Peptic Ulcer What is peptic ulcer A peptic

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 (13 C urea and citric acid), 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 CO 2 will be released. Ig. G serologic testing documents the presence of Helicobacter pylori based on antibody assays.

Diagnostic Procedures and Nursing Interventions �Stool sample tests for the presence of the Helicobacter pylori antigen. �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 �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, histamine 2 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 client’s pain and vital signs (perforation or bleeding 0 �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