Practice & Learn: Peptic Ulcer

The nurse suspects that Mr. Melborne may have peptic ulcer disease. Can you identify Mr. Malborne's contributing risk factor(s) for peptic ulcer disease? Choose all that apply. a) He is in the 40 to 60-year-old age group. b) He has been taking ibuprofen (NSAIDs) for pain. c) He is been under stress at work. d) He has been taking antacids for heartburn. e) He has Zollinger-Ellison syndrome. f) He says his stools have been black and sticky. g) He has a history of cigarette use.

He is in the 40 to 60-year-old age group. He has been taking ibuprofen (NSAIDs) for pain. He is been under stress at work. The two most common causes of peptic ulcer disease are infection with Helicobacter pylori and the use of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen. Even low-dose aspirin can contribute to peptic ulcers. Peptic ulcers most commonly occur in the 40- to 60-year-old age group. Other common risk factors include cigarette smoking, alcohol consumption, and some other medications including oral bisphosphonates, potassium chloride, and immunosuppressive medications. Although psychological stress is no longer considered to be a primary cause of peptic ulcers, stress may be a contributing factor. An uncommon cause of peptic ulcer disease is Zollinger-Ellison syndrome, which causes hypersecretion of acid and digestive enzymes.

The nurse is instructing Mr. Melborne about famotidine. Which statement should the nurse include in the teaching? a. "Famotidine neutralizes acid in the stomach." b. "Famotidine prevents acid from the stomach from backing up into the esophagus." c. "Famotidine works to reduce the production of acid in the stomach." • d. "Famotidine is an analgesic; it will help your pain."

"Famotidine works to reduce the production of acid in the stomach." Famotidine is a histamine H2 receptor antagonist (H2 blocker). It blocks histamine from stimulating gastric cells to produce acid. Other H2 blockers include ranitidine (Zantac), cimetidine (Tagamet), and nizatidine (Axid). Famotidine decreases the amount of acid produced; it does not neutralize acid. Famotidine reduces heartburn pain by reducing the amount of acid produced; it is not an analgesic. Famotidine does not prevent esophageal reflux; it makes the gastric fluid that does reflux into the esophagus less acidic, decreasing the damage done to the esophagus. PREV

What is a Peptic Ulcer?

In the United States, approximately 10% of people will develop peptic ulcer disease throughout their lives. Peptic ulcers occur in the stomach or duodenum due to an imbalance between the production of gastric acid & digestive enzymes & the resistance of the gastric mucosa. Duodenal ulcers are more common than gastric ulcers.

Given Mr. Melborne's symptoms, what intervention is the highest priority? a. Insert a large-bore IV line. b. Position Mr. Melborne in semi-Fowler's position. c. Prepare Mr. Melborne for an ED. d. Obtain a list o Mr. Melborne's current medications.

Insert a large-bore IV line. Mr. Melborne is hemorrhaging and at risk for shock. He will need large volumes of IV fluids. Initiating a large-bore IV is a high priority. Obtaining a list of medications is important, but the IV line is a higher priority. Semi-Fowler's position is not an important intervention in this situation. Mr. Melborne will need an urgent ED, but averting the impending shock is a higher priority.

Mr. Melborne tells the nurse that his uncle had surgery for ulcers "30 or 40 years ago" and asks if he will need surgery too. What is the best response from the nurse? a. "It's too early to tell if you'll need surgery for the ulcer, but many people do." b. "Surgery used to be a common treatment for ulcers, but with the medications we have now, surgery is rarely needed." c. "Surgery is the best treatment for ulcers." d. "Don't worry; I'm sure you won't need surgery."

"Surgery used to be a common treatment for ulcers, but with the medications we have now, surgery is rarely needed." The use of surgery for peptic ulcer disease has decreased dramatically since the introduction of H2 blockers, PPIs, and antibiotic therapy for peptic ulcers. Surgery may be required for refractory ulcers or complications of ulcers including perforation and gastric outlet obstruction. Telling the patient not to worry is non-therapeutic. The other two statements are not correct; surgery for peptic ulcer disease is now rare, and medical treatment is able to heal most peptic ulcers. NEX PREI

What other instructions should the nurse give Mr. Melborne? Choose all that apply. a. Consume 8 ounces of milk whenever the heartburn begins. b. Avoid drinking alcohol. c. Avoid taking ibuprofen, aspirin, & related medications like naproxen (Aleve). d. Decrease caffeine intake e. Avoid smoking tobacco.

- Avoid drinking alcohol - Avoid smoking tobacco - Decrease caffeine intake - Avoid taking ibuprofen, aspirin, & related medications like naproxen (Aleve). - Alcohol irritates the gastric mucosa. - Smoking may inhibit the production of acid-neutralizing bicarbonate by the pancreas. - Caffeine intake may increase gastric acid & Pepcid secretion. - NSAIDs are one of the most common causes of ulcers. - Milk may stimulate gastric acid secretion.

Risk Factors for Peptic Ulcer Disease

2 most common causes of peptic ulcer disease: 1) Infection with Helicobacter pylori 2) Use of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen. Even low-dose aspirin can contribute to peptic ulcers. Peptic ulcers most commonly occur in the 40- to 60-year-old age group. Other common risk factors include cigarette smoking, alcohol consumption, & some other medications including oral bisphosphonates, potassium chloride, & immunosuppressive medications. Although psychological stress is no longer considered to be a primary cause of peptic ulcers, stress may be a contributing factor. An uncommon cause of peptic ulcer disease is Zollinger-Ellison syndrome, which causes hypersecretion of acid & digestive enzymes.

What is included in "triple therapy" for peptic ulcers? a. An H2 rebeptor antagonist, antacids, and a PPI. b. An H2 receptor antagonist, sucralfate (Carafate), and an antacid. c. A PPI, an antacid, and an antibiotic. d. A proton-pump inhibitor (PPI) and two antibiotics.

A proton-pump inhibitor (PPI) and two antibiotics. Triple therapy" (sic) for peptic ulcer disease proven or suspected to be associated with H. pylori infection consists of a PPI and two antibiotics. PPIs inhibit gastric cells' ability to produce acid and are more effective than H2 receptor antagonists at healing peptic ulcers. PPIs include pantoprazole (Protonix), omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), and rabeprazole (Aciphex). The antibiotics used are clarithromycin (Biaxin) plus either amoxicillin (Amoxil) or metronidazole (Flagyl). Triple therapy is very effective at eradicating H. pylon and preventing the recurrence of ulcers. Sucralfate (Carafate) and antacids are used in the treatment of ulcers, but they are not part of "triple therapy" Sucralfate helps ulcers heal by coating the mucosa and protecting it from acid and digestive enzymes.

Which aspect of Mr. Melborne's symptoms do you think is of greatest concern? a. Recurrence of the pain 2 to 3 hours after antacids b. Black, sticky stools c. Being awakened by pain d. Location of the pain

Black, sticky stools Black, sticky (tarry) stools (melena) suggest that the stools contain undigested blood; Mr. Melborne may be bleeding a significant amount from the upper GI tract. Pain from peptic ulcers is usually felt in the epigastric area. Pain that is relieved by food hr antacids but recurs 2 to 3 hours later is a common symptom of duodenal peptic ulcers. While the description of the pain suggests that Mr. Melborne may have peptic ulcer disease, the tarry stools is of greatest concern.

Part 3: Hospital Admission: two days later, Mr. Melborne reports to the ED. He reports that his epigastric pain has worsened & he is also feeling fatigued & weak. His stools are now maroon in color. His BP is 88/52 mm Hg, his pulse is 121 bpm & his respiratory rate is 20.

Mr. Melborne's symptoms indicate that he is hemorrhaging from a peptic ulcer. Maroon-colored stools suggest that a large amount of blood is entering the Gl tract. Mr. Melborne's blood pressure has decreased and his pulse has increased, which, along with fatigue and weakness, are symptoms of acute blood loss.

Part 4: Practice Three hours after Mr. Melborne is admitted to the medical/ surgical unit, he complains of increased abdominal pain. The nurse notes that his abdomen is rigid & tender. What is the most likely explanation for the assessment findings? a. The findings are a reaction to the pain. b. The ulcer has most likely perforated. c. The findings are to be expected in a peptic ulcer. d. The bleeding from the ulcer has worsened.

The ulcer has most likely perforated. Perforation of the ulcer is a serious complication of peptic ulcers. Symptoms of perforation include increased abdominal pain, & a very tender and rigid, board-like abdomen. The findings are not expected; they are signs of perforation. Increased bleeding would cause lowered blood pressure and increased pulse. The pain alone does not explain abdominal rigidity.

Mr. Melborne's BP has decreased & his pulse has increased, which, along with the fatigue & weakness, are symptoms of _______________________

acute blood loss

What is the most likely explanation for Mr. Melborne's symptoms? Patient Interview Mr. Melborne's symptoms indicate that he is hemorrhaging from a_______________________

peptic ulcer