Patterns of interaction of the organism with the environment. Patterns of interaction of the organism with the environment. Diagnosis of students' health in school mode

Present and potential problems in acute gastritis. Principles of treatment. Care.

The real problems with acute gastritis:

Abdominal pain: sharp paroxysmal or constant excruciating;

Nausea is constant or intermittent, often occurring immediately after eating;

Heartburn - an unpleasant burning sensation in the chest that occurs after eating;

Sour-smelling eructations, after eating or on an empty stomach;

Repeated vomiting, first of sour-smelling and tasting stomach contents, then of clear mucus, sometimes greenish or yellow and bitter-tasting (bile);

Increased salivation - the body's reaction to indigestion; sometimes dry mouth (after several bouts of vomiting due to dehydration)

Violation of the stool: constipation or diarrhea;

On the part of the whole body: severe general weakness, dizziness, headache, sweating, fever, lowering blood pressure, increased heart rate - tachycardia.

Potential problems with acute gastritis:

Possible cicatricial deformities of the stomach with a violation of the patency of food.

Chronic gastritis;

stomach ulcer;

Bleeding.

Principles of treatment:

In severe cases, hospitalization is indicated.

Bed or semi-bed rest

Abstinence from food for 1-2 days (hunger), plentiful warm drink.

Within a few days, medical nutrition 1a, 1b, 1. Among the first measures of medical care is gastric lavage with boiled water using a thick probe.

Medical treatment.

If necessary - enveloping agents (bismuth compounds 0.5-1 g 3 times a day), for pain - belladonna preparations relatively quickly normalize the condition of a patient with acute "banal" gastritis.

The need for a diet. The need to stop smoking and drinking alcohol. The need to avoid eating food that exacerbates the disease. The need for systematic intake of drugs (especially during an exacerbation).

Present and potential problems in chronic obstructive bronchitis. Principles of treatment. Care.

Chronic obstructive bronchitis- a disease characterized by chronic diffuse non-allergic inflammation of the bronchi, leading to a progressive obstructive type of pulmonary ventilation and gas exchange disorder and manifested by cough, sputum production, shortness of breath, not associated with damage to other organs and systems.

The real problems in chronic obstructive bronchitis:

Sputum production

Hemoptysis

Sleep disturbance (drowsiness during the day and insomnia at night);

Headache worse at night;

increased sweating;

muscle tremor;

Violation of concentration;

Seizures are possible.

Potential problems in chronic obstructive bronchitis:

1) Directly caused by infection:

Pneumonia;

bronchiectasis;

Bronchospastic (broncho-obstructive) component;

Allergic (asthmatic) component.

2) Due to the evolution of bronchitis:

Hemoptysis;

emphysema;

Diffuse pneumosclerosis;

respiratory failure;

Treatment goals: elimination of symptoms of exacerbation, reduction in the rate of progression of COB, prevention of recurrent exacerbations, improvement of quality of life. For treatment, several groups of drugs are mainly used:

Antibacterial

Expectorants

Mucolytic

Bronchodilators

Normalizing immunity

Present and potential problems in chronic hepatitis. Principles of treatment. Care.

The real problems with chronic hepatitis:

Pain in the right hypochondrium; nausea, bitterness in the mouth;

Flatulence;

Decreased appetite;

Skin itching;

Enlargement of the abdomen (due to ascites);

Oliguria;

Weakness, fatigue;

Sleep disturbance;

Irritability;

The need to constantly take medications;

Lack of information about the disease; the need to stop drinking alcohol;

Lack of self care.

Potential problems in chronic hepatitis:

The risk of bleeding from the veins of the esophagus, hemorrhoidal veins;

The risk of developing hepatic coma; possibility of disability

Treatment for chronic hepatitis is carried out on an outpatient basis, but with a pronounced process or exacerbation, treatment is carried out in a hospital. Such patients are shown bed or ward rest in the department.

diet therapy

Medical therapy. Vitamins B1, B2, B6, B12, nicotinic, folic, ascorbic acids, corticosteroids are prescribed, also in small doses but for a long time they are treated with liver extracts and hydrolysates

Etiotropic therapy. Currently, the main etiotropic agent for the treatment of viral diffuse liver lesions is interferon. It is a combination of peptides that are synthesized by lymphocytes and macrophages

Present and potential problems in chronic gastritis. Principles of treatment. Care.

The real problems with chronic gastritis:

Belching after eating;

Sour breath;

Bloating

Rumbling in the stomach;

Complaints of pain after eating;

Feeling of heaviness in the abdominal cavity;

indigestion;

Sour taste in the mouth;

Weakness of the body;

Headache;

Aggression.

Potential problems with chronic gastritis:

Medical treatment usually includes following groups drugs:

Drugs that reduce the acidity of gastric juice;

antibiotics;

Histamine blockers;

Antisecretory medicinal substances;

enveloping agents;

Painkillers;

Pantothenic acid, etc.

The best results can be achieved with a spa treatment.

Chronic gastritis is a disease of the stomach that occurs with damage to the mucous membrane of the digestive organ. To get rid of the disease, complex treatment is required, as well as a special diet. But sometimes the patient cannot follow the doctor's recommendations on their own. In this case, the main assistant in a hospital setting is a nurse. Her task is to supervise treatment, care, and provide recommendations for a speedy recovery. This is the basis of the nursing process in chronic gastritis.

The nursing process for chronic gastritis consists of the following steps:

  • Survey- anamnesis is collected, the results of the analyzes are studied.
  • Problem definition- it is presumably established what disease the patient suffers from, what it threatens him with in the future, the data is transmitted to the attending physician.
  • Determination of goals How long does it take for a nurse to fully heal a patient?
  • Realization of goals- the actions of the nurse, which will help the patient to become healthy.
  • Evaluation of performance- whether the patient received assistance and how good it is.

The overall result depends on the correct actions carried out at each stage.

Stage 1: examination

The task of the nurse is to determine the nature of the patient's complaints. It should be established what pains bother him when they appear, how quickly the feeling of fullness sets in, whether nausea, vomiting and other characteristic symptoms are present. As for pain, with this disease, they can appear immediately after eating, after 20 minutes or 2 hours.

Objective methods of examination are as follows:

  • visual inspection- detection of bruises under the eyes, white plaque on the tongue, pain on palpation in the abdomen;
  • study of instrumental and laboratory methods diagnostics- examination of feces, general analysis of urine and blood, biopsy, etc.

Stage 2: identifying problems

In people suffering from this disease, the physiological needs associated with eating, sleeping and other things are violated. This means that nursing care for chronic gastritis involves solving these problems.

Based on the symptoms, it is presumably established what disease the patient has. Problems associated with inflammatory processes occurring on the mucous membrane are being investigated. In this regard, there are pains in the stomach and abdomen, a feeling of heaviness. In addition, there are problems that have arisen due to indigestion. These include bloating, nausea and vomiting, belching, heartburn, complete or partial lack of appetite.

If all these problems are determined, the patient must be hospitalized for a complete diagnosis and accurate diagnosis.

Steps 3-4: setting goals and implementing them

Nursing care for chronic gastritis has the main goal, which is to create all the conditions for the complete recovery of the patient and the successful completion of the tasks.

Be sure to provide information about the disease and possible consequences, explain the need for complex treatment, compliance with all doctor's recommendations. During the period of exacerbation, it is desirable to provide bed rest for several days.

Control over compliance with the treatment regimen is as follows:

  • timely intake of drugs in certain dosages and according to the established regimen;
  • protection of the central nervous system from external stimuli;
  • organization of sparing nutrition, developed individually;
  • providing comfortable conditions and the correct daily routine.

result proper organization treatment regimen becomes a decrease in the intensity of clinical signs and an improvement in the general condition.

The nurse is obliged to ensure that comfortable conditions are created in the ward that contribute to the recovery of the patient. Necessary timely wet cleaning, regular change of bed linen, silence. Patients should be fully tuned in to treatment and not be exposed to stress and other negative external factors. Their relatives should be informed about what is allowed to be transferred from food.

The task of the nurse is also to assist with eating and hygiene activities. In this regard, it is necessary to have a conversation about personal hygiene. In addition, it is important to explain and then monitor the patient's compliance with a diet designed personally for him. It is necessary that mineral water be included in his diet.

Step 5: Performance Evaluation

If nursing care is organized correctly, a complete recovery of the patient occurs within a certain period of time and he can be discharged from the hospital, having instructed on further actions during the rehabilitation period. The patient himself must be aware of how necessary it is for him to follow a diet and take certain medications at home. If symptoms appear that indicate an exacerbation of the disease, it is necessary to go to the hospital in a timely manner, without self-medication.

The role of the nurse during the rehabilitation period

At the stage of remission, the patient continues treatment, but already on an outpatient basis. The nurse should inform the patient about what diet he needs to follow during the rehabilitation period, notify him of the need for fractional nutrition. It is advisable to eat at the same time. Portions should be small. Starvation is unacceptable. The diet should contain all the necessary nutrients in certain quantities.

The nurse should explain to the patient, as well as his relatives, about the prohibitions on certain foods. In particular, you can not drink cocoa and coffee, because these drinks irritate the stomach lining. Spicy and fried foods, spices are also excluded. As for alcohol and carbonated drinks, they are strictly contraindicated.

People with this disease, which develops against a background of low acidity, should be registered with a dispensary. They should undergo gastroscopy once a year even in the absence of signs of an exacerbation of the disease. The fact is that they are at risk for the transition of the disease to stomach cancer.

Not the last place in the rehabilitation period is occupied by sanitary-resort treatment. The task of the nurse is to notify the patient about how useful it is for him to go to Essentuki, Kislovodsk and other resort areas with healing mineral water. It improves the function of digestion in chronic gastritis, restores gastric motility, dissolves accumulated mucus and generally has a beneficial effect on health.

The role of the nurse in the treatment of chronic gastritis should not be underestimated. The result of therapy, the speed of recovery and the possibility of further complications depend on its timely and correct actions. The correct approach in the course of treatment gives the chances for a quick and successful recovery.

Chronic gastritis (CG)- chronic inflammation of the gastric mucosa, accompanied by its cellular infiltration, impaired physiological regeneration (recovery) and subsequent atrophic changes, disorders of the secretory, motor (motor) and endocrine functions of the stomach. CG is the most common stomach disease, widespread among the world's population.

CG often occurs without distinct clinical symptoms, it is difficult to suspect and diagnose. Its characteristic clinical manifestations are nonspecific and may occur in syndromes

functional dyspepsia, caused by motor (motor-evacuation) disorders of the stomach and duodenum, and organic dyspepsia that develops in a number of diseases (gastric and duodenal ulcer, gastric cancer, gastroesophageal reflux disease, chronic cholecystitis, pancreatitis, etc.).

The term "dyspepsia" comes from the Greek dys(violation) and peptien(digest). dyspepsia syndrome are defined as sensations of rapidly advancing saturation, fullness (overflow) of the stomach after eating, as well as burning and pain in the epigastric region. Often, these symptoms alone or in combination determine the clinical picture of chronic hepatitis.

If dyspepsia syndrome is detected, the nurse refers the patient for a consultation with a doctor. He plays the main role in carrying out diagnostic measures using physical, laboratory and instrumental (endoscopic, x-ray, ultrasound, etc.) methods, identifying the functional or organic nature of dyspepsia and verifying chronic hepatitis. The latter is achieved with the help of a histological (cytological) study of biopsy specimens of the gastric mucosa and the identification of its morphological changes.

Etiopathogenesis

The main causes of HCG are autoimmune and infectious (Helicobacter pylori infection) factors. A lesser role in the development of chronic hepatitis is played by an unfavorable (damaging) effect on the gastric mucosa of duodenogastric reflux (reflux of the contents of the duodenum and bile into the stomach); long-term use of certain drugs (corticosteroid hormones, non-steroidal anti-inflammatory drugs - NSAIDs, cardiac glycosides, etc.), violation of the quality and diet (long intervals between meals, abuse of monotonous, spicy, cold or hot food, etc.); bad habits (smoking, abuse of alcohol and strong coffee), occupational hazards (heavy metals, acids, alkalis, etc.).

The listed etiological factors contribute to the violation of the physiological balance between protective and damaging processes in the gastric mucosa with a predominance of the latter. The regeneration of the epithelium is disturbed, an inflammatory process develops with cellular infiltration of the mucous membrane and its subsequent atrophic changes. As a result, the secretory, acid-forming, enzyme-forming and motor (contractile) functions of the stomach suffer.

Taking into account the causes and mechanisms of the development of CG, morphological (histological), endoscopic changes and features of the course of the disease, there are The 2 most clinically significant forms of chronic hepatitis: autoimmune (fundal) and Helicobacter pylori (antral).

Autoimmune hCG- a disease of unknown etiology, occurring mainly in the elderly and old people. Its essence is the formation of autoantibodies to the parietal cells of the mucous membrane of the fundus and body of the stomach, which produce hydrochloric acid and an internal factor (promotes the absorption of vitamin B 12 in the intestine). A pronounced atrophy of the mucous membrane of the upper 2/3 of the stomach develops, the production of of hydrochloric acid(achlorhydria), B 12 deficiency anemia occurs.

Much more common Helicobacter hCG. H. pylory first cause an inflammatory process in the antral (output) section of the stomach, followed by its spread to the overlying sections (body and fundus). The source of infection is a sick person and animals. The inflammatory process caused by the production H. pylory toxic substances (cytotoxins), is the "initiator" of atrophic changes in the antrum, and then other parts of the stomach. This form of CG is characterized by the development of superficial defects (erosions) of the mucous membrane, frequent combination with duodenal ulcer, a tendency to malignancy (the occurrence of malignant tumors of the stomach).

Clinic and diagnostics

CG for a long time may not be clinically manifested. Patients seek medical help, as a rule, with an exacerbation of the disease, accompanied by the occurrence of a number of nonspecific symptoms, the nature of which depends on the form of CG and the peculiarities of the secretory and motor functions of the stomach caused by it.

Autoimmune hCG, characterized by atrophic changes in the bottom and body of the stomach, a pronounced decrease in its acid-forming function, characterized by syndromes of gastric and intestinal dyspepsia. Patients are concerned about early dull pain, a feeling of heaviness and fullness after eating in the enclosed area. Often there is a decrease in appetite, belching food and air, nausea, an unpleasant taste in the mouth, bloating and rumbling in the abdomen, a tendency to unstable stools and diarrhea.

An objective examination reveals weight loss, tongue coating with a whitish-yellow coating, dystrophic changes in the skin, brittle nails and hair are possible. There is pain on palpation in the epigastric region.

The presented clinical picture allows the nurse to suspect hCG. Its autoimmune form is identified by a doctor using instrumental research methods. The most valuable of them is endoscopy (esophagogastroduodenoscopy) with a biopsy of the gastric mucosa; at the same time, thinning and smoothness are found, sometimes - pallor of the mucous membrane, and during its histological examination - atrophy with the disappearance of specialized glands.

Less significant in the diagnostic plan is an x-ray examination, indicating a decrease in the severity of the folds of the gastric mucosa, and an analysis of the secretion of gastric juice using probe methods, which reveals a decrease, sometimes a lack of production of hydrochloric acid (achlordria).

It is possible to develop B12-deficiency anemia, which is characterized by an increase in the color index, a decrease in the number of leukocytes and platelets, the appearance of large erythrocytes (macrocytes) and polysegmented neutrophilic leukocytes in the peripheral blood.

Helicobacter pylori hCG less pronounced atrophic changes (often of a focal nature) of the mucous membrane of the antral and higher located sections of the stomach are characteristic, more often - its increased, less often - normal acid-forming function. The clinical picture is dominated by early dull, less often late (1.5-2 hours after eating) cramping pain in the epigastric region. Patients are concerned about heartburn, sour belching, nausea, an unpleasant taste in the mouth, and a tendency to constipation.

As the disease progresses with the development of atrophy of the mucous membrane of all parts of the stomach, the nature of clinical manifestations changes. Often there is a feeling of heaviness and fullness in the epigastric region after eating, rumbling and bloating, a tendency to diarrhea. Appetite worsens.

On examination, the tongue is coated with a whitish-yellow coating, and on palpation of the abdomen - pain in the epigastric region.

Endoscopy with a biopsy of the gastric mucosa helps to identify more often inflammatory, less often - atrophic changes in the mucous membrane and erosion, mainly in the antrum (output) of the stomach. An important diagnostic tool is the detection H. pylory using biochemical, morphological, serological methods and a breath test.

Enough feature Helicobacter pylori chronic hepatitis, especially in the initial stage, - an increase, less often - the preservation of acid-forming and enzyme-forming functions of the stomach.

Patients with CG may experience asthenoneurotic syndrome, characterized by weakness, irritability, chilliness of the extremities, as well as dumping syndrome that occurs after eating and is manifested by sudden weakness, drowsiness, pallor and sweating.

The course of chronic hepatitis is characterized by alternating periods of exacerbation and remission. Exacerbation - the appearance of pain and dyspeptic syndromes - is often facilitated by the use of coarse, spicy, smoked, fried foods, alcoholic beverages, the use of certain drugs (NIIP, etc.).

nursing care

Reasonably (purposefully) collected anamnesis with subsequent objective research allows the nurse to formulate the patient's problems and plan nursing care correctly. It is important to specify the patient's complaints regarding pain and dyspeptic syndromes, and find out when the symptoms of the disease first appeared and whether they are associated with food intake. It is necessary to assess the localization, intensity and nature of pain (early, late, hungry). The nurse should ask the patient about the features of his diet and professional activity, bad habits, use of medicines.

Nursing diagnoses (patient problems)XI"can be represented as follows:

  • pain in the epigastric region;
  • feeling of heaviness and fullness in the epigastric region after eating;
  • dyspeptic disorders (belching, nausea, heartburn);
  • bloating (flatulence);
  • insufficient awareness of the patient about the causes of the disease, how to prevent and treat it.

In a patient diagnosed with chronic hepatitis C, the causes of the exacerbation of the disease, their possible connection with violations of the diet and the regimen of drug treatment, are ascertained.

The scope of the nurse's duties includes assessing the level of knowledge of the patient and his family members about the disease and the features of care for him, organizing psychological, physical, economic and social assistance to the patient, and measures to change his lifestyle. She explains the feasibility and diagnostic capabilities of laboratory tests, the list of which is as follows: a clinical blood test with counting of platelets and reticulocytes (young red blood cells); determination of the levels of total protein, protein fractions, blood sugar, blood type and Rh factor, serum iron; general urine analysis; analysis of feces for occult blood; urease test (to detect infection of the stomach H. pylori)-, esophagogastroduodenoscopy with targeted biopsy and subsequent histological examination of the biopsy; Ultrasound of the liver, biliary tract and pancreas. Conducting additional studies and consultations of specialists depends on the clinical manifestations of the underlying and suspected concomitant diseases.

The nurse observes the patient's behavior, notes changes in his well-being and general condition, teaches self-care methods, monitors the implementation of general hygiene measures, including those related to oral hygiene, tells the patient and his relatives about the basics of oral care. If the tongue is dry, brushing it with a soft toothbrush using a soda solution 2-3 times a day is indicated. You can often and in small portions give the patient pieces of ice, mineral water. Lips smeared with Vaseline. In the absence of teeth in an elderly person, he is fed pureed food.

With the development of stomatitis, a consultation with a dentist is indicated. Infection of the oral cavity can worsen the patient's well-being, interfere with the normal intake of food and medicines. In such cases, spicy and acidic foods are excluded from the diet; teeth, gums and tongue are wiped with a weak solution of boric acid, baking soda, decoctions of chamomile and oak bark. The mucous membrane of the oral cavity is lubricated with rosehip or sea buckthorn oil.

With exacerbation of CG, outpatient (home) treatment is more often used, less often - with severe pain and dyspeptic syndromes - inpatient treatment. The tactics of treatment depends on the form and characteristics of the clinical course of the disease, the nature of disorders of the secretory and motor functions of the stomach. Treatment is individual, complex and is aimed at eliminating and preventing exacerbations of chronic hepatitis. use non-drug(medical nutrition, herbal medicine, exercise therapy) and medicinal methods. In accordance with the appointments of the attending physician, the nurse cooperates with specialists in dietology, physiotherapy, psychotherapy, physiotherapy exercises, etc., conducts conversations with the patient and his relatives about the normalization of work and rest, nutrition, elimination of insomnia, conflict situations, bad habits.

An important condition for the effectiveness of the complex treatment of CG is diet therapy, directed during the period of exacerbation of the disease to thermal, chemical and mechanical sparing of the stomach.

Foods and dishes that have a strong irritant effect on the gastric mucosa are excluded from the diet: pickles, smoked meats, rich soups, marinades, spicy seasonings, fried meat and fish. Limit the use of salt, strong tea and coffee, exclude alcoholic beverages. They recommend slimy soups from cereals, milk soups with grated cereals, mashed boiled vegetables, soft-boiled eggs or in the form of omelettes, calcined cottage cheese, jelly, weak tea with milk, boiled meat and fish, wheat bread baked yesterday.

Mechanical sparing involves reducing the volume of food at each meal, grinding or rubbing it to a mushy consistency, limiting the fiber content, as well as heat treatment, carried out only by steaming or by cooking food. The patient should be fed in small portions 4-5 times a day.

As the signs of exacerbation of CG are eliminated and the transition to good nutrition in case of secretory insufficiency, fatty, fried, smoked foods, canned food, black bread, fresh dough products, concentrated cream and sour cream are excluded from the diet; in the case of normal and increased secretory function, the use of rough, spicy, salty and juice foods is prohibited.

Medical treatment of autoimmune chronic hepatitis It is aimed at replacing disturbed (reduced) secretory and motor functions of the stomach, compensation for B 12 deficiency anemia and trophic disorders. For this purpose, the following drugs are used:

  • replacement therapy with a decrease or absence of hydrochloric acid production (hydrochloric acid, acidin-pepsin, pepsidil, sugast-2, etc.);
  • stimulants of the motor-evacuation function of the stomach - prokinetics: domperidone (motilium), metoclopramide (cerucal); enzyme preparations: festal, mezim-forte, panzinorm forte, creon, etc.;
  • immunomodulators: imunofan, taktivin, etc.;
  • stimulants of regenerative (restorative) processes in the mucous membrane: methyluracil, retabolil, nerobol, etc.;
  • vitamins B, B 2 , B J2 P, PP, folic acid, complexes of vitamins and microelements - "Oligovit", etc.;
  • sedatives (valerian, motherwort, etc.).

The basis of drug therapy for Helicobacter pylori is the eradication (destruction) of bacteria in the gastric mucosa, as well as the use of agents that reduce the formation of hydrochloric acid and weaken its damaging effect on the mucous membrane.

Treatment of this form of HCG:

  • antibacterial agents: tetracycline, tinidazole, clarithromycin, amoxicillin, etc.;
  • antisecretory drugs: H2-receptor blockers (ranitidine, famotidine, etc.); proton pump inhibitors (omeprazole, lansoprazole, esomeprazole, etc.);
  • a combination of antibacterial, antisecretory agents and bismuth preparations: triple therapy - 1st line therapy (omeprazole, clarithromycin, amoxicillin), quadritherapy - 2nd line therapy (omeprazole, clarithromycin, tinidazole, de-nol), etc.;
  • gastroprotectors with enveloping and astringent properties: de-nol, sucralfate, sea buckthorn oil, etc.;
  • antacids: almagel, phosphalugel, maalox, etc.;
  • sedatives (valerian, motherwort, etc.);
  • vitamins B, B 6, ascorbic acid.

The main role in solving the patient's problems - in the relief of pain and dyspeptic syndromes - belongs to dietary and drug treatment. The nurse monitors the patient's compliance with these therapeutic measures, detects dietary violations and the negative effects of drugs and informs the doctor about this. A certain place in the complex treatment of chronic hepatitis is occupied by the use of mineral waters (with secretory insufficiency - chloride and sodium, with preserved and increased secretory function of the stomach - bicarbonate), as well as herbal medicine, physiotherapy and exercise therapy.

Prevention

Prevention of CG and the prevention of its progression include the observance of proper (rational) nutrition, general hygiene measures, the exclusion of bad habits, occupational hazards, the use of certain anti-inflammatory drugs. Preventive measures include sanitation of the oral cavity, treatment of chronic foci of infection.

Patients with chronic hepatitis, especially with its diffuse atrophic forms, are subject to clinical examination, which provides for a comprehensive examination, including endoscopic, and anti-relapse treatment 1-2 times during the year.

Nursing process in diseases of the digestive system. Chronic diseases of the digestive system in children are widespread and do not tend to decrease. Diseases of the stomach and duodenum are of the leading importance. Increased cases of peptic ulcer of the stomach and duodenum.
Nursing process in chronic gastroduodenitis. Information about the disease. Chronic gastritis / gastroduodenitis is a disease that is characterized by diffuse inflammation of the mucous membrane of the stomach, duodenum with the gradual development of atrophy of the gastric glands and secretory insufficiency, impaired motor and evacuation functions.
The main etiological factor in the development of the disease is Helicobacter pylori (H.p), its long stay in the gastric mucosa. N.R. can be transmitted by the fecal-oral and oral route through personal hygiene items. Infection most often occurs in childhood. When examining N.r. in the gastric mucosa is found in 50-100% of patients.
Factors contributing to the development of the disease:
- Alimentary: eating rough, poorly chewed food, eating dry food; eating cold or very hot food; eating food containing a lot of spices; eating disorder.
- Long-term use of drugs.
- Excessive physical and mental overload.
- Food allergies.
- Burdened heredity.
Mechanisms of the pathological process.
Infection and prolonged stay in the gastric mucosa N.r. initially leads to the formation of an inflammatory infiltrate. damage to mucosal cells and destruction of the protective mucosal barrier under the action of bacterial enzymes secreted by H.r. Further, atrophic processes develop in the glands of the stomach, which leads to a change in secretion and dysregulation of the motor-evacuation function. Violation motor function the stomach is accompanied by reflux - the reflux of duodenal contents into the stomach and the ingress of acidic contents of the stomach into the duodenum with the development of inflammation in it - duodenitis.
During chronic gastroduodenitis, periods are distinguished:
- exacerbations - seasonal: spring and autumn;
- incomplete clinical remission:
- complete clinical remission;
- clinical and endoscopic remission.
Variants of the clinical course of gastroduodenitis:
- with unchanged secretory function of the stomach;
- with reduced secretory function of the stomach;
- with increased secretory function of the stomach.
Principles of treatment: staged and complex.
Stages: hospital-polyclinic-sanatorium-polyclinic.
Specialized hospital - treatment in the acute phase.
Sanatorium treatment is indicated in the remission phase, after discharge from the hospital after 3-4 months.
In the clinic, dispensary observation is carried out. The duration of medical examination is 5 years from the moment of exacerbation of the disease.
Medical examination is carried out by a gastroenterologist or a district pediatrician and includes: scheduled examinations by a gastroenterologist; in spring and autumn, scheduled examinations by a dentist and an ENT doctor, sanitation of chronic foci of infection; 2 times a year in spring and autumn, the appointment of anti-relapse treatment: carrying out planned laboratory and instrumental methods of examination.
The child is removed from the register after examination in a specialized hospital with stable clinical-endoscopic-morphological remission for 5 years.
Treatment in a specialized hospital:
Therapeutic and protective regimen - bed rest until the state of health and general condition improve.
Therapeutic Diet:
Table No. 1 moderate mechanical and chemical sparing of the gastrointestinal mucosa, restriction of gastric secretion stimulants. Eating 5-6 times. With reduced gastric secretion, juice dishes: meat and fish broths, sour juices, cottage cheese, kefir.
Table 1A - very strict mechanical and chemical sparing, all food is served in liquid or semi-liquid form, is prescribed for 2-3 days;
Table 1B - strict mechanical and chemical sparing, food is served in a puree state, is prescribed for 7-10 days.
Table 1B - moderate mechanical and chemical sparing - chopping, shredding, boiling, steaming, is prescribed until the end of the exacerbation.
Mineral waters - "Borjomi", "Slavyanovskaya" for patients with increased gastric secretion 1-1.5 hours before meals; "Essentuki 4" Essentuki 17" for patients with reduced gastric secretion 15-20 minutes before meals in a warm form.
Drug therapy:
Preparations with antibacterial activity for the treatment of infection H.r. - "de-nol", amoxicillin, clarithromycin, metronidazole, omeprazole. ezoieprazole. ranitidine for at least 7 days.
Antacids that inhibit gastric secretion, reduce the aggressiveness of hydrochloric acid and pepsin, increase the protective properties of the mucous membrane - almagel, phosphalugel, maalox, gastal, anacid, geluxil, rennie and others are prescribed before meals, immediately after meals, 1 hour after meals, at night, immediately if pain occurs.
Drugs that inhibit gastric secretion - famogidin, ranitidine, omeprazole, etc.
Stimulants of motor function, with antireflux effect - cerucal, motilium.
Enzymes - pepsidil, abomin, panzinorm, pancreatin, mezim-forte, enzistal. Creon.
Cytoprotectors - preparations of local protective action - "venter" or sucralfate. "De-nol" or preparations of colloidal bismuth are prescribed before meals and at night.
Reparants - promote the regeneration of the mucous membrane - sea buckthorn oil, solcoseryl, pentoxyl, Cytotec, vitamin U, B vitamins.
Biological preparations for the restoration of normal intestinal microflora - bifidumbacterin, lactobacterin, bifiform, bificol, polybacterin.

Stages of the nursing process for chronic gastroduodenitis in children:

Stage 1. Collection of information about the patient for the diagnosis of the disease

Survey:
- Typical complaints: pain in the abdomen or near the navel, a feeling of rapid satiety, nausea, belching, heartburn, vomiting, loss of appetite.
- Pain can be: early - appear during or 10-20 minutes after eating; late appear on an empty stomach or after eating after 1.5-2 hours; combination of early and late pains.
Objective examination methods:
-Examination: pallor, blue under the eyes, white coating on the tongue, pain in the epigastric region on palpation of the abdomen.
- Results of laboratory and instrumental diagnostic methods: complete blood count, general urinalysis, scatological examination of feces; determination of the concentration of antigen H.r. in feces; esogastroduodenoscopy; targeted biopsy - morphological examination of the mucosal biopsy and assessment of contamination H.r.

Stage 2. Identification of the problems of a sick child

In a patient with chronic gastroduodenitis, physiological needs are violated: to maintain a general condition, eat, sleep, rest, communicate. Therefore, there are problems that need to be solved.
A. Existing problems caused by chronic inflammation of the mucous membrane of the stomach and duodenum:
- Pain in the epigastric region or near the navel during meals, after meals or on an empty stomach.
- Feeling of heaviness in the stomach.
B. Existing problems caused by digestive disorders.
- Feeling of rapid satiety.
- Nausea.
- Belching niche, air, "rotten", "sour".
- Heartburn.
- Bloating.
- Rumbling in the stomach.
- Tendency to constipation or loose stools.
- Decreased or lack of appetite.
If these problems are identified, the child must be hospitalized in a specialized hospital for a complete examination, diagnosis and comprehensive treatment.

3-4 stages. Planning and implementation of patient care in the hospital

The purpose of nursing care: To promote recovery, to prevent the development of complications.

Nursing process in chronic gastroduodenitis
Care plan:
1. Provide organization and control over compliance with the medical and protective regime
Care implementation:
Independent Interventions:
- Conduct a conversation with the patient / parents about the disease and the prevention of complications
- Explain to the patient/parents about the need for bed rest
- Control the presence of a pot in the patient's room
- Warn the patient and/or his parents that the child should urinate in the potty.
- Visiting the toilet is temporarily prohibited.
- Eating and hygiene procedures in bed in a sitting position
Motivation:
Protection of the central nervous system from excessive external stimuli. Creation of a mode of sparing the gastrointestinal tract, ensuring maximum comfort conditions. Pain reduction. Satisfying the physiological need to excrete waste products
2. Leisure organization
Care implementation:
Independent intervention:
Encourage parents to bring their favorite books, toys
Motivation:
Creation of comfortable conditions
3.Creating comfortable conditions in the ward
Care implementation:
Independent interventions:
- control the conduct of wet cleaning and regular ventilation;
- control the regularity of bed linen change;
- monitor the observance of silence in the ward
Motivation:
Satisfaction of physiological needs for sleep and rest
4. Assistance with hygiene and eating
Care implementation:
Independent Interventions:
-conversation with the patient and / or parents about the need for personal hygiene;
-recommend parents to bring toothpaste, comb, clean change of clothes;
- supervise and assist the child in carrying out hygiene measures
Motivation:
Ensuring sanitary and hygienic measures. The need to be clean
5. Provide organization and control over the diet
Care implementation:
Independent Interventions:
Conducting a conversation with the patient and / or parents about the peculiarities of nutrition, the need to follow a diet. Encourage parents to bring mineral water to drink
Motivation:
Satisfying the physiological need for food
6. Fulfill doctor's orders
Care implementation:
Dependent Interventions:
- distribution of drugs individually in the prescribed dose, regularly in time;
- explain to the patient and / or parents about the need to take medications;
- talk about possible side effects of medications
- to have a conversation with the patient and/or parents about the need for the prescribed laboratory tests;
- teach relatives/patients the rules for collecting urine, feces; provide utensils for collecting urine and feces; control the collection of urine and feces;
- before each instrumental study, conduct psychological preparation of the child / parents, explain the goals and course of the study, teach the child the rules of behavior, accompany to the study.
Motivation:
Etiotropic treatment. Elimination of infection. Prevention of complications.
Early detection of side effects. Diagnosis of the disease. Assessment of the work of the gastrointestinal tract
7. Provide dynamic monitoring of patient response to biscuits
Care implementation:
Independent intervention:
- control over appetite, sleep;
- detection of complaints;
- measurement of body temperature in the morning and evening;
- control of physiological functions;
- in case of deterioration of the general condition, immediately inform the attending physician or the doctor on duty
Motivation:
Monitoring the effectiveness of treatment and care.
Early detection and prevention of complications.

Stage 5 Evaluation of the effectiveness of care

With proper organization of nursing care, the child's recovery occurs on time, the patient is discharged in a satisfactory condition under the supervision of a gastroenterologist / district pediatrician in a children's clinic. The patient and his parents should be aware of the peculiarities of the daily routine and diet that the child must follow after discharge from the hospital, the need for dispensary registration and strict adherence to all recommendations.

Gastritis is one of the most unpleasant diseases of the stomach. It is expressed by inflammation of the mucous membrane of the organ. Gastritis may be acute or chronic and may be accompanied by erosions or edema. What is the nursing process for gastritis?

Causes

There are not many causes of gastritis, but you can always distinguish it from other diseases.

  1. First and most main reason is the consumption of unhealthy foods and drinks. These are fast food, spicy and fatty foods, alcohol. Of course, if you treat yourself to tasty but unhealthy food only on holidays and special occasions, then you will not necessarily become a victim of gastritis. However, note that it most often develops in older people with a weak stomach.
  2. An overdose of various drugs, too, no one excludes. Among them are agents based on aspirin, caffeine, indomethacin, phenylbutazone and various non-steroidal anti-inflammatory drugs.
  3. Certain toxic substances also provoke gastritis: mercury, insecticides, corrosive substances.
  4. Many bacteria contribute to the occurrence of this disease. These include staphylococcus, salmonella and escherichia.

To understand whether you need medical help or can handle it yourself, you should pay attention to the symptoms.

Signs of gastritis

In chronic gastritis, there are often no symptoms or only minor pain. With acute gastritis, everything is much more serious. Symptoms of this disease include:

  • discomfort in the epigastric region;
  • colic;
  • nausea and vomiting of blood;
  • acute pain in the stomach;
  • general weakness.

In the presence of any symptoms, a person needs medical attention, since any physical activity can bring him additional pain.

Actions of a nurse in chronic gastritis

What is the nursing process for gastritis?

  • Conducting surveys and collecting information.
  • Establishing a diagnosis.
  • Setting the goals of the process, i.e. what result is planned to be achieved.
  • Treatment implementation.
  • Evaluation of the effectiveness of the work of a medical worker.

In addition to the nursing process for gastritis, the nurse has duties that must be strictly followed in case of a chronic disease:

  • monitor patient compliance with a strict diet;
  • talk about the importance of proper nutrition;
  • explain to relatives what products can be brought to the patient;
  • give the patient suffering from gastritis, the necessary drugs;
  • to carry out preventive measures and teach the patient, as far as possible, independently carry out the prevention of his body.

In fact, the nursing process for gastritis is quite simple. The main thing is to control all the actions of the patient.

Nursing process in acute gastritis

The situation is different in a situation where a person suffers from an acute form of gastritis. In this case, the nursing process for gastritis includes the following steps:

  • Provide the patient with complete rest - both moral and physical.
  • Give antispasmodics.
  • Lay the patient on his side and ask him to pull his knees up to his stomach. This action will help relax the muscles of the stomach, which will make the pain less. In this position, the patient must be from 15 minutes until the symptoms are completely eliminated.
  • If after an hour of rest the symptoms do not go away, the patient should put a bottle of cold water on his stomach.

The nursing process for acute gastritis must be extremely accurate and fast, since most often the attack begins suddenly. The patient is physically unable to care for himself. An attack can last from half an hour to several hours. It is necessary to follow a strict diet during and after the attack. It is advisable to limit yourself to cereals and lean soups in the next few days. From drinks, you can use either fruit drinks or very weak tea. It is better to give preference to plain water on the first day.

Nursing care for gastritis is a difficult and very painstaking task. The most important thing in this matter is to treat the patient with attention and patience, and then all your actions will definitely benefit. In addition, gastritis can be triggered by a nervous outburst. Peace and a friendly attitude for the patient in such a situation is the most necessary for recovery.