Peptic Ulcer Disease

 may refer to as gastric, duodenal or esophageal ulcer depending on its

location. It may result from excess acid production or from a breakdown in the
normal mechanisms protecting the mucous membranes.

 It is also associated with stress and intake of certain drug (e.g. NSAIDs).
Helicobacter pylori, a spiral shaped bacterium is generally acknowledged as
the main cause for most peptic ulcers. H. pylori lives and multiplies within the
mucous layer that covers and protects tissues that line the stomach and small
intestine. Often, H. pylori cause no problems. But sometimes it can disrupt the
mucous layer and inflame and erode digestive tissues, producing an ulcer.

 One reason may be that people who develop peptic ulcers already have
damage to the lining of the stomach or small intestine, making it easier for
bacteria to invade and inflame tissues.
 COMPARISON OF DUODENAL AND GASTRIC ULCERS

DUODENAL ULCER GASTRIC ULCER

INCIDENCE
Age: 30- 60 Usually 50 and over
Male: Female= 2-3:1 Male; female= 1:1
80% of peptic ulcers are duodenal. 15% of peptic ulcers are gastric.

SIGNS AND SYMPTOMS AND CLINICAL SIGNS AND SYMPTOMS AND CLINICAL
FINDINGS FINDINGS

Hypersecretion of stomach acid (HCL) Normal- Hyposecretion of stomach acid ( HCL)

May have weight gain. Weight loss may occur
Pain occurs 2-3 hours after a meal; often Pain occurs ½ to 1 hour after a meal; rarely
awakened 1-2 a.m; ingestion of food relieves occurs at night; may be relieved by vomiting;
pain. ingestion of food does not help, sometimes
increases pain.
Vomiting uncommon Vomiting common.
Hemorrhage less likely than with gastric ulcer, Hemorrhage more likely to occur than with
but if present, melena more common than duodenal ulcer; hematemesis more common
hematemesis. than melena.
MALIGNANCY POSSIBILITY MALIGNANCY POSSIBILITY
Rare Occasionally
STATISTICS:

 Over the past few decades, the incidence of peptic ulcer disease and ulcer
complication has decreased. For more than a century, peptic ulcer disease
was most often managed surgically, with resulting high morbidity and
mortality rates.

 Effective pharmacologic suppression of gastric acid secretion began with

the introduction of histamine H2-receotor antagonists (H2RAs) in the
1970s, which greatly improved clinical outcome.
BLOOD TRANSFUSION

 isthe process of transferring blood or blood- based products from one person into the
circulatory system of another. Blood transfusion can be life- saving in some situations,
such as massive blood loss due to trauma, or can be used to replace blood lost during
surgery. Blood transfusion may also be used to treat a severe anemia or thrombocytopenia
caused by a blood disease.

When administering whole blood or blood components, unsure the following:

 Follow up on results on complete blood count and report to health care provider so
appropriate blood product can be ordered based on patient’s condition.
 Contact the blood bank with health care provider’s order and ensure timely delivery of
blood products.
 Establish a patent I.V line with compatible I.V fluid.
 Use appropriate administration setup, filter, warmer, etc.,
 Obtain baseline vital signs.
 Make sure proper blood product is given to the right patient.
 Observe for acute reactions- allergic, febrile, circulatory overload- by assessing vital
signs, breath sounds, edema, flushing, vomiting.
OBJECTIVES

A. General Objectives
 
To improve the quality of life and promote health for those who have peptic ulcer
disease.
Recognize the potential causes of peptic ulcer disease.
Gain the necessary information about the prevalence of peptic ulcer disease.

B. Specific Objectives
Develop knowledge, which would make us or the readers aware on what are the
possible causative agents and the signs & symptoms manifested by the patient on
having this specific condition.
Know the possible actions that would help alleviate or even prevent a certain problem
related to the condition of the patient for the prevention of possible complications.
Even give some interventions to those problems that were observed to the patient.
Identify what are the uses of the drugs being prescribed by the patient’s physician
during the entire hospitalization.
PATIENT ASSESSSMENT DATA BASE
 
A. BIOGRAPHIC DATA
Name: Mr. ARM
Age: 70 years old
Sex: Male
Address: Santo Tomas, Biñan Laguna.
Date of Admission: 08/29/2010
Time of Admission: 8: 00 p.
Highest Educational Attainment: High School
Work: Construction Worker (R)
Rank in the Family: Eldest
Civil Status: Married
Source of History: Spouse, himself.
Nationality: Filipino
Admitting physician: Benwyn Rañeses, M.D
Religion: Roman Catholic
Final Diagnosis: UGIB prob. Secondary to BPUD
Chief Complaint: severe abdominal pain 9/10 and (+) melena.
B. PERSONAL HEALTH HISTORY

My patient has not received any blood from the past. He has no
known food and medicine allergies. As his wife said that he was
hospitalized for several times because of his condition (Peptic Ulcer
since 1998). He is known to be a hard- working person but decided to
stop working as a Construction worker due to his condition (2006). The
patient also told me that he always skip his meals. As we all know, that
skipping a meal will lessen our body’s nutrients/ strength and would
become prone to disease when the nutritive status of our body is
altered. And due to inadequate nutrient on his body, the patient would
become weak. The above factors made my patient a susceptible
individual to a certain disease.
C. HISTORY OF PRESENT ILLNESS AND CHIEF
COMPLAIN

 One week prior to admission, Mr. ARM defecate a black tarry stool 1-
2 X a day he just ignored it and did not seek for any consultation. A day
prior to admission patient was then rush to E.R of Laguna Provincial
Hospital due to severe abdominal pain 9/10 with cardiac rate of 84,
respiratory rate of 23 and blood pressure of 120/80. The laboratory shows
decreased hemoglobin and hematocrit. Mr. ARM needs 5 packs of blood
according to his doctor.
D. HISTORY OF PAST ILLNESS

 Mr. ARM was diagnosed to have peptic ulcer since 1998. He always
hospitalized because of his condition. On 2001 he confined at PGH and
was given medications (Zantac, Omeprazole). According to him ingestion
of foods relieves the pain. July of 2004 his BP increased (160/100) and
was confined at Laguna Provincial Hospital and was diagnosed to have
hypertension.
E. FAMILY HISTORY

 According to him, they have familial history of hypertension and history of

Diabetes Mellitus to their maternal side.  

Mother Father

  

MOTHER COUSIN LOLA

(+) D.M LOLO (+) HPN

FATHER

Mr. ARM (+) HPN

ANATOMY AND PHYSIOLOGY:
 The gastrointestinal tract is a 23-25 foot long pathway that extends from the
mouth to the esophagus, stomach, small intestine, large intestine and rectum to
the terminal structure the anus.

FUNCTION OF DIGESTIVE SYSTEM

Primary Functions are:

 Breakdown of food particles into the molecular form for digestion.

 Absorption into the bloodstream of small nutrient molecules produced by
digestion.
 Elimination of undigested unabsorbed food stuffs and other waste products.
PARTS:
Mouth - It is a mucous membrane-lined cavity where foods enter the digestive
tract. It breaks down the food into smaller particles by mastication with the help
of the saliva.

Esophagus -It is the gullet that runs from the pharynx through the diaphragm to
the stomach. It conducts food by peristalsis to the stomach.

Stomach- It is the C-shaped abdominal cavity located at the epigastric region of

the abdomen, nearly hidden by the liver and the diaphragm. It acts as a
temporary “storage tank” for food as well as site of food breakdown. Glands are
present in its lining which are responsible for the secretion of the gastric acid.
The gastric acid aids in breakdown of the food into much smaller particle.
GASTRIC FUNCTION

 The stomach, which stores and mixes food with secretions, secretes highly
acidic fluid in response to the presence or anticipated ingestion of food.

 Hydrochloric Acid

 Pepsin

 Intrinsic Factor

 Peristalsis in the stomach and contractions of the pyloric sphincter allow the
partially digested food to enter small intestine at a rate that permits efficient
absorption of nutrients.
-Small Intestine

3 SECTIONS:
Duodenum (proximal)
Jejunum (middle)
Ileum (distal)

FUNCTION:
The digestive process continues in the duodenum. Duodenal secretions come from the accessory
organs (pancreas, liver and gallbladder) and the glands in the wall of the intestine itself.

This secretion contains digestive enzymes:

Amylase
Lipase
Bile

Intestinal secretions total approximately:

1L/day of pancreatic juice
0.5L/day of bile
3L/day of secretions from the glands of small intestine
Two types of contraction occur regularly in small intestine
 Segmentation contraction

 Intestinal peristalsis

 Absorption is the primary function of the small intestine. Process of absorption

begins in the jejunum and is accomplished by both active transport and diffusion
across the intestinal wall into the circulation.
 Nutrients are absorbed at specific locations throughout the small intestine and
duodenum, whereas fats, proteins, carbohydrates, sodium, chloride are absorbed in
the jejunum. Vitamin B12 and bile salts are absorbed in the ileum. Magnesium,
phosphate and potassium are absorbed throughout the small intestine.
-Large Intestines

COMPLETING TERMINAL PORTION:

 Sigmoid Colon

 Rectum

 Anus

 FUNCTION:
 Its major function is to dry out the indigestible food residues by absorbing water
and to eliminate these residues from the body as feces.

 Anus- It is an opening in the digestive tract where the residues are being excreted
from the body.
GORDON’S FUNCTIONAL HEALTH PATTERN:
BEFORE
HOSPITALIZATION
- Patient is not aware about the
consequence of his lifestyle.
- He perceived healthy person
Health perception/Health
as a person who is able to do/
Management
perform his/her job and does
not have any kind of disease.
DURING
HOSPITALIZATION
- During hospitalization the
patient shows concern about
the foods he needs to avoid.
- According to him he is not
healthy because of his
condition (PUD and
hypertension)

-Patient always skips meal, and - During hospitalization, he eats

drink coffee (2-3 time a day). three times a day because of the
Water- 4-5 times a day medications he needs to take.
Breakfast- bread, water
Nutritional/ Metabolic Lunch- rice, fish, water
Dinner- rice, fish, vegetables,
water

Water- 3-4 times a day

Defecate once or twice a day According to him, he defecates

( black tarry stool)
Urine 4-5 times a day.
Elimination
a black tarry stool 1-2 times a
day (2days on hospitalization)
and then experience
constipation for 4days.
Urine- 2-3 times a day.
PHYSICAL ASSESSMENT

System Methods of Assessment Findings Analysis

I.GENERAL SURVEY - Inspection -Patient was seen lying - Due to his condition
awake on bed, conscious (PUD) and due to
and coherent, appropriate decreased hemoglobin and
responds to question when hematocrit.
asked. Weak in
appearance, have pale
conjunctiva and mucous
membrane.

II. VITAL SIGNS First interaction:

-Inspection T-36. 4 - V/S is within normal
-Palpation P-82 range.
-Auscultation R-24
BP-120/80
Second Interaction.
T- 36.8
P- 84
R-21
BP- 120/80
III.
1) INTEGUMENTAR -noted with obvious signs Result of inadequate
Y of pallor at the areas with circulating blood and
A) SKIN -Inspection the least pigmentation subsequent reduction in
such as conjunctiva, nail tissue oxygenation.
IV. Respiratory System
a) Chest, shape & size -Inspection -RR : 24cpm -normal findings
b) Breath sounds -Palpation - right and left shoulders
-Percussion and hips are at the same
-Auscultation height; skin intact;
uniform temperature;
chest wall intact; no
tenderness; no masses
IV. Cardiovascular System - Palpation -Blood pressure: - indicates normal
120/80mmHg findings
- no pulsations at the -normal findings
aortic and pulmonic areas; -indicates normal findings
no pulsations at the
tricuspid area; No lift or
heave; No aortic
pulsations
-veins not visible
V. Abdomen - Auscultation - Pain at the epigastric
area ‘as verbalized by the - Indicates bleeding.
patient’’; noted abdominal
distention.
- with normoactive bowel
sounds, with 3 bowel
sound per minute upon
auscultation;
VI.Musculoskeletal -Inspection -Muscles equal on both - Normal findings.
System sides of the body; no
contractures;
VII.Neurologic Sytem -Inspection -oriented; without -normal findings
language deficit; has -normal findings
immediate memory recall;
has the ability to focus on
a mental task.
-GCS – 15; alert and
completely oriented
-patient refused to do this
task due to weakness and
needs rest.
VIII. Genitourinary
system
IX. Genitals & inguinal - Inspection -patient refused.
area
 LABORATORY TESTS:

TEST NAME RESULTS INTERPRETATION RANGES

CHEM Tech BUN 9.4 mmo/L HIGH- decrease blood 2.5 to 6.4
flow to the kidney due
to blood loss.
(Increased BUN, but
normal creatinine.)

CHEM Tech 82.92 mmo/L NORMAL 35.40 to 150.30

Creatinine
 TEST NAME RESULTS INTERPRETATION RANGES
SODIUM (Na) 139.8 NORMAL 135- 148 mmol/L
POTASSIUM (K) 4.51 NORMAL 3.5- 5.4 mmol/L

HEMATOLOGY
TEST NAME RESULTS RANGES INTERPRETATION

WBC 27.8 4.1- 10.9 K/uL HIGH- high WBC count

may signify an infection
somewhere in the body.

Lymphocytes 1.3 0.6- 4.1 NORMAL

RBC 1.30 M/uL 4.20- 6.30 M/ uL LOW-Indicates anemia.

Hgb 3.0 g/ dL 12.0- 18.0 g/dl LOW- referred to as

anemia; loss of blood
due to bleeding stomach
ulcer.

Hct 9.2 % 37.0- 51.0% LOW- signifies

hemorrhage/ blood loss.

Platelet Count 350. K/uL 140- 440 K/uL NORMAL

 TEST NAME RESULTS RANGES INTERPRETATION

WBC 19.6 5.0 X 10 /L – 10 X 10 HIGH-– high WBC

9/L count may signify an
infection somewhere in
the body

RBC 1.9 4.20- 6.30 M/ uL LOW- Indicates

anemia.
Hgb 48 120- 150 gm/L LOW- referred to as
anemia; loss of blood
due to bleeding
stomach ulcer.

Hct 0.14 0.40- 0.54 LOW- signifies

hemorrhage/ blood
loss.
 NURSING
NAME OF CLASSIFICA CONTRAINDI ADVERSE
ACTION INDICATION CONSIDERA
DRUG TION CATION EFFECT
TION
Omeprazole - - An -short term -contraindicated CNS: headache, -take drugs
40mg IV q12 Gastrointestinal antisecretory treatment of with dizziness, before meals.
agent compound that active duodenal hypersensitivity asthenia, Swallow the
Proton Pump is a gastric acid ulcer to omeprazole vertigo, capsules whole;
Inhibitor pump inhibitor. -first-line and its insomnia, do not chew,
therapy in components. apathy, anxiety, open or crush
treatment of paresthesias, them. If using
heartburn or dream oral suspension,
symptoms of abnormalities empty packet
GERD Dermatologic: into a small cup
-short –term rash, containing 2
treatment of inflamation, tbsp of water.
active benign urticaria, Stir and drink
gastric ulcer pruritus, immediately;
alopecis, dry fill cup with
skin water and drink
GI: diarrhea, the water. Do
abdominal pain, not use any
nausea, other liquid or
vomiting, food to dissolve
Furosemide Loop Diuretic - Rapid- acting -treatment of - CNS: dizziness, -profound
20mg TIV potent edema contraindicated vertigo, diuresis with
sulfonamide associated with with allergy to weakness, water and
“loop” diuretic hypertension. furosemide, headache, electrolyte
and sulfonamides drowsiness, depletion can
antihypertensiv fatigue, blurred occur; careful
e with vision, tinnitus, medical
pharmacologic irreversible supervision is
effects. Exact hearing loss required.
mode of action CV: orthostatic -administer
not clearly hypotension, with food or
defined, and volume milk to prevent
may increased depletion, GI upset.
renal blood cardiac -reduce dosage
flow. arrhythmias if given with
Dermatologic: other
rash, pruritus, antihypertensiv
urticaria, e; readjust
pupura, dosage
exofoliative gradually as BP
dermatitis, respond.
Cefuroxime - Antibiotic - Second -Treatment of - Body as a - Determine
750mg IV q 8 generation respiratory/urin Hypersensitivit whole: history of
cephalosporin ary tract y to Thrombophlebit hypersensitivity
antibiotic with infection and cephalosporin is (IV site), reactions to
structure other infections. and related pain, burning. cephalosporin
similar to that antibiotic. GI: Diarrhea, and history of
of penicillin. nausea, allergies,
This inhibits SKIn: rash, particularly to
third and final pruritus, drugs, before
stage of urticaria. therapy is
bacterial cell initiated,
wall synthesis, -Inspect IV
thus killing the injection sites
bacterium. frequently for
signs of
phlebitis.
- Monitor for
manifestations
of
hypersensitivity
Magaldrate Antacid -By reducing -Symptomatic - GI: Infrequent -Question
gastric acidity, relief of Contraindicated constipation or patient about
stomach pH hyperacidity to diarrhea (with effectiveness of
increases and associated with hypersensitivity prolonged use). medication in
proteolytic peptic ulcer, to magaldrate , Urogenital: relieving GI
activity of gastritis, peptic and impaired Hypermagnese distress.
pepsin is esophagitis, and renal function. mia (in patients -Lab tests:
inhibited. hiatal hernia, with impaired Check patients
Reportedly particularly in kidney on prolonged
does not patients who function) therapy
produce need to restrict periodically for
alkalosis or acid sodium. electrolyte
rebound and is imbalance (i.e.,
not as likely to hypermagnese
produce mia)
alterations of
bowel function
that occur with
either
aluminum or
magnesium
hydroxide alone
Lactulose -hyperosmotic Reduces blood Prescription for -GI: Flatulence, Promote fluid
laxative ammonia; chronic relief of borborygmi, intake ( 1500–
appears to constipation. belching, 2000 mL/d)
involve abdominal during drug
metabolism of cramps, pain, therapy for
lactose to and distention constipation;
organic acids (initial dose); older adults
by resident diarrhea often self-limit
intestinal (excessive liquids.
bacteria. dose); nausea, Lactulose-
Acidifies colon vomiting, colon induced
contents, which accumulation of osmotic
retards hydrogen gas; changes in the
diffusion of hypernatremia. bowel support
nonionic intestinal
ammonia (NH3) water loss and
from colon to potential
blood while hypernatremia.
promoting its Discuss
migration from strategy with
blood to colon. physician.
Gatosaemia,
In the acidic
intestinal
colon, NH3 is
obstruction.
converted to
nonabsorbable Patients on low
ammonium ions galactose diet.
(NH4+) and is
then expelled in
feces by
laxative action
 NURSING INTERVENTIO
ASSESSMENT PLANNING RATIONALE EVALUATION
DIAGNOSIS N
S>” Maitim ang  Ineffective Long Term Goal:  Monitor  Changes in  After the
dumi ko.” As Tissue  After the bowel sounds bowel sounds nursing
verbalized by the Perfusion nursing and report can signal intervention,
patient. (GI) r/ t interventions, changes impending blood
O > Conscious decrease in the patient obstruction or transfusion
and Coherent oxygen laboratory a return to the laboratory
 Č Abdominal carrying value will normal bowel value
distention capacity. return to function. improved.
 Presence of normal.
black tarry  To detect
stool 1-2  Monitor ischemia
times a day. complete caused by low
 Normal bowel blood count hematocrit
sounds. daily as and
 Pale ordered. hemoglobin
conjunctiva level.
and mucous
membrane.  To prevent
 Capillary constipation.
refill delayed  Establish a
4secs. bowel  To prevent
Hemoglobin- 3.0 regimen. future
g/dL episodes of
Hematocrit- 9.2 %  Teach patient altered GI
RBC- 1.30 M/ uL and family tissue
members perfusion.
about dietary
habits that
may have
contributed to
poor
perfusion.
 To prevent
 NURSING
ASSESSMENT PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
S> “Nasakit ang  Acute pain  After the  After the
tiyan ko” as related to the nursing  Teach patient  It can cause nursing
verbalized by the effect of intervention, to avoid increased interventions,
patient č painscale gastric acid the patient aspirin, foods HCL the patient
of 7/10. secretion on will verbalize and beverages production. verbalized
O > Conscious and damaged relief/ reduce that contain relief of pain
coherent. tissue. of pain. caffeine and from 7/10 to
 Grimacing decaffeinated 4/10.
 Diaphoresis coffee.
 Performing
repetitive  Teach patient
activities. that meals
 Moaning. should be
 Weak in eaten at  To avoid
appearace regular reflux of
V/S intervals in a gastric
Temp- 36. 4 relaxed content.
Pulse- 87 setting.
Resp.- 19
BP- 110/ 80  Assist the
patient to
identify
situations that
are stressful
or exhausting.  A rushed
lifestyle and
irregular
 Assess schedule may
patient’s sign aggravate
and symptoms symptoms.
of pain and  Assessment
administer allows for
 NURSING INTERVENTIO
ASSESSMENT PLANNING RATIONALE EVALUATION
DIAGNOSIS N
S> “ Nawawalan  Imbalanced  After the  Provide small,  To reduce  After the
ako ng gana di kasi Nutrition; nursing frequent fatigue and nursing
ako makakain ng Less than interventions, feedings. improve interventions,
maayos” as body the patient  Promote intake. the patient
verbalized by the requirements will show adequate rest.  To reduce shows interest
patient. r/t insufficient interest in  Monitor fatigue and in eating.
O> Conscious and intake. eating. electrolyte improves the
coherent values and ability to eat.
 Inadequate report  Poor
food intake abnormalities. nutritional
(4-5 tbsp)  Advised about status may
 Pale the cause
conjunctiva importance of electrolyte
and mucous complying imbalance.
membrane with  It is important
 Lack of medication for healing
interest in regimen and process and to
eating. dietary avoid stomach
restriction. to produce
 Instruct more HCL.
patient to  It can worsen
avoid spicy peptic ulcer.
foods.
 DISCHARGE PLANNING:

M- otivate patient to have regular check up.

E- ncourage patient not to skip meals.
L- essen work load and stress.
E- ncourage patient to eat nutritious food.
(ex: Iron rich foods – malunggay, ampalaya, internal organs)
N- o to vices such as drinking alcohol, smoking.
A- void spicy and sour foods.