Peptic Ulcer Disease -Pathophysiology, Podcast, and Care Plan

Peptic Ulcer Disease

Peptic Ulcer Disease (PUD)

The term Peptic ulcer disease is given when the  gastric acid in the digestive tract erodes the inner area of the small intestine, pylorus, stomach, or esophagus.  These erosions cause open sores and can become extremely painful and can even bleed.

Usually, the mucus lining of the small intestine and stomach can protect against gastric acid.  However, if the mucous lining is decreased and the amount of gastric acid is increased, a peptic ulcer can develop in the patient.

Peptic ulcers can encompass:

  • Duodenal ulcers: these ulcers occur in the first part of the small intestine.
  • Gastric ulcers: these ulcers occur inside the patients stomach.
  • Esophageal ulcers: these occur in the patients esophagus.

Causes

Causes if peptic ulcer disease include:

  • Helicobacter pylori bacteria (H. Pylori – most common cause): This bacteria is ingested by contaminated food or water. It is found in 2/3 of the world’s population.
  • Use of NSAIDS (non-steroidal anti-inflammatory drugs, ibuprofen, even enteric coated aspirin can still cause ulcers).
  •  Zollinger-Ellison syndrome (gastrinoma). This is a rare tumor in the stomach that increases acid output.

Risk Factors

Those at risk for developing Peptic Ulcer Disease include:

  • Age – over 45.
  • Gender – more common in women than men.
  • Use of corticosteroids and NSAIDS together.
  • Long term use of NSAIDS.
  • Past history of ulcers.
  • Alcohol use in excess
  • Smoking
  • Radiation treatments

Peptic Ulcer Disease

Signs and Symptoms

The patient may not exhibit any symptoms of illness, however, when symptoms occur they can include:

  • Pain – most common symptom, can be gnawing or burning. Sometimes between meals or at night. pain is usually located mid to upper abdomen.
  • Bloating
  • Heartburn
  • N/V
  • Unexplained weight loss.
  • Changes in appetite.
  • Dark tarry stools (severe symptom).
  • Vomiting blood (severe symptom).

 Complications

If peptic ulcers are left untreated the following may result:

  • Peritonitis – the ulcer can create an opening in the wall of the stomach or small intestine allowing contents to get into the abdominal cavity causing serious infection.
  • Bleeding – this can result in severe blood loss.
  • Scarring – The scar from an ulcer will make it more difficult for the stomach to empty. The patient may feel full, vomit and lose weight.

Diagnosis

The following may be utilized to diagnose a peptic ulcer:

  • Upper endoscopy
  • Test Blood, breath, or stool for H. Pylori
  • Barium swallow or upper GI series – these are x-rays to visualize esophagus all the way down to the small intestine to see if any ulcers are present.

 

Treatments and Nursing Considerations

The following treatments may be used to treat peptic ulcer disease:

  • Antibiotics – to kill the H. pylori bacteria if found in the digestive tract.
  • Proton pump inhibitors – to reduce stomach acid.
  • Histamine H2 blockers – to reduce the amount of gastric acid that is released into the digestive tract.
  • Antacids – to neutralize gastric acid.
  • Anticholinergics – to reduce gastric motility.
  • Prostaglandins –  may be prescribed for antisecretory and protective actions.
  • Surgery – may be needed if bleeding from the ulcer has not stopped or the ulcer has resulted in a tear.

Nurses need to educate the patient for the following:

  • Avoid alcohol
  • Avoid chocolate and caffeine
  • Avoid aspirin
  • Avoid NSAIDS
  • Avoid smoking

 

Nursing Care Plan

Nursing Diagnosis

1. Risk for Infection related to possible tissue damage from necrosis from increased gastric acid breaking down the mucosal lining.

Desired outcomes:

By discharge, the patient will remain free signs and symptoms of infection.

InterventionsRationals
InterventionsRationals
Assess vital signs including temperature every 4 hours and as needed. Report any abnormal findings to the healthcare provider.Fever is often one of the first signs of infection.
Assess mental status and level of consciousnesses every 4-6 hours.Mental status changes, confusion, or any deterioration from baseline can signify infection.
Report and note any abnormal laboratory values (i.e. elevated WBC count) to the healthcare provider.Certain abnormal laboratory results could be an indicator of infection.

 

2. Risk for bleeding related to possible perforation due to ulcerative process.

Desired outcomes:

By discharge, the patient will remain free of signs of symptoms of bleeding or perforation.

InterventionsRationals
InterventionsRationals
Assess for blood in emesis and melana. Assess NGT aspirate, stools, and emesis for occult blood.Due to the ulcerative process, bleeding can occur.
Monitor laboratory results. Especially coags and CBC.Abnormal values may indicate bleeding and healthcare provider should be notified immediately.
Monitor oxygen saturations, report saturations of 92% or less.These patients with an 02 saturations of 92% or less, may require additional oxygen.

 

 

 

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

 

 

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Anna C. RN-BC, BSN, PHN, CMSRN Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process. She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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