Prevention is a complex of various kinds of measures aimed at preventing any phenomenon and/or eliminating risk factors.

Preventive measures are the most important component of the healthcare system, aimed at creating medical and social activity and motivation for a healthy lifestyle among the population.

Preventive measures are carried out at the paramedic-midwife station 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, rational work and rest regime, rational high-quality nutrition, physical activity, environmental protection, etc.). A number of primary prevention activities can be carried out on a national scale.

Secondary prevention is a set of measures aimed at eliminating pronounced risk factors, which under certain conditions (stress, weakened immunity, excessive load on any other functional systems of the body) can lead to the occurrence, exacerbation and relapse of the disease.

The most effective method of secondary prevention is medical examination as a comprehensive method of early detection of diseases, dynamic observation, targeted treatment, and rational consistent recovery.

Some experts propose the term tertiary prevention as a set of measures for the rehabilitation of patients who have lost the ability to fully live.

Tertiary prevention aims at social (building confidence in one’s own social suitability), labor (the possibility of restoring work skills), psychological (restoring behavioral activity) and medical (restoring the functions of organs and systems of the body) 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, promoting the development of the disease and realizing the occurrence or relapse of peptic ulcer.

Hereditary and constitutional factors. Among the etiological factors leading to the development of peptic ulcer disease, the most important place is occupied by hereditary predisposition. However, it only creates a predisposition to the disease, which is realized only in combination with other adverse effects.

Neuropsychic factors. The influence of neuropsychic factors on the occurrence of peptic ulcer disease is assessed ambiguously. 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 vagal tone. Hypervagotonia causes spasm of muscles and blood vessels, resulting in ischemia, decreased tissue resistance and subsequent digestion of the mucosal area by gastric juice. Thus, neuropsychic overload and disturbances of psychophysiological functions can be contributing factors in the occurrence of peptic ulcer disease.

Nutritional factor. In many patients, the onset and relapses of peptic ulcer disease occur after errors in eating or disturbances in the rhythm of eating. Symptoms such as heartburn, sour belching and vomiting often occur after eating irritating and juicey foods. 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. Long-term consumption of rough food contributes to the development of chronic gastritis and gastroduodenitis, which are considered pre-ulcerative conditions.

In turn, the buffering and antacid properties of some products (meat, milk, etc.) have a clear anti-corrosion effect, blocking active gastric juice.

Bad habits. Bad habits that contribute to the development of peptic ulcers primarily include smoking and alcohol abuse.

Among men who smoke, peptic ulcer disease occurs 2 times more often than among non-smokers. Nicotine causes constriction of gastric vessels, 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 plays a multifaceted role in the etiology of peptic ulcer disease. Firstly, it stimulates the acid-forming activity of the stomach, as a result of which the aggressive properties of gastric juice increase. Secondly, it disrupts the barrier function of the mucous membrane.

Thirdly, with long-term consumption of strong alcoholic drinks, 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 coffee consumption can also be considered bad habits. The mechanism of the adverse effects of coffee is associated with the stimulating effect of caffeine on the acid-forming function of the stomach.

Medicinal effects. It has been proven clinically and experimentally that a number of drugs (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, suppress 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 cannot be ruled out.

Other drugs (reserpine, corticosteroid drugs) primarily enhance the aggressive properties of gastric juice, directly stimulating the production of hydrochloric acid by parietal cells or acting through the neuroendocrine apparatus.

Diseases contributing to the development of peptic ulcer. Along with the above etiological factors, peptic ulcer disease occurs much more often in a number of diseases of internal organs. These diseases primarily include chronic diseases of the lungs, cardiovascular system, liver, pancreas, accompanied by functional failure of these organs and systems.

Thus, peptic ulcer is a polyetiological disease. For its occurrence, it is necessary to influence not an isolated causal factor, but a sum of factors in their interaction. In this case, 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 varies depending on the age, gender of the patient and the location of the ulcer. Thus, at a young age, heredity is of greatest importance. In middle age, neuropsychic stress, bad habits, and gross errors in nutrition begin to predominate among the causes of the disease.

In old age, “ulcerogenic” drugs and various concomitant diseases acquire a significant share in the genesis of peptic ulcer disease.

There are primary and secondary prevention of peptic ulcers. Primary prevention is aimed at preventing the disease. It includes proper nutrition, organization of work and rest, the fight against smoking and alcohol, creating good conditions in the family, physical education, etc. Primary prevention should be aimed at early diagnosis and treatment of pre-ulcerative conditions, functional disorders of the stomach and duodenum, as well as to identify other risk factors for the disease.

Secondary prevention involves preventing exacerbations of the disease. It is carried out during medical examination.

Urgent help with studies

Diploma

It is advisable to take laxatives that can be digested with food. These are senna, buckthorn bark, rhubarb root and joster fruit. Taking after a meal If the medicine is prescribed after a meal, then wait at least two hours to get the best therapeutic effect. Immediately after eating, they take mainly medications that irritate the gastric mucosa...

The role of nursing staff in the rehabilitation of patients with gastric ulcer (essay, coursework, diploma, test)

State budgetary educational institution of secondary vocational education

"Krasnodar Regional Basic Medical College" of the Ministry of Health of the Krasnodar Territory Cyclic Commission "Nursing"

DIPLOMA THESIS ON THE TOPIC: “THE ROLE OF NURSING STAFF IN THE REHABILITATION OF PATIENTS WITH GASTRIC ULCER”

Student Shavlach Ksenia Mikhailovna specialty Nursing

3rd year, group E-32

Thesis supervisor:

Osetrova Lyubov Sergeevna Krasnodar - 2014

Abstract Introduction

I. Gastric ulcer

1.1 Gastric ulcer. 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 region

II. Methods of rehabilitation of patients with gastric ulcer

2.1 General rehabilitation methods

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 rehabilitation plans for patients Conclusion List of sources used Appendices

Annotation

The thesis structurally consists of an introduction, three chapters, a conclusion, a list of references and appendices. The thesis is presented on 73 pages of typewritten text.

The introduction substantiates the relevance of the thesis topic and outlines the purpose and objectives of the research.

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 for 68% of men and 30.9% of women among all those suffering from diseases of the digestive system.

Object research: rehabilitation methods for gastric ulcer disease.

Item research: patients with gastric ulcer, medical history of an inpatient, results of a survey of patients with gastric ulcer.

Target research: studying the role of nursing staff in increasing the effectiveness of rehabilitation of patients with gastric ulcers at various stages - preventive, inpatient, outpatient, sanatorium and metabolic.

To achieve the above goal, the following were formulated: tasks:

· collect and systematize material on the causes and prevalence of gastric ulcer among the population of the globe, the Russian Federation, and the Krasnodar Territory;

· perform an analysis of rehabilitation methods for conservative management of patients and surgical management of patients with gastric ulcer;

· develop a rehabilitation questionnaire for specific patients with gastric ulcer and analyze the effectiveness of the inpatient rehabilitation phase;

· justify a complete rehabilitation program for patients with gastric ulcer at the sanatorium-resort and outpatient stages of the patient’s 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 problems set in the process of testing the hypothesis, the following were used: methods:

· subjective method of clinical examination of the patient;

· objective methods of examining the patient;

· comparison method;

· inductive method;

· deductive method.

Research base: State Budgetary Healthcare Institution KKB No. 1 named after. prof. S.V. Ochapovsky, Krasnodar, gastroenterology department.

The first chapter discusses: 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 examined two patients diagnosed with 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 the State Budgetary Healthcare Institution KKB No. 1 named after. prof. S.V. Ochapovsky in Krasnodar made it possible to identify complications of gastric ulcer and to consider the nurse’s tactics when they occur.

The role of medical personnel in carrying out comprehensive rehabilitation of patients cannot be underestimated, since without the participation of nurses in it it would be impossible, and the treatment of patients would not be completed. The reason for the importance of the role of nurses is the wide range of job responsibilities assigned to them, the performance of which by doctors without the help of nursing staff would be physically impossible. These results will help improve the organization of work of medical staff in the prevention of gastric ulcers.

Practical importance work determined by the fact that the results of the study can be implemented in practice in the work of a nurse and will improve the quality of nursing care and the prevention of gastric ulcers.

Gastric ulcer is an important problem in modern medicine. This disease affects approximately 10% of the world's population. 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, about 3 million people are registered with dispensaries. According to reports from the Ministry of Health of the Russian Federation, in recent years the proportion of patients with newly diagnosed peptic ulcer disease in Russia has increased from 18% to 26%.

The relevance of the problem of peptic ulcer disease is determined by the fact that it is the main cause of disability for 68% of men and 30.9% of women among all those suffering from diseases of the digestive system. This disease causes suffering to many patients, so we believe that all health care workers should carry out a wide range of preventive measures to prevent and reduce morbidity. Nowadays, insufficient attention is paid to treatment and rational recovery in the rehabilitation of this pathology. The preventive stage of rehabilitation is not well known to the population. Many people do not know the risk factors for peptic ulcer disease, cannot recognize the first signs of the disease in themselves, therefore, do not seek medical help in a timely manner, cannot avoid complications and provide first aid for gastrointestinal bleeding.

The purpose of this study is to study the role of nursing staff in increasing the effectiveness of rehabilitation of patients with gastric ulcers at various stages - preventive, inpatient, outpatient sanatorium and metabolic.

Before writing the work, the following tasks were formulated to achieve the above goal:

· To collect and systematize material on the causes and prevalence of gastric ulcer among the population of the globe, the Russian Federation, and the Krasnodar Territory;

· Perform an analysis of rehabilitation methods for conservative management of patients and surgical management of patients with gastric ulcer;

· Develop a rehabilitation questionnaire for specific patients with gastric ulcer and analyze the effectiveness of the inpatient rehabilitation phase;

· Justify a complete rehabilitation program for patients with gastric ulcer at the sanatorium-resort and outpatient stages of the patient’s recovery and bring it to the attention of the patient and his family in order to improve the quality of life;

· To substantiate the role of nursing in ensuring effective rehabilitation of patients with gastric ulcer.

Area of ​​research: nursing process at various stages of rehabilitation of patients with gastric ulcer.

The object of this study is rehabilitation methods for gastric ulcer disease.

Subject of the study: patients with gastric ulcer, medical history of an inpatient, 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 famous Russian and foreign scientists as Kharchenko N.V., Baranovsky A.Yu., Kaneyes P. were used.

І. Ulcerative disease stomach

1.1 Ulcerative disease stomach. Etiology. Clinical painting diseases

Gastric ulcer is a chronic recurrent disease that develops when the functional state of the stomach is impaired.

On average, 10% of the world's inhabitants are at risk of developing a stomach ulcer during their lifetime. In the world in 2013, about 250,000 people died from peptic ulcer disease, which is significantly lower than in 1993, when 320,000 people died from the same cause. The development of peptic ulcer disease is facilitated by hereditary predisposition, violation of diet and diet, neuropsychic factors, bad habits (smoking, alcohol, excessive coffee consumption), the action of a number of medications (corticosteroids, reserpine, non-steroidal anti-inflammatory drugs, etc.) can cause ulceration of the mucous membrane stomach lining.

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. Caused by HP, this gastritis contributes to the development of peptic ulcers in people genetically predisposed to this disease.

Peptic ulcer disease occurs much more often in a number of diseases of internal organs. These diseases include chronic diseases of the liver, pancreas, and biliary tract.

From a modern point of view, the pathogenesis of peptic ulcer disease appears to be the result of an imbalance between the factors of aggression of gastric juice and the protection of the gastric mucosa.

Aggressive factors include hydrochloric acid, pepsin, and impaired evacuation.

The modern classification of gastric ulcer is based on the results of endoscopic and histological studies of the 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

· subcardial ulcer;

Prepyloric ulcer.

By stages:

Pre-ulcerative condition (gastritis B);

· exacerbation;

· subsiding exacerbation;

· remission.

By acidity:

· with increased;

· normal;

· reduced;

with achlorhydria.

By age:

· youthful;

· elderly.

For complications:

· bleeding;

· perforation;

· stenosis;

· malignancy;

· penetration.

Clinical picture of the disease Symptoms: Pain in the epigastric region. For ulcers of the cardiac region and the posterior wall of the stomach - it appears immediately after eating, is localized behind the sternum, and can radiate to the left shoulder. With ulcers of the lesser curvature, pain occurs within 15–60 minutes. after eating. Dyspeptic phenomena. Belching with air (the severity and disturbance 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.

Changes occur in the Central nervous system (Asthenovegetative syndrome):

· poor sleep;

· irritability;

· emotional lability.

The following diagnostic methods are distinguished:

Laboratory diagnostic methods

1. A clinical blood test can detect hypochromic anemia, erythrocytosis, and a slow erythrocyte sedimentation rate (ESR).

2. Gregersen's stool can confirm that the ulcer is bleeding.

Instrumental research methods

1. Fibrogastroscopy (FGS). Reveals pathology of the mucous membrane of the upper digestive tract, inaccessible to the x-ray method. Local treatment of a peptic ulcer is possible. 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 for various acid-forming functions. Tablets (test) are given to the patient per os - they interact with hydrochloric acid, change, and are excreted in the urine. Based on the concentration upon release, one can indirectly judge the amount of hydrochloric acid. The method is not entirely reliable and is used when it is impossible to use probing.

3. Leporsky method (probe method). The volume on an empty stomach is assessed (normally 20 - 40 ml and the qualitative composition of the fasting portion: 20 - 30 mmol/l - the norm for 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 - normal. The type of secretion is assessed. Parenteral stimulation with histamine or pentagastrin.

4. pH-metry - measuring 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 administration of histamine).

5. Assessment of the proteolytic function of gastric juice. They examine it by immersing the probe inside the stomach, and it contains the substrate. A day later, the probe is removed and changes are studied.

6. X-ray examination The role of the 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 ulcers (while knowing the effect and side effects of the medications prescribed by the doctor);

4. Know the signs of emergency conditions in this pathology: bleeding, perforation and provide first aid for these conditions;

5. Provide asymptomatic care (for vomiting, nausea, etc.);

6. Be able to have 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 disease).

1.2 Complications And role nursing personnel at their emergence

Complications of peptic ulcer:

1. Gastrointestinal bleeding is the most common and serious complication, it occurs in 15 - 20% of patients and is the cause of almost half of all deaths in this disease. It is observed mainly in young men.

Small bleedings are more common, massive ones are 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. It may be caused by various hemostasis disorders. In this case, a certain role is assigned to gastric juice, which has anticoagulating properties. The higher the acidity of the juice and the activity of pepsin, the less pronounced the coagulation properties of the blood.

Symptoms depend on the amount of blood loss. Minor bleeding is characterized by pale skin, dizziness, and weakness. With severe bleeding, melena (tarry stools), single or repeated vomiting of the color of “coffee grounds” are noted.

1. Information that allows the 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's tactics for bleeding:

1. Call a doctor.

2. Calm and lay the patient down, turn his head to the side to relieve emotional and psychological stress

3. Place an ice pack on the epigastric region to reduce bleeding.

5. Measure heart rate and blood pressure to monitor the condition.

Prepare medications, equipment, tools:

· aminocaproic acid;

Dicinone (etamsylate);

· calcium chloride, gelatinol;

· polyglucin, hemodnesis;

· intravenous infusion system, syringes, tourniquet;

· everything you need to determine your blood group and Rh factor;

· assessment of what has been achieved is:

stop 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. More often there is perforation and abdominal cavity. In 20% of ulcers of the posterior wall of the stomach, “covered” perforations are observed, caused by the rapid development of fibrous inflammation and the covering of the perforated opening by the lesser omentum, the left lobe of the liver or the pancreas.

Clinically manifested by sudden sharp (dagger) pain in the upper abdomen. The suddenness and intensity of pain is not as pronounced as in any other condition. The patient takes a forced position with his knees pulled up to his stomach and tries not to move. On palpation, a pronounced tension in the muscles of the anterior abdominal wall is noted. In the first hours after perforation, patients experience vomiting, which later becomes repeated with the development of diffuse pertonitis.

Bradycardia is replaced by tachycardia, the pulse is weak. Fever appears. Leukocytosis, erythrocyte sedimentation rate (ESR) is increased. An X-ray examination reveals gas in the abdominal cavity under the diaphragm.

3. Ulcer penetration - characterized by penetration of the ulcer into the organs in contact with the stomach: liver, pancreas, lesser omentum.

Clinical picture: in the acute period it resembles a perforation, but the pain is less intense. Soon signs of damage to the organ into which penetration occurred (girdling pain and vomiting with damage to the pancreas, pain in the right hypochondrium with irradiation to the right shoulder and back with penetration of the liver, etc.). In some cases, penetration occurs gradually. When making a diagnosis, it is necessary to take into account the presence of constant pain, leukocytosis, low-grade fever, etc.

4. Pyloric stenosis or pyloric stenosis - the essence of this complication is 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 stretches to such an extent that the upper abdomen becomes noticeably enlarged. Remnants of food eaten the day before are visible in the vomit. Due to insufficient digestion of food and incomplete absorption, general exhaustion of the body occurs, a person loses weight, becomes weaker, and the skin becomes dry, which is one of the signs of dehydration. The patient is depressed and loses his ability to work.

5. Malignant transformation of an ulcer (malignancy) - observed almost exclusively when the ulcer is localized in the stomach. When the ulcer becomes malignant, the pain becomes constant, loses connection with food intake, appetite decreases, exhaustion increases, nausea, vomiting, and subfibrile temperature are noted.

Anemia - accelerated erythrocyte sedimentation rate (ESR), persistently positive benzidone test (Gregersen reaction). Treatment: complications of peptic ulcer: perforation, bleeding, penetration, degeneration into cancer and cicatricial deformation 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 of malignant neoplasm in humans. This provision fully applies to older people. Precancerous diseases play a very important role in the development of stomach cancer. These include stomach polyps, gastric ulcers, and 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;

To fill the lack of positive information about the disease for the patient and his relatives;

Follow doctor's orders;

Provide first aid in case of emergency (bleeding, perforation);

Give competent advice on diet and physical activity;

Provide care if problems arise.

1.4 Statistical analysis emergence ulcerative illnesses stomach V world, Russian Federation And Krasnodar edge

Three factors are considered at the basis of the appearance of gastric ulcer and the occurrence of relapses:

1. Genetic predisposition;

2. Imbalance between the factors of aggression and defense;

3. Presence of Helicobacter Pylori (HP).

Gastric ulcers had a huge impact on mortality until the end of the 20th century.

In Western countries, the proportion of people developing peptic ulcers due to HP, roughly speaking, corresponds to age (for example, 20% at the age of 20 years, 30% at the age of 30 years, 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%. Overall, Helicobacter Pillory shows a declining trend, more so in developed countries. Helicobacter Pillory is transmitted through food, natural water sources and cutlery.

In the United States, about 4 million people have peptic ulcers, and 350,000 people get the disease 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, an increase of 6%, so the growth is within normal limits. The incidence reached its highest level of 5,149,000 people in 2002, the lowest level could be observed in 2000.

Attention should be paid to the increase in the rates of general morbidity (by 10.8%) and primary morbidity (by 9.2%) of the adult population in 2012 compared to 2011 (the overall incidence 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%). An increase in mortality from stomach ulcers (by 16.2%) is associated with the aging of the population and an increase in the number of patients with severe concomitant pathologies who are forced to take non-steroidal anti-inflammatory drugs and antiplatelet agents for a long time. Reducing mortality rates from complicated gastroenterological diseases can only be achieved with the 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 the nurse in the prevention of gastric ulcers is difficult to overestimate. Many cases of peptic ulcer disease can be prevented when nurses assist doctors in conducting outreach to the public. An example of such assistance is assistance to gastroenterologists of the region in holding schools for patients with peptic ulcers, round tables and lectures for patients, and speaking on television and radio with conversations about a healthy lifestyle. Gastric ulcer is currently one of the most common pathologies among patients. In 2012, as a result of additional medical examination, 35,369 such patients were identified and registered at the dispensary.

II. Methods rehabilitation patients sick ulcerative illness stomach

2.1 General methods rehabilitation

According to the WHO definition, rehabilitation is the combined and coordinated use of social, medical, pedagogical and professional measures with the aim of preparing and retraining an individual to achieve his optimal working capacity."

Rehabilitation objectives:

1. Improve the overall reactivity of the body;

2. Normalize the state of the central and autonomic systems;

3. Provide painkillers, anti-inflammatory, trophic effects 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 stages ensured by the continuity of information, the unity of understanding of the pathogenetic essence of pathological processes and the foundations of their pathogenetic therapy. The sequence of stages may vary depending on the course of the disease.

An objective assessment of the results of rehabilitation is very important. It is necessary for the ongoing correction of rehabilitation programs, prevention and overcoming of unwanted side reactions, and 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, 5 stages of medical rehabilitation are distinguished.

The preventive stage aims to prevent the development of clinical manifestations of the disease by correcting metabolic disorders (Appendix B).

Activities at this stage have two main directions: elimination of identified metabolic and immune disorders through dietary correction, the use of mineral waters, pectins from marine and terrestrial plants, natural and reformed physical factors; combating risk factors that can significantly provoke the progression of metabolic disorders and the development of clinical manifestations of the disease. One can count on the effectiveness of preventive rehabilitation only by backing up the measures of the first direction by optimizing the living environment (improving the microclimate, reducing dust and air pollution, leveling the harmful effects of geochemical and biogenic nature, etc.), combating physical inactivity, excess body weight, smoking and others bad habits.

Inpatient stage of medical rehabilitation, in addition to the first most important task:

1. Saving the patient’s life (involves measures to ensure minimal tissue death as a result of exposure to a pathogenic agent);

2. Prevention of complications of the disease;

3. Ensuring the optimal course of reparative processes (Appendix D).

This is achieved by replenishing the deficit of circulating blood volume, normalizing microcirculation, preventing tissue swelling, conducting detoxification, antihypoxic and antioxidant therapy, normalizing electrolyte disturbances, using anabolic steroids and adaptogens, and physiotherapy. In case of microbial aggression, antibacterial therapy is prescribed and immunocorrection is carried out.

The outpatient stage of medical rehabilitation should ensure the completion of the pathological process (Appendix E).

For this purpose, therapeutic measures are continued aimed at eliminating residual effects of intoxication, microcirculation disorders, and restoring 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 principles of dietary correction depending on the characteristics of the course of the disease. A major role at this stage is played by targeted physical culture in a mode of increasing intensity.

The sanatorium-resort stage of medical rehabilitation completes the stage of incomplete clinical remission (Appendix G). Treatment measures should be aimed at preventing relapses of the disease, as well as its progression. To achieve these goals, predominantly natural therapeutic factors are used to normalize microcirculation, increase cardiorespiratory reserves, stabilize the functioning of the nervous, endocrine and immune systems, gastrointestinal tract and urinary excretion.

The metabolic stage includes conditions for the normalization of structural and metabolic disorders that existed after completion of the clinical stage (Appendix E).

This is achieved through long-term dietary correction, the use of mineral waters, pectins, climatotherapy, therapeutic physical training, and balneotherapy courses.

The results of the implementation of the principles of the proposed medical rehabilitation scheme are predicted by the authors to be more effective compared to the traditional one:

Isolating the stage of preventive rehabilitation allows us to form risk groups and develop preventive programs;

Identification 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 progression and chronicity of the pathological process;

Staged medical rehabilitation including independent stages of preventive and metabolic remission will reduce morbidity and increase the level of public health.

Areas of medical rehabilitation include medicinal and non-medicinal areas:

Medicinal 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.

Recommendations for patients on taking medicinal substances Take before meals Most drugs are taken 30 - 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 anti-ulcer drugs - d-nol, gastrofarm. They should be washed down with water (not milk).

Also, half an hour before meals you should take antacids (Almagel, phosphalugel, etc.) and choleretic drugs.

Take with 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 acid preparations or digestive enzymes should be taken with food, as they help the stomach digest food. These include pepsin, festal, enzistal, panzinorm.

It is advisable to take laxatives that can be digested with food. These are senna, buckthorn bark, rhubarb root and joster fruit.

Taking after a meal If the medicine is prescribed after a meal, then wait at least two hours to get the best therapeutic effect.

Immediately after eating, they take mainly medications that irritate the mucous membrane of the stomach and intestines. This recommendation applies to such groups of drugs as:

* painkillers (non-steroidal) anti-inflammatory drugs - Butadione, aspirin, aspirin cardio, voltaren, ibuprofen, askofen, citramon (only after meals);

* acute drugs are components of bile - allohol, lyobil, etc.); taking after meals is a prerequisite for these drugs to “work”.

There are so-called antacid agents, 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 finishing a meal - magnesium oxide, vikalin, vikair.

Aspirin or askofen (aspirin with caffeine) is taken after meals, when the stomach has already begun to produce hydrochloric acid. Thanks to this, the acidic properties of acetylsalicylic acid (which causes irritation of the gastric mucosa) will be suppressed. This should be remembered by those who take these tablets for headaches or colds.

Regardless of food Regardless of when you sit down at the table, take:

Antibiotics are usually taken regardless of food, but fermented milk products must also be present in your diet. Along with antibiotics, they also take nystatin, and at the end of the course, complex vitamins (for example, supradin).

Antacids (Gastal, Almagel, Maalox, Taltsid, Relzer, Phosphalugel) and antidiarrheals (Imodium, Intetrix, Smecta, Neointestopan) - half an hour before meals or one and a half to two hours after. Please note that antacids taken on an empty stomach last for about half an hour, and those taken 1 hour after a meal last for 3 to 4 hours.

Taking on an empty stomach Taking the medicine on an empty stomach is usually in the morning 20 - 40 minutes before breakfast.

Medicines taken on an empty stomach are absorbed and absorbed much faster. Otherwise, the acidic gastric juice will have a destructive effect on them, and the medications will be of little use.

Patients often ignore the recommendations of doctors and pharmacists, forgetting to take a pill prescribed before meals and rescheduling it for the afternoon. If the rules are not followed, the effectiveness of the drugs will inevitably decrease. To the greatest extent if, contrary to the instructions, the drug is taken during or immediately after meals. This changes how quickly drugs pass through the digestive tract and how quickly they are absorbed into the blood.

Some drugs may break down into their component parts. For example, penicillin is destroyed in an acidic stomach environment. Aspirin (acetylsalicylic acid) breaks down into salicylic and acetic acids.

Taking 2 - 3 times a day, if the instructions indicate “three times a day”, this does not mean breakfast - lunch - dinner. The medicine must be taken every eight hours to maintain its concentration in the blood evenly. It is better to take 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, polyphepane 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, you need to increase your fluid intake. It is good to add herbs that have a diuretic effect to your drink.

During the day or at night Drugs with a hypnotic effect should be taken 30 minutes before bedtime.

Laxatives - bisacodyl, senade, glaxena, regulax, gutalax, forlax - are usually taken before bed and half an hour before breakfast.

Ulcer medications are taken early in the morning and late in the evening to prevent hunger pangs.

After inserting the suppositories, you need to lie down, so they are prescribed at night.

Emergency medications are taken 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 medications to patients in accordance with the prescriptions of the attending physician, informing the patient about medications, and monitoring their intake.

Non-drug rehabilitation methods include the following:

1. Diet correction:

The diet for gastric ulcers is used as prescribed by the doctor sequentially; during surgery, it is recommended to start with diet - 0.

Goal: Maximum sparing of the mucous membrane of the esophagus and 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.

Diet characteristics. This diet requires a minimal amount of food. Since it is difficult to take in solid 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. Protein 15 g, fat 15 g, carbohydrates 200 g, calorie content - about 1000 kcal. Table salt 5 g. The total weight of the diet is no more than 2 kg. The food temperature is normal.

Sample set Fruit juices - apple, plum, apricot, cherry. Berry juices - strawberry, raspberry, blackcurrant. Broths - weak from lean meats (beef, veal, chicken, rabbit) and fish (pike perch, bream, carp, etc.).

Cereal decoctions - rice, oatmeal, buckwheat, corn flakes.

Kissels made from various fruits, berries, their juices, and dried fruits (with the addition of a small amount of starch).

Butter.

Tea (weak) with milk or cream.

Sample one-day diet menu No. 0

8 hours - fruit and berry juice.

10 o'clock - tea with milk or cream and sugar.

12 hours - fruit or berry jelly.

14 hours - weak broth with butter.

16 hours - lemon jelly.

18 o'clock - rosehip decoction.

20 o'clock - tea with milk and sugar.

22 hours - rice water with cream.

Diet No. 0A

Her As a rule, they are prescribed for 2-3 days. The food consists of liquid and jelly-like dishes. The diet contains 5 g of protein, 15-20 g of fat, 150 g of carbohydrates, energy value 3.1-3.3 MJ (750-800 kcal); table salt 1 g, free liquid 1.8-2.2 l. Food temperature should not exceed 45 °C. Up to 200 g of vitamin C is added to the diet; other vitamins are added as prescribed by the doctor. Meals 7 - 8 times a day, for 1 meal give no more than 200 - 300 g.

· Allowed: weak 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 with sweet water (up to 50 ml per appointment). If the condition improves, on the 3rd day add: a soft-boiled egg, 10 g of butter, 50 ml of cream.

· Excluded: any dense or pureed foods, 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 the addition of liquid pureed porridges made from rice, buckwheat, rolled oats, cooked in meat broth or water. The diet contains 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 of sodium chloride, up to 2 liters of free liquid. Food is given 6 times a day, no more than 350-400 g per meal.

Diet No. 0 B (No. 1B surgical)

She serves as a continuation of the expansion of the diet and the transition to physiologically nutritious nutrition. The diet includes puree soups and cream soups, steamed dishes from pureed boiled meat, chicken or fish, fresh cottage cheese, pureed with cream or milk to the consistency of thick sour cream, steamed dishes from cottage cheese, fermented milk drinks, baked apples, well-mashed fruit and vegetable purees, up to 100 g of white crackers. Milk is added to tea; They give you milk porridge. The diet contains 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 temperature aggression on the stomach. This diet is prescribed for exacerbation of peptic ulcer disease, bleeding, acute gastritis and other diseases that require maximum sparing of the stomach.

Purpose of diet No. 1a: Reducing reflex excitability of the stomach, reducing interoceptive irritations emanating from the affected organ, restoring the mucous membrane by maximizing sparing the function of the stomach.

General characteristics of diet No. 1a Exclusion of substances that are strong stimulants of secretion, as well as mechanical, chemical and thermal irritants. Food is prepared only in liquid and mushy form. Steamed, boiled, mashed, pureed dishes in a liquid or mushy consistency. In Diet No. 1a for patients who have undergone cholecystectomy, only mucous soups and eggs in the form of steamed protein omelettes are used. Calories are reduced primarily through carbohydrates. The amount of food taken at one time is limited, the frequency of intake is at least 6 times.

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 of the physiological norm, and a strict limitation of the effects of various chemical and mechanical irritants on the upper parts of the gastrointestinal tract. This diet also limits carbohydrates and table salt.

Proteins 80 g, fats 80 - 90 g, carbohydrates 200 g, table salt 16 g, calorie content 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.

· Slimy soups made from semolina, oatmeal, rice, pearl barley with the addition of egg-milk mixture, cream, butter.

· Meat and poultry dishes in the form of puree or steam soufflé (meat cleaned of tendons, fascia and skin is passed through a meat grinder 2-3 times).

· Fish dishes in the form of steam soufflé from low-fat varieties.

· Dairy products - milk, cream, steam soufflé from freshly prepared pureed cottage cheese; Fermented milk drinks, cheese, sour cream, and regular cottage cheese are excluded. If well tolerated, whole milk 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.

· Cereal dishes in the form of liquid porridge with milk, porridge made from cereal (buckwheat, oatmeal) flour with the addition of milk or cream. Almost all cereals can be used, with the exception of pearl barley and millet. Add butter to the finished porridge.

· Sweet dishes - jelly and jellies from sweet berries and fruits, sugar, honey. You can also make juices from berries and fruits by diluting them with boiled water before drinking in a 1:1 ratio.

· Fats - fresh butter and vegetable oil added to dishes.

· Drinks: weak tea with milk or cream, juices from fresh berries and fruits diluted with water. Among the drinks, decoctions of rose hips 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 foods; 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 intended purpose as for diet No. 1a. The diet is fractional (6 times a day). This table is for less severe, in comparison with table No. 1a, limitation of mechanical, chemical and temperature aggression on the stomach. This diet is indicated for mild exacerbation of gastric ulcer, in the stage of subsidence of this process, for chronic gastritis.

Diet No. 1b is prescribed at subsequent stages of treatment while the patient remains in bed. The duration of diet No. 1b is very individual, but on average it ranges from 10 to 30 days. Diet No. 1b is also used during bed rest. The difference from diet No. 1a is the gradual increase in the content of basic nutrients and caloric content of the diet.

Bread in the form of dried (but not toasted) crackers (75 - 100 g) is allowed. Pureed soups are introduced, replacing mucous membranes; Milk porridge can be consumed more often. Homogenized canned baby food made from vegetables and fruits and dishes made from beaten eggs are allowed. All recommended products and dishes from meat and fish are given in the form of steam soufflé, quenelles, mashed potatoes, and cutlets. After the products are boiled until soft, they are rubbed to a mushy state. The food should be warm. The rest of the recommendations are the same as for diet No. 1a.

Chemical composition of diet No. 1b Proteins up to 100 g, fats up to 100 g (30 g vegetable), carbohydrates 300 g, calorie content 2300 - 2500 kcal, table 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 dietary correction The dietitian monitors the operation 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, monitors the correct storage of food supplies. With the participation of the production manager (chef) and under the guidance of a nutritionist, he compiles a daily menu layout in accordance with the dish card index. Performs periodic calculations of the chemical composition and calorie content of diets, monitoring the chemical composition of actually prepared dishes and diets (content of 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 stocking of products and the release of dishes from the kitchen to the departments, according to received orders, and carries out rejecting of finished products. Monitors the sanitary condition of dispensing and canteens at the departments, equipment, utensils, as well as the observance of personal hygiene rules by dispensing employees. Organizes training sessions with paramedics and kitchen staff on clinical nutrition. Monitors the timely conduct of preventive medical examinations of catering workers and prevents persons from working who have not undergone a preliminary or periodic medical examination.

Diet No. 1

General intelligence

· Indications to diet No. 1

Gastric ulcer in the stage of fading exacerbation, during the period of recovery and remission (duration of dietary treatment is 3 - 5 months).

The purpose of diet No. 1 is to accelerate the processes of repair of ulcers and erosions, further reduce or prevent inflammation of the gastric mucosa.

This diet helps normalize the secretory and motor-evacuation functions of the stomach.

Diet No. 1 is designed to satisfy the physiological needs of the body for nutrients in an inpatient setting or in an outpatient setting during work that is not associated with 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 temperature aggression with a restriction in the diet of foods that have a pronounced irritant effect on the walls and receptor apparatus of the upper gastrointestinal tract, as well as difficult-to-digest foods. Avoid foods that are strong secretion stimulants and chemically irritating to the gastric mucosa. Both very hot and very cold foods 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. It is recommended to chew food thoroughly.

· Food is liquid, mushy and has a denser consistency when boiled and mostly pureed. Since the consistency of food is very important during dietary nutrition, the amount of foods rich in fiber (such as turnips, radishes, radishes, asparagus, beans, peas), fruits with skin and unripe berries with rough skin (such as gooseberries, currants, grapes) is reduced. , dates), bread made from wholemeal flour, products containing rough connective tissue (such as cartilage, poultry and fish skin, stringy meat).

Dishes are prepared boiled or steamed. After this, they are crushed to a pasty state. Fish and lean meats can be eaten whole. Some dishes can be baked, but without a crust.

· Chemical composition of diet No. 1

Protein 100 g (of which 60% animal origin), fat 90 - 100 g (30% vegetable), carbohydrates 400 g, table salt 6 g, calorie content 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 liquid is 1.5 l, the food temperature is normal. It is recommended to limit table salt.

· Wheat bread made from premium flour, freshly baked or dried; rye bread and any fresh bread, products made from butter and puff pastry are excluded.

· Soups with vegetable broth from pureed and well-cooked cereals, milk soups, pureed vegetable soups, seasoned with butter, egg-milk mixture, cream; Meat and fish broths, mushroom and strong vegetable broths, cabbage soup, borscht, and okroshka are excluded.

· Meat dishes - steamed and boiled from beef, young lean lamb, trimmed pork, chicken, turkey; Fatty and stringy varieties of meat, poultry, duck, goose, canned meat, and smoked meats are excluded.

· Fish dishes 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.

· Porridges made from semolina, buckwheat, rice, cooked in water, milk, semi-viscous, mashed; millet, pearl barley and barley cereals, legumes, and pasta are excluded.

· Vegetables - potatoes, carrots, beets, cauliflower, boiled in water or steam, in the form of souffles, purees, steam puddings.

· Appetizers - salad of boiled vegetables, boiled tongue, doctor's sausage, milk sausage, diet sausage, jellied fish in vegetable broth.

· Sweet dishes - fruit puree, jelly, 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

There are two food groups you should eliminate from your diet.

· Products that cause or increase 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, mushroom decoctions; fried foods; meat and fish stewed in their own juice; meat, fish, tomato and mushroom sauces; salted or smoked fish and meat products; canned meat and fish; salted, pickled vegetables and fruits; spices and seasonings (mustard, horseradish).

In addition, the following are excluded: rye and any fresh bread, pastry products; high acidity dairy products; millet, pearl barley, barley and corn cereals, legumes; white cabbage, radish, sorrel, onions, cucumbers; salted, pickled and pickled vegetables, mushrooms; sour and fiber-rich fruits and berries.

It is necessary to focus on the patient’s feelings. If, when eating a certain product, the patient feels discomfort in the epigastric region, and even more so nausea and vomiting, then this product should be abandoned.

2. Physiotherapy methods Balneotherapy (Latin balneum bath, bathing + Greek therapeia treatment) - treatment with mineral waters. It helps the body tolerate changes in the external environment, helps 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 for the purpose of eliminating the inflammatory process in the mucous membrane of the gastrointestinal tract, as well as eliminating its functional disorders. In addition, drinking a course of mineral waters helps normalize 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 damage to the stomach and intestines.

For gastric ulcers, 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 of stimulating the secretory function of the stomach, while less mineralized ones (such as Zheleznovodsk) exhibit a greater inhibitory effect on the secretory activity of the gastric glands. Mineral waters are prescribed 1-1.5 hours before meals.

The degree of 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 heated before drinking.

For patients with preserved and increased secretory function of the stomach, mineral waters “Smirnovskaya”, “Slavyanovskaya”, “Moskovskaya”, as well as “Borjomi”, “Jermuk”, “Istisu”, “Sairme”, etc. are recommended. Treatment with mineral waters also has a positive effect on gastric motor function. The duration of treatment with water is 3 - 4 weeks.

If gastritis with secretory deficiency is accompanied by diarrhea, it is advisable to reduce the intake of mineral water to ½ - ½ glass (water temperature 40 - 44°C). After the patient's condition improves, you can proceed to regular doses.

Sodium chloride, bicarbonate sodium chloride waters, especially those containing carbon dioxide, have a stimulating effect on the secretory activity of the stomach: “Essentuki No. 4” and “Essentuki No. 17”, the waters of Staraya Russa, the resorts of Druskininkai, Morshyn, Krainka, Pyatigorsk, and the waters of the Kuyalnitsky spring. In addition to anti-inflammatory and stimulating gastric secretion effects, 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.

When treating gastric 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 therapeutic effect and reduces the carbon dioxide content. Use 1.5 hours before meals.

In addition to drinking mineral waters, rectal procedures using them are highly effective. For such purposes, microenemas from mineral water of 50-100 ml at a temperature of 37 ° C can be used; per course of treatment - 10-12 procedures. For microenemas, the same mineral waters are used as for drinking treatment.

One of the methods of balneotherapy, in addition to drinking mineral waters, is baths.

The most commonly used physiotherapy in the treatment of gastric ulcers are electrosleep and balneotherapy.

One of the varieties of pearl baths is pearl-pine baths. They are a combination of a pearl bath with the healing effect of pine extract dissolved in it. The combined effect of these two factors far exceeds the therapeutic effect of using individual pearl and pine baths.

In addition to the temperature and mechanical effects, the chemical effect of pine extract on the body is also added. In addition, the procedure becomes more pleasant due to the aromatherapy effect, thanks to the pleasant smell of pine needles.

Pearl-coniferous baths are used to normalize the functioning of the nervous system, improve blood circulation and microcirculation, and change the sensitivity of receptors and nerve endings. This procedure also has a pronounced calming, healing and absorbable effect.

Such baths help well in the initial stages of the disease, 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 should be 10 - 15 minutes. The course consists of 10 - 15 procedures, which are carried out every other day.

Electrosleep is a method of electrotherapy based on the use of low frequency pulsed 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.

Special devices are used to carry out the procedure. They serve to generate voltage pulses of constant polarity.

Children are usually prescribed electrosleep from 3 to 5 years of age. In this case, low frequencies and lower current are used. The session duration 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 effects. Electrosleep does not cause predominance of vagal influences.

It is also very different from medicated sleep. It is very important that this procedure does not cause complications and does not lead to intoxication.

Impact of electrosleep on humans

Mechanism The impact of this method lies in the direct and reflex influence of current pulses on the cerebral cortex and subcortical formations of the patient.

The pulsed current is a weak stimulus. It has a monotonous rhythmic effect. During the procedure, current penetrates the patient's brain through the openings of 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 makes it possible to induce a special psychophysiological state, which leads to the restoration of emotional, vegetative and humoral balance.

Electrosleep helps normalize higher nervous activity, improves 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, and improves the activity of the excretory and reproductive systems. Helps reduce blood cholesterol levels.

Electrosleep also leads to the restoration of impaired carbohydrate, lipid, protein and mineral metabolism. Can be used as an antispasmodic and has a hypotensive effect.

The impact of pulsed current on the human brain leads to the production of special substances - endorphins, which a person needs for a good mood and a fulfilling 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 they were going to sleep at night. At the clinic, the patient must remove tight clothing and cover himself with a blanket.

It is best to conduct electrosleep sessions in a special separate room, isolated from noise. The room must be darkened. Electrosleep can also be combined with psycho- and music therapy.

Before the first session, the specialist tells the patient about the procedure and warns him about the sensations that may arise during the procedure.

Before the procedure, a special mask with four metal sockets is put on the patient’s face. These sockets are secured with rubber bands. The person's eyes should be tightly closed. This is how pulsed current is supplied 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. During this period, it is best for women to avoid using 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, current is up to 10 mA, voltage is 50 - 80 Volts.

The duration of the session can vary - from 30-40 to 60-90 minutes. Most often, the duration of the procedure depends on the nature of the pathological process and on the individual characteristics of the patient’s body. To achieve a positive result, procedures should be carried out daily or every other day. Usually 10-15 sessions are prescribed per course.

Electrophoresis is the therapeutic use of direct electric current. Under the influence 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 (drainage-dehydrating), analgesic, sedative (at the anode), vasodilator, muscle relaxant, metabolic, secretory (at the cathode).

Contraindications: acute purulent inflammatory processes, skin sensitivity disorders, individual intolerance to current, violation of the integrity of the skin at the sites where the electrodes are applied, eczema.

The duration of 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 repeat course is prescribed after 30 days.

UHF - therapy is 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 from 1 m to 10 cm, which corresponds to an oscillation frequency from 300 to 3000 MHz.

Exposure to decimeter waves is carried out on the bare surface of the patient’s body, in a lying 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 technique, the emitters are installed above the irradiated surface with an air gap of 3 - 5 cm (usually on stationary devices). For intraorgan effects, the corresponding emitter with a plastic cap or rubber bag treated with alcohol is inserted into the organ cavity and fixed.

Microwaves are dosed according to the power output and thermal sensations of patients. It is customary to distinguish 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: output power up to 6 W is considered low-thermal, 6 - 9 W is considered thermal, and more than 10 W is considered high-thermal. Pay attention to the condition of the skin in the irradiation zone: with low-heat dosages, the skin color does not change, with heat dosages, slight hyperemia is noted. During the procedure, the patient should not be allowed to experience a burning sensation. If you complain of a burning sensation, you need to reduce the power output.

The duration of exposure to microwaves ranges from 4 - 5 to 10 - 15 minutes per field. The total duration of DMV therapy should not exceed 30 - 35 minutes. After the procedure, it is advisable to rest for 1520 minutes. DMV 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, a second course of DMV therapy can be carried out after 2 - 3 months.

Inductothermy (Latin Inductio - excitation, induction + Greek therme heat, warmth), or high-frequency magnetotherapy is a method of electrotherapy, which is based on the effect on the body of a magnetic field (mainly the magnetic component of the electromagnetic field) of high frequency (3 - 30 MHz). In terms of frequency, it occupies an intermediate place between diathermy and UHF therapy.

The procedures are carried out on a wooden couch (chair) in a position comfortable for the patient. You can act through light clothing, dry gauze or plaster bandages. There should be no metal objects in the area of ​​exposure and nearby areas of the body. The inductor is selected depending on the location and area of ​​influence. 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 must be located on the affected area without gaps.

If inductothermal effects on an arm or leg are necessary, the inductor cable is wound around them in the form of a solenoid. In this case, you should ensure 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 arises 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 the 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, ranges from 15 to 30 minutes. A course of treatment is prescribed from 10 to 15 procedures. A second course, if necessary, can be carried out after 8 to 12 weeks. For children, weak and medium dosages are used, the duration of procedures is 10 - 20 minutes daily or every other day, for a course there are 8 - 10 procedures. Inductothermy is prescribed to children from 5 years of age.

To enhance the effect on the area of ​​the pathological focus, inductothermy is sometimes combined with medicinal 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 mud inductothermy, therapeutic mud at a temperature of 37 - 39 °C is applied to the area of ​​the body to be treated, covered with oilcloth and a towel or sheet. A tuned circuit or inductor cable, coiled into a spiral in a shape corresponding to the area of ​​influence, is placed on top of the towel. If treatment is carried out for gynecological diseases or prostatitis, then at the same time you can insert a mud tampon 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 is additionally heated 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. When simultaneously exposed to galvanic or other current of low voltage and frequency, hydrophilic gaskets with a metal electrode are used. The disk 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 develops a feeling of pleasant warmth, a low-voltage current is turned on. Switching off is done in the 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 with conventional electrophoresis, are impregnated with a 1-2% solution of the medicinal substance. With mud inductophoresis, the therapeutic effect of application and interstitial heat, galvanic or rectified sinusoidal modulated current and some liquid components of mud are summed up. The procedure is carried out in the same way as with galvanoinductothermy, but instead of hydrophilic pads, mud applications wrapped in gauze at a temperature of 36 - 38 ° C are used. A mud application can be placed under one of the electrodes, and a hydrophilic pad under the other. According to indications, you can insert into the vagina or rectum. There are several types of electrodes:

1) electrode discs for influencing the abdomen, chest, lower back

2) electrode-cable in the form of a flat spiral for influencing the hip and shoulder joints, mammary gland, and perineum.

3) electrode-cable in the form of a cylindrical spiral of 3 - 4 turns to influence the limbs.

4) electrode-cable in the form of a loop of one or one and a half turns to influence primarily the area of ​​the spine, peripheral nerves and blood vessels.

Local and general reactions of the body to inductothermy are the basis for indications and contraindications for its use.

Indications include chronic and subacute inflammatory processes of various localizations, post-traumatic conditions, metabolic-dystrophic disorders, in particular with rheumatoid arthritis, periarthritis, arthrosis and periarthrosis, nonspecific inflammatory diseases of the respiratory system - bronchitis, pneumonia, etc., chronic inflammatory diseases of the female genital organs , prostatitis, chronic neurological manifestations of spinal osteochondrosis, neuritis, spastic conditions of smooth and striated muscles, chronic purulent-inflammatory processes (with free outflow of pus), diseases of the cardiovascular system. Inductothermy is also used to stimulate adrenal function in a number of diseases (for example, bronchial asthma, rheumatism, rheumatoid arthritis, scleroderma). It is also used for gastric ulcers, hyperkinetic dyskinesias, urolithiasis, itchy dermatoses, scleroderma, chronic eczema, etc.

Contraindications are febrile conditions, acute purulent-inflammatory processes, active tuberculosis, tendency to bleeding, 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 ​​effect, severe organic diseases nervous system.

Inductothermy should not be performed on patients with skin defects, wet plaster or hygienic bandages. 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 inductor projection and at a distance of 8 - 12 cm from it cause skin burns in the patient.

The nurse carries out preventive, therapeutic, and rehabilitation measures prescribed by the doctor of the physiotherapy department. Conducts physiotherapeutic procedures. Prepares physiotherapeutic equipment for work, monitors its serviceability, correct operation and safety precautions. In addition, the nurse prepares patients for physiotherapeutic procedures and monitors the patient’s condition during physiotherapeutic procedures. Ensures infection safety of patients and medical personnel, compliance with the requirements of sanitary and epidemiological surveillance in the physiotherapy department. Prepares medical and other official documentation in a timely and high-quality manner. Ensures proper storage and use of medications. Complies with moral and legal standards of professional communication. Conducts sanitary education work. Provides pre-hospital medical care in emergency situations. Qualifiedly and timely carries out orders, instructions and instructions from the management of the institution, as well as regulatory legal acts related to his professional activities. Complies with internal regulations, fire and safety regulations, and sanitary and epidemiological regulations.

4. Herbal medicine The goal of herbal medicine for gastric ulcers is the most complete restoration of the defect in the mucous membrane and the normalization of all disturbances in the functioning of the gastrointestinal tract.

At the inpatient stage of rehabilitation, one of the main phytotherapeutic agents is oxygen cocktails.

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 special compositions for oxygen cocktails, sometimes spum mixtures, and even less often licorice root extract or dry egg white. Sanatoriums, holiday homes 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 accompanying means of oxygen therapy. Can help eliminate chronic fatigue syndrome and get rid of hypoxia, activate cellular metabolism, etc.

Russian medical institutions may recommend that 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 take oxygen cocktails in combination with other treatments and prevention.

Raw cabbage juice has a unique effect on stomach ulcers. It is obtained by squeezing crushed fresh white cabbage leaves. The juice has a pleasant smell and delicate taste. The patient receives a light meal and drinks fresh raw juice as needed after meals (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 on 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 mucous membrane of the stomach and intestines.

Treatment of stomach ulcers with flax seeds has been used for centuries.

Directions for use: boil flax seeds in water until liquid jelly is obtained and drink ½ glass 5-8 times a day, regardless of meal time. The pain goes away after 2-3 doses. It is advisable to drink this jelly for 3-4 days so that attacks of pain do not recur. The treatment will be more effective if you add 5-7 drops of alcohol tincture of propolis to each single dose of flax seed jelly (infuse 50 g of alcohol and 5 g of propolis for 14 days in a dark, warm place, filter, store in a dark place at room temperature) .

Sea buckthorn oil, taken 1 tsp, has a good healing effect for stomach ulcers. 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 unpleasant sensations, add ¼ cup of a 2% soda solution to sea buckthorn oil before use and shake well. With systematic oral administration, pain, heartburn, and 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.

Directions for use: 20 g of flowers (1 tbsp) pour 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 warm. l. 2 - 3 times a day.

· Therapeutic physical education is an independent medical discipline that uses the means of physical education to prevent exacerbations and treat many diseases and injuries and restore working capacity. The specificity of therapeutic physical culture in comparison with other methods of treatment is that it uses physical exercise as the main therapeutic agent, which is a significant stimulator of the vital functions of the human body.

A nurse in a physical therapy room has the following job responsibilities:

1. Prepare the room (physical therapy room, gymnastics equipment, equipment, etc.) for conducting classes with patients.

2. Calculate the pulse rate of patients exercising before and after physical therapy exercises.

3. Conduct group and individual classes with patients:

A) when conducting group classes, demonstrate physical exercises and provide insurance when patients perform them, monitor the patients’ performance of physical exercises and the tolerance of the classes;

B) when conducting individual sessions with patients with severe disabilities, help the patient take the correct position, assist with active exercises; carry out passive exercises, combining them with individual massage techniques, carefully monitor the patient’s tolerance to the exercises.

4. Conduct classes on mechanotherapeutic devices, correctly place the affected limbs on the device, monitor the correct performance of exercises by patients and their well-being.

6. Draw up schemes of therapeutic exercises and sets of physical exercises for patients differentially, taking into account the nosological form of the disease, the severity of the pathological process and the physical fitness of the patient.

7. Maintain primary medical documentation according to established forms.

8. Systematically improve professional qualifications.

9. Conduct sanitary and educational work among patients on issues of physical education.

10. Observe the principles of deontology.

7. Massage: Massage area: collar area, back, abdomen. Position of the patient: most often in a lying position, options are also possible - lying on the side, sitting. Massage technique. Massage can be performed using the following techniques: classical massage, segmental, vibration, cryo-massage. Segmental massage is the most effective. The first stage of this massage option is to search for segmental zones. In diseases of the stomach, tissues associated with segments C3-- Th8 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. For gastritis with hypersecretion and peptic ulcers, they begin by eliminating changes in the tissues on the back surface of the body, primarily in the most painful points on the back near the spine in the area of ​​the Th7-Th8 and the lower angle of the scapula in the area of ​​segments Th4--Th5, then move 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 area of ​​the Th5-- Th9 segments using the technique of rubbing with skin displacement. Classic therapeutic massage can also be prescribed, but later than segmental - usually in the middle or end of the subacute period, when pain and dyspeptic symptoms have significantly softened. Its effect is usually insignificant and short-lived. The lumbar region and abdomen are massaged. Techniques used: stroking, rubbing, light kneading, light vibration. Impact techniques are excluded. For a general relaxing effect on the body, it is advisable to additionally apply a massage of the collar area. The procedure begins 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 involves not only studying the most characteristic changes in the gastric stump, but also searching for differences in morpho-functional changes depending on the type of gastric resection.

Treatment of uncomplicated peptic ulcer should be conservative. Surgical treatment of peptic ulcer is used only under strict indications, and the issue of surgical treatment of peptic ulcer is discussed by the surgeon together with the therapist.

During an exacerbation, the most appropriate course of treatment in a hospital is six to eight weeks. The main types of treatment used in a hospital are: bed rest, the implementation of which must be monitored by nursing staff; therapeutic nutrition, medications - anticholinergic drugs, 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 the diet should be based on the principles of so-called mechanical and chemical sparing, i.e., do not stimulate the secretory activity of the stomach, reduce its motor activity and do not irritate the gastric mucosa. The anti-ulcer diet developed in the clinical nutrition clinic meets these requirements. 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 antiulcer treatment. Maintaining a rhythm of nutrition is of great importance (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 has become widespread (10-12 g per 300 ml of water, drink throughout the day). For poor sleep, diphenhydramine and pipolfen are prescribed (½ -1 tablet per night).

Anticholinergic drugs include atropine, 0.5 ml of a 0.1% solution, 2-3 times a day, subcutaneously or orally, 5-8 drops of a 0.1% solution over 30-40 minutes. before meals 2-3 times a day; platiphylline 0.5 ml of 0.2% solution 2-3 times a day subcutaneously or orally 10 drops of 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, i.e. 60 mg 3 times; course of treatment is 25-30 days). Contraindications to the use of anticholinergic drugs are glaucoma, organic pyloric stenosis, and prostatic hypertrophy.

Antacids are widely used in the treatment of peptic ulcers; they have the ability to neutralize acidic gastric contents, promote the opening of the pylorus and accelerate the rate of gastric emptying. The most widely used combination of alkalis is in the form of a Bourget mixture: 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. Sodium bicarbonate (baking soda) should not be prescribed separately, since in the second phase of its action it enhances the secretory ability of the stomach. In addition, bismuth is prescribed 0.5-1 g 3 times a day, vikalin 1-2 tablets every 30 minutes. after meals 3 times a day (with warm water). The course of treatment with Vikalin is 2 months. followed by a month's break and an additional course of 4-6 weeks.

The administration of vitamins in increased dosages is indicated (ascorbic acid 300 mg per day orally, thiamine bromide - 50 mg, pyridoxine - 50 mg intramuscularly), alternating these injections every 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).

Among thermal procedures, warming compresses and paraffin applications on the epigastric region are most often used.

If it is impossible to place the patient in a hospital, a course of antiulcer treatment should be provided at home for 4-5 weeks, followed by a transition to the so-called half antiulcer treatment - the patient, after a normal working day, spends the rest of the day in bed at home or in a night sanatorium.

Patients with peptic ulcer disease in the stage of remission or subsiding exacerbation in the absence of pyloric stenosis, penetration, tendency to bleeding and suspicion of malignant degeneration are subject to sanatorium-resort treatment. The following resorts are shown: Zheleznovodsk, Essentuki, Morshin, Borjomi, Jermuk, Druskininkai, Krainka, Izhevsk Mineralnye Vody, Darasun.

According to modern concepts, disturbances in the nervous, hormonal and local mechanisms of digestion in the gastro-duodenal system play a role in the occurrence of peptic ulcer disease, therefore, when constructing rational therapy, these disturbances, as well as disturbances of other systems, must be taken into account. Consequently, two principles should be the basis for the treatment of peptic ulcer disease: complexity and individualization. It is generally accepted that treatment of uncomplicated peptic ulcer disease should be conservative, but different during periods of exacerbation and remission, so recovery varies at different stages.

The diet should be based on the principle of so-called mechanical and chemical sparing (see Diet therapy): do not stimulate the secretory activity of the stomach, reduce the motor activity of the gastro-duodenal system, have buffering properties and spare the gastric mucosa.

The physiological effect of basic nutrients on the secretory and motor functions of the stomach, studied in the laboratory of I. P. Pavlov, should be taken into account when constructing an anti-ulcer diet. Thus, unrefined carbohydrates and especially fats inhibit, and proteins stimulate gastric secretion. At the same time, proteins have the greatest buffering effect. Fat reduces the motor activity of the stomach, but with prolonged stay in it increases it. Thus, the diet for peptic ulcer disease should include a sufficient amount of protein, moderate amounts of refined carbohydrates and fats. It is effective to use vegetable oil in an amount of 25-40 g for 30-40 minutes. before meals. Vitamins are indicated (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 higher dosages are prescribed for 6-8 weeks, after which they switch to smaller, prophylactic doses. Vitamin A increases the protective function of mucous membranes. Vitamin B1 has an analgesic effect. In addition, it regulates the functions of the nervous system, adrenal glands, motility and gastric secretion. Table salt is limited to 3-5 g at the beginning of the course of treatment. To ensure the buffering effect of food, a certain rhythm in food intake is also indicated - little by little every 3-4 hours. Between meals, it is reasonable to prescribe ½ glass of warm milk or a creamy milk mixture every hour (2/3 milk and 1/3 20% cream).

In the complex of antiulcer treatment, anticholinergic drugs play a significant role. They should be prescribed 30-40 minutes in advance. before meals and before bed. From the group of m-anticholinergics, atropine is prescribed as an injection of a 0.1% solution, 0.5 ml 2-3 times a day, or orally, 5-8 drops of a 0.1% solution over 30-40 minutes. before meals 2-3 times a day; platifillin - 0.2% solution 0.5 ml per injection 2-3 times a day or orally 10-15 drops of 0.5% solution. Of the gangliolytic agents, benzohexonium is the 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 injection of the drug, the patient should be in a horizontal position for 30-40 minutes. due to the possible occurrence of orthostatic collapse.

Among n-anticholinergics, quaterone 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; course of treatment is 25-30 days). The drug has almost no side effects. Of the centrally acting anticholinergics, ganglerone has the most “mild” effect. Apply subcutaneously 2 ml of a 1.5% solution 3 times a day, and also orally 0.04 g in capsules, 1 capsule 3-4 times a day. Course 3-4 weeks.

During repeated courses of treatment with anticholinergics, both individual drugs and their combination should be changed (due to the body becoming accustomed to them).

DOXA (deoxycorticosterone acetate) and licorice preparations (imported biogastron and domestic - laviriton) 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 [Bojanowicz (K. Bojanowicz)]. 3. I. Yanushkevicius and Yu. M. Alekseenko used a 0.5% oil solution of DOXA, 2 ml intramuscularly, initially 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 laviriton are prescribed in a dose of 100 mg 3 times in 30 minutes. before meals; course of treatment is 3 weeks. In some patients, biogastron causes edema and other manifestations of heart failure, headaches, and heartburn. Drugs with mineralocorticoid function are more indicated for gastric ulcers.

Impact on local mechanisms. Antacids are widely used in the treatment of peptic ulcers. They have the ability to neutralize acidic gastric contents, promote the opening of the pylorus and accelerate the rate of gastric emptying. All taken together determines their good analgesic effect in peptic ulcers. Antacids are divided into absorbable (absorbable) and non-absorbable (adsorbent). The first 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 advisable 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, and aluminum carbon dioxide. They have a slower neutralizing, adsorbing and enveloping effect. Single dose 0.5-1 g.

To protect the mucous membrane from the irritating effects of gastric juice, bismuth is prescribed 0.5-1 g 3 times a day. It has almost no antacid properties, but causes increased mucus secretion and adsorbs pepsin.

Vikalin (foreign drug Roter) has an antacid, enveloping and laxative effect. Prescribe 1-2 tablets every 30 minutes. after meals 3 times a day (with warm water). The course of treatment is 2 months. followed by a one-month break, after which an additional course (4-6 weeks) is prescribed.

The observations made indicate the advisability of simultaneous administration of antacids and anticholinergics, since the latter increase their neutralizing ability.

2.3 Methods postoperative rehabilitation

Despite certain successes in conservative treatment of gastric ulcer, the main method of treating its complicated forms is still gastrectomy. At the same time, the improvement of surgical techniques and the introduction of new surgical methods have significantly reduced the number of immediate postoperative complications. The principle of individual choice of surgical method significantly influenced the improvement of immediate and long-term results of treatment of gastric ulcer. At the same time, gastrectomy does not bring about a complete course of the disease, since from 10 - 15% to 70 - 85.9% of cases, patients develop certain post-gastroresection disorders, the complexity of the pathogenesis and the variety of clinical manifestations of which creates certain difficulties in their treatment. At the same time, the leading place among post-gastroresection disorders is occupied by gastritis of the gastric stump.

Therefore, it is very important to carry out a set of therapeutic and preventive measures for patients in the early stages of postoperative intervention to prevent the development of post-gastroresection disorders. The basis for conducting sanatorium-resort treatment on the 12th - 14th day after gastrectomy was the desire to prevent the development of post-resection disorders. Early post-hospital rehabilitation of patients after gastrectomy 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-hydrocarbonate-chloride-sodium mineral water of the OJSC sanatorium "Metallurgist", sheets of the 1st option, physical therapy in a specialized gastroenterological department.

In the rehabilitation of patients with diseases of the digestive system, diet, balneotherapy, methods of electrotherapy, light therapy, ultrasound therapy, physical therapy and other factors are successfully used. The most effective are mineral waters of medium and low mineralization, in which bicarbonate anions, sulfate anions, chloride anions, sodium, magnesium, and calcium cations predominate.

Conclusion. In the process of physical rehabilitation of gastric ulcer at the inpatient stage, use a comprehensive approach: drug therapy, nutritional therapy, herbal medicine, physiotherapeutic and psychotherapeutic treatment, therapeutic physical education.

III. Analysis applications methods rehabilitation on practice

3.1 Analysis state health sick on moment started rehabilitation

Our work examines two patients, X and Y, diagnosed with 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. Vomit the color of coffee grounds, indicating bleeding in the stomach.

3. The general condition at the time of admission was serious.

During an emergency examination (using instrumental and laboratory tests), the patient was found to have gastrointestinal bleeding and perforation of the ulcer was identified. After the examination, the patient urgently underwent surgery to excise the stomach tissue (gastric resection).

Patient Y experiences a seasonal exacerbation. The patient came to the emergency department with complaints:

1. Hunger pains;

2. Nausea;

3. Restless sleep due to constant night pain in the epigastric region.

Based on laboratory and instrumental studies, a seasonal exacerbation of gastric ulcers was established.

3.2 Development plans rehabilitation sick

Once the patient’s condition has been stabilized, an individual postoperative rehabilitation program has been developed:

At the inpatient stage, patient X was asked:

1. Drug therapy:

1.1. Antisecretory drugs: cimetidine (Suppresses the production of hydrochloric acid, both basal (intrinsic) and stimulated by food, histamine, gastrin and, to a lesser extent, acetylcholine). 200 mg 1 tab. * 3 rubles/day in 30 - 40 minutes. before meals and 2 tablets. at night;

1.2. Omeprozole (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 prepared in pureed and jelly-like form. Food is taken in fractions 7 - 8 times a day with a temperature no higher than 45°, per meal - no more than 200 - 300 grams. Recommended: weak low-fat meat broth, mucous infusions with cream, fruit and berry jelly, fruit jelly. Excluded: whole milk, dense and pureed foods, carbonated drinks.

5. Exercise therapy after gastric surgery can be carried out 6 to 12 hours after the patient awakens. It must be taken into account 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 mastering chest breathing. Repeat breathing movements every 20 - 40 minutes. With the help of an instructor, the patient does exercises for the distal parts of the lower and upper extremities, rotational movements in the hip joint 3 to 4 times, with pauses for rest if necessary.

On the second day, holding the postoperative wound, he performs the exercises independently and more often. In addition, chest massage with stroking, rubbing, and light vibration techniques is recommended.

On the 3-4th day, classes include general toning and special exercises. The patient should turn on his side as often as possible. In this position, do a back massage 1-2 times a day. After this, 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 cushion 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.

If the course of the postoperative period is smooth, 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, and exercises for the torso (forward bends should be performed with great care). Then you are allowed to stand up, first resting your hands on the back of the chair.

It is recommended to get up on the 6-9th day after gastrectomy and if the previous load is well tolerated. At the beginning, classes are carried out in the ward, in the initial position sitting on a chair, including in the complex general strengthening, breathing exercises, exercises to strengthen the abdominal muscles, for the formation of a mobile postoperative scar, correct posture, normalization of intestinal function (prevention of adhesions).

From the 9-10th day, classes are held in the exercise therapy hall of therapeutic physical education (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 postural defects, and exercises with apparatus. Duration of classes is 20-25 minutes. The set of exercises for independent practice includes walking along the corridor and stairs (climbing the stairs is done while exhaling). After discharge from the hospital, the patient continues to do therapeutic exercises in the clinic. Sports exercises (skiing, skating, swimming, rowing, etc.) are allowed for therapeutic and prophylactic purposes 6 months after surgery.

6. Massage is carried out 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. Omeprozole (reduces basal and stimulated secretion, regardless of the nature of the stimulus);

1.2. Vitamins B6 and E.

2. Herbal medicine

2.1. Plain flax 1.5 tbsp. color - x baskets, brew 400 ml of boiling water, leave for 1 hour, strain. 1 tsp. infusion * 4 rubles/day

3. Physiotherapy

3.1. Electrosleep for gastric ulcers uses the orbitomastoid technique. The pulse frequency is 3.5-5 Hz, the current gradually increases from 2 mA until the patient experiences a feeling of “pulsation” or “vibration” under the electrodes on the eyelids (i.e., 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 there are 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, with subsequent expansion to 1-b, 1. It is necessary to maintain regular nutritious meals 5 - 6 times a day. We recommend soups made from pureed or well-cooked cereals (semolina, rice and others), steamed and boiled beef dishes, lean types of fish without skin, in pieces or in the form of cutlets, boiled in water or steamed. Duration 3 - 5 months.

5. Exercise therapy in a mode of increasing intensity At the sanatorium-resort stage of rehabilitation, patient X was offered:

Treatment in the mountains Hot Key sanatorium "Caucasus Foothills".

1. Drug therapy:

1.1. Mezim forte (replenishes the deficiency of pancreatic enzymes) - 1 tablet. 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 U.

At the inpatient stage, patient U was asked to:

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. Does not cause secondary hypersecretion of gastric juice). - 1 ml. in 20 minutes before meals for 7 days;

1.2. Mezim forte (replenishes the deficiency of pancreatic enzymes) - 1 tablet. after each meal for 1 month;

2. Physical recovery methods:

2.1. Electrosleep for gastric ulcers uses the orbitomastoid technique. The pulse frequency is 3.5-5 Hz, the current gradually increases from 2 mA until the patient experiences a feeling of “pulsation” or “vibration” under the electrodes on the eyelids (i.e., 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 there are 10-15 procedures.

Indications: peptic ulcer with pronounced functional changes in the nervous system, sleep disturbance.

2.2. For UHF therapy, portable and stationary devices are used that operate at a standard electromagnetic frequency of 40.68 MHz, which corresponds to a wavelength of 7.3 m.

When carrying out a medical 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 size 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 absorbed electric field energy in the patient’s body; the physical effect of the UHF electric field is the active absorption of field energy by tissues and its conversion into thermal energy , as well as in the development of the oscillatory effect, 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 do not conduct electrical current well (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 thermal dosage has a more pronounced oscillatory effect.

The UHF electric field has an anti-inflammatory effect by improving blood and lymph formation, tissue dehydration and reducing exudation, activates the functions of connective tissue, stimulates the processes of cell proliferation, which makes it possible to limit the inflammatory focus to a dense connective capsule.

3. Exercise therapy: period of exacerbation of peptic ulcer or chronic gastritis; complicated course of peptic ulcer; severe pain and significant dyspeptic disorders are a contraindication for use.

4. Massage: Massage area: collar area, back, abdomen. Position of the patient: most often in a lying position, options are also possible - lying on the side, sitting. Massage technique. Massage can be performed using the following techniques: classical massage, segmental, vibration, cryo-massage. Segmental massage is the most effective. The first stage of this massage option is to search for segmental zones. In diseases of the stomach, tissues associated with segments C3-- Th8 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. For gastritis with hypersecretion and peptic ulcers, they begin by eliminating changes in the tissues on the back surface of the body, primarily in the most painful points on the back near the spine in the area of ​​the Th7-Th8 and the lower angle of the scapula in the area of ​​segments Th4--Th5, then move 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 area of ​​the Th5-- Th9 segments using the technique of rubbing with skin displacement. Classic therapeutic massage can also be prescribed, but later than segmental - usually in the middle or end of the subacute period, when pain and dyspeptic symptoms have significantly softened. Its effect is usually insignificant and short-lived. The lumbar region and abdomen are massaged. Techniques used: stroking, rubbing, light kneading, light vibration. Impact techniques are excluded. For a general relaxing effect on the body, it is advisable to additionally apply a massage of the collar area. The procedure begins 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 outpatient stage, patient Y was asked to:

1. Drug therapy:

1.1. Omez - 20 mg, 1 drop. * 2 rubles/day at 09:00 and at 19:00, then 1 day per day. for 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 tablet. 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 Provençal oil, pour into a bottle and place in a pan of water on the stove, placing a piece of cloth under the bottom of the bottle. Boil for 3 hours over low heat, cool and seal, store in the refrigerator.

3. Exercise therapy in increasing intensity mode.

At the sanatorium-resort stage, patient Y was offered:

Treatment in the city of Goryachiy Klyuch sanatorium “Izumrudny”.

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 method - up to 50 - 70 mg/l. The pressure with which oxygen enters the water is 1.5 - 2.5 atmospheres. Some of the oxygen, albeit a small one, 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 surface of the water.

The therapeutic effect of oxygen lies in its ability to influence the processes of excitation and inhibition, having a calming effect on processes in the cerebral cortex. In addition, the 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: most often in a lying position, options are also possible - lying on the side, sitting. Massage technique. Massage can be performed using the following techniques: classical massage, segmental, vibration, cryo-massage. Segmental massage is the most effective. The first stage of this massage option is to search for segmental zones. In diseases of the stomach, tissues associated with segments C3-- Th8 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. For gastritis with hypersecretion and peptic ulcers, they begin by eliminating changes in the tissues on the back surface of the body, primarily in the most painful points on the back near the spine in the area of ​​the Th7-Th8 and the lower angle of the scapula in the area of ​​segments Th4--Th5, then move 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 area of ​​the Th5-- Th9 segments using the technique of rubbing with skin displacement. Classic therapeutic massage can also be prescribed, but later than segmental - usually in the middle or end of the subacute period, when pain and dyspeptic symptoms have significantly softened. Its effect is usually insignificant and short-lived. The lumbar region and abdomen are massaged. Techniques used: stroking, rubbing, light kneading, light vibration. Impact techniques are excluded. For a general relaxing effect on the body, it is advisable to additionally apply a massage of the collar area. The procedure begins 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 rehabilitation methods were developed in accordance with the characteristics of the course of the disease at different stages and adapted to them, which helped to effectively combat the disease. Consequently, patient X, after surgery, was sent to a hospital, where, after undergoing rehabilitation, he was given the opportunity to undergo treatment at home, and then in a sanatorium-resort institution. The result of a properly developed rehabilitation program was the complete restoration of patient X’s health.

Patient Y, after seeking medical help, was sent to a hospital for examination and conservative treatment of an identified ulcer, and then underwent rehabilitation at home and at a sanatorium. As a result of the rehabilitation, the disease entered the remission stage, thanks to properly developed rehabilitation methods.

The role of medical personnel in carrying out comprehensive rehabilitation of patients cannot be underestimated, since without the participation of nurses in it it would be impossible, and the treatment of patients would not be completed. The reason for the importance of the role of nurses is the wide range of job responsibilities assigned to them, the performance of which by doctors without the help of nursing staff would be physically impossible.

Conclusion

Gastric ulcer is currently one of the most common pathologies among patients.

Three factors are considered to be the basis for the appearance of gastric ulcers and the occurrence of relapses: genetic predisposition, imbalance between the factors of aggression and defense, and the presence of Helicobacter pylori (HP).

In the process of physical rehabilitation of gastric ulcer at the inpatient stage, use a comprehensive approach: drug therapy, nutritional therapy, herbal medicine, physiotherapeutic and psychotherapeutic treatment, therapeutic physical education.

At the inpatient 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 exercises, natural factors of nature, motor regimes, therapeutic massage. Forms of exercise include morning hygienic exercises, therapeutic exercises, dosed therapeutic walking (on the hospital premises), training walking on the steps of stairs, dosed swimming (if there is a swimming pool), and independent exercises. All these classes can be conducted individually, 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 increasing the effectiveness of rehabilitation of patients with gastric ulcer.

The following tasks were set: collecting material on the causes of the spread of gastric ulcer in the world, Russia and the region; development of a patient questionnaire for the purpose of drawing up a rehabilitation program; the rationale for such programs and the role of nursing personnel in their implementation.

Rehabilitation methods for gastric ulcers were considered as the object of the study; patients were the subject.

During the research, methods of examining patients and analytical methods were used, namely deductive, inductive and comparative.

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

1. Alekseev V. F. Kasyanenko V. I. Early diagnosis and prevention of chronic gastritis // Physiology and pathology of digestion: B. i., 2004,-- P. 132-134.

2. Amirov N. Sh" Trubitsyna I. E. Changes in acid phosphatase in the gastric mucosa during the period of ulceration // Bulletin of Experimental Biology and Medicine. - 2002. - No. 9. - P. 55-57.

3. Anichkov S.V., Zavodskaya I.S. Pharmacotherapy of peptic ulcer: Experimental justification. - JI.: Medicine, 2005. - 183 p.

4. Aruin L. I. Zheludok//Structural foundations of adaptation and compensation of impaired functions/Ed. D. S. Sarkisova. - M.: Medicine, 2007.-- 448 p.

5. Aruin L. I., Zverkov I. V., Vinogradov V. A. Endorphin, gastrin and somatostatin-containing cells in the mucous membrane of the stomach and duodenum in gastric ulcers and chronic gastritis // Clinical Medicine. - 2006. - No. 9. - P. 84-88.

6. Aruin L. I., Shatalova O. L. Immunoglobulin-secreting cells of the stomach in peptic ulcer // Arch. pathology. - 2003. - T. 45, issue. 8. - pp. 11-17.

7. Belousov A. S., Leontyeva R. V., Tumanyan N. A. et al. Morphology of microcirculation and hemostasis disorders in peptic ulcer disease // Medicine. - 2003, - No. 1-- P. 12-15.

8. Boger M. M. Peptic ulcer. - Novosibirsk: Science, 2006. - 256 p.

9. Burchinsky G.I., Kushnir V.E. Peptic ulcer. - 2nd ed. - K.: Health, 2003, --212 p.

10. Burchinsky G.I., Milko V.I., Novopashennaya V.I., etc. Clinical variants of peptic ulcer // Wedge, medicine. - 2005. - No. 9.-- P. 66-71.

11. Burchinsky G.I., Degtyareva I.I. Correlation of factors of aggression and defense in patients with peptic ulcer // Abstract. report XIX Congress of Therapists. - 2007.-- T. 2. --S. 124-125.

12. Burchinsky G.I., Galetskaya T.M., Degtyareva I.I., etc. About general changes in the body of patients with peptic ulcer // Klin, medicine.-- 2007. - No. 2.-- P. 69- 74.

13. Bykov K.M., Kurtsin I.T. Corticovisceral theory of the pathogenesis of peptic ulcer, -M.: Publishing House of the Academy of Sciences of the Russian Federation, 1952. -269 p.

13. Vainshtein S. G., Zvershkhanov F. A. The state of lipid peroxidation in elderly people with gastric ulcer // Therapist, arch. - 2004. - No. 22. - P. 26-28.

14. Vasilenko V. G., Grebenev A. L. Diseases of the stomach and duodenum. ---M.: Medicine, 2001. --341 p.

15. Vasilenko V. X., Grebenev A. L., Sheptulin A. A. Peptic ulcer: Modern ideas about pathogenesis, diagnosis, treatment. - M.: Medicine, 2007, --288 p.

16. Vinogradov V. A. The role of pituitary hormones and neuropeptides in the regulation of the stomach and duodenum // Neurohumoral regulation of digestion / Ed. V. X. Vasileiko, E. N. Kochina. - M: Medicine, 2003, --S. 202-233.

17. Vinoyeradsky O.V., Maloe Yu.S., Kulyga V.N. et al. General and local humoral immunity in patients with peptic ulcer // Therapist, architect. - 2007.- No. 2, --S. 10-12.

18. Vitebsky Ya. D. Substantiation of the reflux theory of the pathogenesis of gastric and duodenal ulcers // Medicine. - 2004.--No. 9.-- P. 82-86.

19. Vitebsky Ya. D. Chronic disorders of duodenal patency as a cause of peptic ulcer of the stomach and duodenum // Issues of practical gastroenterology. - Moscow: Central Research Institute of Gastroenterology, 2007.-- P. 165-166.

20. Vitebsky Ya. D. Fundamentals of valvular gastroenterology. - Chelyabinsk: South Ural Book Publishing House, 2006. - 127 p.

21. Voloshin A.I., Mishchenin I.F. State of bioenergetics of the body in patients with chronic primary gastroduodenitis // Abstract. report Ivano-Frankivsk, September 24-26. 2002, --K.: B. i., 2007.-- 138 p.

22. German S.V. Somatostatin // Klin, medicine. - 2007, - No. 10. - P. 9-15.

23. Degtyareva I. I., Kharchenko N. V., Simeunovich S., Petrovich S. New medicinal and non-medicinal agents and their complex in the treatment of erosive and ulcerative lesions // Diseases of the digestive organs from the point of view of a therapist and surgeon. - Donetsk: B. i., 2002. - P. 95.

24. Degtyareva I. I., Kharchenko N. V. Physical methods of treatment in complex therapy of patients with peptic ulcer // Chronic inflammation and diseases of the digestive organs. - Kharkov: B. i., 2001. - Ch. 1. - pp. 156-157. ;

25. Degtyareva I. I., Kharchenko N. V. Non-drug methods in the complex treatment of patients with ulcer disease // Doctor. case.-- 2002. --No. 9.-- P. 76-80.

Applications

Prpresentation A

Rehabilitation questionnaires

Application B

The number of cases of gastric ulcer in the world.

no data less than 20

Appendix B

Incidence of the population with diseases of the digestive system in Russia.

Application G

Preventive stage of medical rehabilitation.

Application D

Inpatient stage of medical rehabilitation.

Application

Tsaeirry. The existence of lymph nodes in the human and animal body, where contact between lymphatic pathways from several organs occurs, gave us the basis for the assumption that lymph entering the functional segments of the nodes from various organs or regions of the body and, therefore, having a specific composition, can create conditions to form the structural features of these...

Taking into consideration a regulatory effect of redox; STM J 2013 - vol. 5, No.4 T.G. Stcherbatyuk, D.V. Davydenko, V.A. Novikova. Biomedical investigations. Mda. Control; Group 1. Mda. 1>-- - Control; Group 3. Mda. Control; Group 2. Mda. Control; Group 4. Fig. 1. Multiple-vector diagrams showing the parameters of pro-, antioxidant system imbalance in 4 patient groups. Component in adaptation...

Table 2 Compositions of extractants used in the experiment Composition number Composition of extractant Appearance of extracted hop heads. The data obtained indicate that in extracts from hop fruits, the maximum content of the sum of flavonoids and the sum of APG is achieved when extracted with 70% ethanol. The use of surfactant solutions does not provide a higher degree...

A comparative analysis of data on the placement of orphans in general shows that the number of children annually receiving the status of being left without parental care is approximately equal to the number of children placed in families, which, as a result, keeps the number of the contingent constant; Tey in institutions. This means that, in general, the effectiveness of the state and regional systems for protecting the rights of orphans...

The work used standard diagnostic research methods used at the Federal State Budgetary Institution Scientific Center for Cardiovascular Surgery named after. A.N. Bakulev" Russian Academy of Medical Sciences for verification of congenital heart defects and X-ray monitoring of the lungs: X-ray examination, X-ray computed tomography and CT angiography. Practical significance Solving the assigned tasks allowed...

Thesis

A scientific analysis of complications and errors in the surgical treatment of soft tissue defects of the lower leg in open fractures has made it possible to establish the natural development of severely invading lesions that inevitably develop with untimely and ineffective osteosynthesis and late closure of soft tissue defects. Long-term non-healing extensive non-traumatic skin defects, vascular...

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For the first time in the practice of treating patients with recurrent ophthalmoherpes of the anterior part of the eye, the anti-relapse effectiveness of amixin in combination with an antiherpetic vaccine in patients with superficial and deep herpetic keratitis was studied. For the first time, regimens for the use of a combination of amixin with PG vaccine have been developed and tested to prevent relapses of ophthalmoherpes. Implementation...

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Basic provisions submitted for defense. Approbation of work. The dissertation was carried out in accordance with the plan of research work of the Department of Nervous Diseases of the I.M. Sechenov Moscow Medical Academy on the topic “Prevention of cerebrovascular diseases in the elderly.” (state registration number 1,970,007,146). The dissertation was tested at a meeting of the Department of Nervous Diseases of the Medical Faculty of the MMA named after. AND...

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The technical features of laparoscopic lymph node dissection for various localizations of rectal cancer were studied. Indications for choosing the volume of lymph node dissection have been developed depending on the location and stage of cancer. It has been established that performing lymph node dissection using the laparoscopic approach is not inferior in volume to the traditional one. At the same time, long-term results significantly improve, and also does not occur...

INTRODUCTION…………………………………………………………….………3 CHAPTER 1. PROBLEMS OF Peptic Ulcer Disease of the Stomach and Duodenum at the Present Stage 5 1.1. Concept, causes of gastric and duodenal ulcers 5 1.2. Symptoms of gastric and duodenal ulcers, diagnosis 9 1.3. Treatment of gastric and duodenal ulcers 16 CHAPTER 2. PHYSICAL PROCESS FOR GASTROCENT AND DUODENAL ULCERS 18 2.1. Tasks of a paramedic according to the Standards for diagnosing gastric and duodenal ulcers 18 2.2. The tasks of a paramedic in addressing issues of treatment of gastric and duodenal ulcers 20 2.3. The tasks of a paramedic in addressing issues of primary and secondary prevention of gastric and duodenal ulcers 22 CONCLUSION 24 LIST OF SOURCES USED 26

Introduction

Relevance: according to statistics, today approximately 10% of the population suffers from duodenal ulcer. It usually appears at the age of 20-30. 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 residents of villages. 150 years have passed since Cruvelier’s classic description of gastric ulcers, but still, despite numerous studies in this area, disputes regarding both the ethnology of peptic ulcer disease and its treatment do not subside. Peptic ulcer disease is a fairly common disease. According to various statistics, it affects from 4 to 12% of the adult population. The majority of diseases occur in the 3rd-4th decade of life, with duodenal ulcers more common in young people, and gastric ulcers more common in older people. It has been noted that men suffer from peptic ulcers 4 times more often than women. Purpose of the work: to study and reveal the main points of the role of the paramedic in the diagnosis and treatment of peptic ulcer of the stomach and duodenum Objectives: 1. consider the problems of peptic ulcer of the stomach and duodenum at the present stage 2. reveal the concept, causes of peptic ulcer of the stomach and duodenum 3. describe symptoms of peptic ulcer of the stomach and duodenum, diagnosis 4. reveal the main points of treatment of peptic ulcer of the stomach and duodenum 5. consider the paramedic process for peptic ulcer of the stomach and duodenum. 6. reveal the tasks of a paramedic according to the standards for diagnosing gastric and duodenal ulcers. 7. consider the tasks of a paramedic in addressing issues of treatment of gastric and duodenal ulcers. 8. reveal the tasks of a paramedic in addressing issues of primary and secondary prevention of gastric and duodenal ulcers. Draw fundamental conclusions. Object of study: the problem of peptic ulcer of the stomach and duodenum. Subject of study: diagnosis and treatment of peptic ulcer of the stomach and duodenum 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 bibliography.

Conclusion

Peptic ulcer of the stomach and duodenum is a chronic relapsing disease in which, as a result of disturbances in the nervous and humoral mechanisms that regulate secretory-trophic processes in the gastroduodenal zone, an ulcer (less often two or more ulcers) forms in the stomach or duodenum. Its course is characterized by alternating asymptomatic periods with stages of exacerbation, which usually occur in spring or autumn. Causes of peptic ulcers The main source of the disease is the bacterium Helicobacter Pylori, which produces substances that damage the mucous membrane and cause inflammation. Other factors predispose to the development of pathology. In conclusion, we will say once again that to prevent the appearance of Ya.B. not difficult. Compliance with personal hygiene rules, 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, infectious infection or the influence of heredity cannot be ruled out, but these reasons 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. We revealed the concept and causes of gastric and duodenal ulcers. We described the symptoms of gastric and duodenal ulcers, diagnosis. We revealed the main points of treatment for gastric and duodenal ulcers. We examined the paramedic process for gastric and duodenal ulcers. The tasks of a paramedic were revealed according to the standards for diagnosing gastric and duodenal ulcers. We analyzed the tasks of a paramedic in solving the problems of treating gastric and duodenal ulcers. We analyzed the tasks of a paramedic in solving the issues of primary and secondary prevention of gastric and duodenal ulcers. The special role of the paramedic 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.

References

1. Beloborodova E.I., Kornetov N.A., Orlova L.A. Pathophysiological aspects of duodenal ulcer in young people // Clinical. medicine. - 2002. - No. 7. - P. 36-39. 2. Belkov Yu. A., Shinkevich E. V., Makeev A. G., Bogdanova M. G., Dudnik A. V., Kyshtymov S. A. Treatment tactics for patients with chronic ischemia of the lower extremities with erosive-ulcerative duodenitis // Surgery. - 2004. - No. 3. - P. 38-41. 3. Belyaev A.V., Spizhenko Yu.P., Belebezev G.I. et al. Intensive therapy for gastrointestinal bleeding // Ukr. magazine minimally invasive and an endoscope. surgery. - 2001. - T. 5, No. 1. - P. 24-25. 4. Vertkin A.L., Masharova A.A. Treatment of peptic ulcer in a modern clinic // Attending physician, October 2000, No. 8. - pp. 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., etc. Pharmacotherapy of peptic ulcer taking into account concomitant pathology of the gastrointestinal tract // Experimental and practical gastroenterology, 1/2002. pp. 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. - 12. Pimanov S. I. Esophagitis. , gastritis, and peptic ulcer - N. Novgorod, 2000. - 376 p. 13. Collection of dietary nutrition in gastrointestinal sanatoriums for peptic ulcer M 2011 - 303 p.

State budgetary educational institution

secondary vocational education

"Krasnodar Regional Basic Medical College" of the Ministry of Health of the Krasnodar Territory

Cyclic commission "Nursing"

DIPLOMA THESIS

ON THE TOPIC: “THE ROLE OF NURSING STAFF IN THE REHABILITATION OF PATIENTS WITH GASTRIC ULCER”

Student Shavlach Ksenia Mikhailovna

specialty Nursing

3rd year, group E-32

Thesis supervisor:

Osetrova Lyubov Sergeevna

Krasnodar - 2014

Annotation

Introduction

I. Gastric ulcer

1.1 Gastric ulcer. 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 region

II. Methods of rehabilitation of patients with gastric ulcer

2.1 General rehabilitation methods

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 rehabilitation plans for patients

Conclusion

List of sources used

Applications

Annotation

The thesis structurally consists of an introduction, three chapters, a conclusion, a list of references and appendices. The thesis is presented on 73 pages of typewritten text.

The introduction substantiates the relevance of the thesis topic and outlines the purpose and objectives of the research.

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 for 68% of men and 30.9% of women among all those suffering from diseases of the digestive system.

Object of study: rehabilitation methods for gastric ulcer disease.

Subject of research: patients with gastric ulcer, medical history of an inpatient, results of a survey of patients with gastric ulcer.

Purpose of the study: studying the role of nursing staff in increasing 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 were formulated: tasks:

· collect and systematize material on the causes and prevalence of gastric ulcer among the population of the globe, the Russian Federation, and the Krasnodar Territory;

· perform an analysis of rehabilitation methods for conservative management of patients and surgical management of patients with gastric ulcer;

· develop a rehabilitation questionnaire for specific patients with gastric ulcer and analyze the effectiveness of the inpatient rehabilitation phase;

· justify a complete rehabilitation program for patients with gastric ulcer at the sanatorium-resort and outpatient stages of the patient’s 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 problems set in the process of testing the hypothesis, the following were used: methods:

· subjective method of clinical examination of the patient;

· objective methods of examining the patient;

· comparison method;

· inductive method;

· deductive method.

Research base: State Budgetary Healthcare Institution KKB No. 1 named after. prof. S.V. Ochapovsky, Krasnodar, gastroenterology department.

The first chapter discusses: 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 examined two patients diagnosed with 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 the State Budgetary Healthcare Institution KKB No. 1 named after. prof. S.V. Ochapovsky in Krasnodar made it possible to identify complications of gastric ulcer and to consider the nurse’s tactics when they occur.

The role of medical personnel in carrying out comprehensive rehabilitation of patients cannot be underestimated, since without the participation of nurses in it it would be impossible, and the treatment of patients would not be completed. The reason for the importance of the role of nurses is the wide range of job responsibilities assigned to them, the performance of which by doctors without the help of nursing staff would be physically impossible. These results will help improve the organization of work of medical staff in the prevention of gastric ulcers.

Practical significance of the work determined by the fact that the results of the study can be implemented in practice in the work of a nurse and will improve the quality of nursing care and the prevention of gastric ulcers.

Introduction

Gastric ulcer is an important problem in modern medicine. This disease affects approximately 10% of the world's population. 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, about 3 million people are registered with dispensaries. According to reports from the Ministry of Health of the Russian Federation, in recent years the proportion of patients with newly diagnosed peptic ulcer disease in Russia has increased from 18% to 26%.

The relevance of the problem of peptic ulcer disease is determined by the fact that it is the main cause of disability for 68% of men and 30.9% of women among all those suffering from diseases of the digestive system. This disease causes suffering to many patients, so we believe that all health care workers should carry out a wide range of preventive measures to prevent and reduce morbidity. Nowadays, insufficient attention is paid to treatment and rational recovery in the rehabilitation of this pathology. The preventive stage of rehabilitation is not well known to the population. Many people do not know the risk factors for peptic ulcer disease, cannot recognize the first signs of the disease in themselves, therefore, do not seek medical help in a timely manner, cannot avoid complications and provide first aid for gastrointestinal bleeding.

The purpose of this study is to study the role of nursing staff in increasing the effectiveness of rehabilitation of patients with gastric ulcers at various stages - preventive, inpatient, outpatient sanatorium and metabolic.

Before writing the work, the following tasks were formulated to achieve the above goal:

· To collect and systematize material on the causes and prevalence of gastric ulcer among the population of the globe, the Russian Federation, and the Krasnodar Territory;

· Perform an analysis of rehabilitation methods for conservative management of patients and surgical management of patients with gastric ulcer;

· Develop a rehabilitation questionnaire for specific patients with gastric ulcer and analyze the effectiveness of the inpatient rehabilitation phase;

· Justify a complete rehabilitation program for patients with gastric ulcer at the sanatorium-resort and outpatient stages of the patient’s recovery and bring it to the attention of the patient and his family in order to improve the quality of life;

· To substantiate the role of nursing in ensuring effective rehabilitation of patients with gastric ulcer.

Area of ​​research: nursing process at various stages of rehabilitation of patients with gastric ulcer.

The object of this study is rehabilitation methods for gastric ulcer disease.

Subject of the study: patients with gastric ulcer, medical history of an inpatient, 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 famous Russian and foreign scientists as Kharchenko N.V., Baranovsky A.Yu., Kaneyes P. were used.

I. Gastric ulcer

1.1 Gastric ulcer. Etiology. Clinical picture of the disease

Gastric ulcer is a chronic recurrent disease that develops when the functional state of the stomach is impaired.

On average, 10% of the world's inhabitants are at risk of developing a stomach ulcer during their lifetime. Around the world, about 250,000 people died from peptic ulcer disease in 2013, which is significantly lower than in 1993, when 320,000 people died from the same cause. The development of peptic ulcer disease is facilitated by hereditary predisposition, violation of diet and diet, neuropsychic factors, bad habits (smoking, alcohol, excessive coffee consumption), the action of a number of medications (corticosteroids, reserpine, non-steroidal anti-inflammatory drugs, etc.) can cause ulceration of the mucous membrane stomach lining.

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. Caused by HP, this gastritis contributes to the development of peptic ulcers in people genetically predisposed to this disease.

Peptic ulcer disease occurs much more often in a number of diseases of internal organs. These diseases include chronic diseases of the liver, pancreas, and biliary tract.

From a modern point of view, the pathogenesis of peptic ulcer disease appears to be the result of an imbalance between the factors of aggression of gastric juice and the protection of the gastric mucosa.

Aggressive factors include hydrochloric acid, pepsin, and impaired evacuation.

The modern classification of gastric ulcer is based on the results of endoscopic and histological studies of the 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

· subcardial ulcer;

Prepyloric ulcer.

By stages:

Pre-ulcerative condition (gastritis B);

· exacerbation;

· subsiding exacerbation;

· remission.

By acidity:

· with increased;

· normal;

· reduced;

with achlorhydria.

By age:

· youthful;

· elderly.

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 eating, is localized behind the sternum, and can radiate to the left shoulder. With ulcers of the lesser curvature, pain occurs within 15-60 minutes. after eating. Dyspeptic phenomena. Belching with air (the severity and disturbance 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.

Changes occur in the Central nervous system (Asthenovegetative syndrome):

· poor sleep;

· irritability;

· emotional lability.

The following diagnostic methods are distinguished:

Laboratory diagnostic methods

1. A clinical blood test can detect hypochromic anemia, erythrocytosis, and a slow erythrocyte sedimentation rate (ESR).

2. Gregersen's stool can confirm that the ulcer is bleeding.

Instrumental research methods

1. Fibrogastroscopy (FGS). Reveals pathology of the mucous membrane of the upper digestive tract, inaccessible to the x-ray method. Local treatment of a peptic ulcer is possible. 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 for various acid-forming functions. Tablets (test) are given to the patient per os - they interact with hydrochloric acid, change, and are excreted in the urine. Based on the concentration upon release, one can indirectly judge the amount of hydrochloric acid. The method is not entirely reliable and is used when it is impossible to use probing.

3. Leporsky method (probe method). The volume on an empty stomach is assessed (normally 20 - 40 ml and the qualitative composition of the fasting portion: 20 - 30 mmol/l - the norm for 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 - normal. 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 administration of histamine).

5. Assessment of the proteolytic function of gastric juice. They examine it by immersing the probe inside the stomach, and it contains the substrate. A day later, the probe is removed and changes are studied.

6.X-ray examination

The role of the 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 ulcers (while knowing the effect and side effects of the medications prescribed by the doctor);

4. Know the signs of emergency conditions in this pathology: bleeding, perforation and provide first aid for these conditions;

5. Provide asymptomatic care (for vomiting, nausea, etc.);

6. Be able to have 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 disease).

1.2 Complications and the role of nursing staff when they occur

Complications of peptic ulcer:

1. Gastrointestinal bleeding is the most common and serious complication, it occurs in 15-20% of patients and is the cause of almost half of all deaths in this disease. It is observed mainly in young men.

Small bleedings are more common, massive ones are 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. It may be caused by various hemostasis disorders. In this case, a certain role is assigned to gastric juice, which has anticoagulating properties. The higher the acidity of the juice and the activity of pepsin, the less pronounced the coagulation properties of the blood.

Symptoms depend on the amount of blood loss. Minor bleeding is characterized by pale skin, dizziness, and weakness. With severe bleeding, melena (tarry stools), single or repeated vomiting of the color of “coffee grounds” are noted.

1. Information that allows the 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's tactics for bleeding:

1. Call a doctor.

2. Calm and lay the patient down, turn his head to the side to relieve emotional and psychological stress

3. Place an ice pack on the epigastric region to reduce bleeding.

5. Measure heart rate and blood pressure to monitor the condition.

Prepare medications, equipment, tools:

· aminocaproic acid;

Dicinone (etamsylate);

· calcium chloride, gelatinol;

· polyglucin, hemodnesis;

· intravenous infusion system, syringes, tourniquet;

· everything you need to determine your blood group and Rh factor;

· assessment of what has been achieved is:

stop 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. More often there is perforation and abdominal cavity. In 20% of ulcers of the posterior wall of the stomach, “covered” perforations are observed, caused by the rapid development of fibrous inflammation and the covering of the perforated opening by the lesser omentum, the left lobe of the liver or the pancreas.

Clinically manifested by sudden sharp (dagger) pain in the upper abdomen. The suddenness and intensity of pain is not as pronounced as in any other condition. The patient takes a forced position with his knees pulled up to his stomach and tries not to move. On palpation, a pronounced tension in the muscles of the anterior abdominal wall is noted. In the first hours after perforation, patients experience vomiting, which later becomes repeated with the development of diffuse pertonitis.

Bradycardia is replaced by tachycardia, the pulse is weak. Fever appears. Leukocytosis, erythrocyte sedimentation rate (ESR) is increased. An X-ray examination reveals gas in the abdominal cavity under the diaphragm.

3. Ulcer penetration - characterized by penetration of the ulcer into the organs in contact with the stomach: liver, pancreas, lesser omentum.

Clinical picture: in the acute period it resembles a perforation, but the pain is less intense. Soon signs of damage to the organ into which penetration occurred (girdling pain and vomiting with damage to the pancreas, pain in the right hypochondrium with irradiation to the right shoulder and back with penetration of the liver, etc.). In some cases, penetration occurs gradually. When making a diagnosis, it is necessary to take into account the presence of constant pain, leukocytosis, low-grade fever, etc.

4. Pyloric stenosis or pyloric stenosis - the essence of this complication is 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 stretches to such an extent that the upper abdomen becomes noticeably enlarged. Remnants of food eaten the day before are visible in the vomit. Due to insufficient digestion of food and incomplete absorption, general exhaustion of the body occurs, a person loses weight, becomes weaker, and the skin becomes dry, which is one of the signs of dehydration. The patient is depressed and loses his ability to work.

5. Malignant transformation of an ulcer (malignancy) - observed almost exclusively when the ulcer is localized in the stomach. When the ulcer becomes malignant, the pain becomes constant, loses connection with food intake, appetite decreases, exhaustion increases, nausea, vomiting, and subfibrile temperature are noted.

Anemia - accelerated erythrocyte sedimentation rate (ESR), persistently positive benzidone test (Gregersen reaction). Treatment: complications of peptic ulcer: perforation, bleeding, penetration, degeneration into cancer and cicatricial deformation 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 of malignant neoplasm in humans. This provision fully applies to older people. Precancerous diseases play a very important role in the development of stomach cancer. These include stomach polyps, gastric ulcers, and 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;

To fill the lack of positive information about the disease for the patient and his relatives;

Follow doctor's orders;

Provide first aid in case of emergency (bleeding, perforation);

Give competent advice on diet and physical activity;

Provide care if problems arise.

1.4 Statistical analysis of the occurrence of gastric ulcer in the world, the Russian Federation and the Krasnodar region

Three factors are considered at the basis of the appearance of gastric ulcer and the occurrence of relapses:

1. Genetic predisposition;

2. Imbalance between the factors of aggression and defense;

3. Presence of Helicobacter Pylori (HP).

Gastric ulcers had a huge impact on mortality until the end of the 20th century.

In Western countries, the proportion of people developing peptic ulcers due to HP, roughly speaking, corresponds to age (for example, 20% at the age of 20 years, 30% at the age of 30 years, 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%. Overall, Helicobacter Pillory shows a declining trend, more so in developed countries. Helicobacter Pillory is transmitted through food, natural water sources and cutlery.

In the United States, about 4 million people have peptic ulcers, and 350,000 people get the disease 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, an increase of 6%, so the growth is within normal limits. The incidence reached its highest level of 5,149,000 people in 2002, the lowest level could be observed in 2000.

Attention should be paid to the increase in the rates of general morbidity (by 10.8%) and primary morbidity (by 9.2%) of the adult population in 2012 compared to 2011. (overall incidence was 83.22 in 2011 and 92.22 in 2012 per 1000 population of the corresponding age; primary incidence was 25.2 and 27.5 in 2011 and 2012, respectively) in the Krasnodar region. 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%). An increase in mortality from stomach ulcers (by 16.2%) is associated with the aging of the population and an increase in the number of patients with severe concomitant pathologies who are forced to take non-steroidal anti-inflammatory drugs and antiplatelet agents for a long time. Reducing mortality rates from complicated gastroenterological diseases can only be achieved with the 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 the nurse in the prevention of gastric ulcers is difficult to overestimate. Many cases of peptic ulcer disease can be prevented when nurses assist doctors in conducting outreach to the public. An example of such assistance is assistance to gastroenterologists of the region in holding schools for patients with peptic ulcers, round tables and lectures for patients, and speaking on television and radio with conversations about a healthy lifestyle. Gastric ulcer is currently one of the most common pathologies among patients. In 2012, as a result of additional medical examination, 35,369 such patients were identified and registered at the dispensary.

II. Methods of rehabilitation of patients with gastric ulcer

2.1 General rehabilitation methods

According to the WHO definition, rehabilitation is the combined and coordinated use of social, medical, pedagogical and professional measures with the aim of preparing and retraining an individual to achieve his optimal working capacity.”

Rehabilitation objectives:

1. Improve the overall reactivity of the body;

2. Normalize the state of the central and autonomic systems;

3. Provide painkillers, anti-inflammatory, trophic effects 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 stages ensured by the continuity of information, the unity of understanding of the pathogenetic essence of pathological processes and the foundations of their pathogenetic therapy. The sequence of stages may vary depending on the course of the disease.

An objective assessment of the results of rehabilitation is very important. It is necessary for the ongoing correction of rehabilitation programs, prevention and overcoming of unwanted side reactions, and 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, 5 stages of medical rehabilitation are distinguished.

The preventive stage aims to prevent the development of clinical manifestations of the disease by correcting metabolic disorders (Appendix B).

Activities at this stage have two main directions: elimination of identified metabolic and immune disorders through dietary correction, the use of mineral waters, pectins from marine and terrestrial plants, natural and reformed physical factors; combating risk factors that can significantly provoke the progression of metabolic disorders and the development of clinical manifestations of the disease. One can count on the effectiveness of preventive rehabilitation only by backing up the measures of the first direction by optimizing the living environment (improving the microclimate, reducing dust and air pollution, leveling the harmful effects of geochemical and biogenic nature, etc.), combating physical inactivity, excess body weight, smoking and others bad habits.

Inpatient stage of medical rehabilitation, in addition to the first most important task:

1. Saving the patient’s life (involves measures to ensure minimal tissue death as a result of exposure to a pathogenic agent);

2. Prevention of complications of the disease;

3. Ensuring the optimal course of reparative processes (Appendix D).

This is achieved by replenishing the deficit of circulating blood volume, normalizing microcirculation, preventing tissue swelling, conducting detoxification, antihypoxic and antioxidant therapy, normalizing electrolyte disturbances, using anabolic steroids and adaptogens, and physiotherapy. In case of microbial aggression, antibacterial therapy is prescribed and immunocorrection is carried out.

The outpatient stage of medical rehabilitation should ensure the completion of the pathological process (Appendix E).

For this purpose, therapeutic measures are continued aimed at eliminating residual effects of intoxication, microcirculation disorders, and restoring 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 principles of dietary correction depending on the characteristics of the course of the disease. A major role at this stage is played by targeted physical culture in a mode of increasing intensity.

The sanatorium-resort stage of medical rehabilitation completes the stage of incomplete clinical remission (Appendix G). Treatment measures should be aimed at preventing relapses of the disease, as well as its progression. To achieve these goals, predominantly natural therapeutic factors are used to normalize microcirculation, increase cardiorespiratory reserves, stabilize the functioning of the nervous, endocrine and immune systems, gastrointestinal tract and urinary excretion.

The metabolic stage includes conditions for the normalization of structural and metabolic disorders that existed after completion of the clinical stage (Appendix E).

This is achieved through long-term dietary correction, the use of mineral waters, pectins, climatotherapy, therapeutic physical training, and balneotherapy courses.

The results of the implementation of the principles of the proposed medical rehabilitation scheme are predicted by the authors to be more effective compared to the traditional one:

Isolating the stage of preventive rehabilitation allows us to form risk groups and develop preventive programs;

Identification 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 progression and chronicity of the pathological process;

Staged medical rehabilitation including independent stages of preventive and metabolic remission will reduce morbidity and increase the level of public health.

Areas of medical rehabilitation include medicinal and non-medicinal areas:

Medicinal 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.

Take before meals

Most medications are taken 30-40 minutes before meals, when they are best absorbed. Sometimes - 15 minutes before a meal, not earlier.

Half an hour before meals you should take anti-ulcer drugs - d-nol, gastrofarm. They should be washed down with water (not milk).

Also, half an hour before meals you should take antacids (Almagel, phosphalugel, etc.) and choleretic drugs.

Take with 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 acid preparations or digestive enzymes should be taken with food, as they help the stomach digest food. These include pepsin, festal, enzistal, panzinorm.

It is advisable to take laxatives that can be digested with food. These are senna, buckthorn bark, rhubarb root and joster fruit.

Take after meals

If the medicine is prescribed after a meal, wait at least two hours to get the best therapeutic effect.

Immediately after eating, they take mainly medications that irritate the mucous membrane of the stomach and intestines. This recommendation applies to such groups of drugs as:

* painkillers (non-steroidal) anti-inflammatory drugs - Butadione, aspirin, aspirin cardio, voltaren, ibuprofen, askofen, citramon (only after meals);

* acute drugs are components of bile - allohol, lyobil, etc.); Taking after meals is a prerequisite for these drugs to “work.”

There are so-called antacid agents, 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 finishing a meal - magnesium oxide, vikalin, vikair.

Aspirin or askofen (aspirin with caffeine) is taken after meals, when the stomach has already begun to produce hydrochloric acid. Thanks to this, the acidic properties of acetylsalicylic acid (which causes irritation of the gastric mucosa) will be suppressed. This should be remembered by those who take these tablets for headaches or colds.

Regardless of food

Regardless of when you sit down at the table, take:

Antibiotics are usually taken regardless of food, but fermented milk products must also be present in your diet. Along with antibiotics, they also take nystatin, and at the end of the course, complex vitamins (for example, supradin).

Antacids (Gastal, Almagel, Maalox, Taltsid, Relzer, Phosphalugel) and antidiarrheals (Imodium, Intetrix, Smecta, Neointestopan) - half an hour before meals or one and a half to two hours after. Please note that antacids taken on an empty stomach last for about half an hour, and those taken 1 hour after a meal last for 3 to 4 hours.

Take on an empty stomach

Taking the medicine on an empty stomach is usually in the morning 20-40 minutes before breakfast.

Medicines taken on an empty stomach are absorbed and absorbed much faster. Otherwise, the acidic gastric juice will have a destructive effect on them, and the medications will be of little use.

Patients often ignore the recommendations of doctors and pharmacists, forgetting to take a pill prescribed before meals and rescheduling it for the afternoon. If the rules are not followed, the effectiveness of the drugs will inevitably decrease. To the greatest extent if, contrary to the instructions, the drug is taken during or immediately after meals. This changes how quickly drugs pass through the digestive tract and how quickly they are absorbed into the blood.

Some drugs may break down into their component parts. For example, penicillin is destroyed in an acidic stomach environment. Aspirin (acetylsalicylic acid) breaks down into salicylic and acetic acids.

Take 2-3 times a day

If the instructions say “three times a day”, this does not mean breakfast - lunch - dinner. The medicine must be taken every eight hours to maintain its concentration in the blood evenly. It is better to take 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, polyphepane 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, you need to increase your fluid intake. It is good to add herbs that have a diuretic effect to your drink.

Day or night

Drugs with a hypnotic effect should be taken 30 minutes before bedtime.

Laxatives - bisacodyl, senade, glaxena, regulax, gutalax, forlax - are usually taken before bed and half an hour before breakfast.

Ulcer medications are taken early in the morning and late in the evening to prevent hunger pangs.

After inserting the suppositories, you need to lie down, so they are prescribed at night.

Emergency medications are taken 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 medications to patients in accordance with the prescriptions of the attending physician, informing the patient about medications, and monitoring their intake.

Non-drug rehabilitation methods include the following:

1. Diet correction:

The diet for gastric ulcers is used as prescribed by the doctor sequentially; during surgery, it is recommended to start with diet - 0.

Goal: Maximum sparing of the mucous membrane of the esophagus and 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.

Diet characteristics. This diet requires a minimal amount of food. Since it is difficult to take in solid 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. Protein 15 g, fat 15 g, carbohydrates 200 g, calorie content - about 1000 kcal. Table salt 5 g. The total weight of the diet is no more than 2 kg. The food temperature is normal.

Sample set

Fruit juices - apple, plum, apricot, cherry. Berry juices - strawberry, raspberry, blackcurrant. Broths are weak ones made from lean meats (beef, veal, chicken, rabbit) and fish (pike perch, bream, carp, etc.).

Cereal decoctions - rice, oatmeal, buckwheat, corn flakes.

Kissels made from various fruits, berries, their juices, and dried fruits (with the addition of a small amount of starch).

Butter.

Tea (weak) with milk or cream.

Sample one-day diet menu No. 0

8 hours - fruit and berry juice.

10 o'clock - tea with milk or cream and sugar.

12 hours - fruit or berry jelly.

14 hours - weak broth with butter.

16 hours - lemon jelly.

18 o'clock - rosehip decoction.

20 o'clock - tea with milk and sugar.

22 hours - rice water with cream.

Diet No. 0A

Her are prescribed, as a rule, for 2-3 days. The food consists of liquid and jelly-like dishes. The diet contains 5 g of protein, 15-20 g of fat, 150 g of carbohydrates, energy value 3.1-3.3 MJ (750-800 kcal); table salt 1 g, free liquid 1.8-2.2 l. Food temperature should not exceed 45 °C. Up to 200 g of vitamin C is added to the diet; other vitamins are added as prescribed by the doctor. Meals 7 - 8 times a day, for 1 meal give no more than 200 - 300 g.

· Allowed: weak 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 appointment). If the condition improves, on the 3rd day add: a soft-boiled egg, 10 g of butter, 50 ml of cream.

· Excluded: any dense or pureed foods, 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 the addition of liquid pureed porridge from rice, buckwheat, rolled oats, cooked in meat broth or water. The diet contains 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 of sodium chloride, up to 2 liters of free liquid. Food is given 6 times a day, no more than 350-400 g per meal.

Diet No. 0B (No. 1B surgical)

She serves as a continuation of the expansion of the diet and the transition to physiologically nutritious nutrition. The diet includes puree soups and cream soups, steamed dishes from pureed boiled meat, chicken or fish, fresh cottage cheese, pureed with cream or milk to the consistency of thick sour cream, steamed dishes from cottage cheese, fermented milk drinks, baked apples, well-mashed fruit and vegetable purees, up to 100 g of white crackers. Milk is added to tea; They give you milk porridge. The diet contains 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 disease, 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 maximally sparing the function of the stomach.

General characteristics of diet No. 1a

Exclusion of substances that are strong secretion stimulants, as well as mechanical, chemical and thermal irritants. Food is prepared only in liquid and mushy form. Steamed, boiled, mashed, pureed dishes in a liquid or mushy consistency. In Diet No. 1a for patients who have undergone cholecystectomy, only mucous soups and eggs are used in the form of steamed protein omelettes. Calories are reduced primarily through carbohydrates. The amount of food taken at one time is limited, the frequency of intake is at least 6 times.

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 of the physiological norm, and a strict limitation of the effects of various chemical and mechanical irritants on the upper parts of the gastrointestinal tract. This diet also limits carbohydrates and table salt.

Proteins 80 g, fats 80 - 90 g, carbohydrates 200 g, table salt 16 g, calorie content 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 dishes - not lower than 15 - 20 ° C.

· Slimy soups made from semolina, oatmeal, rice, pearl barley with the addition of egg-milk mixture, cream, butter.

· Meat and poultry dishes in the form of puree or steam soufflé (meat cleaned of tendons, fascia and skin is passed through a meat grinder 2-3 times).

· Fish dishes in the form of steam soufflé from low-fat varieties.

· Dairy products - milk, cream, steam soufflé from freshly prepared pureed cottage cheese; Fermented milk drinks, cheese, sour cream, and regular cottage cheese are excluded. If well tolerated, whole milk 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.

· Cereal dishes in the form of liquid porridge with milk, porridge made from cereal (buckwheat, oatmeal) flour with the addition of milk or cream. Almost all cereals can be used, with the exception of pearl barley and millet. Add butter to the finished porridge.

· Sweet dishes - jelly and jellies from sweet berries and fruits, sugar, honey. You can also make juices from berries and fruits by diluting them with boiled water before drinking in a 1:1 ratio.

· Fats - fresh butter and vegetable oil added to dishes.

· Drinks: weak tea with milk or cream, juices from fresh berries and fruits diluted with water. Among the drinks, decoctions of rose hips 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 foods; 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 intended purpose are the same as for diet No. 1a. The diet is fractional (6 times a day). This table is for less severe, in comparison with table No. 1a, limitation of mechanical, chemical and temperature aggression on the stomach. This diet is indicated for mild exacerbation of gastric ulcer, in the stage of subsidence of this process, for chronic gastritis.

Diet No. 1b is prescribed at subsequent stages of treatment while the patient remains in bed rest. The duration of diet No. 1b is very individual, but on average it ranges from 10 to 30 days. Diet No. 1b is also used during bed rest. The difference from diet No. 1a is a gradual increase in the content of basic nutrients and caloric content of the diet.

Bread in the form of dried (but not toasted) crackers (75 - 100 g) is allowed. Pureed soups are introduced, replacing mucous membranes; Milk porridge can be consumed more often. Homogenized canned baby food made from vegetables and fruits and dishes made from beaten eggs are allowed. All recommended products and dishes from meat and fish are given in the form of steam soufflé, quenelles, mashed potatoes, and cutlets. After the products are boiled until soft, they are rubbed to a mushy state. The food should be warm. The rest of the recommendations are the same as for diet No. 1a.

Chemical composition of diet No. 1b

Proteins up to 100 g, fats up to 100 g (30 g vegetable), carbohydrates 300 g, calorie content 2300 - 2500 kcal, table 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 dietary correction

The nutritionist monitors the operation 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, monitors the correct storage of food supplies. With the participation of the production manager (chef) and under the guidance of a nutritionist, he compiles a daily menu layout in accordance with the dish card index. Performs periodic calculations of the chemical composition and calorie content of diets, monitoring the chemical composition of actually prepared dishes and diets (content of 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 stocking of products and the release of dishes from the kitchen to the departments, according to received orders, and carries out rejecting of finished products. Monitors the sanitary condition of dispensing and canteens at the departments, equipment, utensils, as well as the observance of personal hygiene rules by dispensing employees. Organizes training sessions with paramedics and kitchen staff on clinical nutrition. Monitors the timely conduct of preventive medical examinations of catering workers and prevents persons from working who have not undergone a preliminary or periodic medical examination.

Diet No. 1

General information

· Indications to diet No. 1

Gastric ulcer in the stage of fading exacerbation, during the period of recovery and remission (duration of dietary treatment 3 - 5 months).

The purpose of diet No. 1 is to accelerate the processes of repair of ulcers and erosions, further reduce or prevent inflammation of the gastric mucosa.

This diet helps normalize the secretory and motor-evacuation functions of the stomach.

Diet No. 1 is designed to satisfy the physiological needs of the body for nutrients in inpatient settings or in outpatient settings during work that is not associated with 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 temperature aggression with a restriction in the diet of foods that have a pronounced irritating effect on the walls and receptor apparatus of the upper gastrointestinal tract, as well as difficult-to-digest foods. Avoid foods that are strong secretion stimulants and chemically irritating to the gastric mucosa. Both very hot and very cold foods 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. It is recommended to chew food thoroughly.

· Food is liquid, mushy and has a denser consistency when boiled and mostly pureed. Since the consistency of food is very important during dietary nutrition, the amount of foods rich in fiber (such as turnips, radishes, radishes, asparagus, beans, peas), fruits with skin and unripe berries with rough skin (such as gooseberries, currants, grapes) is reduced. , dates), bread made from wholemeal flour, products containing rough connective tissue (such as cartilage, poultry and fish skin, stringy meat).

Dishes are prepared boiled or steamed. After this, they are crushed to a pasty state. Fish and lean meats can be eaten whole. Some dishes can be baked, but without a crust.

· Chemical composition of diet No. 1

Protein 100 g (of which 60% animal origin), fat 90 - 100 g (30% vegetable), carbohydrates 400 g, table salt 6 g, calorie content 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 liquid is 1.5 l, the food temperature is normal. It is recommended to limit table salt.

· Wheat bread made from premium flour, freshly baked or dried; rye bread and any fresh bread, products made from butter and puff pastry are excluded.

· Soups with vegetable broth from pureed and well-cooked cereals, milk soups, pureed vegetable soups, seasoned with butter, egg-milk mixture, cream; Meat and fish broths, mushroom and strong vegetable broths, cabbage soup, borscht, and okroshka are excluded.

· Meat dishes - steamed and boiled from beef, young lean lamb, trimmed pork, chicken, turkey; Fatty and stringy varieties of meat, poultry, duck, goose, canned meat, and smoked meats are excluded.

· Fish dishes 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.

· Porridges made from semolina, buckwheat, rice, cooked in water, milk, semi-viscous, mashed; millet, pearl barley and barley cereals, legumes, and pasta are excluded.

· Vegetables - potatoes, carrots, beets, cauliflower, boiled in water or steam, in the form of soufflés, purees, steam puddings.

· Appetizers - salad of boiled vegetables, boiled tongue, doctor's sausage, milk sausage, diet sausage, jellied fish in vegetable broth.

· Sweet dishes - fruit puree, jelly, jelly, pureed compotes, sugar, honey.

· Drinks - weak tea with milk, cream, sweet juices from fruits and berries.

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