Module 2 Part 2: Peptic Ulcer Disease Flashcards
what are the 3 types of ulcers?
- gastric
- duodenal
- esophageal
what forms in the mucosal wall of the stomach or in the duodenum?
an excavation
what does the name of the ulcer depend on?
it’s location
what are potential risk factors/ causes?
- infection from H. pylori
- excessive secretions of HCl
- familial tendancy
- people with O blood type
- chronic use of NSAIDs
- ETOH
- excessive smoking
what is H. pylori?
a gram negative bacteria
how can H. pylori be acquired?
through the ingestion of food and water
do most infected people with H. pylori develop ulcers?
no
when is testing for H. pylori recommended?
only when there is PUD
what are the clinical manifestations of PUD?
- many people have no symptoms
- may differ depending on the location
- pain
- pyrosis (heart burn)
- eructation (burping)
- vomiting (rare), constipation or diarrhea
- bleeding in stools(occult or melena)
what are the assessments for PUD?
- pain, epigastric tenderness or abdominal distension
- endoscopy
- inflm changes, ulcers, lesions
- stools until they are negative for occult blood
- serologic testing
- stool antigen test
- urea breath test
what are three types of management for PUD?
- medication
- lifestyle changes
- possible surgery
what are some potential complications of PUD?
- perforation
- hemorrhage
- penetration
- pyloric obstruction
what are some nursing diagnoses for PUD?
- acute pain
- anxiety r/t an acute illness
- imbalanced nutrition r/t changes in diet
- deficient knowledge about prevention of symptoms and management of conditions
what are the medications used for PUD?
- proton pump inhibitors
- histamine 2 receptor blockers
- antacids
- antibiotics
what is the mechanism of proton pump inhibitors?
irreversible inhibition of the proton pump (generates gastric) in parietal cells. PPIs effects both both basal and stimulated acid release
what is the use of proton pump inhibitors?
gastric and duodenal ulcers, GERD, Zollinger-Ellison syndrome
what are the side effects proton pump inhibitors?
- minimal in short term use
- can infrequently includes headaches
- diarrhea
- N/V
what can proton pump inhibitors increase the risk of?
- pneumonia
- acid rebound
- c-diff infection
- hypomagnesemia
- gastric cancer
what are examples of proton pump inhibitors?
- omeprazole
- esomeprazole
- rabeprazole
what are nursing considerations for proton pump inhibitors?
- even if medication is discontinued effects can last for weeks
- watch for signs of c-diff infection
- assess for epigastric/abdominal pain, signs of bleeding
- administer 60 mins before meals
- take the lowest dose for shortest time to minimize side effects
what is the mechanism of H2 antagonists?
block H2 receptors on gastric parietal cells
- suppress secretion of gastric acid
- decreases volume of gastric fluid and increases pH
what are the uses for H2 antagonists?
- preop preparation
- GERD
- gastric and duodenal ulcers
what are the side effects of H2 antagonists?
- serious side effects not common but could include:
- headache
- diarrhea
- N/V
- increase in gastric pH increases susceptibility to infection
what are examples of H2 antagonists?
- ranitidine
- famotidine
- cimetidine
what are the nursing considerations for H2 antagonists?
rantidine recently recalled
- usually replaced with pantoprazole (PPI), in peds using famotidine
what are antacids used for?
alkaline substances used to neutralize stomach acid, may also enhancing mucosal protection
what are two benefits of antacids?
- relatively safe
- inexpensive
what might antacids contain/?
- aluminum
- magnesium
- sodium bicarbonate
- alginate
- calcium
what formula of antacids are contraindicated in renal failure?
those with aluminum
what are some examples of antacids?
- calcium carbonate (tums)
- magnesium hydroxide (milk of magnesia)
- aluminum hydroxide (almagel)
why would antibiotics be indicated for PUD?
- when H. pylori is the cause of PUD
what are the common antibiotics that are used for PUD?
clarithromyocin and amoxicillan (or metronidazole for penecilin allergies)
how long would someone be on antibiotics for with PUD?
10-14 days “triple therapy”
what three drugs do you combined together?
antibiotics, PPI, and bismuth salts
what meds do you use to treat NSAID induced ulcers?
- H2RA
- PPI
how long do you have to maintain the dosage for H2RA?
1 year
how are stress ulcers treated?
stress ulcers may be treated prophylactically with IV H2RA
what are non-pharmacological management for PUD?
- stress reduction and rest
- smoking cessation
- dietary modification
- Sx management
what dietary modifications need to be made?
- avoid over-secretion of acid and hyperosmolarity in the GI tract
- avoid consumption of meat extracts, alcohol coffee, and other beverages
- avoid diet rich in milk and cream
- eat three regular meals a day
- small and frequent feedings are not necessary
when is surgery recommended?
when pt have intractable ulcers and they fail to heal after 12-16 weeks
- when there is a life threatening haemorrhage, perforation, or obstruction
what are some assessments for PUD?
- describe pain and strategies used to relieve it
- how often emesis takes place
- usual food intake for 72 hours period and to describe food habits
- pts level of anxiety
- current stressors
- stool for occult blood
- physical exam
what vitals are most important for PUD?
hypotension, tachycardia
what are the nursing interventions for PUD?
- relieve pain
- reduce anxiety
- malnutrition
- maintaining optimal nutritional status (assess for malnutrition and weight loss)
what are signs of haemorrhage in pts with PUD?
- vomited blood can be bright red: hemorrhage is large
- haemorrhage is small: passed in stools
- assess for faintness, dizziness, and nausea
- monitor vitals
- tachycardia, hypotensions, and tachypnea
- hematocrit and hemoglobin tested
what are interventions for hemorrhage?
- inserting peripheral IV line
- NG tube to distinguish fresh blood
- NG lavage of saline solution
- indwelling catheter and monitor urinary output
- recumbent position
- hemorrhagic shock
- selective embolization (unable to undergo Sx)
what happens with perforation and penetration with PUD?
- erosion of the ulcer through the gastric serosa
- requires immediate sx
- back and epigastric pain
- severe upper abdominal pain
- vomiting
- tender rigid
- hypotension and tachycardia
what is a pyloric obstruction?
area distal to the pyloric sphincter becomes scarred and stenosed from spasm edema or scar tissue
what are S&S of pyloric obstructions?
nausea, vomiting, constipation, epigastric fullness, anorexia, later weight loss
what are interventions for pyloric obstruction?
- insert an NG tube
- management of extracellular fluid volume electrolyte balance
how can people with PUD care for themselves at home?
- avoid certain meds and foods that exacerbate symptoms
- avoid acid producing potential substances
- meals at regular times and relaxed setting and to avoid over eating
what are the expected patient outcomes from PUD?
- freedom of pain
- feeling less anxiety
- complies with regimen
- maintains weight
- no complx
