Transcript Peptic Ulcer

What is peptic ulcer?
 A peptic ulcer is an erosion of the mucosal lining of
the stomach or duodenum.
 Peptic ulcer disease (PUD) occurs when the mucosa
is eroded to the point at which the epithelium is
exposed to gastric acid and pepsin.
 There are :
 gastric ulcers,
 duodenal ulcers
 Esophageal ulcer, and
 stress ulcers (these occur after major stress or
trauma).
Causes of peptic ulcers
 Helicobacter pylori infection (80-95%)
 Nonsteroidal anti-inflammatory drug
(NSAID) use.
 Severe stress (surgery, trauma, ICU(
 Injury or death of mucosa producing cells
 Hypersecretory states;
hypercalcemia
Genetics, blood group O
Diagnostic Procedures and Nursing Interventions
 Helicobacter pylori testing:
 Gastric samples are collected via an endoscopy to test
for Helicobacter pylori. Several medications can interfere
with testing for Helicobacter pylori (false negatives).
 Urea breath testing is when the client exhales into a
collection container (baseline), drinks carbon-enriched
urea solution, and is asked to exhale once again into a
collection container. The client should take nothing by
mouth prior to the test. If Helicobacter pylori is present, the
solution will break down and CO2will be released.
IgG serologic testing documents the presence of Helicobacter
pylori based on antibody assays.
 Stool sample tests for the presence of the Helicobacter pylori
antigen.
Diagnostic Procedures and Nursing Interventions
 Esophagogastroduodenoscopy (EGD) is the most
definitive for diagnosis of peptic ulcers and may be
repeated to evaluate treatment effectiveness.
 Nsg responsibilities
 Stool sample for occult blood (risk of PUD).
Assessment
 Monitor for signs and symptoms of a peptic ulcer.
 Dyspepsia – heartburn, bloating, and nausea. May be
perceived as uncomfortable fullness or hunger.
 Pain
Gastric ulcer
Duodenal ulcer
30 to 60 min after a meal
1.5 to 3 hr after a meal
Rarely occurs at night
Often occurs at nigh
Pain worsens with food ingestion
Pain relieved by food ingestion
Assessment
 Assess/monitor the client for:
 Orthostatic changes in vital signs (20 mm Hg drop in
systolic, 10 mm Hg drop in diastolic, and/or tachycardia;
these findings are suggestive of gastrointestinal bleeding).
 Nursing Diagnoses
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Acute pain or chronic pain
Risk for deficient fluid volume
Disturbed sleep pattern
Anxiety related to coping with an acute disease
Imbalanced nutrition related to changes in diet
Deficient knowledge about preventing symptoms and
managing the condition
Nursing Interventions
 Administer prescribed medications.
 Most commonly used is “triple therapy.” This includes:
 Bismuth or a Hyposecretory medication (proton pump
inhibitors, histamine2 antagonists, and prostaglandin
analogues).
 Two antibiotics to combat Helicobacter pylori: metronidazole
(Flagyl) along tetracycline/ clarithromycin / amoxicillin.
 Antacids are given 1 to 3 hr after meals to neutralize gastric
acid, which occurs with food ingestion and at bedtime.
Give 1 hr apart from other medications
Sucralfate (Carafate) is given 1 hr before meals and at bedtime.
Protects healing ulcers. Monitor for side effects of constipation.
Nursing Interventions
 Assist the client with understanding/compliance with
recommended dietary changes:
 Avoiding/limiting substances that increase gastric acid
secretion (caffeine, alcohol, and tobacco).
 Avoiding foods that cause discomfort.
 Smaller meals.
Complications and Nursing Implications
 The nurse should perform periodic assessments of the
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client’s pain and vital signs (perforation or bleeding0
Perforation is severe epigastric pain spreading across the
abdomen. The abdomen is rigid, board-like, hyperactive to
diminished bowel sounds, and has rebound tenderness.
Perforation is a surgical emergency.
Gastrointestinal bleeding (?????????)
The nurse should report findings, prepare the client for
endoscopic or surgical intervention, replace fluid and
blood losses, insert nasogastric tube, provide saline
lavages, and maintain the client’s blood pressure.
Cancer
Definitions
 Constipation is defined as bowel movements that are infrequent,
hard or dry, and difficult to pass (painful, decrease in stool
volume,or prolonged retention of stool in the rectum
 Diarrhea is defined as an increased number of loose, liquid
stools. It is usually associated with urgency, perianal discomfort,
incontinence, or a combination of these factors.
 There are objective ways to assess for the presence of
constipation or diarrhea, but individual bowel patterns
vary greatly.
 For healthy clients, constipation and diarrhea are not serious.
But for older adult clients or clients with pre-existing health
problems, constipation or diarrhea can be serious.
Causes
 Constipation:
 Frequent use of laxatives.
 Advanced age.
 Inadequate fluid intake.
 Inadequate fiber intake.
 Immobilization due to injury.
 A sedentary lifestyle.
 certain medications;
 rectal or anal disorders;
 obstruction;
 metabolic, neurologic, and neuromuscular conditions;
 endocrine disorders;
 lead poisoning;
 connective tissue disorders;
Causes
 Diarrhea:
 Viral gastroenteritis.
 Overuse of laxatives.
 Use of certain antibiotics.
 Inflammatory bowel disease.
 Irritable bowel syndrome.
 Food-borne pathogens.
Diagnostic Procedures and Nursing
Interventions
 Fecal occult blood test . Certain foods (red meat, raw
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vegetables) and medications (aspirin, NSAIDs) can
cause false positives. Bleeding can be a sign of cancer,
which can be a contributing factor to constipation.
Digital rectal exam checks for impaction, (left side
with knees flexed). During the procedure the client’s
vital signs and response should be monitored.
Obtaining stool cultures
barium enema
sigmoidoscopy
Assessment
 Monitor for signs and symptoms of constipation.
 Abdominal bloating
 Abdominal cramping
 Straining at defecation
 Decreased appetite, headache, fatigue, indigestion, sensation
of incomplete emptying
 Monitor for signs and symptoms of diarrhea.
 Signs and symptoms of dehydration
 Frequent loose stools
 Abdominal cramping
Assessment
 Other symptoms, depending on the cause and severity and related to
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dehydration and fluid and electrolyte imbalances,
the following:
• Watery stools, which may indicate small bowel disease
• Loose, semisolid stools, which are associated with disorders of the
large bowel
•Voluminous greasy stools, which suggest intestinal malabsorption
• Blood, mucus, and pus in the stools, which denote inflammatory
enteritis or colitis
•Oil droplets on the toilet water, which are diagnostic of pancreatic
insufficiency
• Nocturnal diarrhea, which may be a manifestation of diabetic
neuropathy
Nursing assessments should include
 A physical examination of the abdomen (bowel sounds
and tenderness).
 Assessment for signs and symptoms of fluid deficit.
 Assessment of the skin integrity around the anal area.
 Collection of a detailed history of the client’s diet,
exercise, and bowel habits.
NANDA Nursing Diagnoses
 Constipation
 Diarrhea
 Fluid volume deficit
 Impaired skin integrity
 Closely monitor the client’s fluid status. Maintain a strict record
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of intake and
output.
Monitor the client for signs and symptoms of dehydration (for
example, postural
hypotension, dizziness when changing positions).
Closely monitor the client’s elimination pattern.
Observe and document the character of the client’s bowel
movements.
Carefully check for blood or pus. If the client is experiencing
diarrhea, measure the
volume of the stools.
Perform an abdominal assessment daily and as needed.
 Administer laxatives and/or enemas as prescribed.
 Encourage the client to engage in adequate fluid
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intake (especially water intake),
adequate fiber intake, and exercise within reason.
Monitor the client’s skin integrity.
Suggest that clients who are taking antibiotics eat
yogurt to help re-establish an
intestinal balance of beneficial bacteria.
Nursing Management for diarrhea
 • Elicit a complete health history to identify character
and pattern of diarrhea, and the following: any related
signs and symptoms, current medication therapy,
daily dietary patterns and intake, past related medical
and surgical history, and recent exposure to an acute
illness or travel to another geographic area.
 • Perform a complete physical assessment, paying
special attention to auscultation (characteristic bowel
sounds), palpation for abdominal tenderness,
inspection of stool (obtain a sample for testing).
 • Inspect mucous membranes and skin to determine
hydration status, and assess perianal area.
Nursing Management for diarrhea
 • Encourage bed rest, liquids, and foods low in bulk until
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acute period subsides.
• Recommend bland diet (semisolids to solids) when food
intake is tolerated.
• Encourage patient to limit intake of caffeine and
carbonated beverages, and avoid very hot and cold foods
because these increase intestinal motility.
• Advise patient to restrict intake of milk products, fat,
whole grain products, fresh fruits, and vegetables for
several days.
• Administer antidiarrheal drugs as prescribed.
•Monitor serum electrolyte levels closely.
Complications of constipation
 Fecal impaction.
 Development of hemorrhoids or rectal fissure.
 Bradycardia, hypotension, and syncope associated
with the Valsalva maneuver (occurs with
straining/bearing down).
 Monitoring constipation carefully. Instruct clients not
to strain to have bowel movements. Take measures to
effectively treat and prevent constipation.
 Removing a fecal impaction
Complications of diarrhea
 Signs and symptoms of dehydration and fluid and
electrolyte disturbances (metabolic acidosis).
 Skin breakdown around the anal area.
 Replace losses as prescribed. Monitor the client’s skin
breakdown carefully and follow skin care protocols