proper rest and exercise.
3, maintain optimism, avoid excessive mental tension, anxiety, anger, depression.
4, should avoid taking aspirin, acetaminophen, pau taisong, indomethacin, tetracycline, erythromycin, prednisone and other drugs, especially in the active period of chronic gastritis.
5. Atrophic gastritis should be followed up and observed. Regular fiberoptic gastroscopy, mild atrophic gastritis 1-1.5 years reexamination once, severe cases 3-6 months reexamination once.
【Cirrhosis】.
Disease summary: Cirrhosis is a chronic, progressive, diffuse liver disease caused by multiple etiologies such as chronic active hepatitis and long-term alcohol abuse that damage the liver for a long time or repeatedly. It is asymptomatic in the early clinical stage and has a poor prognosis in the late stage. Upper gastrointestinal bleeding is the most common complication of cirrhosis, and hepatic coma is the most serious complication of advanced cirrhosis.
Treatment principles: There are no specific drugs for the treatment of cirrhosis, and drugs should not be abused. The general principles are liver protection, symptomatic, and Chinese and Western drug treatment.
Health education prescription.
1, cirrhotic liver function compensated patients, can be the same as normal production, labor, work and study, but should be combined with work and rest, activities to do not feel fatigue. Those with liver function loss or complications should mainly rest in bed.
2. Eat a high protein, high vitamin, high calorie, moderate fat and easy to digest diet. If the liver function is significantly reduced or the blood ammonia is high or there is a precursor of hepatic encephalopathy, the protein food should be strictly limited, and the diet of those with ascites should be less salt or salt-free diet. If there is significant hyponatremia, limit to 500 ml. If there is esophageal varices, eat soft food. Fasting for patients with bleeding. Alcohol consumption is strictly prohibited.
3, cirrhotic patients suddenly appear a large amount of vomiting blood, black stool, dizziness, palpitations, sweating, thirst, black or fainting and other manifestations, indicating the complication of massive upper gastrointestinal bleeding, should be immediately sent to hospital rescue; such as the emergence of personality, abnormal behavior and impaired consciousness, hands fluttering-like tremor, etc., should be considered the occurrence of hepatic encephalopathy, should be immediately sent to hospital rescue.
4. Regularly go to the hospital for liver function, methemoglobin, ultrasound and other examinations.