Medical rehabilitation of patients with diseases of the digestive system. Analysis of the causes of complications of peptic ulcer of the stomach and duodenum. The participation of a nurse in the prevention of complications The role of a paramedic in the rehabilitation of patients with peptic ulcer
APPS
LIST OF ABBREVIATIONS
HP - Helicobacter pylori
LS - medicine
Exercise therapy - physiotherapy exercises
IP - starting position
TM - the pace is slow
TS - average pace
INTRODUCTION
Target:
Tasks:
Complications of peptic ulcer
Sometimes life-threatening complications develop with peptic ulcer: penetration, perforation (perforation), bleeding and narrowing (stenosis) of the pyloroduodenal section of the stomach.
Ulcers are often complicated by bleeding, even if they did not cause pain. Symptoms of bleeding ulcers may include vomiting bright red blood or a red-brown mass of partially digested blood that resembles coffee grounds and black, tarry stools. With very intense bleeding, scarlet blood may appear in the stool. Bleeding may be accompanied by weakness, dizziness, loss of consciousness. The patient must be urgently hospitalized.
ulcers duodenum and the stomach can damage the wall of these organs through and through, forming an opening leading to the abdominal cavity. There is pain - sudden, intense and constant. It quickly spreads throughout the abdomen. Sometimes a person feels pain, which increases with deep breathing. Symptoms are less intense in the elderly, as well as in people taking corticosteroids or in very seriously ill people. An increase in body temperature indicates the development of an infection in the abdominal cavity. If medical care is not provided, shock develops (a sharp drop in blood pressure). When perforation (perforation) of the ulcer requires surgery.
An ulcer can destroy the entire muscular wall of the stomach or duodenum and penetrate into an adjacent organ, such as the liver or pancreas. This complication is called ulcer penetration.
Swelling of the inflamed tissues around the ulcer or scarring from previous exacerbations of the disease can narrow the exit from the stomach (pyloroduodenal region) or the lumen of the duodenum. With this type of obstruction, repeated vomiting often occurs, large volumes of food eaten many hours before are released. There is a feeling of fullness in the stomach after eating, bloating and lack of appetite are the most common symptoms of obstruction. Over time, frequent vomiting leads to weight loss, dehydration, and mineral imbalances in the body. Treatment of the ulcer improves the obstruction in most cases, but severe obstruction may require endoscopic or surgical intervention.
Treatment of peptic ulcer of the stomach and duodenum should take place only under the supervision of the attending physician. The fact is that self-administration of various antacids and other drugs that reduce the acidity of gastric juice can alleviate the symptoms of the disease, but this improvement will only be short-lived. Only adequate treatment prescribed by a gastroenterologist can lead to complete healing of ulcers.
CHAPTER 2
Rehabilitation after treatment
Therapeutic exercise (LFK) in case of peptic ulcer, it contributes to the regulation of excitation and inhibition processes in the cerebral cortex, improves digestion, blood circulation, respiration, redox processes, positively affects the neuro- mental condition sick .
When performing physical exercises, the stomach area is spared. IN acute period disease in the presence of pain exercise therapy is not indicated. Physical exercises are prescribed 2-5 days after the cessation of acute pain.
During this period, the procedure of therapeutic exercises should not exceed 10-15 minutes. In the prone position, exercises for the arms and legs with a limited range of motion are performed. Exercises that actively involve the abdominal muscles and increase intra-abdominal pressure are excluded.
With the cessation of acute phenomena, physical activity is gradually increased. To avoid exacerbation, do it carefully, taking into account the patient's response to exercise. Exercises are performed in the initial position lying, sitting, standing.
To prevent adhesions against the background of general strengthening movements, exercises for the muscles of the anterior abdominal wall, diaphragmatic breathing, simple and complicated walking, rowing, skiing, outdoor and sports games.
Exercises should be done carefully if they aggravate the pain. Complaints often do not reflect the objective state, and the ulcer can progress with subjective well-being (disappearance of pain, etc.)
In this regard, in the treatment of patients, the abdominal area should be spared and very carefully, gradually increase the load on the abdominal muscles. It is possible to gradually expand the patient's motor mode by increasing the total load when performing most exercises, including exercises in diaphragmatic breathing and exercises for the abdominal muscles.
Contraindications to the appointment of exercise therapy are: bleeding; generating ulcer; acute perivisceritis (perigastritis, periduodenitis); chronic perivisceritis in the event of acute pain during exercise
Physiotherapy- this is the use of natural and artificially generated physical factors for therapeutic and prophylactic purposes, such as: electric current, magnetic field, laser, ultrasound, etc. Various types of radiation are also used: infrared, ultraviolet, polarized light.
Basic principles of the use of physiotherapy in the treatment of patients with peptic ulcer:
a) selection of soft operating procedures;
b) the use of small dosages;
c) a gradual increase in the intensity of exposure to physical factors;
d) their rational combination with other therapeutic measures.
As an active background therapy in order to influence the increased reactivity of the nervous system, methods such as:
Impulse currents of low frequency according to the method of electrosleep;
Central electroanalgesia by tranquilizing technique (with the help of LENAR devices);
UHF on the collar zone; galvanic collar and bromoelectrophoresis.
Of the methods of local therapy (i.e., the impact on the epigastric and paravertebral zones), the most popular is galvanization in combination with the introduction of various medicinal substances by electrophoresis (novocaine, benzohexonium, platyfillin, zinc, dalargin, solcoseryl, etc.).
Diet food is the main background of any antiulcer therapy. The principle of fractional (4-6 meals a day) must be observed regardless of the phase of the disease.
Basic principles of therapeutic nutrition (principles of the "first tables" according to the classification of the Institute of Nutrition): 1. good nutrition; 2. observance of the rhythm of food intake; 3. mechanical; 4. chemical; 5. thermal sparing of the gastroduodenal mucosa; 6. gradual expansion of the diet.
The approach to dietary management of peptic ulcer disease is currently marked by a move away from strict to sparing diets. Mainly mashed and non-mashed diet options No. 1 are used.
The composition of diet No. 1 includes the following products: meat (veal, beef, rabbit), fish (perch, pike, carp, etc.) in the form of steam cutlets, quenelles, soufflé, beef sausages, boiled sausage, occasionally - low-fat ham, soaked herring (the taste and nutritional properties of herring increase if it is soaked in whole cow's milk), as well as milk and dairy products (whole milk, powdered, condensed milk, fresh non-acidic cream, sour cream and cottage cheese). With good tolerance, yogurt, acidophilic milk can be recommended. Eggs and dishes from them (soft-boiled eggs, steam scrambled eggs) - no more than 2 pieces per day. Raw eggs are not recommended, as they contain avidin, which irritates the stomach lining. Fats - unsalted butter (50-70 g), olive or sunflower (30-40 g). Sauces - dairy, snacks - mild cheese, grated. Soups - vegetarian from cereals, vegetables (except cabbage), milk soups with vermicelli, noodles, pasta (well boiled). Salt food should be moderate (8-10 g of salt per day).
Fruits, berries (sweet varieties) are given in the form of mashed potatoes, jelly, with tolerance compotes and jelly, sugar, honey, jam. Non-acidic vegetable, fruit, berry juices are shown. Grapes and grape juices are not well tolerated and can cause heartburn. In case of poor tolerance, juices should be added to cereals, jelly or diluted with boiled water.
Not recommended: pork, lamb, duck, goose, strong broths, meat soups, vegetable and especially mushroom broths, undercooked, fried, fatty and dried meats, smoked meats, salted fish, hard-boiled eggs or scrambled eggs, skimmed milk, strong tea, coffee, cocoa, kvass, all alcoholic drinks, carbonated water, pepper, mustard, horseradish, onion, garlic, bay leaf, etc.
You should refrain from cranberry juice. From drinks, weak tea, tea with milk or cream can be recommended.
Sanatorium treatment is an important rehabilitation measure. It is prescribed during the inactive period of the disease. Contraindications are complications of peptic ulcer (malignant degeneration, pyloric stenosis, bleeding - within the last 6 months), the first 2 months after surgical treatment, severe comorbidity. Sanatorium-resort treatment includes a wide range of physiotherapeutic measures, the use of mineral waters aimed at normalizing the functions of not only the gastroduodenal region, but the body as a whole. Resorts are shown: Zheleznovodsk, Essentuki, resorts of Transcarpathia, Truskavets.
Questionnaire 1 "Study of knowledge and means of disease prevention among patients with gastric ulcer and duodenal ulcer" for patients with gastric and duodenal ulcer disease aged 30 to 60 years
1) Who is more likely to get peptic ulcer disease of the stomach and duodenum?
but. men
b. women
in. both equally
2) Peptic ulcer of the stomach and duodenum is serious illness digestive organs?
but. agree
b. do not agree
in. find it difficult to answer
3) Do you know about the consequences of the disease peptic ulcer of the stomach and duodenum?
b. we don't know
in. partially know
4) Do you know about the predisposing factors of gastric ulcer and duodenal ulcer?
b. we don't know
in. partially know
5) Can you distinguish the symptoms of gastric and duodenal ulcer from the symptoms of other diseases of the digestive system?
b. can not
in. partially we can
6) Do you know about the methods of examination for peptic ulcer of the stomach and duodenum?
b. we don't know
in. partially know
7) Can heredity be a contributing factor in the development of gastric ulcer and duodenal ulcer?
b. Can not
in. Sometimes it can
8) Are exacerbations possible in gastric ulcer and duodenal ulcer in the form of bloody (black) vomiting?
but. Possible
b. not possible
in. We doubt it is possible
9) Is bed rest included in the anti-ulcer course of treatment?
but. Agree
b. Do not agree
in. Partially agree
10) Is a strict diet prescribed for exacerbation of peptic ulcer of the stomach and duodenum?
but. Appointed
b. Not assigned
in. Sometimes assigned
11) Do bad habits contribute to the development of gastric and duodenal ulcers?
but. Contribute
b. Don't Contribute
in. Difficult to answer
12) Can long-term use of coarse food lead to a pre-ulcerative condition?
b. Can not
in. Difficult to answer
13) A sharp change in living conditions, diet can provoke peptic ulcer of the stomach and duodenum?
b. Can not
in. Difficult to answer
but. We carry out
b. We do not perform
in. We partially fulfill
15) What means of prevention of peptic ulcer of the stomach and duodenum do you welcome?
but. Individual work of a paramedic with patients
b. Collective events for people suffering from peptic ulcer of the stomach and duodenum
in. Distribution of printed information to patients
CONCLUSIONS
1. The results of the study indicate the need to improve the knowledge and means of disease prevention among patients with gastric ulcer and duodenal ulcer, taking into account their biomedical and socio-hygienic characteristics.
2. The diet and diet in patients with gastric ulcer and duodenal ulcer partially corresponds to the required diet.
3. Prevention and rehabilitation of gastric and duodenal ulcers mainly depends on careful, proper care, adherence to the regimen and diet. In this regard, the role of the paramedic in the effectiveness of the treatment is increasing.
Information booklet No. 1 "Complex of gymnastics for peptic ulcer of the stomach and duodenum" for patients with peptic ulcer of the stomach and duodenum (see Appendix 1)
Information booklet No. 2 "General principles for the prevention of gastric and duodenal ulcers" for patients with gastric and duodenal ulcers (see Appendix 2)
Information booklet No. 3 "Treatment of peptic ulcer" for medical professionals (see Appendix 3)
BIBLIOGRAPHY
Books, textbooks:
1. Bakhmetova B.Kh. Topical issues of peptic ulcer: clinic, diagnosis, treatment and prevention: monograph / - Ufa: ADI, 2010. - 126 p.
2. Vasiliev Yu.V. Peptic ulcer // Selected chapters of clinical gastroenterology / ed. L.B. Lazebnik. M.: Anacharsis, 2010. S. 82–112.
3. Ivashkin V.T., Lapina T.L. Gastroenterology: national leadership / V.T. Ivashkin, T.L. Lapina M: GEOTAR-Media. 2010. - 704 p.
5. Koryagina N.Yu., Shirokova N.V. - Organization of specialized nursing care - M .: - GEOTAR - Media, 2009. - 464 p.
6. Lychev V.G., Karmanov V.K. - Conducting guide practical exercises on the subject "Nursing in therapy with a course of primary care": - educational methodological manual M .: - Forum infra, 2010. - 384 p.
7. Lychev V.G., Karmanov V.K. - Fundamentals of nursing in therapy - Rostov n / a Phoenix 2010 - 512 p.
8. Makolkin V.I., Ovcharenko S.I., Semenkov N.N. - Nursing in therapy - M .: - LLC Medical Information Agency, 2011. - 544 p.
9. Mukhina S.A., Tarnovskaya I.I. - Theoretical basis nursing - 2nd ed., corrected. and add. - M .: - GEOTAR - Media, 2010. - 368 p.
10. Mukhina S.A., Tarnovskaya I.I. - Practical guide to the subject "Fundamentals of Nursing"; 2nd edition Spanish. add. M.: - GEOTAR - Media 2009. - 512 p.
11. Obukhovets T.P., Sklyarov T.A., Chernova O.V. - Fundamentals of nursing - ed. 13th add. revised Rostov n / a Phoenix - 2009 - 552s.
12. Zimmerman Ya.S. Gastroenterology / Ya.S. Zimmerman // M.: GEOTAR-Media. 2012. - 780 p.
Magazines, newspapers, articles:
13. Vasiliev Yu.V. Peptic ulcer and Helicobacter pylori // Russian Journal of Gastroenterology, Hepatology and Coloproctology 2011. V. XI. No. 6. P. 19.
14. Korotko GG Functional assessment of peptic ulcer // Ros. magazine gastroenterology, hepatology, coloproctology. - 2011. - V. 11, No. 5 (app. 15). - S. 25.
15. Lazebnik L.B., Vasiliev Yu.V., Grigoriev P.Ya. Diagnosis and therapy of acid-dependent diseases, including those associated with Helocobacter pylori infection. Draft standards program. First Moscow Agreement, 5 Feb. 2003 // Experimental and clinical gastroenterology. 2013. No. 3. S. 3–18.
Sites:
17. http://www.doctorhelp.ru/info/2753.html
18. https://nmedik.org/
19. http://medportal.ru/enc/gastroenterology/ulcer/2/
20.https://ru.wikipedia.org
ATTACHMENT 1
Causes of peptic ulcer
LIST OF ABBREVIATIONS……………………………………………………………………………4
INTRODUCTION………………………………………………………………………………………….5
CHAPTER 1. Peptic ulcer of the stomach and duodenum…....7
1.1 Characteristics of peptic ulcer of the stomach and duodenum…………………7
1.2 Causes of peptic ulcer of the stomach and duodenum…………………………………...9
1.3Clinical picture gastric ulcer and duodenal ulcer…………………………………...13
1.4 Complications of gastric ulcer and duodenal ulcer………………………………………………...15
1.5 Diagnosis and treatment of peptic ulcer of the stomach and duodenum…………………………………………………………………………………………………………………………………………………………………………………………………………………………………….
CHAPTER 2
2.1 Prevention of peptic ulcer……………………………………………………………..19
2.2Rehabilitation after treatment…………………………………………………………………..19
CHAPTER 3. STUDY OF THE MAIN ASPECTS OF GASTRIC AND DUODENAL ULCER…………………………………………….23
3.1. The study of knowledge and means of disease prevention among patients with gastric ulcer and duodenal ulcer……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
3.2. Study of diet and diet in patients with gastric ulcer and duodenal ulcer…………………………………………………………………………………………………… 26
29
CHAPTER 4. RESULTS OF THE STUDY OF THE MAIN ASPECTS OF GASTRIC AND DUODENAL ULCER……………………………....32
4.1. The results of the study of knowledge and means of preventing the disease among patients with peptic ulcer of the stomach and duodenum………………………………………………………..…32
4.2. The results of the study of diet and diet in patients with peptic ulcer of the stomach and duodenum………………………………………………………………………………………….40
4.3. The results of the study of the role of a medical worker in the prevention and rehabilitation of patients with gastric ulcer and duodenal ulcer ……………………………………………...48
CONCLUSIONS…………………………………………………………………………………………..56
REFERENCES……………………………………………………………………………58
APPS
LIST OF ABBREVIATIONS
duodenum - duodenum
HP - Helicobacter pylori
FEGDS - fibroesophagogastroduodenoscopy
GIT - gastrointestinal tract
LS - medicine
NSAIDs - non-steroidal anti-inflammatory drug
Exercise therapy - physiotherapy exercises
IP - starting position
TM - the pace is slow
TS - average pace
INTRODUCTION
Peptic ulcer refers to a chronic relapsing disease characterized by a common morphological feature - loss of mucous membrane areas in those areas of the digestive tract that are in contact with active gastric juice (stomach, proximal part of the duodenum).
Along with peptic ulcer, as an independent nosological form, it is now customary to distinguish secondary, symptomatic ulcers and gastroduodenal ulcers that occur when exposed to a known etiological factor - stress, impaired local and regional blood circulation, taking non-steroidal anti-inflammatory drugs, etc. The name "peptic ulcer" follows yet retain for gastric and duodenal ulcers, the origin of which remains unknown.
It is generally accepted that men get sick more often than women. However, the ratio of men and women suffering from peptic ulcer varies depending on the age of the patients.
Peptic ulcer among the urban population is recorded more often than among the rural. The high level of morbidity is explained by the peculiarities of nutrition, social and industrial life, pollution of the external environment in cities.
The urgency of the problem of peptic ulcer is determined by the fact that it is the main cause of disability for 68% of men, 30.9% of women from all those suffering from diseases of the digestive system. Despite advances in the diagnosis and treatment of peptic ulcer disease, the disease continues to affect an increasingly younger population, showing no signs of stabilizing or declining incidence rates.
Over the past 10-15 years in many countries of the world, including ours, there has been a trend towards a decrease in the incidence of peptic ulcer, as well as the number of hospitalizations, the frequency of surgical interventions and deaths in this disease.
At the same time, a number of researchers note an increase in the incidence of peptic ulcer disease. The observed increase in the frequency of peptic ulcer disease, apparently, is not due to a true increase in the incidence, but to an improvement in the quality of diagnosis.
Target: to study the main aspects of gastric and duodenal ulcer in patients of the Pavlovsk RB
Tasks:
1. To investigate the knowledge and means of disease prevention among patients with gastric and duodenal ulcers
2. Examine the diet and diet in patients with gastric ulcer and duodenal ulcer
3. To explore the role of a medical worker in the prevention and rehabilitation of gastric and duodenal ulcers
CHAPTER 1. Peptic ulcer of the stomach and duodenum
INTRODUCTION……………………………………………………………….………………………………….3 CHAPTER 1. PROBLEMS OF GASTRIC ULCER AND DUODENAL ULCER AT THE PRESENT STAGE 5 1.1. Concept, causes of peptic ulcer of the stomach and duodenum 5 1.2. Symptoms of peptic ulcer of the stomach and duodenum, diagnosis 9 1.3. Treatment of peptic ulcer of the stomach and duodenum 16 CHAPTER 2. HEALTH PROCESS FOR Peptic ulcer of the stomach and duodenum 18 2.1. The tasks of the paramedic according to the Standards for the diagnosis of peptic ulcer of the stomach and duodenum 18 2.2. The tasks of the paramedic in addressing the treatment of gastric ulcer and duodenal ulcer 20 2.3. The tasks of the paramedic in addressing issues of primary and secondary prevention of gastric and duodenal ulcers 22 CONCLUSION 24 LIST OF USED SOURCES 26
Introduction
Relevance: according to statistics, today about 10% of the population suffers from duodenal ulcer. It occurs, as a rule, in 20-30 years. In men, this pathology occurs approximately twice as often as in women. And the incidence among residents of megacities is several times higher than among the inhabitants of villages. Since classical description 150 years have passed, but so far, despite numerous studies in this area, disputes regarding both the ethnology of peptic ulcer and its treatment have not subsided. Peptic ulcer is a fairly common disease. According to various statistics, it affects from 4 to 12% of the adult population. The main part of the diseases occurs in the 3rd-4th decade of life, and the duodenal ulcer is more common in young people, and the stomach ulcer - in a more mature age. It is noted that men suffer from peptic ulcer 4 times more often than women. The purpose of the work: to study and reveal the main points of the role of a paramedic in the diagnosis and treatment of gastric and duodenal ulcers Tasks: 1. consider the problems of gastric and duodenal ulcers at the present stage 2. reveal the concept, causes of gastric and duodenal ulcers 3. describe symptoms of peptic ulcer of the stomach and duodenum, diagnosis 4. reveal the main points of the treatment of peptic ulcer of the stomach and duodenum 5. consider the paramedical process for peptic ulcer of the stomach and duodenum. 6. to reveal the tasks of the paramedic according to the standards for diagnosing peptic ulcer of the stomach and duodenum. 7. to consider the tasks of the paramedic in addressing the treatment of peptic ulcer of the stomach and duodenum. 8. to reveal the tasks of the paramedic in addressing issues of primary and secondary prevention of gastric and duodenal ulcers. Draw fundamental conclusions. Object of study: the problem of gastric and duodenal ulcers Subject of study: diagnosis and treatment of gastric and duodenal ulcers by a paramedic. Methods used: theoretical, study of scientific and methodological literature. In the process of writing the work, 13 literary sources were studied. The structure of the work is represented by an introduction, main part, conclusion and list of references.
Conclusion
Peptic ulcer of the stomach and duodenum is a chronic relapsing disease in which, as a result of violations of the nervous and humoral mechanisms that regulate secretory and trophic processes in the gastroduodenal zone, an ulcer is formed in the stomach or duodenum (less often two or more ulcers). Its course is characterized by an alternation of asymptomatic periods with exacerbation stages, which usually occur in spring or autumn. Causes of peptic ulcer The main source of the disease is bacterium Helicobacter pylori, which produces substances that damage the lining and cause inflammation. Other factors are predisposing to the development of pathology. In conclusion, we say once again that to prevent the appearance of Ya.B. not difficult. Compliance with the rules of personal hygiene, a balanced diet, giving up bad habits, a healthy lifestyle, the ability to relax and avoid stress are a guarantee of good health. Of course, one cannot rule out an infectious infection or the influence of heredity, but these causes are less common than banal overeating or dry snacks. In the process of writing the work, we studied and revealed the main points of the role of the paramedic in the diagnosis and treatment of gastric and duodenal ulcers. We examined the problems of gastric and duodenal ulcers at the present stage. Revealed the concept, causes of gastric and duodenal ulcers Described the symptoms of gastric and duodenal ulcers, diagnosis Revealed the main points of the treatment of gastric and duodenal ulcers Dismantled the paramedical process for gastric and duodenal ulcers. The tasks of the paramedic were revealed according to the standards for diagnosing gastric and duodenal ulcers. Disassembled the tasks of the paramedic in addressing the treatment of gastric and duodenal ulcers. Disassembled the tasks of the paramedic to address issues of primary and secondary prevention of gastric and duodenal ulcers. The paramedic's special role is to use modern prevention technologies, including the formation of medical activity of the population. They help to increase the motivation of patients to move from theoretical knowledge of prevention to its practical application, to become focused on active disease prevention based on a healthy lifestyle.
Bibliography
1. Beloborodova E. I., Kornetov N. A., Orlova L. A. Pathophysiological aspects of duodenal ulcer in young people // Clinical. the medicine. - 2002. - No. 7. - S. 36-39. 2. Belkov Yu. A., Shinkevich E. V., Makeev A. G., Bogdanova M. G., Dudnik A. V., Kyshtymov S. A. Tactics of treatment of patients with chronic ischemia lower extremities with erosive-ulcerative duodenitis // Surgery. - 2004. - No. 3. - S. 38-41. 3. Belyaev A. V., Spizhenko Yu. P., Belebeziev G. I. et al. Intensive therapy for gastrointestinal bleeding // Ukr. magazine minimally invasive. and endoscope. surgery. - 2001. - V. 5, No. 1. - S. 24-25. 4. Vertkin A. L., Masharova A. A. Treatment of peptic ulcer in a modern clinic // Attending physician, October 2000, No. 8. - S. 14-19. 5. Isakov V.A., Shcherbakov P.L. Comments on the Maastricht Agreement. - 2, 2000//V International Symposium "Diagnostics and Treatment of Diseases Associated with H. pylori", Pediatrics, No. 2, 2002. - C 5-7 6. Kokueva O. V., Stepanova L. L., Usova O. A. et al. Pharmacotherapy of peptic ulcer with regard to concomitant pathology gastrointestinal tract// Experimental and practical gastroenterology, 1/2002. - S. 49-52. 8. Lapina T. L. Modern approaches to the treatment of acid-dependent and H. pylori-associated diseases // Clinical perspectives of gastroenterology, hepatology. 1, 2001. - 21-27. 12. Pimanov S. I. Esophagitis, gastritis, and peptic ulcer - N. Novgorod, 2000. - 376 p. 13. Collection of dietary nutrition of sanatoriums of the gastrointestinal tract for peptic ulcer M 2011 - 303 p.
Prevention is a complex of various kinds of measures aimed at preventing a phenomenon and / or eliminating risk factors.
Preventive measures are the most important component of the healthcare system, aimed at the formation of medical and social activity among the population and motivation for a healthy lifestyle.
Preventive measures at the feldsher-obstetric station are carried out by a paramedic or a nurse.
Depending on the state of health, the presence of risk factors for the disease or severe pathology, three types of prevention can be considered.
Primary prevention is a system of measures to prevent the occurrence and impact of risk factors for the development of diseases (vaccination, a rational regime of work and rest, rational high-quality nutrition, physical activity, environmental protection, etc.). A number of primary prevention activities can be carried out nationwide.
Secondary prevention is a set of measures aimed at eliminating pronounced risk factors that, under certain conditions (stress, weakened immunity, excessive stress on any other functional systems organism) can lead to the onset, exacerbation and recurrence of the disease.
The most effective method of secondary prevention is prophylactic medical examination as a complex method of early detection of diseases, dynamic monitoring, targeted treatment, rational consistent recovery.
Some experts propose the term tertiary prevention as a set of measures for the rehabilitation of patients who have lost the opportunity to fully function.
Tertiary prevention aims at social (formation of confidence in one's own social suitability), labor (the possibility of restoring work skills), psychological (restoration of behavioral activity) and medical (restoration of the functions of organs and body systems) rehabilitation.
Currently, it is generally accepted that peptic ulcer disease is a polyetiological disease. All known etiological factors can be divided into two main groups: predisposing, contributing to the development of the disease and realizing the occurrence or recurrence of peptic ulcer.
Hereditary-constitutional factors. Among the etiological factors leading to the development of peptic ulcer, the most important place is occupied by hereditary predisposition. However, it creates only a predisposition to the disease, which is realized only in combination with other adverse effects.
Neuro-psychic factors. The influence of neuropsychic factors on the occurrence of peptic ulcer is ambiguous. However, most scientists assign them a significant role in the etiology of the disease.
The main role is played by a functional disorder of the autonomic nervous system with a predominance of the tone of the vagus nerve. Hypervagotonia causes muscle spasm and blood vessels, resulting in ischemia, a decrease in tissue resistance and subsequent digestion of the mucosal area with gastric juice. Thus, neuropsychic overload, violations of psychophysiological functions can be realizing factors in the occurrence of peptic ulcer.
Alimentary factor. In many patients, the onset and recurrence of peptic ulcer occur after eating errors or disturbances in the rhythm of food intake. Symptoms such as heartburn, sour belching, and vomiting often occur after eating irritating and sap food. The harmful effects of food on the mucous membrane of the gastrointestinal tract can be different.
Some food components stimulate gastric secretion, having low buffering properties. Prolonged use of coarse food contributes to the development of chronic gastritis and gastroduodenitis, which are considered as pre-ulcerative conditions.
In turn, the buffering and antacid properties of some products (meat, milk, etc.) have a clear anti-corrosion effect, blocking the active gastric juice.
Bad habits. Smoking and alcohol abuse are among the bad habits that contribute to the development of peptic ulcer.
Among male smokers, peptic ulcer occurs 2 times more often than among non-smokers. Nicotine causes vasoconstriction of the stomach, somewhat enhances its secretion, increases the concentration of pepsinogen-1, accelerates the evacuation of food from the stomach, reduces pressure in the pyloric sphincter and promotes duodenogastric reflux.
In addition, nicotine inhibits the secretion of pancreatic bicarbonates, disrupts mucus formation and reduces the synthesis of prostaglandins in the mucous membrane.
Alcohol in the etiology of peptic ulcer plays a multifaceted role. Firstly, it stimulates the acid-forming activity of the stomach, as a result of which the aggressive properties of gastric juice are enhanced. Secondly, it violates the barrier function of the mucous membrane.
Thirdly, with prolonged use of strong alcoholic beverages, chronic gastritis and duodenitis develop, and the resistance of the mucous membrane decreases. Clinical experience shows that peptic ulcer disease and its relapses are often provoked by alcoholic excesses in combination with gross errors in eating.
Excessive consumption of coffee can also be attributed to bad habits. The mechanism of the adverse effect of coffee is associated with the stimulating effect of caffeine on the acid-forming function of the stomach.
medicinal effects. Clinically and experimentally, it has been proven that a number of medicines(non-steroidal anti-inflammatory drugs, corticosteroids, reserpine, etc.) can cause ulceration of the mucous membrane of the stomach or duodenum.
The ulcerogenic effect of these drugs is realized in various ways. Non-steroidal anti-inflammatory drugs, primarily acetylsalicylic acid, reduce the production of mucus, change its qualitative composition, inhibit the synthesis of endogenous prostaglandins and disrupt the protective properties of the mucous membrane; their direct effect on the gastric mucosa with the formation of acute ulcers and erosions is not excluded.
Other drugs (reserpine, corticosteroids) mainly enhance the aggressive properties of gastric juice, directly stimulating the production of hydrochloric acid by parietal cells or acting through the neuroendocrine apparatus.
Diseases that contribute to the development of peptic ulcer. Along with the above etiological factors, peptic ulcer occurs much more often in a number of diseases. internal organs. These diseases are primarily chronic diseases lung, of cardio-vascular system, liver, pancreas, accompanied by functional insufficiency of these organs and systems.
Thus, peptic ulcer is a polyetiological disease. For its occurrence, the influence of not an isolated causal factor, but the sum of factors in their interaction is necessary. At the same time, hereditary burden should be considered as a predisposing background against which the action of other, usually several etiological factors is realized.
The role of etiological factors is different depending on the age, sex of the patient and localization of the ulcer. Yes, at a young age highest value has heredity. In middle age, among the causes of the disease, neuropsychic overstrain, bad habits, gross errors in nutrition begin to predominate.
In old age, in the genesis of peptic ulcer, a significant share is acquired by "ulcerogenic" drugs, various concomitant diseases.
Distinguish between primary and secondary prevention of peptic ulcer disease. Primary prevention is aimed at preventing the disease. It includes proper nutrition organization of work and leisure, the fight against smoking and alcohol, the creation of good conditions in the family, physical education, etc. Primary prevention should be aimed at early diagnosis and treatment of pre-ulcerative conditions, functional disorders stomach and duodenum, as well as to identify other risk factors for the disease.
Secondary prevention involves the prevention of exacerbations of the disease. It is carried out at the dispensary.
Urgent study assistance
diplomaAlong with food, it is advisable to take laxatives to be digested. These are senna, buckthorn bark, rhubarb root and joster fruits. Taking after a meal If the medicine is prescribed after a meal, wait at least two hours to obtain the best therapeutic effect. Immediately after a meal, mainly drugs are taken that irritate the gastric mucosa ...
The role of nursing staff in the rehabilitation of patients with gastric ulcer (abstract, term paper, diploma, control)
State budgetary educational institution of secondary vocational education
"Krasnodar Regional Basic Medical College" of the Ministry of Health of the Krasnodar Territory Cycle Commission "Nursing"
THESIS ON THE TOPIC: "ROLE OF NURSING PERSONNEL IN THE REHABILITATION OF PATIENTS WITH GASTRIC ULCER"
Student Shavlach Xenia Mikhailovna specialty Nursing
3rd year, group E-32
Thesis Supervisor:
Osetrova Lyubov Sergeevna Krasnodar – 2014
Abstract Introduction
I. Peptic ulcer of the stomach
1.1 Peptic ulcer of the stomach. Etiology. Clinical picture of the disease
1.2 Complications and the role of nursing staff when they occur
1.3 Statistical analysis of the occurrence of gastric ulcer in the world, the Russian Federation and the Krasnodar Territory
II. Methods of rehabilitation of patients with gastric ulcer
2.1 General Methods rehabilitation
2.2 Rehabilitation methods for conservative treatment
2.3 Methods of post-operative rehabilitation
III. Analysis of the application of rehabilitation methods in practice
3.1 Analysis of the health status of patients at the time of the start of rehabilitation
3.2 Development of individual plans for the rehabilitation of patients Conclusion List of sources used Annexes
annotation
The thesis structurally consists of an introduction, three chapters, a conclusion, a list of references and applications. The diploma work is presented on 73 pages of typewritten text.
In the introduction, the relevance of the topic of the thesis is substantiated, the purpose and objectives of the study are formed.
Relevance: The problem of gastric ulcer in modern medicine firmly holds one of the first places among the causes of death. It is the main cause of disability in 68% of men, and 30.9% of women of all those suffering from diseases of the digestive system.
An object research: methods of rehabilitation in case of gastric ulcer.
Subject research: patients with gastric ulcer, medical history of an inpatient, results of a survey of patients with gastric ulcer.
Target research: study of the role of nursing staff in improving the efficiency of rehabilitation of patients with gastric ulcer at various stages - preventive, inpatient, outpatient, sanatorium and metabolic.
To achieve the above goal, the following tasks:
· to collect and systematize material on the causes and prevalence of gastric ulcer among the population of the world, the Russian Federation, the Krasnodar Territory;
· to analyze the methods of rehabilitation in the conservative management of patients and operational management of patients with gastric ulcer;
· to develop a rehabilitation questionnaire for specific patients with gastric ulcer and to analyze the effectiveness of the stationary stage of rehabilitation;
justify full program rehabilitation of patients with gastric ulcer at the sanatorium-resort and outpatient stages of patient recovery and bring it to the attention of the patient and his family in order to improve the quality of life;
· substantiate the role of nursing in ensuring effective rehabilitation of patients with gastric ulcer.
To solve the tasks in the process of testing the hypothesis, the following were used: methods:
subjective method of clinical examination of the patient;
objective methods of examination of the patient;
comparison method;
The inductive method
deductive method.
Research base: GBUZ KKB No. 1 named after. prof. S. V. Ochapovsky, Krasnodar, gastroenterological department.
The first chapter deals with: etiology, classification, diagnosis, clinical picture of gastric ulcer.
The second chapter presents methods of rehabilitation of patients with gastric ulcer.
To create the third, practical chapter, we considered two patients with a diagnosis of "gastric ulcer". An analysis of the application of rehabilitation methods in practice was also carried out here.
Conclusions on the practical part:
A study conducted in the gastroenterological department of GBUZ KKB No. 1 named after. prof. S. V. Ochapovsky, Krasnodar, made it possible to identify complications of gastric ulcer, to consider the tactics of a nurse when they occur.
The role of medical personnel in the conduct of complex rehabilitation of patients cannot be underestimated, since without the participation of nurses in it, it would not be possible, and the treatment of patients is incomplete. The reason for the importance of the role of nurses is a wide range of official duties assigned to them, the execution of which by doctors without the help of nursing staff would be physically impossible. These results will help to improve the organization of work of medical staff in the prevention of gastric ulcer.
Practical significance work determined by the fact that the results of the study can be put into practice in the work of a nurse and will improve the quality of nursing care and prevention of gastric ulcer.
Gastric ulcer is an important problem of modern medicine. This disease affects approximately 10% of the world's population. It occurs in people of any age, but more often at the age of 30-40 years; men get sick 6-7 times more often than women.
In Russia, there are about 3 million people on dispensary records. According to the reports of the Ministry of Health of the Russian Federation, in recent years the proportion of patients with newly diagnosed peptic ulcer in Russia has increased from 18% to 26%.
The urgency of the problem of peptic ulcer is determined by the fact that it is the main cause of disability for 68% of men and 30.9% of women from all those suffering from diseases of the digestive system. This disease causes suffering to many patients, so we believe that all medical workers should carry out a wide range of preventive measures to prevent and reduce the incidence. In our time, insufficient attention is paid to the treatment and rational recovery in the rehabilitation of this pathology. The preventive stage of rehabilitation by the population is not well known. Many people do not know the risk factors for peptic ulcer disease, they cannot recognize the first signs of the disease in themselves, therefore, they do not apply for medical care, cannot avoid complications and provide first aid for gastrointestinal bleeding.
aim this study is to study the role of nursing staff in improving the efficiency of rehabilitation of patients with GU at various stages - preventive, inpatient, outpatient sanatorium and metabolic.
Before writing the work to achieve the above goal, the following tasks were formulated:
· Collect and systematize material on the causes and prevalence of gastric ulcer among the population of the world, the Russian Federation, the Krasnodar Territory;
· To analyze the methods of rehabilitation in the conservative management of patients and operational management of patients with gastric ulcer;
· Develop a rehabilitation questionnaire for specific patients with gastric ulcer and analyze the effectiveness of the inpatient phase of rehabilitation;
· Substantiate the full program of rehabilitation of patients with gastric ulcer at the sanatorium-resort and outpatient stages of patient recovery and bring it to the attention of the patient and his family in order to improve the quality of life;
· Substantiate the role of nursing in ensuring effective rehabilitation of patients with gastric ulcer.
Research area: nursing process at various stages of rehabilitation of patients with gastric ulcer.
The object of this study is the methods of rehabilitation in case of gastric ulcer.
Subject of study: patients with gastric ulcer, medical history of a hospital patient, the results of a survey of patients with gastric ulcer.
Research hypothesis: the nursing process at various stages of rehabilitation can increase the period of remission and improve the quality of life of patients with gastric ulcer.
When writing the work, the following methods were used: subjective method of clinical examination of the patient, objective methods of examination of the patient, comparison method, inductive and deductive methods.
In the process of writing the work, the works of such well-known Russian and foreign scientists as N. V. Kharchenko, A. Yu. Baranovsky, P.
І. Ulcerative disease stomach
1.1 Ulcerative disease stomach. Etiology. Clinical painting diseases
Peptic ulcer of the stomach is a chronic relapsing disease that develops in violation of the functional state of the stomach.
Over the course of a lifetime, an average of 10% of the world's inhabitants are at risk of developing a stomach ulcer. Globally, about 250,000 people died from peptic ulcer in 2013, which is significantly lower than in 1993, when 320,000 people died from the same cause. The development of peptic ulcer is promoted by hereditary predisposition, violation of the regimen and nature of nutrition, neuropsychic factors, bad habits (smoking, alcohol, excessive coffee consumption), the action of a number of drugs (corticosteroids, reserpine, non-steroidal anti-inflammatory drugs, etc.) can cause ulceration of the mucous membrane membranes of the stomach.
In 1984, Australian researchers B. Marshall and J. Warren discovered a new bacterium, which was later renamed Helicobacter pylori (HP). HP has been shown to damage the gastric mucosa and is an etiological factor in the development of active antral gastritis. This HP-induced gastritis contributes to the development of peptic ulcers in people who are genetically predisposed to this disease.
Peptic ulcer occurs much more often in a number of diseases of the internal organs. These diseases include chronic diseases of the liver, pancreas, biliary tract.
From a modern point of view, the pathogenesis of peptic ulcer appears to be the result of an imbalance between the factors of aggression of gastric juice and protection of the gastric mucosa.
Aggressive factors include hydrochloric acid, pepsin, violation of evacuation.
The modern classification of gastric ulcer is based on the results of endoscopic and histological studies mucous membrane of the esophagogastroduodenal system in different phases of the development of the disease. This classification reflects the clinical and anatomical parameters of the disease: developmental phase, morphological substrate, course and complications.
Classification:
precordial ulcer
ulcer of the subcardial region;
Prepyloric ulcer.
By stages:
pre-ulcerative condition (gastritis B);
exacerbation;
fading exacerbation;
remission.
By acidity:
with increased;
normal;
reduced;
with achlorhydria.
By age:
youthful;
old age.
For complications:
bleeding
· perforation;
· stenosis;
· malignancy;
penetration.
Clinical picture of the disease Symptoms: Pain in the epigastric region. With ulcers of the cardiac region and the posterior wall of the stomach, it appears immediately after a meal, is localized behind the sternum, and can radiate to the left shoulder. With ulcers of lesser curvature, pain occurs after 15-60 minutes. after meal. dyspepsia. Belching with air (the severity and violation of belching with air is characteristic of a stomach ulcer, and rotten is a sign of stenosis). Nausea is characteristic of antral ulcers. Vomiting - with functional or organic pyloric stenosis.
There are changes in the Central nervous system (Asthenovegetative syndrome):
poor sleep;
· irritability;
Emotional lability.
There are the following diagnostic methods:
Laboratory diagnostic methods
1. Clinical blood test can detect hypochromic anemia, erythrocytosis, slow erythrocyte sedimentation rate (ESR).
2. Feces for the Gregersen reaction can confirm ulcer bleeding.
Instrumental research methods
1. Fibrogastroscopy (FGS). Reveals the pathology of the mucous membrane of the upper digestive tract, inaccessible to the X-ray method. Maybe local treatment ulcer defect. Control of mucosal regeneration or scar formation.
2. Acidotest (probeless method). Study of the acid-forming function of the stomach. Assessed on an empty stomach and with various acid-forming functions. Tablets (test) are given to the patient per os - they interact with hydrochloric acid, change, are excreted in the urine. The concentration during isolation can indirectly judge the amount of hydrochloric acid. The method is not entirely reliable and is used when it is impossible to use sounding.
3. Leporsky method (probe method). The volume on an empty stomach is estimated (normally 20 - 40 ml and the qualitative composition of the fasting portion: 20 - 30 mmol / l - the norm of total acidity, up to 15 - free acidity). Then stimulation is carried out: cabbage broth, caffeine, alcohol solution, (5%) meat broth. Breakfast volume 200 ml, after 25 minutes. the volume of gastric contents (residue) is studied - normally 60 - 80 ml, free 20 - 40 - the norm. The type of secretion is assessed. Parenteral stimulation with histamine or pentagastrin.
4. PH-metry - measurement of acidity directly in the stomach using a probe with sensors: ph is measured on an empty stomach in the body and antrum (6-7 is normal in the antrum, 4-7 after the introduction of histamine).
5. Evaluation of the proteolytic function of gastric juice. Examine with the immersion of the probe inside the stomach, and it contains the substrate. A day later, the probe is removed and the changes are studied.
6. X-ray examination The role of a nurse in rehabilitation is complex and multifaceted:
1. Identify the patient's problems and solve them competently;
2. Prepare the patient for laboratory and instrumental studies as prescribed by the doctor;
3. Follow the doctor's prescriptions for the treatment and prevention of peptic ulcer (while knowing the effect and side effects medicines prescribed by a doctor);
4. Know the signs of emergency conditions in this pathology: bleeding, perforation and provide first aid in these conditions;
5. Carry out symptomatic care (with vomiting, nausea, etc.);
6. Be able to conduct a conversation with the patient about the prevention of exacerbations;
7. Work with the population to prevent the disease (inform about the causes and contributing factors in the development of peptic ulcer).
1.2 Complications And role nursing personnel at them occurrence
Complications of peptic ulcer:
1. Gastrointestinal bleeding is the most frequent and serious complication, it occurs in 15-20% of patients and is the cause of almost half of all deaths in this disease. It occurs predominantly in young men.
Minor bleeding is more common, massive bleeding is less common. Sometimes sudden massive bleeding is the first manifestation of the disease. Bleeding occurs as a result of vessel erosion in the ulcer, venous stasis, or venous thrombosis. Its reason may be various violations hemostasis. In this case, a certain role is assigned to gastric juice, which has anticoagulant properties. The higher the acidity of the juice and the activity of pepsin, the less pronounced the coagulation properties of the blood.
Symptoms - depends on the amount of blood loss. Minor bleeding is characterized by pale skin, dizziness, weakness. With severe bleeding, melena (tarry stools), single or repeated vomiting of the color of “coffee grounds” are noted.
1. Information that allows a nurse to suspect gastrointestinal bleeding:
1.1. Nausea, vomiting, black stools, weakness, dizziness.
1.2 The skin is pale, moist, vomit is the color of "coffee grounds", the pulse is weak, a decrease in blood pressure is possible.
Nurse tactics for bleeding:
1. Call a doctor.
2. Calm and lay the patient, turn his head to the side to relieve emotional and psychological stress
3. Put an ice pack on the epigastric region to reduce bleeding.
5. Measure your heart rate and arterial pressure, to implement status control.
Prepare medicines, equipment, tools:
aminocaproic acid;
dicynone (etamsylate);
· calcium chloride, gelatinol;
polyglucin, haemodnesis;
system for intravenous infusion, syringes, tourniquet;
Everything you need to determine the blood type, Rh factor;
The assessment of what has been achieved is:
cessation of vomiting
stabilization of blood pressure and heart rate.
2. Perforation of an ulcer is one of the most severe and dangerous complications. Occurs in 7% of cases. Perforation and abdominal cavity are more often noted. In 20% of patients with ulcers of the posterior wall of the stomach of the intestine, “covered” perforations are observed, due to the rapid development of fibrous inflammation and the covering of the perforation by the lesser omentum, the left lobe of the liver or the pancreas.
It is clinically manifested by a sudden sharp (dagger) pain in the upper abdomen. The suddenness and intensity of the pains are not so pronounced under any other condition. The patient takes a forced position with knees pulled up to the stomach, trying not to move. On palpation, there is a pronounced tension in the muscles of the anterior abdominal wall. In the first hours after perforation, patients develop vomiting, which later becomes multiple with the development of diffuse peritonitis.
Bradycardia is replaced by tachycardia, the pulse is weak filling. Fever appears. Leukocytosis, erythrocyte sedimentation rate (ESR) increased. On x-ray, gas is detected in the abdominal cavity under the diaphragm.
3. Penetration of the ulcer - characterized by the penetration of the ulcer into the organs in contact with the stomach: the liver, pancreas, lesser omentum.
Clinical picture: in the acute period, it resembles perforation, but the pain is less intense. Soon, signs of damage to the organ into which the penetration occurred (girdle pain and vomiting with damage to the pancreas, pain in the right hypochondrium with irradiation to the right shoulder and back during penetration of the liver, etc.) join. In some cases, penetration occurs gradually. When making a diagnosis, it is necessary to take into account the presence of a constant pain syndrome, leukocytosis, subfebrile condition, etc.
4. Pyloric stenosis or pyloric stenosis - the essence of this complication lies in the fact that the ulcer in the narrow outlet part of the stomach (pylorus) heals with a scar, this area narrows and food passes through it with great difficulty. The stomach cavity expands, food stagnates, fermentation and increased gas formation occur. The stomach is stretched to such an extent that the upper abdomen is noticeably enlarged. In the vomit, the remnants of food eaten the day before are visible. Due to insufficient digestion of food and incomplete absorption, a general exhaustion of the body occurs, a person loses weight, weakens, the skin becomes dry, which is one of the signs of dehydration. The patient is depressed, loses his ability to work.
5. Malignant transformation of the ulcer (malignancy) - observed almost exclusively in the localization of the ulcer in the stomach. With malignancy of the ulcer, pain becomes constant, loses connection with food intake, appetite decreases, exhaustion increases, nausea, vomiting, subfibrile temperature are noted.
Anemia - accelerated erythrocyte sedimentation rate (ESR), persistently positive benzidone test (Gregersen test). Treatment: complications of peptic ulcer: perforation, bleeding, penetration, degeneration into cancer and cicatricial deformity of the stomach (pyloric stenosis) are subject to surgical treatment. Only uncomplicated ulcers are subject to conservative treatment.
6. Stomach cancer is the most common form malignant neoplasms in a person. This provision also applies to the elderly. Precancerous diseases play a very important role in the development of stomach cancer. These include gastric polyps, stomach ulcers, chronic atrophic gastritis. Hereditary predisposition also matters.
The role of the nurse in complications of gastric ulcer:
Provide psychological support to the patient and his family;
Compensate for the lack of positive information of the patient and his relatives on the disease;
Carry out doctor's orders;
Provide medical first aid in case of emergency (bleeding, perforation);
Give sound advice on diet and regimen motor activity;
Provide care in case of problems.
1.4 Statistical analysis occurrence ulcerative disease stomach in world, Russian Federations And Krasnodar edge
At the heart of the appearance of gastric ulcer and the occurrence of relapses, three factors are considered:
1. Genetic predisposition;
2. Disbalance between the factors of aggression and defense;
3. The presence of Helicobacter Pylori (HP).
Peptic ulcer disease had a huge impact on mortality until the end of the 20th century.
In Western countries, the proportion of patients with peptic ulcer due to HP, roughly speaking, corresponds to age (for example, 20% at the age of 20, 30% at the age of 30, etc.). The proportion of cases due to Helicobacter Pillory in third world countries is estimated at 70%, while in developed countries it does not exceed 40%. In general, Helicobacter Pillory shows a decreasing trend, in more in developed countries. Helicobacter Pillory is transmitted through food, natural water sources and eating utensils.
In the United States, about 4 million people have peptic ulcers, and 350,000 people get sick each year.
In the Russian Federation, since 2000, there has been an increase in the incidence of diseases of the digestive system from 4,698,000 people to 4,982,000 people in 2012, the growth was 6%, so the growth is within the normal range. The incidence reached its highest level of 5,149,000 in 2002, the lowest level could be observed in 2000.
Attention should be paid to the increase in general morbidity (by 10.8%) and primary morbidity (by 9.2%) in the adult population in 2012 compared to 2011 (total morbidity was 83.22 in 2011 and 92, 22 - in 2012 per 1000 population of the corresponding age, primary - 25.2 and 27.5 in 2011 and 2012, respectively) in the Krasnodar Territory. In 2012, there was an increase in the overall incidence of gastritis (by 2.7%), while at the same time there was a decrease in the overall incidence of gastric ulcer (by 7.1%). The increase in mortality from gastric ulcers (by 16.2%) is associated with the aging of the population and an increase in the number of patients with severe comorbidities who are forced to take non-steroidal anti-inflammatory drugs and antiplatelet agents for a long time. A decrease in mortality rates from complicated gastroenterological diseases can only be achieved with a wider introduction of minimally invasive surgical technologies. An important area of preventive work in the region is the implementation of measures to promote a healthy lifestyle.
Conclusion: The role of a nurse in the prevention of gastric ulcer is difficult to overestimate. Many cases of peptic ulcers can be prevented when nurses assist physicians in their outreach to the public. An example of such assistance is assistance to gastroenterologists of the region in organizing schools for patients with peptic ulcer, round tables and lectures for patients, appear on television and radio with talks about a healthy lifestyle. Peptic ulcer of the stomach is, at present, one of the most common pathologies among patients. In 2012, as a result of additional medical examination, 35,369 such patients were identified and taken for dispensary registration.
II. Methods rehabilitation patients sick ulcerative sickness stomach
2.1 General methods rehabilitation
According to the WHO definition, rehabilitation is the combined and coordinated application of social, medical, pedagogical and professional activities with the aim of preparing and retraining the individual to achieve optimal working capacity.
Rehabilitation tasks:
1. Improve the overall reactivity of the body;
2. Normalize the state of the central and autonomic systems;
3. Provide analgesic, anti-inflammatory, trophic effect on the body;
4. Maximize the period of remission of the disease.
Comprehensive medical rehabilitation is carried out in the system of hospital, sanatorium, dispensary and polyclinic stages. An important condition for the successful functioning of a staged rehabilitation system is the early start of rehabilitation measures, the continuity of the stages, provided by the continuity of information, the unity of understanding the pathogenetic essence of pathological processes and the foundations of their pathogenetic therapy. The sequence of stages can be different depending on the course of the disease.
An objective assessment of the results of rehabilitation is very important. It is necessary for the current correction of rehabilitation programs, prevention and overcoming of undesirable problems. adverse reactions, the final assessment of the effect when moving to a new stage.
Thus, considering medical rehabilitation as a set of measures aimed at eliminating changes in the body that lead to a disease or contribute to its development, and taking into account the knowledge gained about pathogenetic disorders in asymptomatic periods of the disease, there are 5 stages of medical rehabilitation.
The preventive stage aims to prevent the development of clinical manifestations of the disease by correcting metabolic disorders (Appendix B).
The activities of this stage have two main directions: elimination of the identified metabolic and immune disorders by dietary correction, the use of mineral waters, pectins of marine and terrestrial plants, natural and reshaped physical factors; the fight against risk factors that can largely provoke the progression of metabolic disorders and the development of clinical manifestations of the disease. You can count on the effectiveness of preventive rehabilitation only if you reinforce the measures of the first direction with the optimization of the habitat (improving the microclimate, reducing dust and gas content in the air, leveling the harmful effects of geochemical and biogenic nature, etc.), combating hypodynamia, overweight, smoking, and others. bad habits.
Stationary stage of medical rehabilitation, except for the first important task:
1. Saving the patient's life (provides for measures to ensure minimal tissue death as a result of exposure to a pathogenic agent);
2. Prevention of disease complications;
3. Ensuring the optimal course of reparative processes (Appendix D).
This is achieved by replenishing with a deficit in the volume of circulating blood, normalizing microcirculation, preventing tissue swelling, conducting detoxification, antihypoxant and antioxidant therapy, normalizing electrolyte disturbances, using anabolics and adaptogens, and physiotherapy. With microbial aggression, antibiotic therapy is prescribed, immunocorrection is carried out.
The polyclinic stage of medical rehabilitation should ensure the completion pathological process(Appendix D).
To this end, therapeutic measures are being taken to eliminate residual effects intoxication, microcirculation disorders, restoration of the functional activity of body systems. During this period, it is necessary to continue therapy to ensure the optimal course of the restitution process (anabolic agents, adaptogens, vitamins, physiotherapy) and develop the principles of dietary correction, depending on the characteristics of the course of the disease. An important role at this stage is played by purposeful physical culture in the mode of increasing intensity.
The sanatorium-and-spa stage of medical rehabilitation completes the stage of incomplete clinical remission (Appendix G). Therapeutic measures should be aimed at preventing the recurrence of the disease, as well as its progression. To implement these tasks, predominantly natural therapeutic factors are used to normalize microcirculation, increase cardiorespiratory reserves, stabilize the functioning of the nervous, endocrine and immune systems, organs of the gastrointestinal tract and urinary tract.
The metabolic stage includes conditions for the normalization of structural and metabolic disorders that existed after completion clinical stage(Appendix E).
This is achieved with the help of long-term dietary correction, the use of mineral waters, pectins, climatotherapy, therapeutic physical culture, and balneotherapy courses.
The results of the implementation of the principles of the proposed scheme of medical rehabilitation by the authors are predicted to be more effective than the traditional one:
Identification of the stage of preventive rehabilitation makes it possible to form risk groups and develop preventive programs;
Isolation of the stage of metabolic remission and the implementation of measures at this stage will make it possible to reduce the number of relapses, prevent the progression and chronicity of the pathological process;
Staged medical rehabilitation with the inclusion of independent stages of preventive and metabolic remission will reduce the incidence and improve the health of the population.
Directions of medical rehabilitation include drug and non-drug directions:
Medical direction of rehabilitation.
Drug therapy in rehabilitation is prescribed taking into account the nosological form and the state of the secretory function of the stomach.
Advice for Patients on Taking Medicinal Substances Taking Before Meals Most medications are taken 30 to 40 minutes before meals, when they are best absorbed. Sometimes - 15 minutes before a meal, not earlier.
Half an hour before meals, you should take antiulcer drugs - d-nol, gastrofarm. They should be taken with water (not milk).
Also, half an hour before meals, you should take antacids (almagel, phosphalugel, etc.) and choleretic agents.
Reception during meals During meals, the acidity of gastric juice is very high, and therefore significantly affects the stability of drugs and their absorption into the blood. In an acidic environment, the effect of erythromycin, lincomycin hydrochloride and other antibiotics is partially reduced.
Gastric juice preparations or digestive enzymes should be taken with food, as they help the stomach digest food. These include pepsin, festal, enzistal, panzinorm.
Along with food, it is advisable to take laxatives to be digested. These are senna, buckthorn bark, rhubarb root and joster fruits.
Taking after a meal If the medicine is prescribed after a meal, wait at least two hours to obtain the best therapeutic effect.
Immediately after eating, they take mainly drugs that irritate the mucous membrane of the stomach and intestines. This recommendation applies to drug groups such as:
* painkillers (non-steroidal) anti-inflammatory drugs - Butadion, aspirin, aspirin cardio, voltaren, ibuprofen, askofen, citramon (only after meals);
* funds, acute are components of bile - allochol, lyobil, etc.); taking after meals is a prerequisite for these drugs to “work”.
There are so-called anti-acid drugs, the intake of which should be timed to coincide with the moment when the stomach is empty, and hydrochloric acid continues to be released, that is, an hour or two after the end of the meal - magnesium oxide, vikalin, vikair.
Aspirin or askofen (aspirin with caffeine) is taken after a meal, when the stomach has already begun to produce hydrochloric acid. Due to this, the acidic properties will be suppressed. acetylsalicylic acid(provoking irritation of the gastric mucosa). This should be remembered by those who take these pills for headaches or colds.
Regardless of the meal Regardless of when you sit down at the table, take:
Antibiotics are usually taken regardless of food, but dairy products must also be present in your diet. Along with antibiotics, nystatin is also taken, and at the end of the course, complex vitamins (for example, supradin).
Antacids (gastal, almagel, maalox, talcid, relzer, phosphalugel) and antidiarrheals (imodium, intetrix, smecta, neointestopan) - half an hour before meals or one and a half to two hours after. At the same time, keep in mind that antacids taken on an empty stomach last about half an hour, and taken 1 hour after eating - for 3-4 hours.
Taking on an empty stomach Taking the medicine on an empty stomach is usually in the morning 20 to 40 minutes before breakfast.
Medicines taken on an empty stomach are absorbed and absorbed much faster. Otherwise, acidic gastric juice will have a destructive effect on them, and there will be little use from medicines.
Patients often ignore the recommendations of doctors and pharmacists, forgetting to take a pill prescribed before meals, and transferring it to the afternoon. If the rules are not followed, the effectiveness of drugs inevitably decreases. To the greatest extent, if, contrary to the instructions, the drug is taken during meals or immediately after it. This changes the rate of passage of drugs through the digestive tract and the rate of their absorption into the blood.
Some drugs may break down into their component parts. For example, penicillin is destroyed in an acidic gastric environment. Breaks down into salicylic and acetic acid aspirin (acetylsalicylic acid).
Reception 2 - 3 times a day if the instructions indicate "three times a day", this does not mean breakfast - lunch - dinner at all. The medicine must be taken every eight hours so that its concentration in the blood is evenly maintained. It is better to drink the medicine with plain boiled water. Tea and juices are not the best remedy.
If it is necessary to resort to cleansing the body (for example, in case of poisoning, alcohol intoxication), sorbents are usually used: activated carbon, polyphepan or enterosgel. They collect toxins "on themselves" and remove them through the intestines. They should be taken twice a day between meals. At the same time, fluid intake should be increased. It is good to add herbs with a diuretic effect to the drink.
Day or night Sleep medications should be taken 30 minutes before bedtime.
Laxatives - bisacodyl, senade, glaxena, regulax, gutalax, forlax - are usually taken at bedtime and half an hour before breakfast.
Ulcer remedies are taken early in the morning and late in the evening to prevent hunger pains.
After the introduction of the candle, you need to lie down, so they are prescribed for the night.
Facilities emergency assistance take regardless of the time of day - if the temperature rises or colic begins. In such cases, adherence to the schedule is not important.
The key role of the ward nurse is the timely and accurate delivery of medicines to patients in accordance with the prescriptions of the attending physician, informing the patient about medicines, and monitoring their intake.
Among the non-drug methods of rehabilitation are the following:
1. Diet correction:
The diet for gastric ulcer is used as prescribed by the doctor sequentially, with surgical intervention it is recommended to start with a diet - 0.
Purpose: Maximum sparing of the mucous membrane of the esophagus, stomach - protection from mechanical, chemical, thermal factors of food damage. Providing an anti-inflammatory effect and preventing the progression of the process, preventing fermentation disorders in the intestines.
characteristics of the diet. This diet provides a minimum amount of food. Since it is difficult to take it in a dense form, food consists of liquid and jelly-like dishes. The number of meals is at least 6 times a day, if necessary - around the clock every 2-2.5 hours.
Chemical composition and calorie content. Proteins 15 g, fats 15 g, carbohydrates 200 g, calories - about 1000 kcal. Table salt 5 g. The total weight of the diet is not more than 2 kg. Food temperature is normal.
Approximate set Fruit juices - apple, plum, apricot, cherry. Berry juices - strawberry, raspberry, blackcurrant. Broths - weak from low-fat varieties of meat (beef, veal, chicken, rabbit) and fish (perch, bream, carp, etc.).
Cereal broths - rice, oatmeal, buckwheat, corn flakes.
Kissels from various fruits, berries, their juices, from dried fruits (with the addition of a small amount of starch).
Butter.
Tea (weak) with milk or cream.
Approximate one-day diet menu No. 0
8 hours - fruit and berry juice.
10 o'clock - tea with milk or cream with sugar.
12 hours - fruit or berry jelly.
14 hours - a weak broth with butter.
4 p.m. - lemon jelly.
6 p.m. - rosehip decoction.
20:00 - tea with milk and sugar.
22 hours - rice water with cream.
Diet No. 0A
Her are prescribed, as a rule, for 2-3 days. Food consists of liquid and jelly-like dishes. In the diet 5 g of protein, 15-20 g of fat, 150 g of carbohydrates, the energy value 3.1-3.3 MJ (750-800 kcal); table salt 1 g, free liquid 1.8-2.2 liters. The food temperature is not higher than 45 °C. Up to 200 g of vitamin C is introduced into the diet; other vitamins are added as prescribed by the doctor. Eating 7-8 times a day, for 1 meal they give no more than 200-300 g.
Permitted: low-fat meat broth, rice broth with cream or butter, strained compote, liquid berry jelly, rosehip broth with sugar, fruit jelly, tea with lemon and sugar, freshly prepared fruit and berry juices diluted 2-3 times sweet water (up to 50 ml per reception). When the condition improves on the 3rd day, add: soft-boiled egg, 10 g of butter, 50 ml of cream.
Excluded: any dense and puree-like dishes, whole milk and cream, sour cream, grape and vegetable juices, carbonated drinks.
Diet No. 0B (No. 1A surgical)
Her prescribed for 2-4 days after diet No. 0-a, from which diet No. 0-b differs in addition in the form of liquid pureed cereals from rice, buckwheat, oatmeal, boiled in meat broth or water. In the diet 40-50 g of protein, 40-50 g of fat, 250 g of carbohydrates, energy value 6.5 - 6.9 MJ (1550-1650 kcal); 4-5 g sodium chloride, up to 2 liters of free liquid. Food is given 6 times a day, no more than 350-400 g per reception.
Diet No. 0 V (No. 1B surgical)
She serves as a continuation of the expansion of the diet and the transition to a physiologically complete diet. The diet includes cream soups and soups, steam dishes from mashed boiled meat, chicken or fish, fresh cottage cheese, mashed with cream or milk to the consistency of thick sour cream, steam dishes from cottage cheese, sour-milk drinks, baked apples, well-mashed fruit and vegetable purees, up to 100 g of white crackers. Milk is added to tea; give milk porridge. In a diet of 80 - 90 g of protein, 65-70 g of fat, 320 - 350 g of carbohydrates, energy value 9.2-9.6 MJ (2200-2300 kcal); sodium chloride 6-7 g. Food is given 6 times a day. The temperature of hot dishes is not higher than 50 °C, cold - not less than 20 °C.
Then there is an expansion of the diet.
Diet No. 1a Indications for diet No. 1a This diet is recommended for maximum limitation of mechanical, chemical and thermal aggression on the stomach. This diet is prescribed for exacerbation of peptic ulcer, bleeding, acute gastritis and other diseases that require maximum sparing of the stomach.
Purpose of diet No. 1a Reducing the reflex excitability of the stomach, reducing interoceptive irritations emanating from the affected organ, restoring the mucous membrane by sparing the function of the stomach as much as possible.
general characteristics diet No. 1a Exclusion of substances that are strong causative agents of secretion, as well as mechanical, chemical and thermal irritants. Food is cooked only in liquid and mushy form. Steamed, boiled, pureed, pureed dishes in a liquid or mushy consistency. In Diet No. 1a for patients who have undergone cholecystectomy, only mucous soups, eggs in the form of steam protein omelettes are used. Caloric content is reduced mainly due to carbohydrates. The amount of food taken at a time is limited, the frequency of intake is at least 6 times.
The chemical composition of diet No. 1a Diet No. 1a is characterized by a decrease in the content of proteins and fats to the lower limit physiological norm, strict limitation of the impact of various chemical and mechanical irritants on the upper gastrointestinal tract. With this diet, carbohydrates and salt are also limited.
Proteins 80 g, fats 80 - 90 g, carbohydrates 200 g, table salt 16 g, calories 1800 - 1900 kcal; retinol 2 mg, thiamine 4 mg, riboflavin 4 mg, nicotinic acid 30 mg, ascorbic acid 100 mg; calcium 0.8 g, phosphorus 1.6 g, magnesium 0.5 g, iron 0.015 g. The temperature of hot dishes is not higher than 50 - 55 ° C, cold - not lower than 15 - 20 ° C.
· Mucous soups from semolina, oatmeal, rice, pearl barley with the addition of egg-milk mixture, cream, butter.
· Meat and poultry dishes in the form of mashed potatoes or steam soufflé (meat cleaned from tendons, fascia and skin is passed through a meat grinder 2-3 times).
· Dishes from fish in the form of a steam soufflé from low-fat varieties.
Dairy products - milk, cream, steamed soufflé from freshly grated cottage cheese; fermented milk drinks, cheese, sour cream, ordinary cottage cheese are excluded. Whole milk with good tolerance is drunk up to 2-4 times a day.
· Soft-boiled eggs or in the form of a steam omelet, no more than 2 per day.
Dishes from cereals in the form of liquid porridge in milk, porridge from cereal (buckwheat, oatmeal) flour with the addition of milk or cream. You can use almost all cereals, with the exception of barley and millet. Butter is added to the finished porridge.
Sweet dishes - kissels and jelly from sweet berries and fruits, sugar, honey. You can also make juices from berries and fruits, diluting them with boiled water in a 1: 1 ratio before drinking.
· Fats - fresh butter and vegetable oil added to dishes.
Drinks: weak tea with milk or cream, juices from fresh berries, fruit diluted with water. Of the drinks, decoctions of wild rose and wheat bran are especially useful.
Excluded foods and dishes of diet No. 1a Bread and bakery products; broths; fried foods; mushrooms; smoked meats; fatty and spicy dishes; vegetable dishes; various snacks; coffee, cocoa, strong tea; vegetable juices, concentrated fruit juices; fermented milk and carbonated drinks; sauces (ketchup, vinegar, mayonnaise) and spices.
Diet No. 1b Indications for diet No. 1b Indications and purpose as for diet No. 1a. The diet is fractional (6 times a day). This table is for less sharp, in comparison with table No. 1a, limitation of mechanical, chemical and thermal aggression on the stomach. This diet is indicated for mild exacerbation of gastric ulcer, in the stage of remission of this process, with chronic gastritis.
Diet No. 1b is prescribed at subsequent stages of treatment with the patient remaining in bed. The timing of diet No. 1b is very individual, but on average they range from 10 to 30 days. Diet No. 1b is also used subject to bed rest. The difference from diet No. 1a lies in the gradual increase in the content of essential nutrients and the calorie content of the diet.
Bread is allowed in the form of dried (but not toasted) crackers (75 - 100 g). Pureed soups are introduced, replacing mucous membranes; milk porridge can be consumed more often. Homogenized preserves are allowed for baby food from vegetables and fruits and dishes from beaten eggs. All recommended products and dishes from meat and fish are given in the form of steam soufflé, quenelles, mashed potatoes, cutlets. After the products are boiled to softness, they are rubbed to a mushy state. Food must be warm. The rest of the recommendations are the same as for diet No. 1a.
The chemical composition of diet No. 1b Proteins up to 100 g, fats up to 100 g (30 g vegetable), carbohydrates 300 g, calories 2300 - 2500 kcal, salt 6 g; retinol 2 mg, thiamine 4 mg, riboflavin 4 mg, nicotinic acid 30 mg, ascorbic acid 100 mg; calcium 0.8 g, phosphorus 1.2 g, magnesium 0.5 g, iron 15 mg. The total amount of free liquid is 2 liters. The temperature of hot dishes is up to 55 - 60 ° C, cold - not lower than 15 - 20 ° C.
The role of the nurse in diet correction The dietitian monitors the work of the catering unit and compliance with the sanitary and hygienic regime, monitors the implementation of dietary recommendations when the doctor changes the diet. Checks the quality of products when they arrive at the warehouse and kitchen, controls the correct storage of food stocks. With the participation of the head of production (chef) and under the guidance of a dietitian, draws up a daily menu-layout in accordance with the card file of dishes. Carries out periodic calculation of the chemical composition and calorie content of diets, control of the chemical composition of actually prepared dishes and diets (protein, fat, carbohydrates, vitamins, minerals, energy value, etc.) by selectively sending individual dishes to the laboratory of the State Sanitary and Epidemiological Supervision Center. Controls the bookmarking of products and the release of dishes from the kitchen to the departments, according to the orders received, carries out the grading of finished products. Carries out control over the sanitary condition of dispensing and canteens at departments, inventory, utensils, as well as the implementation of distributing rules of personal hygiene by employees. Organizes classes with secondary medical workers and nutritional kitchen staff. Carries out control over the timely conduct of preventive medical examinations of catering workers and the exclusion from work of persons who have not passed a preliminary or periodic medical examination.
Diet No. 1
General intelligence
· Indications to diet number 1
Peptic ulcer of the stomach in the stage of fading exacerbation, during the period of recovery and remission (the duration of dietary treatment is 3-5 months).
The purpose of diet No. 1 is to accelerate the processes of reparation of ulcers and erosions, further reduce or prevent inflammation of the gastric mucosa.
This diet contributes to the normalization of the secretory and motor-evacuation function of the stomach.
Diet No. 1 is designed to meet the physiological needs of the body for nutrients in stationary conditions or on an outpatient basis during work that is not related to physical activity.
General characteristics of diet No. 1
The use of diet No. 1 is aimed at providing moderate sparing of the stomach from mechanical, chemical and thermal aggression with a restriction in the diet of dishes that have a pronounced irritating effect on the walls and receptor apparatus of the upper gastrointestinal tract, as well as indigestible foods. Exclude dishes that are strong causative agents of secretion and chemically irritate the gastric mucosa. Both very hot and very cold dishes are excluded from the diet.
The diet for diet No. 1 is fractional, up to 6 times a day, in small portions. It is necessary that the break between meals should not be more than 4 hours, a light dinner is allowed an hour before bedtime. At night, you can drink a glass of milk or cream. Food is recommended to chew thoroughly.
· The food is liquid, mushy and denser in boiled and mostly pureed form. Since the consistency of food is very important in dietary nutrition, they reduce the amount of foods rich in fiber (such as turnips, radishes, radishes, asparagus, beans, peas), fruits with skins and unripe berries with rough skins (such as gooseberries, currants, grapes). , dates), bread made from wholemeal flour, products containing coarse connective tissue (such as cartilage, poultry and fish skin, sinewy meat).
Dishes are cooked boiled or steamed. After that, they are crushed to a mushy state. Fish and coarse meats can be eaten whole. Some dishes can be baked, but without a crust.
The chemical composition of diet No. 1
Proteins 100 g (of which 60% of animal origin), fats 90 - 100 g (30% vegetable), carbohydrates 400 g, table salt 6 g, calories 2800 - 2900 kcal, ascorbic acid 100 mg, retinol 2 mg, thiamine 4 mg , riboflavin 4 mg, nicotinic acid 30 mg; calcium 0.8 g, phosphorus at least 1.6 g, magnesium 0.5 g, iron 15 mg. The total amount of free fluid is 1.5 liters, food temperature is normal. Salt is recommended to be limited.
· Wheat bread from the highest grade flour of yesterday's baking or dried; rye bread and any fresh bread, pastry and puff pastry products are excluded.
· Soups on vegetable broth from mashed and well-boiled cereals, dairy, vegetable puree soups seasoned with butter, egg-milk mixture, cream; meat and fish broths, mushroom and strong vegetable broths, cabbage soup, borscht, okroshka are excluded.
· Meat dishes - steamed and boiled beef, young low-fat lamb, trimmed pork, chickens, turkeys; fatty and sinewy varieties of meat, poultry, duck, goose, canned meat, smoked meats are excluded.
· Dishes from fish are usually low-fat varieties, without skin, in pieces or in the form of cutlets; cooked with water or steam.
Dairy products - milk, cream, non-acidic kefir, yogurt, cottage cheese in the form of soufflé, lazy dumplings, pudding; dairy products with high acidity are excluded.
· Cereals from semolina, buckwheat, rice, boiled in water, milk, semi-viscous, mashed; millet, barley and barley groats, legumes, pasta are excluded.
Vegetables - potatoes, carrots, beets, cauliflower, boiled in water or steam, in the form of soufflés, mashed potatoes, steam puddings.
· Appetizers - boiled vegetable salad, boiled tongue, doctor's sausage, dairy, dietary, jellied fish on vegetable broth.
· Sweet dishes - fruit puree, kissels, jelly, pureed compotes, sugar, honey.
Drinks - weak tea with milk, cream, sweet juices from fruits and berries.
Fats - butter and refined sunflower oil added to dishes.
Excluded foods and dishes of diet No. 1
Two food groups should be excluded from your diet.
Products that cause or enhance pain. These include: drinks - strong tea, coffee, carbonated drinks; tomatoes, etc.
Products that strongly stimulate the secretion of the stomach and intestines. These include: concentrated meat and fish broths, decoctions of mushrooms; fried foods; meat and fish stewed in own juice; meat, fish, tomato and mushroom sauces; salted or smoked fish and meat products; meat and fish canned food; salted, pickled vegetables and fruits; spices and seasonings (mustard, horseradish).
In addition, the following are excluded: rye and any fresh bread, pastry products; dairy products with high acidity; millet, barley, barley and corn grits, legumes; white cabbage, radish, sorrel, onion, cucumbers; salted, pickled and pickled vegetables, mushrooms; sour and fiber-rich fruits and berries.
It is necessary to focus on the feelings of the patient. If when eating specific product the patient feels discomfort in the epigastric region, and even more so nausea, vomiting, then this product should be discarded.
2. Methods of physiotherapy Balneotherapy (lat. balneum bath, bathing + Greek therapeia treatment) - treatment with mineral waters. It helps the body to endure changes in the external environment, helps to eliminate or reduce functional disorders during illness. Mineral waters are very helpful for patients with various diseases of the stomach and intestines. They are recommended in order to eliminate the inflammatory process in the mucous membrane of the gastrointestinal tract, as well as the elimination of its functional disorders. In addition, drinking a course of mineral waters contributes to the normalization of metabolic processes in the body as a whole and has a positive effect on the functional state of the digestive glands (liver, pancreas), the defeat of which often accompanies chronic lesions of the stomach and intestines.
With gastric ulcer, the choice of mineral water depends on the type of secretory disorders. It should be remembered that more mineralized waters (such as "Essentuki No. 17") have a pronounced property to stimulate the secretory function of the stomach, and less mineralized waters (such as Zheleznovodsk) have a greater inhibitory effect on the secretory activity of the gastric glands. Mineral waters are prescribed 1-1.5 hours before meals.
The severity of the inhibitory or stimulating effect of mineral waters on the secretory ability of the gastric glands also depends on their chemical composition and temperature. Bottled mineral waters should be warmed up before drinking.
Smirnovskaya, Slavyanovskaya, Moskovskaya mineral waters, as well as Borjomi, Jermuk, Istisu, Sairme and others are recommended for patients with preserved and increased secretory function of the stomach. positive influence on the motor function of the stomach. The duration of the course of water treatment is 3-4 weeks.
If gastritis with secretory insufficiency is accompanied by diarrhea, it is advisable to reduce the intake of mineral water to ¼ - ½ cup (water temperature 40 - 44 ° C). After improvement of a condition of the patient it is possible to pass to usual doses.
stimulating effect on secretory activity the stomach has sodium chloride, bicarbonate sodium chloride waters, especially those containing carbon dioxide: "Essentuki No. 4" and "Essentuki No. 17", the waters of Staraya Russa, the resorts of Druskininkai, Morshin, Krainka, Pyatigorsk, the waters of the Kuyalnitsky spring. In addition to anti-inflammatory and stimulating gastric secretion action, mineral waters have the ability to activate the motor activity of the stomach and increase its tone. Courses of treatment with mineral waters for gastritis with reduced secretion last from 3 to 4 weeks.
In the treatment of stomach ulcers, mineral waters such as Essentuki No. 4, Smirnovskaya, Slavyanovskaya, Borjomi, Truskavets are used. Mineral water is heated to 38-40°C, which enhances its healing effect and reduces the content of carbon dioxide. Apply 1.5 hours before meals.
In addition to the drinking application of mineral waters, rectal procedures with their use are highly effective. For such purposes, microclysters from mineral water of 50-100 ml with a temperature of 37 ° C can be used; for a course of treatment - 10-12 procedures. For microclysters, the same mineral waters are used as for drinking treatment.
One of the methods of balneotherapy, in addition to taking mineral waters, are baths.
The most commonly used physiotherapy in the treatment of stomach ulcers are electrosleep and balneotherapy.
One of the varieties of pearl baths are pearl-pine baths. They are a combination of a pearl bath with the healing effect of a coniferous extract dissolved in it. The combined effect of these two factors far exceeds the therapeutic effect of the use of individual pearl and coniferous baths.
To the temperature and mechanical effects, the chemical effect on the body of coniferous extract is also added. In addition, the procedure becomes more pleasant due to the aromatherapy effect, thanks to the pleasant smell of pine needles.
Pearl-pine baths are used to normalize the functioning of the nervous system, to improve blood circulation and microcirculation, to change the sensitivity of receptors and nerve endings. This procedure also has a pronounced soothing, healing and resolving effect.
These baths help initial stages diseases, and are most often used for patients with a strong type of nervous system. With pronounced vegetative-vascular and vasomotor disorders, with increased excitability of the nervous system, pearl-pine baths can cause adverse reactions.
To prepare a bath, you need to dissolve 1 - 2 tablets (or 100 ml of liquid extract) of pine needles in a pearl bath. The water temperature should be 35 - 36 degrees, the duration of the bath - 10 - 15 minutes. The course is 10 - 15 procedures, which are carried out every other day.
Electrosleep is a method of electrotherapy based on the use of pulsed low-frequency currents. They have a direct effect on the central nervous system. This causes its inhibition, leading to sleep. This technique has found wide application in medical institutions of various kinds.
The electrosleep method was developed in 1948 by a group of Soviet scientists: Liventsev, Gilyarevsky, Segal, and others. In Western countries, this technique is called electroanalgesia.
For the procedure, special devices are used. They serve to generate voltage pulses of constant polarity.
Electrosleep for children is usually prescribed from 3 to 5 years. In this case, low frequencies and a current of lesser strength are used. The duration of the session is also shorter.
We can say that in terms of its characteristics, electrosleep is quite close to natural sleep. Its advantages are the provision of antispastic and antihypoxic actions. Electrosleep does not cause a predominance of vagal influences.
It is also very different from drug sleep. It is very important that this procedure does not give complications and does not lead to intoxication.
The impact of electric sleep on humans
Mechanism The impact of this method lies in the direct and reflex effect of current pulses on the cerebral cortex and subcortical formations of the patient.
The impulse current is a weak stimulus. It has a monotonous rhythmic effect. During the procedure, current enters the patient's brain through the holes in the eye sockets. There it spreads along the vessels and reaches such structures of the human brain as the hypothalamus and the reticular formation.
This allows you to cause a special psycho-physiological state, which leads to the restoration of emotional, vegetative and humoral balance.
Electrosleep contributes to the normalization of higher nervous activity, improves the blood supply to the brain, and has a sedative and soporific effect.
This procedure stimulates the process of hematopoiesis in the human body, normalizes blood clotting, activates the function of the gastrointestinal tract, improves the activity of the excretory and reproductive systems. Helps lower blood cholesterol levels.
Electrosleep also leads to the restoration of disturbed carbohydrate, lipid, protein and mineral exchanges. It can be used as an antispasmodic, has a hypotensive effect.
The impact of pulsed current on the human brain leads to the production of special substances - endorphins, which are necessary for a person to feel good and full life. It can be prescribed for almost any type of disease.
The patient lies in a comfortable position on a semi-soft couch or bed. In the hospital, patients undress as if for a night's sleep. In the clinic, the patient should take off the tight clothing and cover with a blanket.
It is best to conduct electrosleep sessions in a special separate room, isolated from noise. The room must be dark. Electrosleep can also be combined with psycho- and music therapy.
Before the start of the first session, the specialist tells the patient about the procedure and warns him about the sensations that may occur during the procedure.
Before the procedure, a special mask with four metal sockets is put on the patient's face. These nests are fixed on rubber bands. The person's eyes must be tightly closed. This is how a pulsed current is applied to the patient.
During the session, the patient falls into a state of drowsiness or even sleep. The procedure is not recommended to be performed on an empty stomach. Women during this period are best to abandon the use of cosmetics.
The pulse frequency is selected individually by a specialist, taking into account the severity of the disease and the general condition of the patient. The usual frequency is 10 - 150 Hz, the current is up to 10 mA, the voltage is 50 - 80 Volts.
The duration of the session can be different - from 30-40 to 60-90 minutes. Most often, the duration of the procedure depends on the nature of the course of the pathological process and on the individual characteristics of the patient's body. To achieve a positive result, the procedures should be carried out daily or every other day. Usually 10-15 sessions are prescribed for the course.
Electrophoresis - medicinal use direct electric current. Under the action of an external electromagnetic field applied to the tissues, a conduction current arises in them. Positively charged particles (cations) move towards the negative pole (cathode), and negatively charged particles (anions) move towards the positively charged pole (anode). Approaching the metal plate of the electrode, the ions restore their outer electron shell (lose their charge) and turn into atoms with high chemical activity (electrolysis).
Therapeutic effects: anti-inflammatory (draining-dehydrating), analgesic, sedative (at the anode), vasodilatory, muscle relaxant, metabolic, secretory (at the cathode).
Contraindications: acute purulent inflammatory processes, skin sensitivity disorders, individual current intolerance, violation of the integrity of the skin at the electrode sites, eczema.
The duration of the procedures carried out every other day depends on the conditions of exposure and does not exceed 30 minutes, the course of treatment is 10-15 procedures. If necessary, a second course is prescribed after 30 days.
UHF - therapy - a method of high-frequency electrotherapy, based on the use of ultra-high-frequency electromagnetic oscillations of the decimeter range, or decimeter waves, for therapeutic, prophylactic and rehabilitation purposes. Decimeter waves have a length of 1 m to 10 cm, which corresponds to an oscillation frequency of 300 to 3000 MHz.
Exposure to decimeter waves is carried out on the naked surface of the patient's body, in the supine or sitting position. All metal objects are removed from the irradiation zone. To influence small areas and the head area, portable devices are used, the emitter is applied without pressure directly to the patient's body (contact technique). With the remote method, the emitters are installed above the irradiated surface with an air gap of 3–5 cm (usually on stationary devices). In case of intraorganic influences, the corresponding emitter with a plastic cap or rubber bag treated with alcohol is introduced into the organ cavity and fixed.
Microwaves are dosed according to the output power and thermal sensations of patients. It is customary to allocate low-thermal, thermal and high-thermal dosages of exposure. Approximately for stationary devices, output power up to 30 - 35 W is considered a low thermal dose, 35 - 65 W thermal, above 65 W - high thermal. For portable devices, this division looks like this: an output power of up to 6 W is considered low-thermal, 6-9 W is thermal, and more than 10 W is high-thermal. Attention is also paid to the condition of the skin in the irradiation zone: with low thermal dosages, the skin color does not change, with thermal dosages, slight hyperemia is noted. During the procedure, a burning sensation in the patient should not be allowed. If there is a burning sensation, the output power should be reduced.
The duration of exposure to microwaves is from 4 - 5 to 10 - 15 minutes on the field. The total duration of UHF-therapy should not exceed 30-35 minutes. After the procedure, it is desirable to rest for 1520 minutes. UHF-therapy is carried out daily or every other day, the course of treatment is prescribed from 3-6 to 12-16, less often - 16-20 procedures. If necessary, after 2-3 months, a second course of UHF-therapy can be carried out.
Inductothermy (lat. Inductio - excitation, guidance + Greek therme heat, warmth), or high-frequency magnetotherapy - a method of electrotherapy, which is based on the impact on the body of a magnetic field (mainly the magnetic component of the electromagnetic field) high frequency (3 - 30 MHz). In frequency, it occupies an intermediate place between diathermy and UHF therapy.
The procedures are carried out on a wooden couch (chair) in a comfortable position for the patient. You can act through light clothing, dry gauze or plaster bandages. There should be no metal objects in the area of influence and on adjacent parts of the body. The inductor is chosen depending on the location and area of impact. Install it with a gap of 1 - 2 cm from the skin surface. When using an inductor-cable, a gap of 1 - 2 cm is created using a thin blanket or terry towel. Resonant cylindrical inductors should be located on the impact area without gaps.
If necessary, inductothermic action on the arm or leg, the cable-inductor is wound around them in the form of a solenoid. In this case, it should be ensured that there is a distance of 1-1.5 cm between the cable and the surface of the body, as well as between the turns of the cable, which is necessary to weaken the electric field that occurs between the cable and the body, as well as between the turns of the cable. If the gap between the cable and the body is less than 1 cm, overheating of the surface tissues may occur.
During the procedure, the patient experiences a feeling of pleasant warmth in the tissues. In accordance with thermal sensations, low-thermal (small), thermal (medium) and high-thermal (large) dosages are distinguished. The duration of exposures carried out daily or every other day is from 15 to 30 minutes. The course of treatment is prescribed from 10 - 15 procedures. If necessary, a second course can be carried out after 8 - 12 weeks. Children use weak and medium dosages, the duration of the procedures is 10-20 minutes daily or every other day, for a course of 8-10 procedures. Inductothermia is prescribed for children from 5 years old.
To enhance the impact on the area of the pathological focus, inductothermy is sometimes combined with drug electrophoresis, including electrophoretic introduction of liquid components of therapeutic mud into the area of the pathological focus, with other effects of low voltage and frequency currents, or with mud applications (mud inductothermy). In case of mud inductothermy, therapeutic mud is applied to the area of the body to be affected, having a temperature of 37 - 39 ° C, covered with oilcloth and a towel or sheet. A tuned circuit or inductor cable is placed on top of the towel, coiled into a spiral in a shape corresponding to the area of influence. If the treatment is carried out for gynecological diseases or prostatitis, then at the same time you can insert a mud swab into the vagina or rectum. The advantage of mud inductothermy over mud therapy is that during the procedure the mud application does not cool down, but additionally heats up by another 2-3 °C, which is well tolerated by patients. In this case, a current of 160-220 mA is used, the duration of the procedure is 10-30 minutes, the course of treatment is 10-20 procedures. With simultaneous exposure to galvanic or other current of low voltage and frequency, hydrophilic pads with a metal electrode are used. The disc applicator is installed above the electrode at a distance of 1–2 cm. When using an inductor cable, the electrodes are covered with oilcloth. First, the inductothermy apparatus is turned on, and 2-3 minutes after the patient has a feeling of pleasant warmth, a low voltage current is turned on. Switching off is done in reverse order. Electrophoresis-inductothermy is prescribed to increase the passage of drug ions into the body and mutually enhance the activity of each of the factors involved - low voltage current, drug ions and interstitial heat. The procedure is carried out in the same way as with galvanoinductothermy, with the only difference that one or both hydrophilic pads, as in conventional electrophoresis, are impregnated with a 1-2% solution of a medicinal substance. In mud-inductophoresis, the therapeutic effect of application and interstitial heat, galvanic or rectified sinusoidal modulated current and some liquid mud components are summed up. The procedure is carried out in the same way as with galvanoinductothermy, however, instead of hydrophilic pads, mud applications wrapped in gauze are used, having a temperature of 36 - 38 °C. A mud application can be placed under one of the electrodes, and a hydrophilic pad can be placed under the other. According to indications, it can be inserted into the vagina or rectum. There are several types of electrodes:
1) electrode discs for exposure to the abdomen, chest, lower back
2) an electrode-cable in the form of a flat spiral for influencing the hip and shoulder joint, mammary gland, perineum.
3) electrode-cable in the form of a cylindrical spiral of 3 - 4 turns to affect the limbs.
4) an electrode-cable in the form of a loop of one or one and a half turns to influence mainly the region of the spine, peripheral nerves and blood vessels.
Local and general body reactions to inductothermy are the basis for indications and contraindications for its use.
Indications include chronic and subacute inflammatory processes of various localization, post-traumatic conditions, metabolic-dystrophic disorders, in particular with rheumatoid arthritis, periarthritis, arthrosis and periarthrosis, non-specific inflammatory diseases of the respiratory system - bronchitis, pneumonia, etc., chronic inflammatory diseases of the female genital organs , prostatitis, chronic neurological manifestations osteochondrosis of the spine, neuritis, spastic conditions of smooth and striated muscles, chronic pyoinflammatory processes (with free outflow of pus), diseases of the cardiovascular system. Inductothermia is also used to stimulate the function of the adrenal glands in a number of diseases (for example, bronchial asthma, rheumatism, rheumatoid arthritis, scleroderma). It is also used for gastric ulcer, hyperkinetic dyskinesias, urolithiasis, itching dermatoses, scleroderma, chronic eczema, etc.
Contraindications are febrile conditions, acute purulent-inflammatory processes, active tuberculosis, bleeding tendency, severe hypotension, decompensation of the cardiovascular system, impaired temperature sensitivity, malignant and benign neoplasms, pregnancy, the presence of metal objects and pacemakers in the area of action, severe organic diseases of the nervous system.
It is impossible to carry out inductothermy to patients with skin defects, wet plaster and hygienic dressings. Clothing (without metal objects) and hair do not interfere with inductothermy; it must be remembered that metal, especially ring-shaped, objects in the area of the projection of the inductor and at a distance of 8-12 cm from it cause a skin burn in the patient.
The nurse performs preventive, therapeutic, rehabilitation measures prescribed by the doctor of the physiotherapy department. Conducts physiotherapy. Prepares physiotherapy equipment for work, monitors its serviceability, correct operation and safety. In addition, the nurse prepares patients for physiotherapy procedures, monitors the patient's condition during physiotherapy procedures. Ensures infectious safety of patients and medical personnel, compliance with the requirements of sanitary and epidemic supervision in the physiotherapy department. Timely and qualitatively draws up medical and other official documentation. Ensures the correct storage and accounting of the use of medicines. Complies with the moral and legal norms of professional communication. Carries out sanitary-educational work. Provides first aid in emergency situations. Qualified and timely executes orders, orders and instructions of the management of the institution, as well as legal acts on his professional activities. Complies with the rules of internal regulations, fire safety and safety, sanitary and epidemiological regime.
4. Phytotherapy The goal of phytotherapy for gastric ulcer is the most complete restoration of the mucosal defect and the normalization of all disorders in the gastrointestinal tract.
At the stationary stage of rehabilitation, oxygen cocktails are one of the main phytotherapeutic agents.
An oxygen cocktail is an oxygenated drink that forms a foamy "cap". To form the structure of the cocktail, food foaming agents are used - mainly these are special compositions for oxygen cocktails, sometimes spum mixtures, even less often licorice root extract or dry egg white. Sanatoriums, rest houses and other health-improving establishments often add vitaminizing ingredients to the cocktail. The taste of an oxygen cocktail depends entirely on the components of its base; oxygen itself has no taste or smell. It is believed to have tonic properties. It is used for therapeutic and prophylactic purposes as one of the concomitant means of oxygen therapy. It can help eliminate chronic fatigue syndrome and get rid of hypoxia, activate cell metabolism, etc.
Russian medical institutions can recommend residents of large cities with poor environmental conditions, people suffering from hypoxia, diseases of the cardiovascular and digestive systems, immune problems, insomnia, chronic fatigue and excess weight to take oxygen cocktails in combination with other means of treatment and prevention.
Raw cabbage juice has a unique effect on stomach ulcers. It is obtained by pressing from crushed fresh cabbage leaves. The juice has a pleasant smell and delicate taste. The patient receives light meals and, as needed, after meals, drinks fresh raw juice (about 1 liter per day). Sensations such as sour belching and pain pass very quickly. The course of treatment lasts 4 - 5 weeks. In most cases, cabbage juice is well tolerated, although bloating may occur in some cases. To eliminate it, cumin infusion is added to the juice. Cabbage juice also has a beneficial effect in inflammatory processes in the small and large intestines. Numerous scientific studies have confirmed that cabbage juice has a healing effect due to vitamin U, which has a special protective effect on the gastric and intestinal mucosa.
Treatment of stomach ulcers with flax seeds has been used for centuries.
How to use: Boil flax seeds in water until liquid jelly is obtained and drink ½ cup 5-8 times a day, regardless of the meal time. Pain disappears after 2-3 sessions. It is advisable to drink such a jelly for 3-4 days so that attacks of pain do not recur. Treatment will be more effective if 5-7 drops of alcohol tincture of propolis are added to each single dose of flaxseed jelly (50 g of alcohol and 5 g of propolis are infused for 14 days in a dark, warm place, filtered, stored in a dark place at room temperature) .
Has a good therapeutic effect on stomach ulcers sea buckthorn oil, which is taken in 1 tsp. 3 times a day before meals for 3-4 weeks. In the first 3-4 days of treatment, heartburn intensifies and sour belching appears. To prevent these discomfort, add ¼ cup of 2% soda solution to sea buckthorn oil before use and shake well. With systematic ingestion, pain, heartburn, belching decrease or completely disappear. Sea buckthorn oil does not significantly affect the acidity of gastric juice.
Calendula officinalis (marigold) is also used for peptic ulcers.
How to use: Pour 20 g of flowers (1 tbsp.) With 1 cup of boiling water, keep in a water bath for 15 minutes, strain, bring the volume of boiled water to 1 cup and take 1-2 tbsp. l. 2 - 3 times a day.
· Therapeutic physical culture is an independent medical discipline that uses the means of physical culture for the prevention of exacerbations and the treatment of many diseases and injuries and rehabilitation. The specificity of therapeutic physical culture in comparison with other methods of treatment lies in the fact that it uses as the main remedy physical exercise, which is an essential stimulator of the vital functions of the human body.
The nurse in the office of medical physical culture has the following job responsibilities:
1. Prepare a room (physiotherapy room, gymnastic items, equipment, etc.) for classes with patients.
2. Calculate the pulse rate of the patients involved before and after exercise therapy.
3. Conduct group and individual sessions with patients:
A) when conducting group classes, to carry out a demonstration of physical exercises and insurance when they are performed by patients, monitor the performance of physical exercises by patients and exercise tolerance;
B) when conducting individual classes with patients with severe disorders, help the patient to take the correct position, help with active exercises; carry out passive exercises, combining them with individual massage techniques, carefully monitor the tolerance of patients to classes.
4. Conduct classes on mechanotherapeutic devices, correctly install the affected limbs on the device, monitor the correct performance of exercises by patients and their well-being.
6. To draw up schemes of therapeutic exercises and complexes of physical exercises for patients differentially, taking into account the nosological form of the disease, the severity of the course of the pathological process and the physical fitness of the patient.
7. Maintain primary medical documentation in accordance with established forms.
8. Systematically improve professional qualifications.
9. Carry out sanitary-educational work among patients On the issues of physical culture.
10. Observe the principles of deontology.
7. Massage: Massage area: collar area, back, abdomen. Position of the patient: more often in the prone position, there are also options - lying on the side, sitting. Massage technique. Massage can be carried out according to the following methods: classical massage, segmental, vibration, cryo-massage. The most effective segmental massage. The first stage of this massage option is the search for segmental zones. In diseases of the stomach, tissues associated with the C3-Th8 segments are mainly affected, more on the left. Segmental massage can be prescribed immediately after the acute condition subsides. The therapeutic effect usually occurs after 4-7 procedures. The total number of procedures until a lasting effect is achieved rarely exceeds 10. In gastritis with hypersecretion and peptic ulcer, they begin with the elimination of changes in the tissues on the back surface of the body, primarily in the most painful points on the back of the spine in the region of the Th7-Th8 segments and in the lower angle of the scapula in the region of the Th4-Th5 segments, then they pass to the anterior surface of the body. In the presence of hyposecretion, it is recommended to act only on the anterior surface of the difficult cell on the left in the region of the Th5--Th9 segments using the rubbing technique with skin displacement. Classical therapeutic massage can also be prescribed, but later than segmental, usually in the middle or end of the subacute period, when the pain syndrome and dyspeptic symptoms have significantly softened. Its effect, as a rule, is insignificant and short-lived. The lumbar region and abdomen are massaged. Techniques used: stroking, rubbing, light kneading, light vibration. Percussion is excluded. For a general relaxing effect on the body, it is desirable to additionally apply a massage of the collar area. Begin the procedure with a back massage. The duration of the procedure is from 10 to 25 minutes. The course of treatment is 12-15 procedures every other day.
2.2 Methods rehabilitation at conservative treatment
ulcerative stomach nursing rehabilitation This study provides not only the study of the most characteristic changes in the stomach stump, but also the search for differences in morphological and functional changes depending on the type of gastric resection.
Treatment of uncomplicated peptic ulcer should be conservative. Surgical treatment of peptic ulcer is resorted to only under strict indications, and the surgeon discusses the issue of surgical treatment of peptic ulcer together with the therapist.
During the period of exacerbation, the most correct is a six-, eight-week course of treatment in a hospital. The main types of treatment used in the hospital: bed rest, the implementation of which should be monitored by nursing staff; medical nutrition, medications - anticholinergics, antacids, sedatives, thermal procedures. Strict bed rest, which the patient must observe in the first three weeks of treatment, is gradually expanded in the future. Smoking is strictly prohibited. The construction of a diet should proceed from the principles of the so-called mechanical and chemical sparing, i.e., do not excite the secretory activity of the stomach, reduce its motor activity and not irritate the gastric mucosa. These requirements are met by the anti-ulcer diet developed in the clinical nutrition clinic. It consists of three diets - diet 1-a, 1-b and 1. Each of the first two diets is prescribed for 10-14 days at the beginning of the course of anti-ulcer treatment. Of great importance is the observance of the rhythm of nutrition (break in eating no more than 3-4 hours).
To restore the normal functional state of the nervous system, various tranquilizers are prescribed. Of these, an infusion of valerian root is widely used (10-12 g per 300 ml of water, drink during the day). In case of poor sleep, diphenhydramine, pipolfen are prescribed (½ -1 tablet at night).
Of the anticholinergic drugs, atropine is prescribed in 0.5 ml of a 0.1% solution 2-3 times a day subcutaneously or orally, 5-8 drops of a 0.1% solution in 30-40 minutes. before meals 2-3 times a day; platifillin 0.5 ml of a 0.2% solution 2-3 times a day subcutaneously or orally, 10 drops of a 0.5% solution. Quateron is also used (orally, 30 mg per day for 3 days; if the drug is well tolerated, the dose is increased to 180 mg per day, that is, 60 mg 3 times; the course of treatment is 25-30 days). Contraindications to the use of anticholinergics are glaucoma, organic pyloric stenosis, prostatic hypertrophy.
Antacids are widely used in the treatment of peptic ulcer; they have the ability to neutralize acidic gastric contents, promote the opening of the pylorus and accelerate the speed of gastric emptying. The most widespread combination of alkalis in the form of a mixture of Bourget: sodium sulfate 6 g, sodium phosphate 8 g and sodium bicarbonate 4 g, which are dissolved in 1 liter of water. Take ½ cup every 30 minutes. before meals 2-3 times a day. It is not necessary to prescribe sodium bicarbonate (baking soda) separately, since in the second phase of its action it enhances the secretory ability of the stomach. In addition, bismuth is prescribed at 0.5-1 g 3 times a day, vikalin 1-2 tablets every 30 minutes. after meals 3 times a day (drink warm water). The course of treatment with vicalin 2 months. followed by a monthly break and an additional course of 4-6 weeks.
The appointment of vitamins in an increased dosage (ascorbic acid 300 mg per day inside, thiamine bromide - 50 mg, pyridoxine - 50 mg intramuscularly) is shown, alternating these injections after 1 day during the course of antiulcer treatment.
A blood transfusion is prescribed by a doctor for an uncomplicated form of peptic ulcer with a sluggish course and a general decline in nutrition (75-100 ml of blood at intervals of 2-5 days, 3-5 times per course).
Of the thermal procedures, warming compresses, paraffin applications on the epigastric region are more often used.
If it is impossible to place the patient in a hospital, a course of antiulcer treatment at home should be provided for 4-5 weeks, followed by a transition to the so-called half antiulcer treatment - the patient spends the rest of the day in bed at home or in a night sanatorium after a normal working day.
Patients with peptic ulcer in remission or fading exacerbation in the absence of pyloric stenosis, penetration, tendency to bleeding and suspicion of malignant degeneration are subject to sanatorium treatment. The following resorts are shown: Zheleznovodsk, Essentuki, Morshin, Borjomi, Jermuk, Druskininkai, Krainka, Izhevsk Mineralnye Vody, Darasun.
According to modern concepts, disorders in the nervous, hormonal and local mechanisms of digestion in the gastroduodenal system play a role in the occurrence of peptic ulcer, therefore, when constructing rational therapy, these disorders, as well as disorders of other systems, should be taken into account. Therefore, two principles should be the basis for the treatment of peptic ulcer: complexity and individualization. It is generally accepted that the treatment of uncomplicated peptic ulcer should be conservative, but different in periods of exacerbation and remission, so recovery at different stages is different.
The diet should be based on the principle of the so-called mechanical and chemical sparing (see Diet therapy): do not excite the secretory activity of the stomach, reduce the motor activity of the gastroduodenal system, have buffer properties and spare the gastric mucosa.
The physiological effect of the main nutrients on the secretory and motor functions of the stomach, studied in the laboratory of IP Pavlov, should be taken into account when building an antiulcer diet. So, unrefined carbohydrates and especially fats inhibit, and proteins stimulate gastric secretion. However, proteins have the greatest buffering effect. Fat reduces the motor activity of the stomach, but with a long stay in it increases it. Thus, a diet for peptic ulcer disease should include a sufficient amount of protein, moderate - refined carbohydrates and fats. Effective use of vegetable oil in the amount of 25-40 g for 30-40 minutes. before meals. Vitamins are shown (C - 300 mg, B1 - 50 mg, B6 - 50 mg per day, A - in an average daily dose of 5 - 10 mg with fish oil). All vitamins in an increased dosage are prescribed for 6-8 weeks, after which they switch to smaller, preventive doses. Vitamin A increases the protective function of the mucous membranes. Vitamin B1 has an analgesic effect. In addition, it regulates the functions of the nervous system, adrenal glands, motility and secretion of the stomach. Table salt is limited to 3-5 g at the beginning of the course of treatment. To ensure the buffering action of food, a certain rhythm in food intake is also shown - a little every 3-4 hours. Between meals, it is reasonable to prescribe hourly ½ cup of warm milk or a creamy milk mixture (2/3 milk and 1/3 20% cream).
In the complex of antiulcer treatment, anticholinergics play an important role. They should be administered 30-40 minutes before. before meals and at bedtime. From the group of m-anticholinergics, atropine is prescribed in the form of injections of a 0.1% solution of 0.5 ml 2-3 times a day or orally, 5-8 drops of a 0.1% solution for 30-40 minutes. before meals 2-3 times a day; platifillin - 0.2% solution of 0.5 ml per injection 2-3 times a day or inside, 10-15 drops of a 0.5% solution. Of the gangliolytic agents, benzohexonium is most widely used (0.1-0.2 g orally 2-3 times or subcutaneously 1-2 ml of a 2% solution 2-3 times a day for 20-30 days). After the injection of the drug, the patient should be in a horizontal position for 30-40 minutes. due to the possibility of orthostatic collapse.
Among n-anticholinergics, quateron has the best effect (orally, 30 mg per day for 3 days; if the drug is well tolerated, the dose is increased to 180 mg per day, i.e., 60 mg 3 times; the course of treatment is 25-30 days). The drug has almost no side effects. Of the centrally acting anticholinergics, gangleron acts the most “softly”. Apply subcutaneously, 2 ml of a 1.5% solution 3 times a day, as well as inside 0.04 g in capsules, 1 capsule 3-4 times a day. The course is 3-4 weeks.
With repeated courses of treatment with anticholinergics, it should be changed as individual preparations, and their combination (due to the body getting used to them).
DOXA (deoxycorticosterone acetate) and licorice preparations (imported biogastron and domestic - laquiriton) have a mineralocorticoid function. Their use is justified by the assumption of a decrease in this function of the adrenal glands in peptic ulcer disease [Bojanovich (K. Bojanowicz)]. 3. I. Yanushkevichus and Yu. M. Alekseenko used a 0.5% oil solution of DOXA, 2 ml intramuscularly, at first once a day every day (5 days), and then every other day. The course of treatment is 20-25 injections. The dose of the drug should be reduced gradually to prevent "withdrawal syndrome". Biogastron and lakviriton are prescribed at a dose of 100 mg 3 times in 30 minutes. before meals; course of treatment 3 weeks. In some patients, biogastron causes edema and other manifestations of heart failure, headaches, and heartburn. Preparations of mineralocorticoid function are more indicated for stomach ulcers.
Impact on local arrangements. Antacids are widely used in the treatment of peptic ulcer. They have the ability to neutralize acidic gastric contents, promote the opening of the pylorus and accelerate the speed of gastric emptying. All taken together determines their good analgesic effect in peptic ulcer disease. Antacids are divided into absorbable (absorbable) and non-absorbable (adsorbent). The former include sodium bicarbonate (baking soda), calcium carbonate and magnesium oxide (burnt magnesia).
It is not advisable to prescribe each drug separately, since they have a short-term effect; in addition, sodium bicarbonate subsequently enhances the secretory ability of the stomach, calcium carbonate causes constipation, and burnt magnesia causes diarrhea. It is most expedient to combine them with other alkalis, for example in the form of a Bourget mixture: Natrii phosphorici 8.0, Natrii sulfurici 6.0, Natrii bicarbonici 4.0; dissolve in 1 liter of water. Take ½ cup every 30 minutes. before meals 2-3 times a day.
The second group includes aluminum hydroxide, aluminum phosphate, aluminum carbonate. They have a slower neutralizing, adsorbing and enveloping action. Single dose 0.5-1 g.
To protect the mucous membrane from the irritating effects of gastric juice, bismuth is prescribed at a dose of 0.5-1 g 3 times a day. It is almost devoid of antacid properties, but causes increased mucus separation and adsorbs pepsin.
Vikalin (foreign drug Roter) has an antacid, enveloping and laxative effect. Assign 1-2 tablets every 30 minutes. after meals 3 times a day (drink with warm water). The course of treatment is 2 months. followed by a monthly break, after which an additional course (4-6 weeks) is prescribed.
The observations made indicate the expediency of the simultaneous appointment of antacids and anticholinergics, since the latter increase their neutralizing ability.
2.3 Methods postoperative rehabilitation
Despite certain successes in the conservative treatment of gastric ulcer, the main treatment for its complicated forms is still gastric resection. At the same time, the improvement of surgical technique and the introduction of new surgical methods have significantly reduced the number of immediate postoperative complications. The principle of individual choice of the operation method significantly influenced the improvement of the immediate and long-term results of the treatment of gastric ulcer. At the same time, gastric resection does not bring the full course of the disease, since from 10 - 15% to 70 - 85.9% of cases, patients develop one or another post-gastroresection disorder, the complexity of pathogenesis and the variety of clinical manifestations of which creates certain difficulties in their treatment. At the same time, gastritis of the stomach stump occupies the leading place among post-gastroresection disorders.
Therefore, it is very important to carry out a complex of therapeutic and preventive measures for patients in the early stages of postoperative intervention to prevent the development of post-gastroresection disorders in them. Early post-hospital rehabilitation of patients after gastric resection has not been carried out to date.
In this regard, we were interested in the question of the possible use of a complex of rehabilitation measures using low-mineralized sulfate-bicarbonate-chloride-sodium mineral water of the OJSC Metallurg Sanatorium, sheets of 1-I option, physiotherapy exercises in a specialized gastroenterological department.
In the rehabilitation of patients with diseases digestive system successfully used diet, balneotherapy, methods of electrotherapy, phototherapy, ultrasound therapy, exercise therapy and other factors. The most effective are mineral waters of medium and low mineralization, in which hydrocarbonate anions, sulfate anions, chloride annones, sodium, magnesium, and calcium cations predominate.
Output. In the process of physical rehabilitation of gastric ulcer at the stationary stage, apply a comprehensive approach: drug therapy, medical nutrition, phytotherapy, physiotherapeutic and psychotherapeutic treatment, therapeutic physical culture.
III. Analysis applications methods rehabilitation on the practice
3.1 Analysis states health sick on the moment start rehabilitation
In our work, we considered two patients, X and Y, with a diagnosis of gastric ulcer.
Patient X's illness is complicated by gastrointestinal bleeding. Patient X was brought by his son to a medical institution with the following complaints:
1. Pain in the epigastric region;
2. Vomiting the color of coffee grounds, which indicates bleeding in the stomach.
3. The general condition at the time of admission is severe.
During an emergency examination (using instrumental and laboratory studies) of the patient, the presence of gastrointestinal bleeding was established and perforation of the ulcer was detected. After the examination, the patient urgently underwent an operation to excise the stomach tissue (gastric resection).
Patient Y has a seasonal exacerbation. The patient came to the emergency department with complaints:
1. Hungry pains;
2. Nausea;
3. Restless sleep, due to constant night pains in the epigastric region.
Based on the laboratory and instrumental research established seasonal exacerbation of gastric ulcers.
3.2 Development plans rehabilitation sick
When the patient's condition stabilized, an individual program of postoperative rehabilitation was developed:
At the inpatient stage, patient X was offered:
1. Drug therapy:
1.1. Antisecretory drugs: cimetidine (Suppresses the production of hydrochloric acid, both basal (own) and stimulated by food, histamine, gastrin and, to a lesser extent, acetylcholine). 200 mg 1 tab. * 3 rubles / day in 30 - 40 min. before meals and 2 tab. for the night;
1.2. Omeprazole (reduces basal and stimulated secretion, regardless of the nature of the stimulus). 2 mg 1 tab. 2 times a day for 7 days, then 1 tab. per day for 7 days.
4. Diet correction: 1st 3 days, diet No. 0, food cooked in pureed and jelly-like form. Food is taken fractionally 7 - 8 times a day with a temperature not higher than 45 °, at one time - no more than 200 - 300 gr. Recommended: low-fat meat broth, slimy decoctions with cream, fruit and berry jelly, fruit jelly. Excluded: whole milk, dense and mashed dishes, carbonated drinks.
5. Exercise therapy after surgery on the stomach can be carried out 6-12 hours after the patient wakes up. It should be borne in mind that deep breathing with the participation of the diaphragm sharply increases pain in the area of the postoperative wound. In this regard, breathing after surgery should be predominantly chest.
The first lesson should begin with the development of chest breathing. Repeat every 20-40 minutes breathing movements. With the help of an instructor, the patient does exercises for the distal lower and upper limbs, rotational movements in hip joint 3-4 times, if necessary with pauses for rest.
On the second day, holding the postoperative wound, performs exercises independently and more often. In addition, it is recommended to massage the chest with stroking, rubbing, light vibration techniques.
On the 3-4th day, classes include general tonic and special exercises. The patient should turn sideways as often as possible. In this position, back massage is done 1-2 times a day. After that, the patient is given an elevated position by placing a pillow under his back or raising the head end of the functional bed; the legs are bent at the knee joints, a roller is placed under them. The patient sits for 5-10 minutes (3-5 times a day). In this position, he performs static and dynamic breathing exercises. In the initial lying position, the patient "walks" with a small range of motion in the knee joints, sliding his feet along the bed.
With a smooth course of the postoperative period, the patient is allowed to sit with his legs down from the bed on the 4-5th day. After sufficient adaptation to the sitting position, classes include exercises for the upper and lower extremities, head tilts and rotational movements with it, exercises for the body (forward bends should be done with great care). Then it is allowed to get up, first leaning with your hands on the back of the chair.
It is recommended to get up on the 6-9th day after gastric resection and with good tolerance of the previous load. At the beginning, classes are carried out in the ward, in the initial position sitting on a chair, including general strengthening, breathing exercises, exercises to strengthen the abdominal muscles, to form a mobile postoperative scar, correct posture, and normalize bowel function (prevention of adhesive disease).
From the 9th-10th day, classes are held in the gymnastics hall of physiotherapy exercises (they are preceded by morning hygienic gymnastics in the ward). The emphasis is on restoring diaphragmatic breathing. The classes include exercises to strengthen the abdominal muscles, correct posture defects, exercises with projectiles. The duration of classes is 20-25 minutes. The set of exercises for self-study includes walking along the corridor and stairs (climbing the stairs is done on the exhale). After discharge from the hospital, the patient continues to engage in therapeutic exercises in the clinic. Sports exercises (skiing, skating, swimming, rowing, etc.) are allowed for therapeutic and prophylactic purposes 6 months after the operation.
6. Massage is performed after abdominal surgery, includes stroking - superficial, with fingertips and palm around the surgical suture, in the same way, very gently - circulatory rubbing, shifting with a small amplitude, stable vibration, very slowly. Massage the abdomen, fixing the postoperative suture.
At the outpatient stage, patient X was asked:
1. Drug therapy:
1.1. Omeprazole (reduces basal and stimulated secretion, regardless of the nature of the stimulus);
1.2. Vitamins B6 and E.
2. Phytotherapy
2.1. Flax ordinary 1.5 tbsp. color - x baskets brew 400 ml of boiling water, leave for 1 hour, strain. 1 tsp infusion * 4 r./d.
3. Physiotherapy
3.1. Electrosleep in gastric ulcer, the orbital-mastoid technique is used. The pulse frequency is 3.5-5 Hz, the current strength gradually increases from 2 mA until the patient has a sensation of "pulsation" or "vibration" under the electrodes on the eyelids (ie, up to 6-8 mA). The duration of the procedure during the course is gradually increased from 8 to 15 minutes, for a course of treatment 10-15 procedures.
4. Diet correction
4.1. Then diet No. 1-a, where spicy, fried, salty, fatty foods are excluded from the diet, alcohol is excluded, followed by expansion to 1-b, 1. It is necessary to observe regular good nutrition 5-6 times a day. Soups are recommended from mashed or well-boiled cereals (semolina, rice and others), steamed and boiled beef dishes, low-fat types of fish without skin, in a piece or in the form of a cutlet mass, boiled in water or steamed. Duration 3 - 5 months.
5. Exercise therapy in the mode of increasing intensity At the sanatorium-resort stage of rehabilitation, patient X was offered:
Treatment in mountains. Hot key sanatorium "Foothills of the Caucasus".
1. Drug therapy:
1.1. Mezim forte (replenishes the deficiency of pancreatic enzymes) - 1 tab. after each meal for 1 month.
2. Balneotherapy
2.1. Pearl-pine baths
4. Diet correction
4.1. Diet No. 1-r At the metabolic stage, Mr. X was asked to:
1. Long-term dietary correction
2. Balneotherapy
2.1. Pearl-pine baths
3. Exercise therapy An individual rehabilitation program was developed for patient Y.
At the inpatient stage, patient Y was offered:
1. Drug therapy:
1.1. Almagel (Almagel neutralizes free hydrochloric acid in the stomach, which leads to a decrease in the digestive activity of gastric juice. It does not cause secondary hypersecretion of gastric juice). - 1 ml in 20 min. before meals for 7 days;
1.2. Mezim forte (replenishes the deficiency of pancreatic enzymes) - 1 tab. after each meal for 1 month;
2. Physical Methods recovery:
2.1. Electrosleep in gastric ulcer, the orbital-mastoid technique is used. The pulse frequency is 3.5-5 Hz, the current strength gradually increases from 2 mA until the patient has a sensation of "pulsation" or "vibration" under the electrodes on the eyelids (ie, up to 6-8 mA). The duration of the procedure during the course is gradually increased from 8 to 15 minutes, for a course of treatment 10-15 procedures.
Indications: peptic ulcer disease with pronounced functional changes in the nervous system, sleep disturbance.
2.2. For UHF therapy, portable and stationary devices are used, operating at a standard frequency of electromagnetic oscillations of 40.68 MHz, which corresponds to a wavelength of 7.3 m.
During the treatment procedure, the area of the body exposed to e, p., is placed between two capacitor plates-electrodes, so that there is an air gap between the patient's body and the electrodes, the value of which should not change during the entire procedure. The total total gap for portable devices is 6 cm, for stationary devices - 10 cm. The size of the air gap is of great importance for the distribution of the absorbed energy of the electric field in the patient's body, the physical effect of the UHF electric field is to actively absorb the energy of the field by tissues and convert it into thermal energy , as well as in the development of the oscillatory effect, which is characteristic of high-frequency electromagnetic oscillations.
The thermal effect of UHF therapy is less pronounced than with inductothermy. The main heat generation occurs in tissues that conduct electricity poorly (nervous, brain, bone, etc.). The intensity of heat generation depends on the power of exposure and the characteristics of energy absorption by tissues. When using e. n. UHF in a thermal dosage, the oscillatory effect is more pronounced.
The UHF electric field has an anti-inflammatory effect by improving blood and lymph formation, dehydration of tissues and reducing exudation, activates the functions connective tissue, stimulates the processes of cell proliferation, which makes it possible to limit the inflammatory focus with a dense connective capsule.
3. Exercise therapy: period of exacerbation of peptic ulcer or chronic gastritis; complicated course of peptic ulcer; severe pain syndrome and significant dyspeptic disorders - is a contraindication to use.
4. Massage: Massage area: collar area, back, abdomen. Position of the patient: more often in the prone position, there are also options - lying on the side, sitting. Massage technique. Massage can be carried out according to the following methods: classical massage, segmental, vibration, cryo-massage. The most effective segmental massage. The first stage of this massage option is the search for segmental zones. In diseases of the stomach, tissues associated with the C3-Th8 segments are mainly affected, more on the left. Segmental massage can be prescribed immediately after the acute condition subsides. The therapeutic effect usually occurs after 4-7 procedures. The total number of procedures until a lasting effect is achieved rarely exceeds 10. In gastritis with hypersecretion and peptic ulcer, they begin with the elimination of changes in the tissues on the back surface of the body, primarily in the most painful points on the back of the spine in the region of the Th7-Th8 segments and in the lower angle of the scapula in the region of the Th4-Th5 segments, then they pass to the anterior surface of the body. In the presence of hyposecretion, it is recommended to act only on the anterior surface of the difficult cell on the left in the region of the Th5--Th9 segments using the rubbing technique with skin displacement. Classical therapeutic massage can also be prescribed, but later than segmental, usually in the middle or end of the subacute period, when the pain syndrome and dyspeptic symptoms have significantly softened. Its effect, as a rule, is insignificant and short-lived. The lumbar region and abdomen are massaged. Techniques used: stroking, rubbing, light kneading, light vibration. Percussion is excluded. For a general relaxing effect on the body, it is desirable to additionally apply a massage of the collar area. Begin the procedure with a back massage. The duration of the procedure is from 10 to 25 minutes. The course of treatment is 12-15 procedures every other day.
At the polyclinic stage, patient Y was offered:
1. Drug therapy:
1.1. Omez - 20 mg, 1 cap. * 2 r./d. at 09:00 and at 19:00, then 1 r./d. within 7 days (reduces basal and stimulated secretion regardless of the nature of the stimulus.);
1.2. Mezim forte (replenishes the deficiency of pancreatic enzymes) - 1 tab. after every meal;
2. Herbal medicine: mix 1.5 cups of aloe juice (squeeze the juice with your hands through a napkin, do not cut the leaf with a knife), a glass of honey and a glass of Provence oil, pour into a bottle and put in a pot of water on the stove, placing a piece of cloth under the bottom of the bottle. Boil for 3 hours on low heat, cool and cork, store in the refrigerator.
3. Exercise therapy in the mode of increasing intensity.
At the sanatorium-resort stage, patient Y was offered:
Treatment in the city of Goryachiy Klyuch sanatorium "Emerald".
1. Balneotherapy: Oxygen baths - baths with fresh water saturated with oxygen. Methods of physical and chemical saturation of water with oxygen are used. With the physical method, the amount of oxygen in water reaches 40 - 50 mg / l, with the chemical - up to 50 - 70 mg / l. The pressure with which oxygen enters the water is 1.5 - 2.5 atmospheres. Part of the oxygen, however small, penetrates through intact skin into the body. Its external effect is characterized by slight irritation of skin receptors. Most of the oxygen, which is poorly soluble in water, tends upward and leaves the bath, creating an increased concentration above the water surface.
The therapeutic effect of oxygen lies in its ability to influence the processes of excitation and inhibition, having a calming effect on the processes in the cerebral cortex. In addition, an increased concentration of oxygen normalizes blood pressure, normalizes vegetative processes, improves metabolic processes in the body, activates respiratory functions and replenishes oxygen deficiency.
The procedure lasts 10 - 20 minutes at a water temperature of 34 - 36 degrees. The course of treatment is 10 - 15 oxygen baths, which are taken every day or every other day.
2. Massage: Massage area: collar area, back, abdomen. Position of the patient: more often in the prone position, there are also options - lying on the side, sitting. Massage technique. Massage can be carried out according to the following methods: classical massage, segmental, vibration, cryo-massage. The most effective segmental massage. The first stage of this massage option is the search for segmental zones. In diseases of the stomach, tissues associated with the C3-Th8 segments are mainly affected, more on the left. Segmental massage can be prescribed immediately after the acute condition subsides. The therapeutic effect usually occurs after 4-7 procedures. The total number of procedures until a lasting effect is achieved rarely exceeds 10. In gastritis with hypersecretion and peptic ulcer, they begin with the elimination of changes in the tissues on the back surface of the body, primarily in the most painful points on the back of the spine in the region of the Th7-Th8 segments and in the lower angle of the scapula in the region of the Th4-Th5 segments, then they pass to the anterior surface of the body. In the presence of hyposecretion, it is recommended to act only on the anterior surface of the difficult cell on the left in the region of the Th5--Th9 segments using the rubbing technique with skin displacement. Classical therapeutic massage can also be prescribed, but later than segmental, usually in the middle or end of the subacute period, when the pain syndrome and dyspeptic symptoms have significantly softened. Its effect, as a rule, is insignificant and short-lived. The lumbar region and abdomen are massaged. Techniques used: stroking, rubbing, light kneading, light vibration. Percussion is excluded. For a general relaxing effect on the body, it is desirable to additionally apply a massage of the collar area. Begin the procedure with a back massage. The duration of the procedure is from 10 to 25 minutes. The course of treatment is 12-15 procedures every other day.
Conclusion: The proposed methods of rehabilitation were developed in accordance with the characteristics of the course of the disease at different stages and adapted to them, which helped to effectively fight the disease. Consequently, patient X after surgery was sent to a hospital, where, after undergoing rehabilitation, he was able to undergo treatment at home, and then in a sanatorium-resort institution. The result of a properly designed rehabilitation program was the complete restoration of the health of patient X.
Patient Y, after seeking medical help, was sent to the hospital for examination and conservative treatment identified ulcer, then underwent rehabilitation at home and on the basis of a sanatorium. As a result of the rehabilitation, the disease entered the remission stage, thanks to properly developed methods of rehabilitation.
The role of medical personnel in the conduct of complex rehabilitation of patients cannot be underestimated, since without the participation of nurses in it, it would not be possible, and the treatment of patients is incomplete. The reason for the importance of the role of nurses is the wide range of duties assigned to them, the performance of which by doctors without the help of nursing staff would be physically impossible.
Conclusion
Peptic ulcer of the stomach is, at present, one of the most common pathologies among patients.
At the heart of the appearance of gastric ulcer and the occurrence of relapses, three factors are considered: genetic predisposition, imbalance between the factors of aggression and defense, the presence of Helicobacter pylori (HP).
In the process of physical rehabilitation of gastric ulcer at the stationary stage, apply a comprehensive approach: drug therapy, clinical nutrition, herbal medicine, physiotherapy and psychotherapy, therapeutic physical culture.
At the stationary stage of rehabilitation, patients with this pathology, taking into account the capabilities of the medical institution and the prescribed motor regimen, can be recommended all means of therapeutic physical culture: physical exercise, natural factors of nature, motor modes, therapeutic massage. From the forms of classes - morning hygienic gymnastics, therapeutic exercises, dosed therapeutic walking (on the territory of the hospital), training walking up the stairs, dosed swimming (if there is a pool), self-study. All these classes can be carried out by individual, small group (4 - 6 people) and group (12 - 15 people) methods.
At the initial stage of the study, we set a goal to study the role of nursing in improving the efficiency of rehabilitation of patients with gastric ulcer.
Such tasks were set as collecting material on the causes of the spread of gastric ulcer in the world, Russia and the region; development of a patient questionnaire in order to draw up a rehabilitation program; rationale for such programs and the role of nursing staff in their implementation.
As an object of study, methods of rehabilitation for gastric ulcer were considered, the subject was patients.
In the course of the study, methods of examining patients, analytical methods, namely deductive, inductive and comparative, were used.
It was hypothesized that the nursing process in rehabilitation helps to increase the period of remission and improve the quality of life of patients, this hypothesis was confirmed in our work.
List used sources
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Applications
Etcposition BUT
Rehabilitation questionnaires
Appendix B
The number of patients with gastric ulcer in the world.
no data less than 20
Annex B
Morbidity of the population with diseases of the digestive system in Russia.
Appendix G
Preventive stage of medical rehabilitation.
Appendix D
Stationary stage of medical rehabilitation.
Appendix
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Diseases of the digestive system in the structure of general morbidity occupy one of the first places, most often affecting people of working age. The chronic nature of the course of most of these diseases causes high rates of temporary disability and disability. Of the numerous diseases of the stomach, gastritis and peptic ulcer are common.
GASTRITIS- inflammatory or inflammatory-dystrophic changes in the gastric mucosa. It can be primary and be considered as an independent disease and secondary, accompanying a number of infectious and non-infectious diseases and intoxication. Gastritis is divided into sharp And chronic. In acute gastritis, the development of inflammatory changes in the stomach occurs quickly. However, the most common disease is chronic gastritis, a characteristic feature of which is the gradual development of the inflammatory process, i.e. changes in the mucous membrane, impaired motor and secretory function of the stomach.
Physical factors are used mainly in patients with chronic gastritis. At acute gastritis they are rarely prescribed, mainly for the purpose of providing an analgesic effect.
Rehabilitation tasks in patients with chronic gastritis:
Restoration of the structure of the gastric mucosa.
Restoration of its secretory function.
Influence on the inflammatory process and disorders of the trophism of the gastric mucosa.
Normalizing effect on the functional state of other digestive organs.
Patients can use novocaine electrophoresis on the stomach area according to the transverse (anode - in the epigastric zone, cathode - on the back) method (15-30 minutes, 10-16 procedures). Very useful topical application diadynamic or sinusoidal modulated currents according to the method of treatment of pain syndromes. After the acute phenomena subside, patients can be prescribed paraffin or ozocerite applications (48-52 ° C, 10-12 procedures for 15-20 minutes).
In patients with chronic gastritis, the main tasks of physiotherapy are: providing analgesic and anti-inflammatory effects, restoring the function of the disgraced state of the stomach, improving the activity of other digestive organs. They are used differentially, primarily in accordance with the state of the secretory and motor function of the stomach.
Patients with chronic gastritis with reduced secretory function during the period of exacerbation are prescribed UV irradiation in erythemal dosages (3-4 biodoses, 4-5 procedures); diadynamic currents (DPN - 30 s, DP - 30 s, alternation for 6-8 minutes); sinusoidal modulated currents (II and III p.p. for 2-3 minutes, 100 Hz, 25-100%); inductothermy in a low-thermal dosage (8-10 min); microwaves of centimeter and especially decimeter range (25-40 W, 8-12 min).
As the exacerbation subsides, the complex of therapeutic measures can include electrophoresis (cathode - in the epigastric region, anode - in the region of the lower thoracic spine) of various drugs (novocaine, vitamin B1, aprofen, etc.), ultrasound on the epigastric region and paravertebral ( 0.2-0.6 W cm 2, for 3-5 minutes), irradiation with a lamp - solux or infrared rays (15-20 minutes).
During the period of attenuation of exacerbation and incomplete remission, thermotherapy can already be used (paraffin or ozocerite applications, 45-50 ° C, 20-30 minutes; mud applications, 38-42 "C, 10-20 minutes).
Patients with chronic gastritis with normal and increased secretory function of the stomach during the period of exacerbation are prescribed locally calcium or novocaine electrophoresis (the anode is in the epigastric region) or general bromine electrophoresis. Diadynamic therapy is used (alternating 4-5 times for I min DNT and ONT, 10-12 procedures) or amplipulse therapy (2-3 min I and IV pp, 100 Hz, 25-100%, 10-12 procedures), magnetotherapy (10 -20 mT, 8-15 min). During the period of exacerbation subsidence, ultrasound therapy and thermotherapy (paravertebral and epigastric) can be prescribed.
One of the most important methods of treatment of chronic gastritis is the drinking application of mineral waters of various composition and concentration. More mineralized waters, especially those containing chlorides and sulfates, have a predominantly stimulating effect, while less mineralized waters exhibit an inhibitory effect. In chronic gastritis with secretory insufficiency, drink mineral water slowly, in small sips, starting from 1/4-1/2 cup to 1 cup 3 times a day.
With concomitant colitis, accompanied by an increase in motor function, the dose of water is somewhat reduced, and its temperature is increased to 40-44 ° C (usually 32-36 ° C) and even up to 44-46 ° C with concomitant liver diseases. Water is drunk 20-30 minutes before meals, and with accelerated evacuation - 10-15 minutes before meals. In chronic gastritis with normal and increased secretion, water is taken at a temperature of 38 ° C, they drink it in large sips, 1-1.5 hours before meals (with normal secretion - 45-60 minutes). The course of drinking treatment - 21-24 days.
The complex of treatment of patients with chronic gastritis with both increased and decreased secretory function of the stomach also includes the external use of mineral water in the form of baths (36-37 ° C, 8-12 minutes, every other day, 10-12 procedures). Of the baths, sodium chloride, carbonic acid, radon (more often with hyposecretory forms), coniferous, pearl and nitrogen are used more often than others.
In order to provide a general strengthening effect on the body, normalize regulatory processes and metabolism, rain, fan and circular showers can be used (35-37 ° C, 3-5 minutes, 8-12 procedures).
Spa treatment is indicated for patients with chronic gastritis with reduced, increased and normal secretory and motor-evacuation function of the stomach without an exacerbation phase.
Various types of motor activity are widely used in the system of medical rehabilitation of patients with chronic gastritis.
Rehabilitation tasks:
Impact on the impaired function of the intestine, on inflammatory and biochemical processes in it, on the pathological microflora, on the functional state of other digestive organs, on immunological reactivity.
Therapeutic factors of rehabilitation: regimen, diet, mineral waters, mud therapy, balneotherapy, exercise therapy, climatotherapy, water procedures, apparatus physiotherapy.
The tasks of physiotherapy: to provide anti-inflammatory, analgesic and restorative effect, improve blood circulation and nutrition of the intestinal wall, normalize the functional state of the intestine.
One of the most important means of treatment is the internal intake of mineral waters. With a tendency to diarrhea, it is most advisable to use low-mineralized water containing calcium ions, heated to a temperature of 45-50 ° C, 100-200 ml 1-3 times a day. For colitis occurring with constipation, highly mineralized waters are used, as well as mineral waters containing magnesium ions and sulfate ions. Water at room temperature is used 250 ml 3 times a day. Mineral waters are also used for intestinal washings and irrigations, enemas and microclysters.
The use of low-thermal dosages of high-frequency electrotherapy methods on the intestinal area and segmentally is effective: inlucothermy (10-15 min), ep. UHF (8-12 min), microwave (10-20 min).
Often, the complex of therapeutic measures includes sinusoidal modulated currents used with a transverse arrangement of electrodes according to the following method: II and IV p. R. 2-3 minutes, 50 Hz, 25-75%, 10-12 procedures. In patients with severe intestinal stasis, exposure is carried out with the following parameters: 1 p. R., variable mode, 30 Hz, 100%, 7-8 min. With the predominance of intestinal atony, the bowl is used H p.p., 10-30 Hz, 75-100 %, 5-10 minutes on the field, 10-15 procedures.
To provide an analgesic effect and normalize the activity of the intestine, diadynamic and other types of pulsed currents are differentially used.
In chronic colitis, patients are prescribed drug electrophoresis on the intestinal area using a transverse technique. For electrophoresis, novocaine, magnesium sulfate, dibazol, papaverine (for constipation), calcium preparations, and less often antibiotics are used. In the spastic form of colitis, ultrasound is shown on the corresponding segments spinal cord(0.2-0.4 W / cm 2, 5-8 min) or (less often) on the intestinal area (0.4-0.6 W / cm 2, 2-3 min).
According to generally accepted methods, the abdomen is irradiated with a sollux lamp or infrared rays (20-30 minutes), UVI (1-2 biodoses, 3-5 procedures).
Mud therapy is effective in chronic colitis. It is carried out on the abdomen and segmentally (38-42°C, 15-20 minutes, 8-10 procedures). In order to prevent exacerbations, mud therapy is combined with antibiotic therapy. It is good to prescribe combined methods for patients - electromud therapy, electrophoresis of mud solutions, mud inductothermy. Instead of mud therapy, ozokerig and especially paraffin applications can be used (50-52°C, 20-30 minutes, 10-12 procedures).
In chronic colitis, especially in the spastic form, baths are indicated: sodium chloride, iodine-bromine, radon, coniferous, etc. (36-37 ° C, 10-15 minutes, 8-10 procedures).
As general regulatory procedures, it is recommended to prescribe electrosleep (10-20 Hz, 30-60 minutes), acupuncture, massage of the abdomen and lower back (especially in the atonic form), and general ultraviolet irradiation.
DYSKINESIA OF THE BILITARY TRACTS - functional disorders tone and motility of the gallbladder and biliary tract - up to 70% of diseases of the biliary system.
Physiotherapy, like treatment in general, depends on the cause and form of dyskinesia.
In hypertensive and hyperkinetic forms of dyskinesia, sedative therapy is indicated predominantly. It is carried out in the form of prescribing baths - radon, coniferous, sodium chloride, iodine-bromine (36-37 ° C, 15-20 min. 10-12 procedures, every other day) or showers - rain, circular, fan (3-5 min, 10 -15 procedures). Electrophoresis of novocaine, platifillin, papaverine, magnesium sulfate (15-20 minutes, 20 procedures), as well as bromine electrophoresis according to the general method, is prescribed for the area of the right hypochondrium. Interference therapy is also used (100 Hz, 10-20 min).
Ultrasound therapy is effective according to the combined technique (paravertebral at the level of Th 6-Th 10 - 0.2-0.4 W / cm 2, 2-3 min; on the area of the right hypochondrium - 0.2-0.4 W / cm 2, 3-5 min, 12-15 procedures).
You can also use phototherapy procedures: irradiation with a lamp - solux or infrared rays (15-20 minutes), paraffin applications (52-55 ° C, 20-30 minutes). On the area of the right hypochondrium, low-thermal dosages are also used for high-frequency electrotherapeutic factors - e.p. UHF (8-12 min), inductothermy (20-25 min).
With hypomotor dyskinesia, carbonic baths (34-33 ° C, 7-12 minutes) are prescribed in combination with electrotherapeutic procedures of a stimulating nature:
Galvanization (calcium electrophoresis) of the gallbladder area according to the transverse method (cathode in front, up to 15 Ma, 15-20 min);
Electrical stimulation of the gallbladder or right phrenic nerve various types pulse currents - tetanizing (100 Hz, modulation frequency - 8-12 per minute, 10-15 minutes in intermittent mode), diadynamic (single-wave rhythmic or half-wave wave, 10-30 minutes), sinusoidal modulated (II and III pp for 3 minutes , 50 Hz, 50%), etc.
An important place is given to drinking treatment with mineral waters. In spastic form, it is recommended to ingest low- and medium-mineralized waters in hot form (44-45 ° C), 1 glass per reception, 3 times a day 30-50 minutes before meals (depending on the secretory function of the stomach).
Therapeutic exercises in patients with cholecystitis are prescribed to normalize the central and peripheral regulation of bile secretion, prevent secondary complications and improve bowel function.
Tasks of exercise therapy: increasing the intensity of regional blood flow, creating optimal conditions for the outflow of bile, normalizing bowel function, improving the general condition of the patient.
Therapeutic exercises are prescribed after a decrease in the severity of inflammation, pain relief in the right hypochondrium.
Along with general developmental exercises, the complex of therapeutic exercises includes dynamic breathing exercises with lengthening of inhalation and exhalation, lower chest localized breathing, diaphragmatic breathing, exercises to strengthen the muscles of the anterior abdominal wall, relaxation exercises, complicated walking, walking with high hips. In the hyperkinetic form, exercises that cause intense tension of the anterior abdominal wall are limited, while in the hypokinetic form, on the contrary, the intensity of the load is increased by including static exercises and increasing the pace of their implementation.
Motor mode - general (sparingly training with a transition training). The method of conducting classes is group and small group. I.p. - lying on your back, left and right side, on all fours, standing, sitting. The pace of the exercises is slow, medium, with a gradual transition to fast. The number of repetitions of exercises is 8 - 12. The duration of classes is 20-30 minutes 1-2 times a day.
As the condition improves, the training loads are gradually increased. Sedentary games, exercises with shells, exercises at the gymnastic wall, sports and applied exercises (swimming) are introduced into the classes.
Peptic ulcer of the stomach and duodenum.
Peptic ulcers are among the most common diseases of the digestive system. The disease is characterized by a long course, a tendency to recurrence and exacerbation, which increases the degree of economic damage from this disease. Peptic ulcer of the stomach and duodenum is a chronic, cyclically occurring, recurrent disease characterized by ulceration in the gastroduodenal zone.
Goals of rehabilitation:
Prevention of exacerbations of the disease and prevention of further progression of the process.
Stabilization and prolongation of remission.
Normalization of neuroendocrine regulation of the gastroduodenal region.
Reducing functional-morphological and trophic disorders.
Normalization of the state of the autonomic and central nervous system.
Normalization of the functional state of the stomach.
Physical factors are used to normalize the functions of the central nervous system and the reactivity of the body, improve tissue trophism, eliminate motor and secretory disorders, provide analgesic, anti-inflammatory and anti-spastic effects.
In the phase of exacerbation of the disease physical factors are used to a limited extent and only with a not pronounced exacerbation.
FROM physiotherapeutic methods are prescribed:
- Electrosleep (3-5-10 Hz, 30-45 min);
- Amplipulse therapy (I IV r.r., 25-100%, 100 Hz, 3-4 minutes each kind of work, 8-12 procedures);
- Electrophoresis of medicinal substances with a transverse arrangement of electrodes on the stomach or pyloroduodenal region (novocaine, benzohexonium, dimexide, atropine sulfate, dalargin, etc.).
Less commonly, other physical factors of e.p. are used during this period. UHF, microwaves, ultraphonodiadynamic therapy, etc.
In the stage of fading exacerbation and incomplete remission, in addition to the above methods, the following are used:
Ultrasound on the epigastric region (0.4-06 W/cm2, 2-4 min) and paravertebral (0.2-0.4 W/cm2, 2-3 min);
Diadynamic therapy, the parameters of which depend on the state of the secretory function of the stomach;
Microwave therapy on the projection area of the pyloroduodenal zone or on the epigastric region on the left; centimeter, decimeter and millimeter (EHF - therapy) waves are used: the latter are used in non-thermal dosages on the sternum or acupuncture points;
Magnetotherapy (15-20 mT, 10-20 min, 8-12 procedures);
UVR of the epigastric region and the spine at the level of Th 7-Th 12 (2-3 biodoses, 3-5 exposures);
Laser therapy performed with a fiber endoscope (up to 10 mW / cm², 2-8 minutes, 3-12 procedures).
During this period, you can start drinking treatment with mineral waters. Patients with peptic ulcer are recommended low-mineralized waters (bicarbonate sodium, bicarbonate sodium-calcium, sulfate calcium-magnesium-nitrium, chloride, etc.). More often, water is prescribed at a temperature of 38ºС 60-90 minutes before meals 3 times a day, 21-24 days.
The amount of water taken gradually increases from ¼ to 1 glass. Patients with abrupt hyperacidity and dyspeptic syndrome, a small amount of water (100-150 ml) can be given 30 minutes before meals. With concomitant lesions of the liver and biliary tract, colitis, drink mineral water heated to a temperature of 40-42ºС.
Among the effective methods of treatment include mud therapy. It is carried out more often in the form of applications on the epigastric region and segmentally (38 42ºС, 10-20 minutes, 8-12 procedures). With pronounced pain syndrome mud therapy can be combined with galvanic, diadynamic and sinusoidally modulated currents. Mud treatment is not used for complicated peptic ulcer disease.
From other thermotherapeutic methods, lamp irradiation is prescribed - solux, ozocerite or paraffin applications on the epigastric region and segmental zones according to generally accepted methods. Outside the acute phase and in the absence of complications, patients with peptic ulcer are shown the following baths: sodium chloride, radon, carbon dioxide, oxygen, iodine-bromine, etc. It is good to include massage in the treatment complex. Massage is carried out in the reflex zones of the back, as well as the abdomen (12-15 minutes, every other day, 8-12 procedures).
Sanatorium-and-spa treatment is indicated for patients with peptic ulcer in the phase of remission or fading exacerbation, without motor insufficiency of the stomach, a tendency to bleeding, penetration and suspicion of ulcer malignancy. Patients are sent to local sanatoriums or resorts with drinking mineral waters or therapeutic mud. Taking into account the seasonality of exacerbation of peptic ulcer, the preference for sanatorium treatment is carried out in winter or summer, early spring or early autumn.
Training load is one of the main means of rehabilitation of patients with peptic ulcer.
Tasks of exercise therapy: restoration of disturbed corticovisceral relations, improvement of blood circulation and trophism, activation of regenerative processes, normalization of motor and secretory functions of the mucous membrane of the stomach and duodenum.
Therapeutic exercises are prescribed after pain relief, a decrease in the severity of dyspeptic disorders.
I.p. - lying, sitting, standing. In the acute period after the subsidence of acute phenomena from the 5-7th day of the disease, they begin with the use of elementary general strengthening exercises with the gradual inclusion of special exercises for the muscles of the abdominal wall, simple dynamic breathing exercises, lower thoracic localized breathing, diaphragmatic breathing, relaxation exercises, static (isometric ) exercises that increase intra-abdominal pressure. Motor mode - sparing, sparing-training and training. The pace of the exercises is slow and medium. The number of repetitions gradually increases from 4-6 to 12-16. The duration of classes increases from 20-30 to 30-40 minutes.
As the condition improves and fitness increases, sports-applied exercises are included - dosed walking, walking in place, swimming. Classical massage of segmental zones of the thoracic spine, epigastric region is recommended in combination with hardening procedures.
Test questions.
1. Give a description of gastritis and its types.
2. What are the rehabilitation tasks for patients with chronic gastritis?
3. What is the method of physical rehabilitation for gastritis?
4. What methods of physiotherapy are used for gastritis?
5. Describe peptic ulcer of the stomach and duodenum.
6. List the goals of rehabilitation for gastric and duodenal ulcers.
7. List the tasks of physical rehabilitation for peptic ulcer of the stomach and duodenum.
8. Expand the method of physical rehabilitation for peptic ulcer of the stomach and duodenum.
9. In what period can you start drinking treatment with mineral waters for peptic ulcer of the stomach and duodenum.
10. What types of intestinal dyskinesia do you know, describe them.
11. What is the method of exercise therapy and massage for intestinal dyskinesia?
12. Describe biliary dyskinesia. What is the method of training for biliary dyskinesia?
13. List what methods of physiotherapy are used for biliary dyskinesia?
14. Rehabilitation tasks for chronic colitis?
15. Physiotherapy methods used for colitis?
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