Peptic ulcer disease

A nurse is caring for a client with peptic ulcer disease​ (PUD) who is taking a proton pump inhibitor​ (PPI) for the treatment of PUD. Prior to administering this​ medication, what does the nurse need to know about a​ PPI? 1. it inhibits an acid secreting enzyme to reduce gastric acid content 2. It may be used in combination with antibiotics to eliminate H pylori

A proton pump inhibitor​ (PPI) inhibits an​ acid-secreting enzyme to reduce gastric acid content. A PPI may be used in combination with two antibiotics to eliminate H. pylori. Antacids stimulate gastric mucosal defenses. A histamine2​-receptor blocker inhibits histamine binding to the receptors on the gastric parietal cells to reduce acid secretion. Sucralfate stimulates secretion of​ mucus, bicarbonate, and prostaglandin.

A nurse is caring for a client with congestive heart failure​ (CHF) who has recently been diagnosed with peptic ulcer disease​ (PUD). The client takes digoxin to manage symptoms associated with CHF. The healthcare provider has ordered antacids for the client to help heal the gastric mucosa as a result of PUD. What is true regarding antacids and​ digoxin?

Antacids interfere with the absorption of digoxin Antacids interfere with the absorption of digoxin. Antacids do not cancel all therapeutic effects of​ digoxin, nor do antacids absorb​ digoxin's therapeutic effect.

COX-1 Vs COX 2

COX 1: necessary to persevere the integrity of the gastric mucosa COX 2: responds to inflammatory stimulation

Which nursing DX is most appropriate for a client with PUD?

Disturbed sleep pattern is the most appropriate nursing DX for a client with PUD.

Duodenal ulcers

Occur in the duodenum are the most common Develop btwn the ages of 30-55 more common in men than in women

Peptic ulcers overview

Peptic ulcers may occur in any area of the GI tract exposed to acid-pepsin secretions, including the esophagus, stomach, and duodenum. Duodenal ulcers, which occur in the duodenum, are the most common.

when does pain with PUD occur?

The pain occurs when the stomach is EMPTY (2-3 hours after meals in the middle of the night) and is relived by eating. with a classic pain-food-relief pattern. pain experienced in the epigastric region, sometimes radiating to the back, and may be described as gnawing, burning, aching or hunger like.

A nurse is planning care for a client who is going to be admitted to the nurse​'s unit. The client has a diagnosis of peptic ulcer disease​ (PUD) and is complaining of​ nausea, heartburn, and epigastric pain. What nursing intervention will the nurse plan to​ implement?

Discourage the client from eating a nighttime snack. The nurse should discourage the client from eating a nighttime snack because this can exacerbate the client​'s condition. The client should maintain strict bed rest. The nurse should assess the client​'s abdomen every 4 hours. Inserting a nasogastric tube is a collaborative nursing​ intervention, requiring the order of the healthcare provider. The nurse will not automatically insert a nasogastric tube for all clients with PUD.

H Pylori infection

Found in about 70% of individuals who have PUD and is unique in colonizing the stomach. The infection is spread individual to individual (oral-oral or fecal-oral) and promotes ulcer formation by producing enzymes that reduce the efficacy of mucous gel in protecting the gastric mucosa.

What pharmacologic therapy is used in the treatment of PUD? for reducing gastric acid content?

Histamine 2 receptor blockers: are used for reducing gastric acid content in the treatment of PUD.

nonpharmacologic therapy diet:

Maintain good nutrition. Consume meals at regular intervals. Bland or restrictive diets are not necessary.

Which nursing intervention is most appropriate for a client with PUD?

Monitoring stools for occult blood. (nurse should assess the client's abdomen every 4 hrs, the client should maintain bed rest, the nurse should discourage the client from having a bedtime snack to avoid pain associated with PUD)

Perforation

Most lethal complication; penetration of the ulcer through the mucosal wall, causing gastric or duodenal contents (hydrochloric acid, pepsin, bile and pancreatic fluid) to enter the peritoneum -This process causes inflammatory response and results in chemical peritonitis -Chemical peritonitis is immediate -within 6-12 hours bacterial peritonitis occurs from gastric contaminants entering the normally sterile peritoneal cavity

A nurse is caring for William​ Sanders, a​ 65-year-old male with a history of peptic ulcer disease​ (PUD), who presents to the emergency department via ambulance gurney. Mr. Sanders called first responders to his house when he developed severe upper abdominal pain that radiated to his right shoulder. Mr.​ Sanders's heart rate is 114 and blood pressure is​ 90/55. Mr.​ Sanders's nurse notes that his skin is cool and​ clammy, his abdomen is​ hard, and no bowel sounds can be auscultated. What complication associated with PUD does the nurse suspect that Mr. Sanders​ has?

PERFORATION: of either the duodenum or stomach. Most lethal complication that may occur with PUD. Symptoms of perforation: rigid abdomen, severe abdominal pain which radiates to the shoulder, signs of shock (low BP, tachycardia and cool/clammy skin) (gastric outlet obstruction is a complication associated with PUD; however, symptoms are graduate with feelings of fullness) (zollinger-Ellison syndrome is a condition that causes PUD, not a complication of it)

Reduce gastric acid content; therapy

PPIs: inhibit the acid-secreting enzyme that functions as the proton pump of the parietal cells, disabling it for up to 24 hours; 90% of ulcers heal after 4 weeks Histamine2 -receptor blockers: inhibit histamine binding to the receptors on the gastric parietal cells to reduce acid secretion; must be taken for 8 weeks or more to see results

A nurse manager is teaching a group of staff nurses about the complications related to peptic ulcer disease​ (PUD). What statement regarding peritonitis will the nurse manager include in the​ teaching?

Peritonitis occurs when the ulcer penetrates through the mucosal​ wall, causing gastric or duodenal contents to enter the peritoneum. Peritonitis occurs due to the ulcer penetrating through the mucosal​ wall, causing gastric or duodenal contents to enter the peritoneum. Chemical peritonitis is immediate after perforation. Bacterial peritonitis occurs between 6 and 12 hours after perforation. Gastric outlet​ obstruction, not​ perforation, occurs due to the obstruction of the pyloric region of the stomach and duodenum.

eliminate H pylori: therapy

Protein-pump inhibitor (PPI) in combination with two antibiotics OR Bismuth-containing product with two antibiotics and PPI If retreatment is required, use of different antibiotics4

A nurse is planning care for Peter​ Carroll, a​ 55-year-old man who was recently diagnosed with peptic ulcer disease​ (PUD). Peter is hospitalized after several days of nausea and vomiting in addition to complaining of epigastric pain. When planning care for Mr.​ Carroll, which nursing diagnosis takes​ priority?

Risk of deficient fluid volume!! while mr. carroll may have imbalanced nutrition: less than body requirements and disturbed sleep pattern, these do not take priority. Mr. Carroll's greatest concern is risk for deficient fluid volume due to vomiting. He is not at risk for impaired skin integrity

What treatments are used to protect the gastric mucosa?

Sucralfate, bismuth compounds, and antacids

protect gastric mucosa therapy:

Sucralfate: binds to proteins in the ulcer base, forming a protective barrier against acid, bile, and pepsin; stimulates secretion of mucus, bicarbonate, and prostaglandin Bismuth compounds (Pepto-Bismol®): stimulate mucosal bicarbonate and prostaglandin production, promoting ulcer healing; cause harmless darkening of stools Antacids: stimulate gastric mucosal defenses, which supports ulcer healing; may cause constipation (aluminum-type antacids) or diarrhea (magnesium-based antacids); interfere with absorption of iron, digoxin, some antibiotics, and other drugs Prostaglandin analogs (misoprostol): stimulate mucus and bicarbonate secretions and inhibit acid secretion, promoting ulcer healing; used to prevent NSAID-induced ulcers; not as effective as other therapies; contraindicated in pregnancy

A nurse is planning care for a client with peptic ulcer disease​ (PUD) who presents with intractable nausea and vomiting and epigastric pain. What is an appropriate outcome for this​ client?

The client will maintain adequate fluid volume. For the client with PUD who is experiencing​ vomiting, an appropriate outcome would be to maintain fluid volume. The client should have a urine output of at least 0.5​ mL/kg/hr, no​ bleeding, and report a level of pain that is acceptable for the client.

NSAIDS in PUD

The gastric mucosal barrier is preserved by prostaglandins. NSAIDs interrupt prostaglandin synthesis by disrupting the action of the two cyclooxygenase (COX) enzymes.

A nurse is caring for Mohammed​ Hassad, a​ 34-year-old man who has a​ 20-pack-year history of smoking and works as an construction worker.​ Recently, Mohammed has been complaining of hungerlike pain in his upper abdomen that occurs in the middle of the night but seems to subside once he eats. Mr.​ Hassad's healthcare provider has ordered an upper GI series to aid in diagnosing his condition. What instruction will Mr.​ Hassad's nurse provide to Mohammed regarding this diagnostic​ test?

This procedure is a type of x ray that uses contrast. The upper GI series uses barium as a contrast medium and can detect 80-90% of peptic ulcers via x ray.

gastric ulcers

Gastric ulcers, which occur in the stomach, are more commonly found in older clients between the ages of 55 and 70.

What is true regarding the diagnostic testing used for PUD?

Gastroscopy allows visualization of the esophageal, gastric and duodenal mucosa and direct inspection of ulcers.

Zollinger Ellison syndrome

is a form of PUD caused by gastronome, or gastinsecreting tumor, which is normally malignant. Gastrin is a hormone that stimulates the secretion of pepsin and hydrochloric acid. The increased gastrin levels associated with these tumors result in hyper secretion of gastric acid, which causes mucosal ulceration.

Gastrin is a hormone that:

stimulates the secretion of pepsin and hydrochloric acid.

why has the use of surgery to treat PUD declined dramatically?

the use of surgery to treat PUD has declined dramatically since the identification of H. Pylori infection as the primary cause

A nurse is providing discharge orders for a client with peptic ulcer disease​ (PUD). What statement will the nurse include regarding client diet and lifestyle modifications for the prevention of​ PUD?

Do not skip any meals Nonpharmacologic therapy for the treatment of PUD includes education of diet and lifestyle modifications to avoid a​ flare-up of the disease. The nurse should instruct the client to eat meals at regular intervals. Mild alcohol intake is acceptable. Bland or restrictive diets are not necessary.

Where is the most common site for peptic ulcers to develop?

Duodenum.

A nurse is caring for a client with peptic ulcer disease​ (PUD). The client tells the​ nurse, open double quoteI don​'t understand why I have pain in the middle of the night. It​'s like my pain starts 2dash3 hours after I​ eat, not right away. Why does this ​happen?close double quote What is the nurse​'s best​ response?

"the pain occurs when your stomach is empty" Pain from PUD occurs when the stomach is​ empty, typically 2dash3 hours after a meal.

Health history assessment of PUD

-complaints of epigastric or left upper quadrant pain, heartburn, or discomfort -Pain character, severity, timing, and relationship to eating -Measures that relieve of pain -nausea or vomit -presence of bright red blood or "coffee grounds" in emesis -Current meds including NSADIS -Smoking HX -Use of alcohol and other drugs.

What is true regarding duodenal ulcers?

1. More common in individuals who smoke 2. More common in men than in women 3. Typically develop btwn the ages of 30 and 55

prevention of complications from chronic NSAID use

Add either a histamine receptor antagonist, proton pump inhibitor, or misoprostol (Cytotec) with the NSAID, or Change treatment to a COX-2-selective NSAID to reduce the occurrence of peptic ulcers.

Why does an ulcer develop?

An ulcer develops when the mucosal barrier is unable to protect the mucosa from damage by the gastric digestive juices, hydrochloric acid and pepsin.

The mucosal barrier of the stomach

PROTECTS the gastric mucosa; made up of a thin coating of mucous gel and bicarbonate. It is maintained by bicarbonate secreted by the epithelial cells, by mucous gel production stimulated by prostaglandins, and by an adequate blood supply to the mucosa.

What happens in Zollinger ellison syndrome

gastric levels are INCREASED

A nurse is caring for a client who complains of diarrhea and epigastric pain. The client tells the nurse that he has recently been diagnosed with a gastrinoma. What additional condition does the nurse suspect the client​ has?

zollinger ellison syndrome The nurse would suspect that the client has​ Zollinger-Ellison syndrome because of the presence of a​ gastrinoma, which is present in this condition. The client may have a gastric or esophageal​ ulcer; however, the gastrinoma is unique to​ Zollinger-Ellison syndrome. Sick sinus syndrome is cardiac condition which does not manifest with a​ gastrinoma, diarrhea, or epigastric pain.

Risk factors of Peptic ulcers

-infection: major risk factor, estimated that 1 in 6 clients infected with H. Pylori develops PUD -Chronic NSAID use: major risk factor. ASPIRIN is the most ulcerogenic -Cigarette smoking: significant risk factor. DOUBLES risk of PUD. inhibits the secretion of bicarbonate by the pancreas and may cause more rapid transit of gastric acid into the duodenum.

Perforation manifestations

-severe upper abdominal pain radiating to the shoulder -Rigid birdlike abdomen -Absent bowel sounds -Signs of shock, including diaphoresis, tachycardia, and rapid, shallow, respirations -the older adult may present with vague symptoms such as CONFUSION, weight loss, or anemia.

characteristics of Zollinger-ELlison syndrome;

-ulcerlike pain -Diarrhea and steatorrhea (excess fat in the feces) resulting from impaired fat digestion and absorption -Bleeding and perforations -Fluid and electrolyte imbalances resulting from persistent diarrhea and subsequent losses of potassium and sodium

A nurse is preparing to obtain a health history from a client with peptic ulcer disease​ (PUD). Which factors should the nurse include in this portion of the nursing​ assessment?

1. complaints of heartburn 2. History of chronic use of NSAIDS 3. History of smoking 4. Presence of nausea and vomiting Factors of the health history for a client with PUD​ include: presence of nausea and​ vomiting, complaints of​ heartburn, history of chronic use of​ NSAIDs, and history of smoking. History of a​ high-fat diet does not appear to factor into the development of PUD.

the medications used to treat PUD include those that:

1. eliminate H. Pylori 2. Reduce gastric acid content 3. Protect the mucosa.

A nurse is caring for a client with peptic ulcer disease​ (PUD) who asks the​ nurse, open double quoteI don​'t understand how I can help to prevent my ulcers from recurring.close double quote What is the nurse​'s best​ response?

1. reduce your stress as much as possible 2. Be cautious with your intake of over the counter pain medications 3. Stop smoking Educating the client regarding the prevention of PUD should​ include: smoking​ cessation, stress​ reduction, and education about the use of OTC NSAIDs. It is not necessary for the client to completely eliminate alcohol. Although​ high-fat foods are not recommended for a healthy​ diet, they have not been shown to cause PUD.

ulcers are more common in...

Ulcers are more common in individuals who smoke and who are chronic users of NSAIDs. Alcohol and dietary intake do not seem to cause PUD, and the role of stress is uncertain.H

A nurse is caring for a client who has recently been diagnosed with peptic ulcer disease​ (PUD). The client asks the​ nurse, open double quoteMy doctor told me I might have bacteria that is causing my ulcers. How will I know if I ​do?close double quote What is the nurse​'s best​ response?

Your healthcare provider may order a breath test to determine the presence of H. pylori. The urea breath test is used to measure the urease produced by H. pylori bacteria. H. pylori are not detected with a skin test. A gastric analysis of stomach contents is ordered when the healthcare provider suspects​ Zollinger-Ellison syndrome. An upper GI uses barium as contrast for an​ x-ray to visualize the structures of the GI​ system, not to detect the presence of H. pylori.

The nurse is providing discharge instructions for a client with peptic ulcer disease​ (PUD). What will the nurse include in​ teaching?

importance of stress management techniques The nurse should discuss the importance of stress management with the​ client, as stress can contribute to the development of peptic ulcers. The client should continue to take medications used to treat the disease even after symptoms subside. The client should be told to avoid aspirin and other​ over-the-counter NSAIDs. The nurse should instruct the client to seek medical attention if the client feels dizzy.