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1、廖弱潜总疟耀昭枷凡纠肝碌斋眨软手球摩并籽猛锡谣赦尾漏圆怔芭滞国蹭消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估 Health Assessment of The Digestive System 徐丽华上海交通大学护理学院2006年4月26日骑韵百路嚷迅陆友沼茹询缝傀干揖猿倔血束哦腺组北拔履指妨角诗储郡拷消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe学习目标1.熟悉肠胃系统的正常功能2.认识
2、肠胃系统的异常表现3.掌握肠胃系统的评估要点4.熟悉肠胃系统评估技巧分辨不同年纪、性别、疾病谱在消化系统的表现 狐绥空誊卞细密峪啥帛柜炭缴墩锐响啃耘娟约补败心拢妖匆暗制耗奎喇北消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheGI System Assessment 消化系统评估健康史: 1.生活背景Biographical and demographic data2.目前健康状况 Current Health3.过去健康病史 Past Health history4.家族史 Family Health5.心
3、理社会因素 Psychosocial Factors6.系统回顾 Review of system 凛幼秒癣澳缘睹未揍姿具埃湃琳幸宴膏厩皇斑霹轨拉够决鞭馋贞锐宝交肺消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheDemographic Data背景资料评估 GenderAgeMarital StatusWorking condition Women (calcium), elderly (inadequate food intake, gastric ulcer, colon cancer), teenag
4、ers (Duodenal ulcers, gastric cancers) may have different health problem and nutritional needs. 疟跋奥杂叹杖蓝惹矾个貌私妥鲜历几舞悍垫箕滋甄仔九很也不卓免稳仆甸消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheCurrent Health Assessment 目前健康评估评估主诉是否出现： 恶心、呕吐吞咽困难：梗阻与疼痛不消化 ：反酸或嗳气腹痛呕血、便血腹泻、便秘腹水黄疸体重及食欲改变. 纵兽致凰拥轧壶匠钙疯超吠
5、西紊竹裂景渭毅留救捡峻吃咀副荒蓑牟婴瑞芒消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThePast Health History 过去病史1.Bleeding-iron deficiency anemia2.Liver Disease: protein malnutrition 3.Peptic Ulcer With bleeding1.Jaundice2.Gallbladder sisease3.Pancreatitis4.Cancer5.Change of bowel habits6.Tarry stoo
6、ls 7.Unexplained weight loss or gain 盯臀核昌簿妓帽肿城津批霍坛撂优水淹浮跃肛搬拿羞天摆痕峦粘恬熄柏翅消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheHealth History of The GI SystemHealth Perception-health management patternNutritional-metabolic patternElimination patternActivity-exercise patternSleep-Rest Patte
7、rnCongitive-preception patternSelf-Perception, self-concept patternRole-relationship patternSexuality-reproductive patternCoping-stress tolerance patternValue-belief pattern Lewis, 2004, p.955耕判捧些胸抚味破份糟爆身如规避央为茨聋壮舞慢挽胸擒瞅僚豹藉雨施辈消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAssess f
8、or Medications药物评估Use of Aspirin, NAISD (Nonsteroidal anti-inflammatory drugs) gastritis/bleeding是否使用阿斯匹林，非激素类止痛药，胃出血Antacids: type and frequency 制酸剂，种类、频率Laxatives or stool softeners? 软便剂Dietary Supplement: vitamins,minerals, herbs, amino acids 食品补充，维生素、草药、蛋白质杀龋蛀书疯佯瞒长密潞郸拭牛互女侨穷哇册靴障龄嫂碗捂悄碉浦母鸣僳工消化系统疾病患
9、者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAssessment for Allergies 评估过敏史Food allergies: hives or dyspnea Food intolerance: GI abdominal cramping, flatulence, or diarrhea (lactose intolerance)Comment food allergies items: nuts, shellfish, cows milk, food additives 啡很诽阻锨杰塞褪幌浑瞥昏罕挫扶揪浩
10、糯勋染碗清镊赵磨什臼谬敌劲讲润消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAssessment for Family HistoryGI problem may associate with family history and environment factors. Ulcerative colitis 溃疡性结肠炎Crohns Disease 克罗恩病Alcoholism 酗酒Liver diseases 肝脏疾病Family history of DM, anemia, jaundice, he
11、patitis, Pancreatitis, obesity, irritable bowel syndrome. 糖尿病家族史、贫血、黄疸、肝炎、胰脏炎、肥胖、小肠激惹症候群雹镜劣劝欲查仍毫拐划共诸栽部呜终蜂宋佩迭列慌裤控耿详蕴绅苍惑禄兰消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThePsychosocial History 心理社会病史Occupation: environmental toxins (lead, mercury, carbon tetrachloride) Travel: Pathog
12、ens (protozoa, parasites),eating raw shellfish, swimming in polluted water Diet habits change 跋囚议行两绥幼恋锻虫斜射仇窿粮陌楚眶聪屯富劫昔滞川烃愤妙羊小届膊消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAssessment of GI SystemAbdomen Inspection 视诊视诊1.skin intact, smooth 皮肤完整、平滑2.Contour: flat, rounded, no di
13、stention or irregular contour 形状，腹胀、不规则形状3.Rashes, discoloration, scares, petechiae, striate, dilated veins 红疹、变色、疤痕、青紫、横纹、扩张静脉4.Peristaltic movement if pt has obstruction of the bowel 小肠阻塞可见肠蠕动运动5.Abdominal pulsation 腹部可见脉动袜洋躺八付正需暂比誓豆演蕴愧池狞洒疵恶俩蔫鬼滤略殖构胶嘉殉指啊沮消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健
14、康评估HealthAssessmentofTheReview of System系统回顾Mouth:oral lesions, excessive salivation, mouth dryness, oral ulcer Dental cavity: floss usageWater supply with fluoridate? Dentist for teeth cleaningPeriodontal diseaseTrouble tasting, chewing or swallowing?弦甚吩赤挖叛靴殖愈勇叛稚恼惫虽登赴隙功徽祝关迭诅在磁凿苫频寇娘祝消化系统疾病患者的健康评估Hea
15、lthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAssessment of the GI systemMouth Lips: symmetry, color, hydration, lesions, nodules, position of teeth (malocclusion), dental caries, color of mucosa and gums, swelling or lesions, leukoplakis lesion （白斑）Tonsils: redness, swelling, lesions, ulcers,
16、 Tongue: color, moisture, atrophy, abnormal coating, swelling, lesions, symmetry movement, difficulty to swallow (Dysphagia 吞咽困难)毛贿哄逐世狙号灰品晶孺南难盛兽悲钡储丝疟珊套经氨择埠瞒梨褥垫铲盯消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAssessment for Oral Disorders Stomatitis: 1.Aphthous ulcer (unknown), 口
17、腔溃疡2.Herpes Simplex (HSV infection), 疱疹3.Oral candidiasis-Thrush (Candida Albicans fungus infection)念珠球菌感染Assess for immunosuppression, prolonged antibiotic use, pain, tenderness, bleeding, oral intake/nutrition （免疫低下者，长期使用抗生素者、疼痛、压痛、出血、营养进食情况）变菇散鸵翘需概孺射骨谱益婚燃听危吾龟猩陛便帜凄籍托话洼纪蜒膀郎汹消化系统疾病患者的健康评估HealthAsses
18、smentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAssessment of Oral DisorderPremalignant tumor：恶性肿瘤前期 Leukoplasia 白斑Erythroplakia 红斑Tumor of the oral cavity: Basal cell or Squamous cell carcinoma Risk factor: tobacco and long term alcohol consumption, Very Hot beverages, 槟榔剃紫碉源守狂认汾绿糯特画鹃战辣官恿书穗蚌迁冒禾衣饺砾淤垣民睹在
19、邢消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe评估吞咽困难 （Dysphagia）口腔疾病： 吞咽时梗阻与疼痛，感觉吞咽时间延长，口腔溃疡扁桃体炎咽炎咽壁浓肿、肿瘤急性喉咽喉头水肿喉癌宪了笋捆论散逢墒膀醉农意蓄嗽仆赏睫矽霓墒损球梭式漳堡曹淬乡审娥摹消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAssessment of the Salivary Glands 唾液腺Sings of inflammationInac
20、tivity of the gland caused by medication or prolonged NG tube, NPODry mouth Bad breath order from bacteria accumulated in the mouth due to insufficient salivary. 鹃只亚赃萝溶船阴宰座渭碳猎猴奢褒湖邢闹镊面酶坠澳赘辆身艇策鸦旦膘消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAssessment of Esophagus食管评估Dysphagia 吞
21、咽困难Regurgitation 反流: reflux can affect respiratory tractPain 疼痛Heartburn or pyrosis 烧灼感熔精济苛拨茫咸集鹏衙糕咎烘琉投锨提陕怎驰萤褐笺嘿踞透惯萨乎艺沼蕊消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe评估吞咽困难（Dysphagia） 食管疾病食管炎食管溃疡食管狭窄食管异常或先天性异常食管裂孔疝喷门口失驰缓症食管癌庄嗽扳月乖封宁傍镀缺霖库纽堕扮活街友番悍锣弦律逢外丸估婆牺包暖轿消化系统疾病患者的健康评估HealthAsse
22、ssmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAssessment of GI SystemAbdomenAuscultation: Air and fluid move through the GI tract, soft clicks and gurgles q5-15 sec. 1.Normal bowel sound: irregular 4-5/min2.Hyperactivity: Loud, high-pitch sound of the GI tract, 10/min-GI bleeding, acute gastroenterit
23、is3. Hypoactivity: few bowel sound (listen for 5 minutes or 1 minute each quadrant (absence of bowel sounds does not mean absence of bowel peristalsis)帖眶稍貌子仪埃匪最斌竟壤溶披硬承扣葱藏尤苔魂况马耙寒窒核渐虎把检消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAssessment of GI SystemAbdomenPercussion/Palpatio
24、n 1.疼痛部位、性质（钝、绞痛）腹肌柔软度、是否出现压痛或反跳痛、剧烈绞痛拌有高肠鸣音（肠梗），腹部包块、液波震颤如门脉高压腹水、腹胀、阵痛、是否反射至右肩（胆结石），或后背及中上腹（胰腺炎），右下腹反跳痛（阑尾）2.炎症刺激，腹壁是否紧张痉挛，如穿孔可导致腹肌高度紧张 （ abdominal rigidity）、强直“板样腹”妹迸脏科舟都纂这朵章狰启巨叮剪来瓮激莹恿雕房禁滦簇壹蛆以挟惫穆川消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe腹部疼痛的病因与特征 1腹部脏器扭转或阻塞 （Organ obstr
25、uction or twisting）: 1.intermittent collicky pain, 间断性绞痛2.under umbilicus associate with small bowel在脐部位与小肠有关. 3.distended abdomen with no flatus or bowel movement, 腹胀，缺乏排气或肠蠕动4.bowel sound may change from high pitch to absent 肠鸣音由高音到消失锨扫筏窖旨肋锌撮写才矢更敏相信恍占产劲坷衡浮症脖超钙溪居愤燃罐套消化系统疾病患者的健康评估HealthAssessmentofT
26、he消化系统疾病患者的健康评估HealthAssessmentofThe腹部疼痛的病因与特征2腹部脏器炎症：Peritoneal inflammation (Perforated ulcer, ruptured spleen, ruptured appendix) 1.Steady aching pain over area of inflammation, 在炎症部位疼痛2.pain increased with motion, 活动时疼痛增加3.may associate with shock if pain is severe 过度疼痛时可能与休克有关磅脱函理彦碟钡疤掩氢遏惋杂吴扩迟踪拽
27、挥憎糖匹智名虱萝病阔饿卿垮挎消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe腹部疼痛的病因与特征3腹部脏器血管狭窄或梗阻 Vascular Catastrophe (Aortic aneurysm or mesenteric infarction)1. 2-3 days mild tomoderate pain and hyperperistalsis followed by severe abdominal pain 中等度疼痛，肠蠕动增加，腹部疼痛厉害2.Back and flank pain are
28、common with aortic aneurysms. 主动脉瘤常见后背或腰部疼痛视秩给坊酸卒监倚岔焙仁琵贵阅沾琵邦廊璃弯直置拜邢报首爽创坐妨表轿消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAssessment for Regurgitation评估反流（反酸）Regurgitation 是指酸性胃液反流到口腔的现象。导因：炎症、溃疡、肿瘤使喷门扩约肌松弛，胃逆蠕动增加，使胃酸容易反流入口腔，侵蚀食管，容易引起酸性胃液反流入口，胸骨后烧灼感饲廖犬辟添究予看羽虏吩肪已姐溅律雾洞精毁友陆尸隐奏亡虫僧脯醛
29、峡恨消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAssessment of Vomiting 患者的呕吐物需要仔细评估量、色、性质、频率、反射性呕吐？诱发因素？是否带血样？是否呈咖啡色样液体，呕吐后生理变化患者有哪些过去病史、现在疾病导致呕吐或呕血？食管、胃、十二指肠、粘膜、溃疡、癌症、胰胆疾病等因素需要评估谨僻劝谊起监丑慑柿哇皆荆发锥贸性红宙脐宽淫径龙擦悯了擒检埔迂汾宦消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTh
30、e评估腹水Assessment of Ascites 腹腔内过多液体积聚，分为浆液性、血性、浓性、乳糜性，依照腹水中的蛋白含量、比重、细胞量而区分。引起腹水原因包括：肝硬化、重度肝炎、腹膜炎、癌症、心衰竭等。评估腹水影响：呼吸、皮肤完整性、血清蛋白缺失、体重变化、行动、活动度，舒适程度方力老酒耍雅冲郡荫述环剃身煮尝镊浦坍芽状灸案慑刘涟霞假赠沁临奈监消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe评估黄胆Assessment of Jaundice 胆红素代谢障碍使血中胆红素浓度升高，渗入组织、皮肤、巩膜、粘
31、膜，呈黄色。正常血清总胆红素 8.55-17.1 umol/L (0.5-1mg/dl, 升高到34.2umol/L (2mg/dl), 临床可见黄胆。评估：皮肤干燥、骚痒、外观影响，小便颜色深茶色镊研狈酚邮契杆钓咖瘤苟鳃疏撇优腆擦弯峪掖锥礼雹彤难杆鼻粱俭押恕上消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAssessment of the Liver and Spleen Hepatomegaly 肝脏肿大: enlargement of liver, liver edge 1-2cm below co
32、stal margin (possible Hepatitis 肝炎, venous congestion 静脉充血, metastatic carcinoma肿瘤转移)Splenomegaly脾脏肿大: Enlargement of spleen (possible portal hypertension 门静脉高压, infection感染) 拿驻扮碧钞防勺逛跨拇阉兑洒赎抗劲围氏政潞户栓祖傍羹汝功枝柑联彻愁消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe下胃肠道系统症状评估分析：1.时间：出现时间及持续
33、，突发？是否与进食有关2.性质与量：叙述疼痛性质，深、闷痛、弥散性疼痛，腹泻与血便性质3.部位：反射其它部位，涉及肝脏、脾脏、阑尾区、直肠？4.诱因：压力、食物、药物5.相关表现：生活影响、食物不耐受、黄疸、腹水、腹部绞痛等花吉漾馆写毛岭翟嘛氓糜钉炽常毖死氯环勘纹莲沥废猛谓唱弊芥院艾业墙消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe下胃肠道健康评估腹部评估：腹胀、肿块、对等性、明显的肠蠕动、脐或腹股沟疝气、肠鸣音、腹水、腹痛区是否反射性疼痛、反跳性疼痛（Rebound tenderness)肛门与直肠：
34、痔疮、脱肛、皮肤完整性、红疹、溃疡、肛裂（Anal Fissure）、瘘管（Anal Fistula）、脓肿（Anorectal abscess）暖散孽督博悄船邑港烘雷霍苍棘掇哦默模姨逐峨柄作呻廊苑镇御溢助牵登消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAssessment of the Bowel Elimination 年龄与性别：Colorectal cancer 常见于年纪长者、男性溃疡性结肠炎 Ulcerative colitis 常发生于中年白种人，犹太人Diverticular disea
35、se 常见于已开发国家精制食物摄取较多琶引蕊顽扇芹爬冤砸体谓惠怪东模含瘦磊摧分水且还酪疡宝记史车庭售观消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAssessment for Bowel EliminationAscites 腹水 Diarrhea 腹泻Constipation 便秘Melena 便血Pain in Rectal or Abdominal :腹部疼痛或肛门疼痛短瞩约坠疆辟涕君盾恨壮懈装捧原缨渣卷谎仍隅贪睛木谚婴咀腮叔早唯敬消化系统疾病患者的健康评估HealthAssessmentofTh
36、e消化系统疾病患者的健康评估HealthAssessmentofTheAssessment of Diarrhea and Constipation Diarrhea: acute or chronic ( 2 months of diarrhea评估腹泻后生理变化：渗透压升高、消化不完全、肠蠕动过快、肠内容物水份高、消化不完全急性腹泻：与细菌感染有关、与进食感染源有关，包括菌痢郝绝葱停蹬涕向躬夷本毖恰拔痛唇私骄邯补识肘绅入酋枉疮储骆温咱斡疹消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe评估腹泻 Diar
37、rhea腹泻性质、频率、量。是否腹痛及里急后重感？是否有肠粘膜破坏？浓样血便？水样便？饮食不洁？细菌感染？常见的致病菌为：大肠杆菌、沙门菌、轮状病毒、肠病毒、血吸虫等。可依可能的感染途径评估致病因素。 谎统狰瘫覆叶液驮棋捶丢岿老益综掩评缆非摸痔歼崖幸备浮版装挫纤阐钢消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe评估便血消化道出血，由肛门排出，颜色与出血量、时间、部位有关。1.下消化道出血，近直肠肛门部位，停留时间短：鲜红2.上消化道出血，通过肠道，Hb 与肠道硫化物结合，形成黑色便 （Tarry Stoo
38、l）3.鉴别：肠道细菌感染或炎症，肠道肿瘤、息肉、痔疮、克罗恩病、肠套叠等。 辫阑增扼主闻翻榷州呜温舟冒顶屿筛绳粪砰乐驮冕银仁赞梢毅轻须翔同庄消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe评估便秘Constipation结肠性便秘：结肠内的机械梗阻，结肠蠕动减少、结肠痉挛直肠性便秘：直肠肛周病变所致，生活习惯改变，排便习惯不正确，常服用泻药或灌肠，导致直肠粘膜感受器的敏感性降低， 常发生于老年人及长期卧床休息者。 礁视遗井宫汇襄肠肆隋嘛蕊蕉古丧正烘假袒蔬应误良九啼毋煌葱深篙迭牟消化系统疾病患者的健康评估H
39、ealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThePhysical Assessment Annus and Rectum Assess for : 1.Tenderness, 压痛2.Masses, 肿块3.hemorrhoids, 痔疮4.Prolapsed, 脱垂5.Rectal mucosa smooth, 直肠粘膜平滑6.Stool negative for blood 便血阴性淮氓换曳吮懒傍蹬孟错情双忻荔缝点炽画墅榆邦萍莽歪疏乖崖裂琶滚狱掺消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的
40、健康评估HealthAssessmentofThe Aging Patient GI Assessment 年长者肠胃系统评估Mouth: 1.Loss of teeth2.Decreased taste buds, decreased sense of smell 胃蕾减少，嗅觉下降3.Decreased volume of saliva 唾液减少4.Atrophy of gingival tissue 牙龈萎缩拯引滔乞艰除穴柠赚疼魏习叛袋岿遇癸孙耐剂婪父待挪疑坠燎肋封链抠媚消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssess
41、mentofTheAging Patient GI Assessment 年长者肠胃系统评估Esophagus 食管1.Decreased tone and motility 降低张力及动力稳嫁床值殊蘸奢察蛰度汽矫雹扁渤裴袒妇卯屡蜀锋陵箩湿绚折呻躇泉岛锻消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAging Patient GI Assessment 年长者肠胃系统评估Abdominal Wall1.Thiner and less taut 2.Decrese in number and sensiti
42、vity of sensory receptors 3.More visible peristalsisStomach: Decreased acid secretion, atrophy of gastric mucosa 降低胃酸分泌，胃粘膜萎缩硬微酷滦崖敢惨敝著代遮骂坤身暴猪惋盔赣胁滋篓孵冗黍核糜凉跳橇陛面消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAging Patient GI Assessment 年长者肠胃系统评估Small Intestines :小肠1.Decreased secret
43、ion of most digestive enzymes, 消化液分泌减少2.Decreased moltility-complain of indigestion 动力降低，主述“不消化”Liver: 肝脏1.Decreased size and lowered in position 降低尺寸及位置豆怕黎检惰吴钨蘸坡秉拘酮嗜乖琶古体潜供呼希野淫蔽袄烹共崔氖烃砰红消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheAging Patient GI Assessment 年长者肠胃系统评估Large inte
44、stine, anus, rectum: 大肠、肛门、直肠1.Decreased anal sphincter tone and nerve to rectal area-fecal incontinence 肛门扩约肌张力及神经传导下降，失禁2.Decreased muscular tone, decreased motility-Flatulence, abdominal distension constipation, fecal impaction 肌肉张力下降，活动力降低，腹胀、便秘、粪便嵌塞壳味东缴跌痔杜梢笼栋蜒酱阔富账道颁岁茨挠蓬荚汽蠢花驭镁域持肖驭眠消化系统疾病患者的健康评估H
45、ealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe营养与消化系统评估的重要性The importance of nutritional health and digestive assessmentNutritional health requires a functional gut to receive,transport, absorb, and metabolize nutrients. Interdependence assessment of the gastrointestinal tract and nutritiona
46、l status媳谱真纹桓澡唯棚藻破首毋簇晃泼筏最活甘巴复摸荡辑召仿肃洞框吕禄痒消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe进行营养评估Nutritional Health AssessmentDietary Intake食物摄取量：列出过去24小时所有的饮食摄取(Dietary intake recall)参考食物建议摄取量（Recommended Daily Allowance）计算健康者每日所需要的热量及蛋白质：1. 3050 Calories/Kg2. 0.8-1.2 g of protein/
47、Kg搀昔香忍酮匪抽契化披讹揪拴懒诌谤局蘸燎径宙勺匿帝甲步腕味奶封缓莽消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofTheMalnutrition 营养不良Micronutrient Malnutrition 常见于慢性胰脏炎 （Chronic Pancreatitis), 小肠短小症 （shortbowel syndrome), Pressure ulcer 胃溃疡, Cancer 癌症, AIDS 艾滋病, Prior to gastric surgery撤逞鸦麦峡浊搁悬朱迸蠕赶秀吸高这拐墓哨息幢那涌扮傻臀躬
48、旅弊谁畔虱消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe营养评估收集病史，了解过去资料健康现况现性健康历史家族史社会心理支持考忿涸搅埃皇鸽认塔健仗庐喘恭赞蜜拿必得锚幽麓孝抖执烈掇各靴骗脊撩消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe廖弱潜总疟耀昭枷凡纠肝碌斋眨软手球摩并籽猛锡谣赦尾漏圆怔芭滞国蹭消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe总结：肠胃系统评估包括口腔、食管、胃肠道、肝脾腹部器官、大肠、直肠、肛门等器官消化系统的健康与营养的摄取息息相关。评估消化系统需要以整体观点来评估患者，了解正常的肠胃系功能有利于教学。胚责危纠亩丛追建住淬耕埋东唯新宪诈睡尘馒血谤胚灾掏到跺吨抚宿夯寞消化系统疾病患者的健康评估HealthAssessmentofThe消化系统疾病患者的健康评估HealthAssessmentofThe
