Peptic Ulcer Disease

Peptic Ulcer Disease PUD Nursing Diagnosis Interventions and Care Plans

Peptic Ulcer Disease Nursing Diagnosis NCLEX Review Care Plans

Nursing Study Guide: Peptic Ulcer Disease

Peptic Ulcer Disease is a medical condition that involves the formation of open sores or ulcers on the stomach’s lining and/or the upper part of the small intestine (duodenum).

Most patients with peptic ulcer disease have stomach pain as the first symptom.

Both gastric and duodenal ulcers can be caused by the infection of the bacteria H.pylori, which is usually considered as a part of the normal flora of the upper digestive tract.

Contrary to common belief, spicy foods do not result to peptic ulcers, but they can aggravate the symptoms and make them even worse.

The same is true with having high stress levels.

Signs and Symptoms of Peptic Ulcer Disease

  • Stomach pain that can be described as “burning”
  • Bloating or belching
  • Feeling of fullness
  • Intolerance to fatty foods
  • Chest pain or heartburn
  • Nausea and/or vomiting.

Long-term or severe symptoms include:

  • Vomiting – which may have red or black color (indicating blood)
  • Stool color changes – dark blood or black, tarry stools
  • Trouble breathing
  • Feeling faint
  • Loss of appetite
  • Unexplained weight loss

Causes and Risk Factors of Peptic Ulcer Disease

The stomach and the rest of the gastro-intestinal tract has a mucous layer that acts as a coating to protect the tissues from the damage that the stomach acid might cause.

However, increased stomach acid and/or the destruction of this coating may result to the development of peptic ulcers.

H. pylori is a bacterium that can normally be found in the upper GI tract in 3 out of 4 people.

It can produce an enzyme called urease that can neutralize the stomach acid, thus weakening the stomach lining.

Close contact such as kissing, as well as food and water are the probable method of transmission of H. pylori. Regular use of pain medications, particularly non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, can cause irritation and eventual inflammation of the stomach and small intestine’s lining.

Steroids, low-dose aspirin, anticoagulants, and other medications, when taken with NSAIDs, may increase the risk of developing peptic ulcers. Smoking, eating spicy foods, drinking alcohol, and chronic stress may worsen the symptoms of peptic ulcer disease.

Complications of Peptic Ulcer Disease

  1. Stomach perforation. If left untreated, peptic ulcers can create a hole in the stomach or small intestine’s lining. This can lead to serious infections, such as peritonitis of the abdominal cavity.
  2. Internal bleeding. This is suspected in severe peptic ulcer disease wherein there is evidence of dark red or black tarry stools, and/or vomiting blood. The blood loss can be slow but progressive, and may put the patient at risk for anemia, which then requires blood transfusion.
  3. Gastric cancer. People with H. pylori infections such as peptic ulcer disease has a greater risk of developing gastric cancer.
  4. GI obstruction. Peptic ulcers can cause blockage of the food’s passageway, resulting to symptoms such as weight loss, vomiting, and feeling of fullness.
Peptic Ulcer Disease

Diagnosis of Peptic Ulcer Disease

  • Physical examination and history taking – to check for food habits and stress levels, as well as physical symptoms of peptic ulcer disease
  • H.pylori test – H.pylori can be detected from stool or vomit, but the most accurate one is the breath test. In the breath test, the patient is asked to eat or drink a substance containing radioactive carbon, then he/she will blow into a bag. The presence of carbon dioxide in the breath means that H.pylori broke down the radioactive carbon in the stomach; this indicates a positive H.pylori result. Patients on regular antacids will be asked to stop taking them for a period of time to prevent false negative results.
  • Endoscopy – to visualize the digestive tract by means of inserting an endoscope, a thin and flexible tube that comes with a camera and light. Endoscopy can also be used to perform a biopsy, collecting a sample of stomach and/or small intestine tissue.
  • Ambulatory acid (pH) probe test – to check for the frequency and duration of acid reflux by means of inserting a thin catheter from the nose down to the esophagus
  • Barium swallow, GI X-ray or Upper gastrointestinal series – to visualize the upper gastrointestinal system by means of asking a patient to swallow a barium liquid that will coat the digestive tract, making the peptic ulcers easier to visualize.

Treatment of Peptic Ulcer Disease

  1. Medications
  2. Antibiotics against H. pylori. To eradicate H.pylori, the doctor may need to prescribe a combination of antibiotics for about two weeks. These may include amoxicillin, levofloxacin, metronidizole, and clarithromycin.
  3. Antacids are helpful in neutralizing stomach acid. These include Tums, Rolaids, and Mylanta. Side effects of antacids include kidney disorders and diarrhea.
  4. H2-receptor blockers. These medications reduce the production of stomach acid. H2-receptor blockers include famotidine, cimetidine, and nizatidine. Compared to the quick relief provided by antacids, H2-receptor blockers take time to act but provides long-term relief, reducing the production of acid for a maximum of 12 hours.
  5. Proton-pump inhibitors. These medications work by reducing the amount of stomach acid. They include omeprazole and lansoprazole.
  • Lifestyle changes. Smoking cessation and reduced alcohol intake can prevent worsening of ulcer symptoms. Consistent stress management and avoidance of spicy foods should also be included to promote ulcer healing.

Nursing Care Plans for Peptic Ulcer Disease

  1. Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to abdominal pain secondary to Peptic Ulcer Disease, as evidenced by burning stomach pain, bloating, weight loss, nausea and vomiting, loss of appetite, heartburn

Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.

InterventionRationale
Explore the patient’s daily nutritional intake and food habits (e.g. mealtimes, duration of each meal session, snacking, etc.)To create a baseline of the patient’s nutritional status and preferences.
Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term nutrition and weight goals related to peptic ulcer disease.To effectively monitory the patient’s daily nutritional intake and progress in weight goals.
Help the patient to select appropriate dietary choices to avoid spicy foods and limit alcohol and coffee intake.To promote ulcer healing and healthy food habits. Caffeine is a stimulant of gastric acid production. Decaffeinated coffee or tea can still stimulate gastric acid secretion.  
Refer the patient to the dietitian.To provide a more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed peptic ulcer disease.  
Administer the prescribed medications for peptic ulcer disease.To reduce stomach acid production or neutralize the stomach acid, relieving the burning stomach pain and helping the patient to have a better appetite.
Peptic Ulcer Disease Nursing Care Plan
  • Nursing Diagnosis: Acute Pain related to abdominal muscle spasms secondary to peptic ulcer disease as evidenced by pain score of 10 out of 10, verbalization of chest pain or heartburn after eating, guarding sign on the chest or abdomen

Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.

InterventionsRationale
Administer prescribed medications that alleviate the symptoms of heart burn/ stomach pain.Antibiotics such as amoxicillin can kill H.pyloriAntacids are helpful in neutralizing stomach acid. H2-receptor blockers reduce the production of stomach acid. Proton-pump inhibitors work by reducing the amount of stomach acid.  
Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.  To monitor effectiveness of medical treatment for the relief of heartburn and stomach pain. The time of monitoring of vital signs may depend on the peak time of the drug administered.  
Teach the patient on how to perform non-pharmacological pain relief methods such as deep breathing, massage, acupressure, biofeedback, distraction, music therapy, and guided imagery.To reduce stress levels, thereby relieving the symptoms of peptic ulcer disease, especially stomach pain and heartburn.
Encourage the patient to follow appropriate mealtimes and meal portions.To ensure that the patient does not eat a huge meal, or that he/she does not eat late at night/ before bedtime as both of these may trigger nausea/vomiting.
Peptic Ulcer Disease Nursing Care Plan

Other Nursing Diagnoses for Peptic Ulcer Disease:

  • Deficient Knowledge
  • Risk for Deficient Fluid Volume
  • Anxiety

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

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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