To deliver organized, relevant and logical

presentation in order to further understand and gain

extensive knowledge regarding the patient’s disease
condition.
• Discuss the case and the definition of the problems associated

• Recognize the contributing risk factors associated in the development of the disease

• Identify the different signs and symptoms that may be manifested by the patient having the

disease

• Understand the pathophysiology and etiology of the disease

• Describe the laboratory tests used and its results

• Know the role of drug therapy in managing the client with the disease

• Present the Nursing Care and Discharge Plan for the patient having the disease
Patient R.M.M., a 48-year-old Filipino male, born on November 19, 1971 in
Cebu City. He is a married man whom currently resides in Tambis St,
Banawa, Cebu City. The patient was admitted to the emergency department
of Southwestern University Medical Center on November 18, 2020 at 4:45 pm
with chief complaint of melena and dizziness. Admitting physician is Dr. Avila,
Charlie. Patient’s final diagnosis is Upper Gastrointestinal Bleeding secondary
to Duodenal Ulcer, Anemia Severe secondary to UGIB, Reflux Esophagitis
Grade A.
 UPPER GASTROINTESTINAL BLEEDING
SEC TO DOUDENAL ULCER

 Upper gastrointestinal bleeding includes hemorrhage originating from the esophagus

to the ligament of Treitz.
 Upper gastrointestinal bleeding is twice as common in men as in women
and increases in prevalence with age.
 It has been associated with increasing nonsteroidal anti- inflammatory
drug use and the high prevalence of Helicobacter pylori infection in
patients with peptic ulcer bleeding.
 CAUSES

 Peptic ulcer bleeding

Peptic ulcers are open sores that develop on the inside lining of your stomach and the
upper portion of your small intestine. PUD can be associated with NSAIDs, Helicobacter
pylori, and stress-related mucosal disease.

 Gastritis and Duodenitis

Gastritis is inflammation of your stomach lining. Duodenitis is
inflammation of the duodenum. The most common cause of gastritis
and duodenitis is a bacterium called Helicobacter pylori.
 CAUSES

 Esophageal varices
Esophageal varices are abnormal, enlarged veins in the tube that connects the throat
and stomach (esophagus). This condition occurs most often in people with serious liver
diseases.

 Esophagitis or esophageal ulcer

Esophagitis is an inflammation of the lining of the esophagus, the tube
that carries food from the throat to the stomach. If left untreated, this
condition can become very uncomfortable, causing problems
with swallowing, ulcers, and scarring of the esophagus.
 SIGNS AND SYMPTOMS
Signs and symptoms of GI bleeding can be either obvious (overt) or hidden (occult).
Overt bleeding might show up as:
 Vomiting blood, which might be red or might be dark brown and resemble coffee grounds in texture
 Black, tarry stool
 Rectal bleeding, usually in or with stool
With occult bleeding, you might have:
 Lightheadedness
 Difficulty breathing
 Fainting
 Chest pain
 Abdominal pain
 ANEMIA

 Anemia is a medical condition in which the red blood cell count or

the hemoglobin is less than normal.
 In men, anemia is typically defined as a hemoglobin level of less
than 13.5 gram/100 ml and in women as hemoglobin of less than 12.0
gram/100 ml.
 Anemia is caused by either a decrease in the production of red blood
cells (decreased erythropoiesis) or hemoglobin or an increase in
loss (usually due to bleeding) or the destruction of red blood cells.
 CAUSES

There are many types of anemia and no single cause.

The three main causes of anemia are:
 Blood loss
Iron-deficiency anemia is the most common type of anemia, and
blood loss is often the cause. A shortage of iron in the blood leads to
this form of the condition, and low iron levels frequently occur as a
result of blood loss.
 CAUSES

 Decreased or impaired RBCs

Bone marrow is soft, spongy tissue at the center of bones, and it plays an
essential role in creating RBCs. Problems with bone marrow can cause
anemia.

 Destruction of RBCs
One type of anemia that results from the destruction of RBCs is autoimmune
hemolytic anemia. It occurs when the immune system mistakes RBCs
for a foreign substance and attacks them.
 SIGNS AND SYMPTOMS

 The most common symptom of anemia is fatigue.

Other common symptoms include:

 Pale skin

 A fast or irregular heartbeat

 REFLUX ESOPHAGITIS

 defined as inflammation of the esophagus, which is the tube that

connects the throat to the stomach.
 an esophageal mucosal injury that occurs secondary to retrograde
flux of gastric contents into the esophagus.
 Clinically, this is referred to as gastro esophageal reflux
disease (GERD).
 CAUSES
Esophagitis can be caused by infection or irritation of the esophagus.
Infections of the esophagus can be caused by bacteria, viruses, or fungi,
including:
 Candida, a yeast infection.
This is more common in patients with weakened immune systems, such as those
with diabetes, HIV/AIDS, patients undergoing chemotherapy, or people who are
taking antibiotics or steroids.
 Herpes, a viral infection.
It may develop in the esophagus when the body's immune system is weak.
 CAUSES

 GERD (gastroesophageal reflux disease):

Weakness or dysfunction of the muscle that keeps the stomach closed (lower
esophageal sphincter) can allow stomach acid to leak into the esophagus
(acid reflux), causing irritation of the inner lining.
 Vomiting:
when vomiting is frequent or chronic it can lead to acid damage to the esophagus.
Excessive or forceful vomiting may cause small tears of the inner lining of the
esophagus (a rare condition called Mallory-Weiss syndrome [MWS]), leading
to further damage.
 SIGNS AND SYMPTOMS

 Bad breath (halitosis)  Hoarseness

 Acid reflux  An unpleasant taste in mouth
 Swallowed food becoming stuck  Mouth sores
 in the esophagus (food impaction)  Indigestion
 Sore throat  Heartburn
 Difficult and/or painful swallowing  Abdominal pain or indigestion
 PATHOPHYSIOLOGY OF
UPPER GASTROINTESTINAL
BLEEDING
PATHOPHYSIOLOGY OF
ANEMIA
PATHOPHYSIOLOGY OF
REFLUX ESOPHAGITIS
Activity: Rest as directed. Ask when you can return to your usual activities such as work and slowly do more each day
as tolerated.

Nutrition: Ask if you need to be on a special diet. A special diet can help treat GI conditions and prevent problems
such as GI bleeding. Eat small meals more often while your digestive system heals. Avoid or limit caffeine and spicy foods
also take into considerations foods that causes heartburn, nausea , or diarrhea.

Medication: Instruct and educate the patient and SO about medications regarding their use, dosage, timing,
advantages, contraindications, side effects and adverse effects. The patient and SO should report any symptoms of
adverse effects if there are any abnormal behaviors being experienced. The patient must adhere to the following
medications:
1. Omeprazole (Pantor) 40 mg/cap 1 cap PO once a day 30 mins to 1 hr before breakfast for 2 months
2. Clarithromycin 500 mc/cap 1 cap PO 2x/day (8am; 6pm) after meals for 10 days
3. Amoxicillin 500mg/cap 2 caps PO 2x/day (8am; 6pm) after meals for 10 days
4. Rebamippide (Mucosta) 100mg/tab 1 tab PO 3x/day (8am; 1pm; 6pm) for 14 days
Environment: Make sure that the environment is clean and must be a good place to stay. Homemaking

services and emotional and economic support systems are in place.

Treatment: Encourage patient to have a special diet to help treat GI conditions and prevent problems such

as GI bleeding. Make sure that the family and patient knows the purpose and action of their treatment.

Emphasize the importance of home medications prescribed by the physician.

Health Teaching: The patient and the family is taught how to administer drugs and treatments when

necessary. Instructed the patient and his family to monitor vital signs at all times and avoid strenuous

activities. Isolation for about 14 days upon arrival. The patient will be able to identify and report signs and

symptoms of potential health problems as well as drug and treatments side effects.
Outpatient Referral: The patient and family members must have available telephone numbers of

referred physicians and agencies. A written discharge will be provided. It will be reviewed and explained to

the patient and family. Follow up care in Dr. Avila’s clinic in Adventist Hospital (Miller Hospital) on December

2, 2020 with all repeat laboratory results will be arranged. The patient will be informed the time, date, and

location of appointments given by the physician.

Spiritual: Provide emotional support coming from the family. Emphasize the importance of hope for

longevity of life, growth through developing spiritual assessments from chosen religion, culture, belief, or

organizations and pray accordingly to the patient needs.

Evaluation: The patient and SO verbalized understanding of instructions and health teachings given by

the nurse.