What is peptic ulcer A peptic ulcer is

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 CO 2 will be released. �Ig. G 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 �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

Constipation and Diarrhea

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;

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 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 dehydration and fluid and electrolyte imbalances: �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

Nursing Interventions �Closely monitor the client’s fluid status. Maintain a strict record of I&O. �Monitor the client for S&Sx of dehydration (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.

Nursing Interventions �Administer laxatives and/or enemas as prescribed. �Encourage the client to engage in adequate fluid 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 �Complete health Hx to identify character and pattern of diarrhea, and: �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 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