UNIT 8 GASTRITIS AND PEPTIC ULCER DISEASE CHAPTER 50 Flashcards
What is Gastritis?
Gastritis is the inflammation of gastric mucosa (stomach lining).
Risk factor of Gastritis
Long-term NSAID use creates a high risk for acute gastritis. NSAIDs inhibit prostaglandin production in the mucosal barrier.
Other risk factors include use of alcohol, coffee, and caffeine.
Stress and cigarette e smoking are considered risk factors for the development of acute gastritis.
Use of drugs such as steroids, aldosterone antagonists, and selective serotonin reuptake inhibitors can contribute to gastroduodenal inflammation and ulceration.
What is Peptic Ulcer Disease?
Peptic ulcer disease (PUD) results when GI mucosal defenses become impaired and no longer protect the epithelium from the effects of acid and pepsin.
ulcerations in stomach or
duodenum
What are the 2 types of Peptic Ulcer Disease
Three types of peptic ulcers may occur: duodenal ulcers, gastric ulcers, and stress ulcers (less common).
EPIGASTRIC PAIN AFTER EATING (UPPER MIDDLE EAREA OF ABDOMEN)
What are the Risk Factors for Peptic Ulcers Disease
NSAID use,
H. Pylori
ICU Setting: Anything that causes physiologic stress
Which of the following categories pain gets worse when a patient eats?
Gastric Ulcer
Duodenal
Gastric Ulcer
Gastric Ulcer: The stomach secretes acid when you eat,
irritates ulcer ad causes pain immediately after eating.
Duodenal: Ulcer far off in duodenum; when acid comes into contact with duodenum they get pain 2-3 hours after eating.
Signs and Symptoms of PUD
Symptoms:
*Post prandial epigastric pain
*Epigastric pain that awakens patient at night
*“Heartburn” that doesn’t respond to antacids
*Dyspepsia
Treatment for PUD
PPI’s- proton pump inhibitors
Stop NSAIDS (replace with COX-2 if necessary) CELECOXIB
H.Pylori: Triple therapy
1. (PPI), such as Lansoprazole,
2. 2 antibiotics
ANTIBIOTICS
* amoxicillin
* metronidazole
* tetracycline
* clarithromycin
A common drug regimen for H. pylori infection is PPI–triple therapy, which includes a proton pump inhibitor (PPI), such as lansoprazole, plus two antibiotics such as metronidazole and tetracycline or clarithromycin and amoxicillin for 10 to 14 days.
NG TUBE USE
Quadruple therapy for H. Pylori
Some primary health care providers may prefer to use quadruple therapy, which contains a combination of a proton pump inhibitor (PPI), any two commonly used antibiotics as described previously, and the addition of bismuth. Bismuth therapy is often used in patients who are allergic to penicillin-based medications.
Bismuth subsalicylate inhibits H. pylori from binding to the mucosal lining and stimulates mucosal protection and prostaglandin production. Teach patients that they cannot take aspirin while on this drug because aspirin is a salicylic acid and could cause an overdose of salicylates.
Patients should also be taught that Bismuth may cause the stools and/or tongue to be discolored black. This discoloration is temporary and harmless.
What food should a patient avoid with PUD
Teach the patient with peptic ulcer disease to follow healthy nutrition habits and avoid substances that increase gastric acid secretion. This includes caffeine-containing beverages (coffee, tea, cola). Both caffeinated and decaffeinated coffees should be avoided because coffee contains peptides that stimulate gastrin release (Priyanka et al., 2016).
What are some complications of PUD
Bleeding: Very deep ulcers can erode into arteries,
leading to rapid blood loss and shock
Symptoms: Bright red or coffee ground emesis, dark tarry stool (melena); signs of hypovolemia: Tachycardia, pallor, hypotension, etc.
Signs and Symptoms of Peritonitis
If perforation PUD into the peritoneal cavity is present, the patient typically has a rigid, boardlike abdomen accompanied by rebound tenderness and intense pain (peritonitis). , pt may curl into the fetal position. !!Surgical Emergency!!
*Pain is significantly worse (suddenly worsening),
*Abdomen is sensitive to touch, ridged, and boardlike
*Rebound tenderness over affected area (Blumberg’s
sign)
Which of the following is a symptom of shock?
A. Bradycardia
B. Hypotension
C. Constricted pupils
D. Diarrhea
B. Hypotension
HYPOTENSION
TACHYCARDIA
DIAPHORESIS
Passing few/no stools/gas
When blood loss exceeds 1 L/24 hr, manifestations of hypovolemic shock may occur, such as hypotension, chills, palpitations, diaphoresis, and a weak, thready pulse
Post Surgery Nursing Interventions for Peptic Ulcer Disease
1.Keep head of bed (HOB) at high fowlers.
2.Never manipulate the nasogastric tube (NGT).
3.Monitor patient-controlled analgesia (PCA) pump.
4.Start patient on clear liquid diet as prescribed.
5. Monitor v/s and for post op complications like
mechanical obstruction and bleeding.
Why would a pt with PUD need a Nasogastric tube?
A combination of several different treatments, including nasogastric tube (NGT) placement and lavage, endoscopic therapy, interventional radiologic procedures, and acid suppression, can be used to control acute bleeding and prevent rebleeding
Nasogastric tube placement and lavage. Upper GI bleeding or obstruction often requires the primary health care provider or nurse to insert a large-bore NGT to:
- Determine the presence or absence of blood in the stomach
- Assess the rate of bleeding
- Prevent gastric dilation
