DEFINITION OF DIAGNOSIS:

Final Diagnosis: UPPER GI BLEEDING 2O BLEEDING DUODENAL ULCER

ANEMIA SEVERE 2O TO UGIB

Others: HYPOKALEMIA, ISCHEMIC HEART DISEASE

PROTEIN ENERGY MALNUTRITION

 UPPER GI BLEEDING

 Upper gastrointestinal (GI) bleeding refers to hemorrhage in the upper

gastrointestinal tract. The anatomic cut-off for upper GI bleeding is the
ligament of Treitz, which connects the fourth portion of the duodenum to
the diaphragm near the splenic flexure of the colon.

Retrieved on August 26, 2013 from http://en.wikipedia.org/wiki/Upper_

gastrointestinal_bleeding

 Defined as bleeding in the esophagus, stomach or duodenum. Commonly

cause by bleeding peptic ulcers. Other causes include esophageal or
gastric varices junction from severe retching or cancer.

Huether, S. (2010).Understanding Pathophysiology.6 th Edition. Mosby Elsevier.

Singapore

 UGIB is characterized by frank, bright red bleeding or “coffee ground”

material that has been affected by stomach acids.

White, C., Duncan, G., Baumle, W.(2013). Medical-Surgical Nursing: An Integrated

Approach. 3rdEdition.Delmar, Cengage Learning. United States of
America

 BLEEDING DUODENAL ULCER

 A duodenal ulcer is a type of peptic ulcer that occurs in the duodenum, the
beginning of the small intestine. Peptic ulcers are eroded areas in the
lining of stomach and duodenum, which result in abdominal pain, possible
 bleeding, and other gastrointestinal symptoms. The most common cause
of duodenal ulcer is a stomach infection associated with the Helicobacter
pylori (H pylori) bacteria.

Retrieved on August 26, 2013 fromhttp://www.localhealth.com/article/duodenal-

Ulcer

 It is characterized by chronic intermittent pain in epigastric area. The pain

begins 2 or 3 hours after eating, when the stomach is empty. It is not
unusual for pain to occur in the middle of the night and disappear by
morning. Pain is relieved rapidly by ingestion of food or antacids, creating
a typical “pain-food-relief” pattern.

Huether, S. (2010).Understanding Pathophysiology.6 th Edition. Mosby Elsevier.

Singapore

 If the duodenal ulcer is caused by H pylori infection, antibiotic therapy is

the mainstay of treatment. It is important to follow the antibiotic regimen
precisely to avoid re-infection or recurrence. Most commonly, two
antibiotics are given for 14 days.Medications such as proton pump
inhibitors and histamine H2-receptor antagonists, which decrease the
amount of acid in the stomach, can also be an effective treatment for
duodenal ulcer.

McCance, K., Huether, S., Brashers, V.(2010). Pathophysiology: The biologic Basis for
Disease in Adultsand Children.6th Edition. Mosby Elsevier. Philadelphia

 ANEMIA SEVERE

 Severe anemia is considered for hemoglobin concentrations below 8.0

g/dL. There may be signs of a hyperdynamic circulation: tachycardia (a
fast heart rate), bounding pulse, flow murmurs, and cardiac ventricular
hypertrophy (enlargement). There may be signs of heart failure.

Retrieved on August 26, 2013 fromhttp://health.nytimes.com/health/guides/disease/

anemia/diagnosis.html

 HYPOKALEMIA
  A low serum potassium level indicates hypokalemia. Excessive loss of
gastric fluids and the use of diuretics can place the client at risk for
hypokalemia and an acid-base imbalance (metabolic alkalosis). Potassium
wasting diuretics such as furosemide (Lasix) or chlorothiazide (Diuril) can
cause hypokalemia.

White, C., Duncan, G., Baumle, W.(2013). Medical-Surgical Nursing: An Integrated

Approach. 3rdEdition.Delmar, Cengage Learning. United States of
America

 Hypokalemia refers to a decrease in plasma potassium levels below 3.5

mmol/L. Because of transcellular shifts, temporary changes in plasma
potassium may occur as the result of movement between ICF and ECF
compartments.

McCance, K., Huether, S., Brashers, V.(2010). Pathophysiology: The biologic Basis for
Disease in Adultsand Children.6th Edition. Mosby Elsevier. Philadelphia

 Hypokalemia refers to the condition in which the concentration of

potassium (K+) in the blood is low with serum potassium level of less than
3.5 mEq/L (3.5 mmol/L). The prefix hypo- means "under"; kal- refers to
kalium, the Neo-Latin for potassium, and -emia means "condition of the
blood."
Retrieved on August 26, 2013 fromhttp://en.wikipedia.org/wiki/Hypokalemia

 ISCHEMIC HEART DISEASE

 Ischaemic or ischemic heart disease (IHD), or myocardial ischaemia, is a

disease characterized by ischaemia (reduced blood supply) of the heart
muscle, usually due tocoronary artery disease (atherosclerosis of the
coronary arteries). Its risk increases with age, smoking,
hypercholesterolaemia (high cholesterol levels), diabetes, and
hypertension(high blood pressure), and is more common in men and
those who have close relatives with ischaemic heart disease.

Retrieved on August 26, 2013 fromhttp://en.wikipedia.org/wiki/Ischaemic_

heart_disease

 Ischaemic heart disease may be present with any of the following

problems; Angina pectoris (chest pain on exertion, in cold weather or
 emotional situations), acute chest pain: acute coronary syndrome,
unstable angina or myocardial infarction[4] ("heart attack", severe chest
pain unrelieved by rest associated with evidence of acute heart damage),
heart failure (difficulty in breathing or swelling of the extremities due to
weakness of the heart muscle), heartburn

McCance, K., Huether, S., Brashers, V.(2010). Pathophysiology: The biologic Basis for
Disease in Adultsand Children.6th Edition. Mosby Elsevier. Philadelphia

 Ischemic heart disease can be treated with organic nitrates, beta blockers,
calcium channel blockers, statins and aspirin.

White, C., Duncan, G., Baumle, W.(2013). Medical-Surgical Nursing: An Integrated

Approach. 3rd Edition.Delmar, Cengage Learning. United States of
America

 PROTEIN ENERGGY MALNUTRITION

 Protein–energy malnutrition (or protein–calorie malnutrition) refers to a

form ofmalnutrition where there is inadequate protein intake. It applies to a
group of related disorders that include marasmus, kwashiorkor, and
intermediate states of marasmus-kwashiorkor.

Retrieved on August 26, 2013 fromhttp://emedicine.medscape.com/article/1104623-

overview

 It is a type of undernutrition caused by poor intake of nutrients. Secondary

causes may be attributed to gastrointestinal problem such as indigestion
and malabsorption of nutrients as a result of disease entities.

White, C., Duncan, G., Baumle, W.(2013). Medical-Surgical Nursing: An Integrated

Approach. 3rd Edition.Delmar, Cengage Learning. United States of
America

 PEM is a compilation of some disease such as fever, tuberculosis,

malignancy, digestive andmalabsorption disorders and psychogenic
illness. Radiation therapy and chemotherapy also can contribute to PEM.
Acute and chronic malnutrition is common in hospitalized children.

McCance, K., Huether, S., Brashers, V.(2010). Pathophysiology: The biologic Basis for
Disease in Adultsand Children.6th Edition. Mosby Elsevier. Philadelphia