PUD Flashcards
1
Q
PUD
A
- A peptic ulcer is an erosion of the mucosal lining of the stomach, esophagus, or duodenum
- Most common in duodenum
- Mucous membranes can become eroded to the point that the epithelium is exposed to gastric acid and pepsin, which can precipitate bleeding and perforation
- Perforation that extends thru all the layers of the stomach or duodenum can cause peritonitis
- If a person has a peptic ulcer, they have PUD
- Most peptic ulcers are caused by gram negative Helicobacter pylori
- Contact w/ the bacteria from food, water, body fluids like saliva
2
Q
stress ulcers
A
- Stress ulcers can also occur from acute period of stressful events like burns, shock, severe sepsis, multiple organ trauma
- These are different than peptic ulcers and can be present in a ventilated client in the ICU
- Curling’s ulcer: in clients w/ burns
- Cushing’s ulcer: in clients w/ head/brain trauma
- Bleeding is primary manifestation of stress ulcer
- Clients experiencing trauma often receive PPI prophylaxis to prevent development of stress ulcer
3
Q
PUD: health promotion and dz prevention
A
- Drink alcohol in moderation
- Stop smoking and using tobacco
- Use stress mgmt techniques
- Avoid NSAIDs as indicated
- Limit caffeine containing beverages
- Consume a balanced diet
- Engage in exercise
4
Q
PUD: risk factors
A
- H. pylori infection
- NSAID and corticosteroid use
- Severe stress
- Familial tendency
- Hypersecretory state
- Gastric secreting benign or malignant tumors of the pancreas
- Type O blood
- Excess alcohol consumption
- Chronic pulmonary or kidney dz
- Zollinger Ellison syndrome: combo of peptic ulcers, hypersecretion of gastric acid, and gastric secreting tumors
- Pernicious anemia
5
Q
PUD: expected findings
A
- Dyspepsia: heartburn, bloating, n/v
- Can be perceived as uncomfortable fullness or hunger
- Dull, gnawing pain or burning sensation at the midepigastrium or back
- Physical Assessment:
- Pain or epigastric tenderness or abdominal distention
- Blood emesis: hematemesis or stools (melena)
- Weight loss
6
Q
gastric ulcer VS. duodenal ulcer
A
- gastric ulcer:
- pain most commonly 30-60 min after meal
- less often pain at night
- pain exacerbated by ingestion of food
- malnourishment
- hematemesis
- duodenal ulcers:
- pain occurs 1.5-3 hrs after a meal
- awakening w/ pain at night
- pain relieved by ingestion of food/antacid
- well-nourished
- melena
7
Q
PUD: lab tests
A
- H. pylori testing: gastric samples collected via endoscopy to check for H. pylori
- Urea breath testing: client exhales into a collection container (baseline), drinks carbon enriched urea solution, and is asked to exhale into the collection container
- The client should be NPO prior to test
- If H. pylori is present, the solution will breakdown and CO2 will be released
- Serologic testing documents presence of H. pylori based on antibody assays
- Stool sample test: for presence of H. pylori antigen
- H&H: unexpected findings secondary to bleeding
- Stool sample: for occult blood
8
Q
PUD: EGD
A
- provides a definitive diagnosis of peptic ulcers and can be repeated to evaluate tx effectiveness
- Gastric samples obtained to test for H. pylori
- Nursing Actions:
- Monitor V/S until sedation wears off
- Keep client NPO until return of gag reflex
- Monitor for manifestations of perforation: pain, bleeding, fever
- Client Edu: NPO 6-8 hours prior to exam
9
Q
PUD: nursing care
A
- Client should avoid foods that cause distress: coffee, tea, carbonated beverages
- Monitor for orthostatic changes in V/S and tachycardia, as these signs of suggestive of GI bleed or perforation
- Administer saline lavage via NG tube
- Administer medication as prescribed
- Decrease environmental stress
- Encourage rest periods
- Encourage smoking cessation and avoiding alcohol consumption
- Monitor lab results (H&H, coagulation studies)
10
Q
PUD: medication classes
A
- abx
- H2 receptor antagonists
- PPIs
- antacids
- mucosal protectant
11
Q
PUD: abx
A
- metronidazole, amoxicillin, clarithromycin, tetracycline
- Eliminate H. pylori infection
- Nursing Considerations:
- Combo of 2-3 abx is administered
- Client edu:
- Complete full course of abx
12
Q
PUD: H2 receptor antagonists
A
- ranitidine, famotidine, cimetidine, nizatidine
- Suppress the secretion of gastric acid by selectively blocking H2 receptors in parietal cells lining the stomach
- Used in conjunction w/ abx to tx ulcers caused by H. pylori
- Used to prevent stress ulcers in clients who are NPO after major surgery, have large burns, are septic, have inc intracranial pressure
- Nursing Considerations:
- Ranitidine and famotidine: can be given IV in acute situations
- Ranitidine can be taken w/ or w/o food
- Tx of PUD is usually started as an oral dose BID until ulcer is healed followed by a maintenance dose taken once daily at bedtime
- Client edu:
- Instruct client to notify provider of obvious or occult GI bleeding
- Complete prescribed regimen even if S/S subside
13
Q
PUD: PPIs
A
- pantoprazole, omeprazole, lansoprazole, esomeprazole
- Suppress gastric acid secretion by irreversibly inhibiting the enzyme that produces gastric acid and inhibits basal and stimulated acid production
- Nursing Considerations:
- Insignificant ADRs w/ short term tx
- Long term use can inc risk of frx, pneumonia, acid rebound, and possibility of c. diff
- Rabeprazole and pantoprazole are enteric coated and should not be crushed
- Client edu:
- Instruct client not to crush, chew, or break sustained release capsules
- Take omeprazole and lansoprazole once daily prior to eating main meal of the day
- Take rabeprazole after eating breakfast
- Encourage client to avoid alcohol and irritating NSAIDs
- Complete regimen even if S/S subside
14
Q
PUD: antacids
A
- Aluminum hydroxide and magnesium hydroxide: neutralize acid in the gut
- Medication provides symptomatic relief by does not accelerate healing
- Antacids can be given 7x a day, 1-2 hours after meals and at bedtime to neutralize gastric acid which occurs with food ingestion
- Nursing Considerations:
- Give 1-2 hours apart from other meds to avoid reducing absorption of other meds
- Monitor kidney function for clients prescribed aluminum hydroxide and magnesium hydroxide
- Client edu:
- Encourage compliance by reinforcing the intended effect of the antacid (relief of pain, promote healing of ulcer)
- Teach clients to take all meds at least 1-2 hours before or after taking an antacid
- Avoid use of flavored antacids which delay emptying of the stomach
15
Q
PUD: mucosal protectants
A
- Sucralfate coats the ulcer and protects it from the actions of pepsin and acid
- Bismuth subsalicylate prevents H. pylori from binding to the mucosal wall
- Nursing Considerations:
- Administer on empty stomach 1 hour before meals and at bedtime
- Oral suspension is easier for the older adult clients to ingest b/c tablet form is large and difficult to swallow
- Monitor for adverse effect of constipation
- Client Edu:
- If taking bismuth subsalicylate, avoid aspirin to avoid salicylate overdose
- Clients taking bismuth subsalicylate can have black stools which are temporary and harmless
