Peptic Ulcer Disease Flashcards
What does PUD stand for?
Peptic ulcer disease
Where does peptic ulcer disease occur?
- Esophagus
- Stomach
- Duodenum
Where are peptic ulcers most common
-Duodenum
Which age class has the most incidence of peptic ulcers?
Older adults
How are peptic ulcers described?
A break in mucous lining of GI tract.
What infection causes peptic ulcer disease?
Helicobacter pylori
What protects the GI tract?
A mucosal barrier
What are the risk factors for peptic ulcer disease?
- Chronic H. pylori infection
- Chronic Aspirin and NSAID use
- Familial pattern suggests genetic factor
- Type O blood
- Smoking
- Advanced Age
- Crowded, unsanitary living conditions
How can you prevent peptic ulcer disease?
- Meticulous hand washing
- Implementing all recommendations related to food preparations, including thorough cooking of all meat
- All clients who have started on long-term therapy for non-selective NSAIDs should be tested
What are the clinical manifestations of peptic ulcer disease?
- Dull, gnawing pain or burning sensation in midepigastric area or back
- Gastric pain occurs immediately after eating
- Duodenal pain 2-3 hours after eating
What are the complications associated with peptic ulcer disease?
- Hemorrhage
- Gastric outlet obstruction
- Perforation
What are the diagnostic tests for peptic ulcer disease?
- Upper GI series
- Gastroscopy
- Noninvasive testing for H. pylori
- CBC
- Stools for hemoccult
This syndrome causes a form of peptic ulcer disease due to a gastrin-secreting tumor.
Zollinger-Ellison syndrome
If a patient has peptic ulcer disease due to H. pylori what types of pharmacologic therapy is used?
-Clarothromycin + amoxicillin + PPI
OR
-Bismuth subsalicylate + tetracycline + metronidazole + PPI or H2-receptor blocker
What is the treatment for NSAID induced ulcers?
- Discontinuation of NSAID if possible
- If not possible, twice daily dosing with PPI
What class does clarithromycin belong to?
Macrolide
What is the mechanism of action for clarithromycin?
Inhibits protein synthesis by binding to the bacterial ribosome
What is clarithromycin effective against?
Most gram-positive and many gram-negative bacteria
What is the primary use for clarithromycin?
- Whooping cough
- Legionnaire’s disease
- Infections by streptococcus, H. influenza, and mycoplasma pneumoniae
What are the adverse effects of clarithromycin?
- Nausea
- Abdominal cramping
- Vomiting
- Diarrhea
- Superinfections
- Resistant bacterial strains
What class does amoxicillin belong to?
penicillin
What is the mechanism of action for amoxicillin?
-Kill bacteria by disrupting their cell walls
What bacterium is most effected by amoxicillin?
Gram-positive
Why does amoxicillin not disrupt the replication of human cells?
because they do not have cell walls
What is amoxicillin used for?
- Pneumonia
- Meningitis
- Skin, bone, and joint infections
- Stomach infections
- Blood and valve infections
- Gas gangrene
- Tetanus
- Anthrax
What are the adverse effects of amoxicillin?
- Bacteria can become resistant
- Allergy is possible
- Lowered red/white blood cell and platelet levels
Why is amoxicillin prescribed so frequently?
Due to it being one of the safest classes of antibiotics
What is the mechanism of action for tetracycline?
- Effective against broad range of gram-positive and gram-nematic organisms
- Inhibits bacterial protein synthesis
What is the primary use for tetracycline?
- Rocky mountain spotted fever
- Typhus
- Cholera
- Lyme disease
- Peptic ulcers
- Chlamydia
What are the adverse effects of tetracycline?
- Superinfections
- Nausea
- Vomiting
- Diarrhea
- Discoloration of teeth
- Photosensitivity
What class does metronidazole belong to?
Antiprotozoal drugs-nonmalarial antiprotozoa agents
What is the trade name of metronidazole?
Flagyl
What is the mechanism of action of metronidazole?
To act as antiprotozoal drug that also has antibiotic activity against anaerobic bacteria
What is the primary use for metronidazole?
Treats most forms of ameobas
What are the adverse effects of metronidazole?
- Anorexia
- Nausea
- Diarrhea
- Dizziness
- Headache
- Dry mouth
- Unpleasant metallic taste
What are the routes of administration for metronidazole?
Oral and IV
What is the onset of metronidazole when given orally?
Varies
What is the peak of metronidazole when given orally?
1-2 hours
What is the onset of metronidazole when given by IV?
-Rapid
What is the peak of metronidazole when given by IV?
1-2 hours
What does sucralfate do?
Coats ulcer and protects it from further erosion
What does Misoprostol do?
Inhibits acid and stimulates production of mucus
What can misoprostol cause?
miscarriage
What does bismuth compounds do?
inhibit bacterial growth
prevent H. pylori from adhering to gastric mucosa
What are the goals of treatment of H. pylori?
Primary: bacteria completely eradicated
- Ulcers heal more rapidly
- Ulcers remain in remission longer
If H. pylori is not eradicated completely what can happen?
Reoccurrence if very high
How long can a H. pylori infection remain active if not treated?
For life
The treatment of H. pylori infection has greatly reduced the incidence of what?
Surgery
What are the three nonpharmacologic therapies for treating peptic ulcer disease?
- Nutriton
- Mild alcohol intake
- Smoking is discouraged
What type of nutrition interventions can help a patient with peptic ulcer disease?
- Maintain good nutrition
- Bland or restrictive diets are no longer necessary
What are the three surgical managements of peptic ulcer disease?
- Vagotomy
- Pyloroplasty
- Biliroth I or II
What health history assessments need to be made in a patient with peptic ulcer disease?
- Description of pain
- Family history of H. pylori infection
- Relief measures
- Nausea, vomiting, stool characteristics
- Medications
- Cigarette smoking
- Alcohol use
What physical examinations should be done on a patient with peptic ulcer disease?
- General appearance
- Abdominal exam
- Vital signs
What are the 5 nursing diagnoses for peptic ulcer disease?
- Imbalanced Nutriton: Less than body requirements
- Chronic Pain
- Knowledge deficit
- Risk for bleeding
- Risk for deficient fluid volume
What would a client demonstrate in terms of nurse planning in a patient with peptic ulcer disease?
- Demonstrate no complications related to bleeding
- Demonstrate fluid volume balance, including maintenance of urine output of at least 0.5/ml/kg/hr
- Demonstrate dietary intake that adequately meets nutritional and caloric needs
What would a client verbalize in terms of nurse planning in a patient with peptic ulcer disease?
- Verbalize risk factors related to PUD exacerbation and recurrence
- Verbalize maintaining pain at a tolerable level
What should the nurse implement for a patient with PUD?
- Promote balanced nutrition
- Manage pain and facilitate adequate rest
- Restore and maintain fluid volume
What should a nurse include in their evaluation of a patient with PUD?
- Client experiences no complication
- Client maintains balanced oral intake and output
- Using a predetermined pain rating scale- patient rates pain at a tolerable level
- Client describes actions that will reduce recurrence of PUD
The nurse is caring for a client who was admitted to the hospital with peptic ulcer disease (PUD). Which of the following, if noted by the nurse, is a manifestation of complication from PUD?
- Bradycardia
- Numbness in the legs
- Nausea and vomiting
- A rigid, birdlike abdoment
- Nausea and vomiting
The client who is being evaluated for peptic ulcer disease (PUD) asks the nurse what tests would provide the most definitive diagnosis of PUD. Which response by the nurse is most accurate?
- Urea breath test
- Gastroscopy with biopsy
- Barium contrast studies
- Gastric acid analysis
- Gastroscopy with biopsy
