CA - Peptic Ulcer Disease Flashcards
What is peptic ulcer disease?
Open sores that develop on the stomach lining or small intestine that can lead to perforation and GI bleed
When is pain from ulcers felt?
Gastric ulcer: 15-30 mins after a meal
- Eating stimulates gastric acid secretion -> food buffers stomach acid for awhile but pain worsens as more acid is produced when digestion worsens
Duodenum ulcer: 1-2 hrs after meal & at night
- After a meal -> Stomach empties acidic chyme (partially digested food) into duodenum -> delayed exposure to acid -> delayed pain
Clinical presentations of PUD? (t)
- Pain, bloating, abdominal fullness, nausea
- Upper GI bleeding -> hematemesis (vomit blood) + blood passes through lower GI -> melena (dark, tar like stool)
- Anemia from extensive blood loss -> fatigue, pallor, SOB
- Ulcer can perforate through GI tract & create opening in peritoneum cavity -> peritonitis -> hypervolemia
- Abdominal pain & rigidity, tachycardia
What are the causes of peptic ulcer disease?
- H. pylori infection
- causes inflammatory response that mechanically disrupts protective mechanisms of gastric mucosa - NSAIDs - eg aspirin
- inhibit prostaglandin -> less mucus & bicarbonate production -> erodes mucosa + less protection against ulcers - Smoking and alcohol
- decreases blood flow to mucosa -> cell death & poor healing -> increase risk of ulcers - African American / Hispanic + 1st degree relative with PUD
How does smoking and alcohol worsen peptic ulcer disease?
Increase gastric acid
Reduce bicarbonate production
Delays healing
What medication suppresses prostaglandin production?
NSAIDs
What is the immediate nursing care for a patient with PUD?
LECT ANSWERS: for a pt with pain
Assessment:
- inspection, Auscultation, percussion & palpation (IAPP)
Objective data: pain assessment
Planning:
The patient will experience less abdominal
pain (reduction in pain score)
Implementation
Administer pain relief medications as prescribed.
*no NSAIDS as it will further irritate GI tract
Patient education:
Monitor for side effects of medications
Instruct patient that meals should be eaten at regular paced interval.
To prevent interfering the administration of medications. (certain medications given 1h before meal by orders)
Lifestyle modification. Encourage smoking
cessation and reduce alcohol consumption
TUT ANSWERS
Assessment
Inspection, Auscultation, Percussion, Palpation (IAPP)
COLDSPA:
Character - intermittent and gnawing
Onset - three days ago
Location - epigastric area
Duration - two to three hours after a meal
Severity - ask for the pain score
Pattern - ?
Additional associating factors - blood streaked stools, decreased caliber of stools, occasional constipation with occasional loose stools
Diagnosis
Fluid volume deficit related to GI bleeding
Nutritional deficit (due to pain = no appetite)
Fatigue related to blood loss
Acute pain related to mucosal injury
Nausea related to mucosal injury (may or may not have)
H. pylori infection worsening PUD
Get H.pylori through eating contaminated food (she enjoys eating outside food)
Planning
Free from signs and symptoms of GI bleeding (s/s: pallor, fatigue, tachy, blood in vomitus)
restoration of normal fluid volume
hemoglobin & hematocrit -> normal
reduced fatigue (depends on the bleed)
reduced GI pain, pain score < 3/10
Anxiety level - HTHT, allow PT to ask questions to ease anxiety
Intervention
Vitals Q4H + hourly or two hourly pain score (COLDSPA)
Strict I/O
Administer pain relief medications except NSAIDs (eg: aspirin; irritates gastric mucosa → worsens ulcer) as ordered, can use non-pharmacological interventions such as deep breathing,
Antiemetics to prevent any potential vomiting
Main treatment:
Triple therapy
(**Clarithromycin, amoxicillin, omeprazole), provided if there’s H.Pylori detected else it’s PPI only
Eat 30mins - 1h before food, cannot crush the drug
if triple therapy doesn’t work, use quadruple therapy
Encourage patient to take food that contain iron such as dark green leafy vegetables, meat, legumes and cereals + bland food
Tell patient to avoid caffeine, alcohol and highly processed fatty foods -> can trigger mucosa
Discharge Advice:
Advise the patient to eat a balanced diet with high fibre, lean protein, and low cholesterol. No/ less fried food, alcohol, or spicy foods.
Better to eat at home (cleaner food)
To eat small meals more often
Finish antibiotics on time and complete the course, even if symptoms improve to prevent antibiotic resistance.
If forget to eat, eat immediately and complete the course.
Educate patients on the medicines (PPIs, antibodies, antacids) and their side effects: PPIs - nausea, vomiting, high flatulence + Educate them not to crush the PPI tablet to protect the enteric coating. Must eat 30mins to 1 hr before food
Educate them to call the doctor when they experience sharp pain, dizziness.
How does the body protect the stomach lining?
Mucus
Bicarbonate
Adequate blood flow
Prostaglandins
What are the diagnostic tests that can be done for H. pylori PUD? (NOT TESTED)
Serum antibody test
Urea breath test
Stomach biopsy (gold standard)
