การพยาบาลผู้ป่วยเลือดออกในระบบทางเดินอาหารส่วนต้นเฉียบพลันร่วมกับภาวะช็อค จากการเสียเลือด กรณีศึกษา 2 ราย

Abstract

Background   : Acute Upper gastrointestinal bleeding is a major surgical emergency where patients need  immediate  help. Proper nursing care Rapid diagnosis of bleeding  It can make patients safe from shock and reduce mortality rate.

Objectives   : The purpose of study to nursing care of patients were Acute Upper GastrointestinalBleeding with Hypovolemic shock

Methods :  This study was comparisons of two case patients with Acute Upper Gastrointestinal Bleeding with Hypovolemic shock and admitted to the female surgical ward. Mahasarakham Hospital from November to December 2017. The data collections  were from medical  record, interview there relative and patient observation. The data analysis were compared  functional  health pattern, clinical, sign and symptom,  treatment,  problem  and nursing diagnosis, nursing care of patients with critical period, continuing care and discharge planning

Result   : The comparisons of two case patients with Acute Upper Gastrointestinal Bleeding withHypovolemic shock Case 1, Thai female 70 years old and have hematochezia 4 time a day before came to hospital 5 day. Diagnosis of Acute Upper Gastrointestinal Bleeding with Hypovolemic  shock and postoperative patients with re-bleeding symptoms  have resulted  in open abdominal  surgery to stop bleeding. Patient clinical improve and discharge to home. Case 2 Thai female 79 years old with hematochezia,  tired exhausted for 2 days, the patient has col- lapsed  since the community  hospital  resuscitation.  And insert endotrachal   tube . This patient  has been undergoing permanent stabilization.

Conclusion : This study shows the process of caring for patients from community  hospitals. In crisis, physicians need to make the right decisions, including referrals. Patient care using a multidisciplinary team of physicians, nurses and physical therapists. Potential in each role leads the patient to overcome the critical period of life. Safe and able to return home. However, the perception of the severity of these two patients is delayed, so the pre-sales must focus on surveillance and knowledge in self care.

Keywords   : Acute Upper Gastrointestinal bleeding, Hypovolemic shock, Rebleeding