Peptic Ulcer Disease (PUD) is a condition characterized by open sores that develop on the inner lining of the stomach and upper portion of the small intestine. This nursing diagnosis focuses on identifying symptoms, managing pain, preventing complications, and promoting healing through proper nutrition and medication management.
Causes (Related to)
Peptic ulcers can develop due to various factors that affect the balance between stomach acid production and mucosal defense mechanisms:
- H. pylori bacterial infection
- Regular use of NSAIDs
- Excessive acid production
- Lifestyle factors such as:
- Smoking
- Excessive alcohol consumption
- High-stress levels
- Poor dietary habits
- Medical conditions including:
- Zollinger-Ellison syndrome
- Chronic liver disease
- COPD requiring steroid therapy
- Chronic kidney disease
Signs and Symptoms (As evidenced by)
PUD presents with various symptoms that nurses must recognize for accurate diagnosis and treatment planning.
Subjective: (Patient reports)
- Burning epigastric pain
- Pain that improves with eating
- Nocturnal pain
- Nausea
- Early satiety
- Bloating
- Loss of appetite
- Food intolerance
Objective: (Nurse assesses)
- Weight loss
- Pallor
- Epigastric tenderness
- Hematemesis
- Melena
- Tachycardia
- Decreased hemoglobin levels
- Changes in vital signs
Expected Outcomes
The following outcomes indicate successful management of peptic ulcer disease:
- Patient will report decreased abdominal pain
- Patient will maintain adequate nutritional intake
- Patient will demonstrate compliance with the medication regimen
- Patient will identify and avoid trigger factors
- Patient will show no signs of complications
- Patient will maintain stable hemoglobin levels
- Patient will demonstrate an understanding of disease management
Nursing Assessment
Monitor Pain Status
- Assess pain characteristics
- Document pain triggers
- Evaluate pain relief measures
- Monitor pain patterns
- Note associated symptoms
Evaluate Nutritional Status
- Monitor weight
- Track food intake
- Assess for dietary triggers
- Document nutritional deficiencies
- Monitor hydration status
Check for Complications
- Monitor for bleeding signs
- Assess for perforation symptoms
- Watch for obstruction
- Check for infection indicators
- Monitor vital signs
Review Medication Compliance
- Assess medication understanding
- Monitor side effects
- Check adherence patterns
- Document effectiveness
- Review drug interactions
Assess Risk Factors
- Evaluate lifestyle habits
- Document family history
- Review medical conditions
- Check medication history
- Monitor stress levels
Nursing Care Plans
Nursing Care Plan 1: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to mucosal inflammation and erosion as evidenced by reported burning epigastric pain and guarding behavior.
Related Factors:
- Mucosal inflammation
- Increased acid production
- Delayed gastric emptying
- Stress-induced acid secretion
Nursing Interventions and Rationales:
- Assess pain characteristics and patterns
Rationale: Establishes baseline and monitors treatment effectiveness - Administer prescribed medications on schedule
Rationale: Maintains therapeutic drug levels for pain control - Teach stress reduction techniques
Rationale: Reduces acid production triggered by stress
Desired Outcomes:
- The patient will report decreased pain intensity
- The patient will demonstrate effective pain management strategies
- The patient will maintain regular activities without pain interference
Nursing Care Plan 2: Imbalanced Nutrition
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less than Body Requirements related to decreased intake due to pain and early satiety as evidenced by weight loss and altered eating patterns.
Related Factors:
- Epigastric pain
- Early satiety
- Food avoidance
- Altered absorption
- Medication side effects
Nursing Interventions and Rationales:
- Monitor nutritional intake
Rationale: Ensures adequate nutrition for healing - Provide small, frequent meals
Rationale: Prevents gastric distention and promotes comfort - Identify and avoid trigger foods
Rationale: Reduces symptoms and promotes healing
Desired Outcomes:
- The patient will maintain adequate nutritional intake
- The patient will demonstrate weight stabilization
- The patient will identify appropriate food choices
Nursing Care Plan 3: Risk for Impaired Tissue Integrity
Nursing Diagnosis Statement:
Risk for Impaired Tissue Integrity related to altered gastric pH and presence of H. pylori as evidenced by mucosal erosion.
Related Factors:
- Increased acid production
- H. pylori infection
- NSAID use
- Compromised mucosal defense
- Poor tissue perfusion
Nursing Interventions and Rationales:
- Monitor for bleeding signs
Rationale: Enables early detection of complications - Administer prescribed medications
Rationale: Promotes mucosal healing - Teach lifestyle modifications
Rationale: Reduces factors that impair healing
Desired Outcomes:
- The patient will maintain mucosal integrity
- The patient will demonstrate healing of ulcers
- The patient will avoid complications
Nursing Care Plan 4: Deficient Knowledge
Nursing Diagnosis Statement:
Deficient Knowledge related to unfamiliarity with disease process and management as evidenced by questions about self-care and verbalized misconceptions.
Related Factors:
- Lack of exposure to information
- Misinterpretation of information
- Cognitive limitations
- Language barriers
- Cultural beliefs
Nursing Interventions and Rationales:
- Provide disease education
Rationale: Improves understanding and compliance - Teach medication management
Rationale: Ensures proper treatment adherence - Demonstrate lifestyle modifications
Rationale: Promotes self-management skills
Desired Outcomes:
- The patient will verbalize understanding of the disease process
- The patient will demonstrate proper medication administration
- The patient will identify appropriate lifestyle modifications
Nursing Care Plan 5: Anxiety
Nursing Diagnosis Statement:
Anxiety related to chronic condition and potential complications as evidenced by expressed concerns and increased tension.
Related Factors:
- Chronic disease process
- Fear of complications
- Treatment uncertainties
- Lifestyle changes
- Financial concerns
Nursing Interventions and Rationales:
- Assess anxiety levels
Rationale: Establishes baseline for intervention - Provide emotional support
Rationale: Reduces stress and promotes coping - Teach relaxation techniques
Rationale: Provides tools for anxiety management
Desired Outcomes:
- The patient will report decreased anxiety levels
- The patient will demonstrate effective coping strategies
- The patient will maintain effective stress management
References
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- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
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