Traditional Chinese Medicine Nursing Protocols for Gastric ulcer (peptic ulcer)

Gastric ulcer (peptic ulcer) is one of the most common digestive system diseases, in which mucosa develops inflammatory reactions, necrosis, detachment or even ulcer under various pathogenic factors[1-2], and the ulcerative mucosa necrotizes and defects, and then penetrates mucosal muscular layer, or even deep into muscularis propria. Peptic ulcer, also termed as gastric ulcer in traditional Chinese medicine (TCM), is mainly marked by stomach pain, eructation and sour regurgitation, which may decrease patients' quality of life (QOL)[3-5]. Gastric ulcer (peptic ulcer) has been included in theTraditionalChineseMedicineNursingProtocolsfor19PredominantDiseasesconfirmed by State of Administration of Traditional Chinese Medicine of The People's Republic.

Keypointsofcommonsyndromes

Syndrome due to disharmony of liver and stomach: Swelling pain of stomach which radiates to bilateral thorax; frequent sign, with aggravation of stomach pain in case of emotional upset; frequent eructation; bitter mouth; impatience and irritability; acid regurgitation and gastric discomforts such as hunger, empty and burning sensation; light red tongue; thin-white or thin-yellow coat.

SyndromeduetoQideficiencyofspleenandstomach: Dull pain of stomach; abdominal distension and anorexia which aggravates after meals; loose stools; weakness of limbs; weak breath and laziness to speak; sallow complexion; emaciation; light tongue, and white coat.

Syndromeofastheniccoldofspleenandstomach: Dull pain of stomach, and prefer to warm and press; aggravation of pain at empty stomach and alleviation of pain after full stomach; anorexia and eating less food; aversion to cold and cold extremities; vertigo or weakness of limbs; vomiting of rinsing; loose stools and diarrhea; plump tongue with tooth marks; thin and white coat.

Syndromeduetoheataccumulationinliverandstomach: Acute stomach pain with burning sensation; dry and bitter mouth; acid regurgitation and gastric discomforts such as hunger, empty and burning sensation; dysphoria and irritability; constipation; preferring cold drinks; red tongue, yellow or curdy or greasy coat.

SyndromeduetodeficiencyofstomachYin: Dull or burning pain in stomach; hunger without desire for food, and thirst without desire for drinks; dry mouth and scorched tongue; anorexia and dry vomiting; insomnia and dreaminess; feverish sensation over hands, foot and heart; dry stools; red tongue with little fluid and cracks; less, scanty or peeled coat.

Nursingforcommonsymptoms/syndromes

Stomachpain

· Observe the location, nature, severity, lasting duration, incentives and concomitant symptoms of pain in order to obtain pain score using numeric rating scale (NRS), and record the detailed scores.

· Guide patients to rest on red, and avoid activities or mental stress, and inform the physicians immediately if patients develop vomiting or hemafecia.

· Perform acupoint application therapy on acupoints like Zhongwan, Jianli, Shenque and Guanyuan for dull pain and on acupoints like Qihai and Tianshu for distending pain following doctors' orders.

· Press acupoints like Zhongwan, Qihai, Weishu, Hegu and Zusanli following doctors' orders.

· Perform moxibustion on acupoints like Zhongwan, Shenque, Qihai and Guanyuan following doctors' orders.

· Perform hot compress with TCM on gastric part following doctors' orders.

· Perform auricular application on auricular acupoints like spleen, stomach, sympathia, Shenmen as well as liver and gallbladder following doctors' orders.

· Perform cupping therapy on acupoints like Pishu, Weishu, Shenshu and Ganshu following doctors' orders.

Eructationandacidregurgitation

· Observe the frequency, severity, concomitant symptoms of eructation and acid regurgitation and their relationships with diet.

· Guide patients not to lie on their back immediately after taking meals, to sit at disease onset, and to drink warm water. Meanwhile, tell patients to take food immediately to relieve the discomforts if they suffer eructation and acid regurgitation at an empty stomach.

· Perform hot compress with TCM on acupoints like Zusanli, Tiantu, Zhongwan and Neiguan following doctors' orders.

· Perform moxibustion on acupoints like Ganshu, Weishu, Zusanli, Zhongwan and Shenque following doctors' orders.

· Perform acupoint injection on acupoints like Zusanli and Neiguan following doctors' orders.

· Perform acupressure on acupoints like Zusanli, Hegu, Tiantu, Zhongwan and Neiguan following doctors' orders.

Anorexia

· Observe the diet conditions, oral smell, concomitant symptoms and changes of tongue texture and coat, and keep mouth clean.

· Regularly measure and record the body weight.

· Perform auricular acupoint application therapy on auricular acupoints like spleen, stomach, liver, small intestine, heart and sympathia following doctors' orders.

· Perform acupressure on acupoints like Zusanli, Neiguan, Fenglong, Hegu, and Zhongwan following doctors' orders.

TCMspecialnursing

Medications

· TCM for oral administration: ①Take the decoction for syndrome due to asthenic cold of spleen and cold while it is warm, and take the decoction for special treatment following doctors' orders.②Others.

· Drugs for infection.

· TCM for external application.

Specialtechniques

· Acupoint application therapy.

· Hot compress with TCM.

· Acupoint injection.

· Moxibustion.

· Auricular acupoint application therapy

· Acupressure

· Cupping therapy

Healthyguidance

Dailylife

· Keep inpatient ward quiet and neat, and keep air fresh without abnormal odour.

· Have regular life and alternation work with rest.

· Rest in bed in case of acute exacerbation.

· Guide the patients to pay attention to keep warm, avoid getting cold on abdomen and wear more or less clothes based on temperature change.

· Avoid administer analgesics, especially non-steroidal anti-inflammatory drugs, for fear of covering disease conditions or aggravating the damage to gastric mucosa. Avoid administer drugs that may stimulate stomach and intestine, such as analgesic-antipyretic agents and prednisone, etc.

· Observe patients' stool color and property, and record occurrence of bleeding.

Guidancefordiet

Avoid eating foods that promote heat, such as dried and spicy food and alcoholic beverages, and avoid polyorexia and satiety.

· Syndrome due to disharmony of liver and stomach: It is advisable to eat foods that can smooth liver to promote Qi circulation, such as Foshou, Shanzha, Shanyao, turnips and fresh gingers. Foods that obstruct qi pathogenesis should be avoided, such as beans, sweet potatoes and pumpkin. Dietary formulas: Shanyao Porridge and Turnip Soup.

· Syndrome due to Qi deficiency of spleen and stomach: It is advisable to eat foods that can tonify stomach and invigorate spleen, such as Dazao, Baibiandou and Shanyao. Dietary formulas: Dazao Shanyao Porridge.

· Syndrome of asthenic cold of spleen and stomach: It is advisable to eat foods that can warm stomach and invigorate spleen, such as Guiyuan, Dazao, Fresh ginger, and mutton. Dietary formulas: Ginger Juice Mutton Soup.

· Syndrome due to heat accumulation in liver and stomach: It is advisable to eat foods that can smooth liver to clear away heat, such as Yiyiren, Lianzi, and Juhua. Dietary formulas: Yiren Lianzi Porridge, etc.

· Syndrome due to deficiency of stomach Yin: It is advisable to eat foods that can invigorate spleen and harmonize stomach, such as eggs, Lianzi, Shanyao, Baibiandou, Baihe, Daao, Yiyiren, and Gouqi. Dietary formulas: Shanyao Baihe Dazao Porridge, etc.

Emotionaladjustment

· The nurse in charge should communicate with the patients frequently to understand their mental status, guide the patients to keep positive emotions, live regularly and avoid overstress and overstrain.

· Guide patients to take empathy mutual restriction therapy specific to their bad emotions like griefs, angry, fear and tension, so as to distract their attentions, relieve or even eliminate the bad emotions. Guide patients to take suggestive therapy or obeying feelings and desire therapy specific to changes of anxiety or depression, such as mental relaxation therapy and respiratory control training therapy, so as to promote self-regulation capacity and psychological emergency capacity.

· Encourage the patients' families to accompany the patients so as to supply the patients with psychological support.

· Encourage the patients to communicate and share experiences in prevention and treatment of this disease, so as to promote cognition and enhance treatment confidence.

· Guide the patients to grasp simple methods to control pain, relieve body pain and mental stress.

[1] CHENG H H, TSENG G Y, YANG H B, et al. Increased numbers of Foxp3-positive regulatory T cells in gastritis, peptic ulcer and gastric adenocarcinoma[J]. World J Gastroenterol, 2012, 18(1): 34-43.

[2] LI Z, ZOU D, MA X, et al. Epidemiology of peptic ulcer disease: endoscopic results of the systematic investigation of gastrointestinal disease in China.[J]. Am J Gastroenterol, 2010, 105(12): 2570-2577.

[3] WANG Y R, RICHTER J E, DEMPSEY D T. Trends and outcomes of hospitalizations for peptic ulcer disease in the United States, 1993 to 2006[J]. Annals of Surgery, 2010, 251(1): 51-58.

[4] BERTLEFF M J, LANGE J F. Perforated peptic ulcer disease: a review of history and treatment.[J]. Dig Surg, 2010, 27(3): 161-169.

[5] BARKUN A, LEONTIADIS G. Systematic review of the symptom burden, quality of life impairment and costs associated with peptic ulcer disease[J]. Am J Med, 2010, 123(4): 358-366.