Peptic Ulcer Disease

A 75-year-old client is diagnosed with type 2 diabetes mellitus, hypertension, osteoporosis, and gastric ulcer disease. She is prescribed PPIs. The nurse is aware that long-term (greater than 1 year) administration of PPIs may increase the risk for which problem for this client? Hypercalcemia Liver cancer Hip fractures Peptic ulcer disease

Hip fractures Proton pump inhibitors (PPIs) are known to decrease calcium absorption which can lead to hypocalcemia. This in turn affects the bones leading to osteoporosis. For clients over the age of 50, the long term use of PPIs (more than one year) will increase the risk for hip fractures due to the affect on the bones. PPTs can be used to treat gastric ulcers. It is not known to cause liver cancer.

People taking aluminum-containing antacids may develop what condition because aluminum combined with phosphates in the GI tract and prevents phosphate absorption.

Hypophosphatemia and osteomalacia

Types of medications for upper GI disorders:

- Antacids - Histamine2 receptor Antagonist (H2RA) - Histamine2 Proton Pump Inhibitors (PPIs) - Sucralfate (Carafate) - Bismuth subsalicylate (Pepto Bismol)

Non-Pharmalogic management for Peptic Ulcer Disease

- Avoid cigarette smoking, gastric irritants (e.g. alcohol, aspirin & NSAIDs, caffeine) - Well-balanced diet - Adequate rest - Regular exersize - Reduce psychological stress-healthful stress reduction strategies - Diet - recommendations vary, range from no dietary restrictions to minimizing highly spicy foods, gas-forming foods, and caffeine-containing beverages

Signs & Symptoms of Peptic Ulcer Disease

- GI bleeding: mild to severe when ulcer erodes through a blood vessel - Chronic duodenal ulcer: + Periodic epigastric pain + 1 to 4 hours after eating or during the night + "Burning" or "gnawing" + c/o fullness or bloating + Awakened by pain

Histamine 2 proton pump inhibitors (PPIs) names:

- Omeprazole (prilosec) PROTOTYPE - Esomeprazole (Nexium) - Lansoprazole (Prevacid) - Pantoprazole (Protonix) PO or IV

Administration of Sucralfate (Carafate)

- Take lansoprazole about 30 minutes before sucralfate - Take ciprofloxacin and other fluoroquinolones, digoxin, phenytoin, warfarin, or other drugs 2 hours before sucralfate - Do not take antacids within 30 minutes before or after administration of sucralfate

What does medications for Upper GI disorders do?

- They promote healing of lesions - Prevent recurrence of lesions - Decrease cell-destructive efforts - Increase cell-protective efforts

Histamine2, Proton Pump Inhibitors (PPIs)

-Strong inhibitors of gastric acid secretion. PPIs (Omeprazole) are similar to the H2RAs (Cimetidine) in terms of effects but have a different mode of action. - precent "pumping" or release of gastric acid from parietal cells. Faster symptom relief and faster healing in acid-related diseases -Compared with H2RAs, PPIs suppress gastric acid more strongly, for a longer period. This effect provides faster symptom relief and faster healing in acid-related diseases.

A nurse is teaching a client about prescribed lansoprazole. The nurse instructs the client to take the drug at which time? 2 hours after a meal first thing on arising 1 hour before eating at bedtime

1 hour before eating

Antacid administration

1-3 hours after meals and at bedtime (4-7 doses daily); 1-2 hrs before or after other meds (interferes with absorption)

Risk factors for Peptic Ulcer Disease

1. Cigarette smoking - Stimulates gastric acid secretion - Decreased blood supply to gastric mucosa - Ulcers heal slower and reoccur more often 2. Physiologic stress(e.g. shock, sepsis, burns, surgery, head injury, severe trauma, medical illness) 3. Psychological stress 4. Aspirin and other NSAIDs, corticosteroids, and antinoplastic

Most cases of Peptic ulcer disease are caused by

1. Helicobacter pylori 2. NSAID use 3. Stress

The nurse should administer which of the following medications cautiously to clients with vitamin B12 deficiency as the prolonged use of these drugs decreases the body's ability to absorb vitamin B12? Select all that apply. A) Metoclopramide (Reglan) B) Rabeprazole (AcipHex) C) Sucralfate (Carafate) D) Pantoprazole (Protonix) E) Promethazine (Phenergan)

B, D Feedback: The nurse should administer proton pump inhibitors, like rabeprazole (AcipHex) and pantoprazole (Protonix), cautiously to clients with vitamin B12 deficiency as the prolonged use of these drugs decreases the body's ability to absorb vitamin B12.

A nurse is caring for an elderly patient who has been administered cimetidine. Which intervention should the nurse perform? Closely monitor the patient for confusion and dizziness. Inform the PHCP if the patient exhibits tardive dyskinesia symptoms. Monitor the patient for reports of pain or sour taste. Monitor the patient for concentrated urine and restlessness.

CLosely monitor the patient for condusion and dizziness

Reflux-contributing factors

Foods Fluids Medications Gastric distention Cigarette smoking Recumbent posture

Ulcer formation in the esophagus, stomach, or duodenum areas of the gastrointestinal (GI) mucosa that are exposed to ?

Gastric acid and pepsin

What ulcers are the most common? Gastric & duodenal or espohageal?

Gastric and duodenal ulcers

The nurse is caring for a client who is receiving antacids to relieve gastrointestinal discomfort. Which nursing action is most appropriate? Tell the client not to crush or chew the tablet. Limit fluid intake when administering the medication. Give 1 hour before or 2 hours after other oral medications. Administer the medication with other drugs or food.

Give 1 hour before or 2 hours after other oral medications.

Duodenal ulcers are strongly associated with what infection?

H. pylori

What do Histamine2-Receptor Antagonists do

Inhibit both basal secretion of gastric acid and the secretion stimulated by histamine, acetylcholine, and gastrin

Magnesium containing antacids should not be used for people with ______ ______.

Kidney disease

Antacids MOA

Neutralize gastric acid to bring the pH above 3 and inactivate pepsin Most preparations not absorbed Excreted through feces

What group do gastric ulcers most often occur in?

Older adults

After teaching a group of students about proton pump inhibitors, the instructor determines that the students have understood the information when they identify which agent as the prototype proton pump inhibitor? Omeprazole Pantoprazole Lansoprazole Esomeprazole

Omeprazole

Which of the following would a nurse expect as most likely to be used in combination with antibiotics for treatment of Helicobacter pylori infection? Sucralfate Calcium carbonate Omeprazole Famotidine

Omeprazole

Route of administration of Histamine 2 Receptor Antagonists

PO & IV

Sucralfate (Carafate) prevents

Peptic Ulcer Disease

Antacid Indications

Peptic ulcer disease, GERD, gastritis, esophagitis, GI bleeding

What people are most affected by acid reflux?

Pregnant people, >40 years

Sucralfate (Carafate)

Provides a barrier between mucosal erosions or ulcers and gastric secretions

Main symptom of acid reflux

Pyrosis (heartburn)

What is Gastroespohageal reflux (GERD)

Regurgitation of gastric contents into the esophagus and/or mouth

H. pylori treatment

Triple therapy: 2 antibiotics and an acid reducer - 14 days of treatment - Esomeprazole, moxifloxacin, & amoxicillin

T or F Healing occurs over 6-8 weeks for a peptic ulcer

True

T or F: Antacids are OTC medications

True

Acid reflux happens most often during what time?

after evening meal and at night

The nursing instructor is teaching students about proper administration of sucralfate. According to the instructor, sucralfate should be administered: with meals. immediately after each meal. with an antacid. an hour before meals.

an hour before meals.

A client with a gastrointestinal (GI) disorder is prescribed the proton pump inhibitor omeprazole. Which information would the nurse include when instructing the client about this medication? a. Encourage the client to eat three meals a day. b. Remind the client to skip a dose if symptoms subside. c. Instruct the client to swallow the capsule whole. d. Explain that the medication has minimal side effects.

c. Instruct the client to swallow the capsule whole.

A female client presents to the health care provider's office with increasing stomach acidity. She self-administers calcium antacids. She notes that she seems to be having more issues with stomach acid, so she has been taking the calcium antacids more frequently. The nurse suspects that this may have caused what to occur in this client? A. Gastric reflux B. Hyperactive gastric mucosa C. Hypocalcemia D. Rebound acidity

d (Rebound acidity; when a pt stops uses an antacid, the production of gastric acid resumes and the body can OVER produce gastric acid to make up for the lack of production)

What is the benefit of adding proton pump inhibitors (PPIs) to the treatment regime treating an H. pylori bacterial infection? protects ulcer craters decreases pepsin production assists in eliminating the bacteria decreases production of gastric secretions

decreases production of gastric secretions

Antacids are mixtures of aluminum hydroxide and

magnesium hydroxide

The nurse is preparing to discharge a client who has been prescribed sucralfate. When does the nurse instruct the client to take the medication? with meals with an antacid before breakfast one hour before or 2 hours after meals and at bedtime after each meal, no more than 15 minutes after finishing

one hour before or 2 hours after meals and at bedtime

A client who takes aluminum hydroxide with magnesium hydroxide (Mylanta) frequently for upset stomach, heartburn, and sour stomach is seen regularly in the clinic. The nurse should assess: urine specific gravity. serum phosphate level. aspartate transaminase levels. blood glucose level.

serum phosphate levels serum phosphate levels because aluminum binds with phosphate. This can lower phosphate levels and cause an electrolyte imbalance

A client, with recent abdominal pain and a 40-pack per year smoking history, is prescribed a treatment regimen for a diagnosis of duodenal ulcer. What important teaching would the nurse include in relation to treatment? a. smoking effects on the healing of ulcers b. general health dangers research has proven to be c.associated with smoking d. the importance of taking prescribed medication until symptoms subside e. the connection between smoking and chronic pain

smoking effects of the healing ulcers

Histamine 2 Receptor Antagonists

- Ranitidine (Zantac) - Famotidine (Pepcid)

The health care provider has prescribed sucralfate for a client with a gastric ulcer. The client asks how long he must take this medication. What is the nurse's best response to this client? a. "You will need to take this medication for the rest of your life." b. "You will take it for 5 days, then skip 5 days, then take it for another 5 days and you will be done with it." c. "You must take this medication for the full 10 days." d. "You will need to take this medication for 4 to 8 weeks to ensure healing has occurred."

d. "You will need to take this medication for 4 to 8 weeks to ensure healing has occurred."

Antacids names

- Mylanta (prototype) - aluminum hydroxide-magnesium hyrdoxide-simethicone mixture - Maalox (Tums) - calcium carbonate antacid- high neutralizing capacity - Aluminum-containing antacids - slower onset of action, low neutralizing capacity. Used for Constipation long term. - Magnesium-containing antacids - Rapid onset of action, high neutralizing capacity. Used for Diarrhea and hypermagnesemia.

Misoprostol is used for

- Prevention of NSAID induced gastric ulcers (synthetic form of prostaglandin E approved for concurrent use with NSAIDS to protect the gastric mucosa - Medical abortion

GERD (gastroesophageal reflux disease) prevention & treatment

- Small meals - Avoid irritant, highly spiced, or fatty foods - Do Not lay down for 1-2 hours after eating - Elevate head of bed (HOB) - Avoid obesity, constipation and other activities that increase intra-abdominal pressure

Antacids have not been effective in managing a client's gastroesophageal reflux disease, so the health care provider is prescribing a proton pump inhibitor. Why might the health care provider prescribe a proton pump inhibitor (PPI) rather than a histamine2 receptor antagonist (H2RA)? H2RAs do not suppress acid. PPIs suppress acid more strongly and for a longer time. PPIs suppress acid more strongly and for a shorter time. PPIs are less expensive.

PPIs suppress acid more strongly and for a longer time.