A Case Study on a Patient Diagnosed with Peptic Ulcer

Presented to the faculty of USJ-R College of Nursing

In partial Fulfillment of the requirement in Related Learning Experience

(Female Medical Ward/ Eversley Child Sanitarium)

Ms. Lavenia Caballero, R.N

Clinical Instructor

Negrin, Jo Vincent M._____ 

Student

University of San Jose – Recoletos

 College of Nursing

Cebu City

Nursing Health History and Assessment Guide

I. Objectives

 The USJ-R CN has the fallowing

fallowing objectives for
for the RLE (Related Learning
Learning
Experience) in Eversley Child Sanitarium, Female Medical Ward: within the
inclusive dates of: December

Student

- Utilize
Utilize the
the nursing
nursing to arrive
arrive at an
an appropri
appropriate
ate plan
plan of care
care for
for a given
given
client.

- Practices
Practices therapeuti
therapeutic
c communi
communicatio
cation
n techni
techniques
ques in elici
eliciting
ting data from
the client.

- Creat
Creates
es thera
therapeu
peutic
tic mili
milieu
eu for
for the clie
client’
nt’s
s optima
optimall being
being..

- Designs an appropriate plan of care reflective of the integration of 

various theories to promote the clients optimal functioning and its
relationship with behavioral manifestations.
manifestations.

Clients

- Carrie
Carries
s out
out of ADL with
with mini
minima
mall Assi
Assista
stance
nce..

- Develops
Develops social
social and interp
interperson
ersonal
al skills
skills as they
they relate
relate to the staff
staff and
other patients.

- Improv
Improves
es on the use of commun
communica
icatio
tion
n skil
skills.
ls.

- Learns
Learns the
the value
value of liste
listening
ning to others
others and openly
openly shari
sharing
ng import
important
ant
things about oneself.

- Gains insight into the root causes of the conditional.

- Revise
Revisess her viewp
viewpoin
ointt of herself
herself towar
towards
ds achie
achievin
ving
g accepta
acceptance
nce of 
herself and a more positive self-view.

II.
II. Intr
Introd
oduc
ucti
tion
on

Ulcers are crater-like sores (generally 1/4 inch to 3/4 inch in diameter, but
sometimes 1 to 2 inches in diameter) which form in the lining of the stomach
(called gastric ulcers), just below the stomach at the beginning of the small
intestine in the duodenum (called duodenal ulcers) or less commonly in the
esophagus (called esophageal ulcers).

In general, ulcers in the stomach and duodenum are referred to as peptic ulcers.
 Causes/Risk Factor

 The stomach defends itself from hydrochloric acid and pepsin by creating a mucus
coating (that shields stomach tissue), by producing bicarbonate and by circulating
blood to the stomach lining to aid in cell renewal and repair. If any of these functions
are impaired it can lead to the formation of an ulcer.

 The primary cause of ulcers is the bacterium called Helicobacter pylori (H. pylori). H.
 pylori is a spiral-shaped bacterium found in the stomach. Unlike other bacterium, H.
 pylori is able to twist through the layer of mucous that protects the stomach cavity
and attach to cells on the surface of the stomach wall, where it produces urease, an
enzyme that generates ammonia.

Urease generates substances that neutralize the stomach's acid and allows H. pylori
to thrive. H. pylori weakens the stomach's defenses by thinning the mucous coating
of the stomach, making it more susceptible to the damaging effects of acid and
pepsin; inflaming the area; poisoning nearby cells and producing more stomach acid.

Although H. pylori is the primary cause of ulcers, there are other factors that play a
role in ulcer development. These factors are the use of nonsteroidal anti-
inflammatory drugs (NSAIDs), a person's lifestyle and the stomach's inability to
defend itself against digestive fluids, hydrochloric acid and pepsin.

NSAIDs such as aspirin, ibuprofen (Motrin, Advil, Nuprin), naproxen (Naprosyn,

Anaprox), or piroxicam (Feldene) interfere with the stomach's ability to produce
mucus and bicarbonate (a chemical produced in the stomach that neutralizes and
breaks down the hydrochloric acid and pepsin into substances less harmful).

NSAIDs also affect blood flow to the stomach, hinder cell repair and cause the
stomach's defense mechanisms to fail.

Lifestyle factors such as smoking, drinking caffeine, consuming alcohol and stress are
also associated with ulcers.

Smoking slows the healing of ulcers and makes them likely to recur.

Caffeine stimulates acid secretion in the stomach, thus aggravating the pain of an
existing ulcer.

Studies on alcohol consumption and ulcers have been less conclusive, although
alcoholic cirrhosis has been linked to an increased risk of ulcers, and heavy drinking
has been shown to delay the healing of ulcers.

Although emotional stress is no longer thought to be a cause of ulcers, people with

ulcers often report that emotional stress increases ulcer pain. However, physical
stress increases the risk of  developing gastric ulcers.

Signs and Symptoms

 There may be no symptoms of ulcers or the individual may experience:

• A gnawing or burning pain in the abdomen between the breastbone and the
navel. The pain is usually worse a couple of hours after a meal or in the
middle of the night when the stomach is empty.
• Nausea
• Vomiting
• Loss of appetite
• Loss of weight
•  Tiredness (a symptom of a bleeding ulcer)
• Weakness (a symptom of a bleeding ulcer)
• Blood in vomit or stool. When blood is in the stool, it appears tarry or black
(symptom of a bleeding ulcer).
 Epidemiology / Statistic

Prevalance of Peptic Ulcer: 5 million in the USA 1987 (Digestive diseases in the
United States: Epidemiology and Impact – NIH Publication No. 94-1447, 1994)

Prevalance Rate: approx 1 in 54 or 1.84% or 5 million people in USA [about data]

Incidence (annual) of Peptic Ulcer: 3.7 million annually

Incidence Rate: approx 1 in 73 or 1.36% or 3.7 million people in USA [about data]

Incidence extrapolations for USA for Peptic Ulcer: 3,699,999 per year, 308,333
per month, 71,153 per week, 10,136 per day, 422 per hour, 7 per minute, 0 per
second. Note: this extrapolation calculation uses the incidence statistic: 3.7 million
annually

Lifetime risk for Peptic Ulcer: 1 in 10 Americans over lifetime

Prevalance of Peptic Ulcer: 5 million people (1987) (Source: excerpt from

Digestive Diseases Statistics

Diagnosis

Doctors have a number of options available for diagnosing ulcers, such as performing
endoscopic and x-ray examinations, as well as testing for H. pylori. Endoscopy is a
diagnostic procedure that gives the doctor a direct view of the upper digestive tract
from within the body itself. By means of an instrument called a fiber-optic endoscope,
the doctor is able to illuminate and follow the same path that food takes, examining
the esophagus, stomach and duodenum from within. Along the way, the doctor will
look closely at inflamed, ulcerated or infected areas, as well as growths and
malformations.

If the doctor suspects ulcers, an upper GI (gastrointestinal) series (x-rays) of the

esophagus, stomach and duodenum will usually be performed. The patient will
swallow a chalky liquid that contains barium, which makes the ulcer visible on the x-
ray.

 The doctor may also order a gastroscopy, in which a flexible tube-shaped device with
a special light-conducting properties will be put down the throat to enable the doctor
to see the ulcer and obtain tissue samples for microscopic examination to determine
if the ulcer is cancerous.

Confirming the presence of  H. pylori is important in diagnosing an ulcer because

elimination of H. pylori is likely to cure the ulcer. H. pylori can be detected using a
blood, breath or tissue test. The blood test uses a blood sample to identify and
measure H. pylori antibodies. Approved in 1996, the Meretek UBT Breath Test
requires that a person first drink a liquid or swallow a capsule containing a small
amount of a protein. The person is then asked to blow through a straw into a balloon.
A lab technician checks the exhaled air for evidence of the H. pylori bacteria. If the
doctor previously performed an endoscopy, the tissue obtained through that
procedure is cultured and watched for growth of  H. pylori organisms.

Medical Treatment

Along with reducing stress and modifying lifestyle, doctors treat gastric and duodenal
ulcers with several types of medicines, including H2-blockers, proton-pump inhibitors
and mucosal protective agents. When treating H. pylori, these medications are used
in combination with antibiotics. If medication is ineffective or complications arise,
surgery may be required.

Medications

H2-blockers reduce the amount of acid that the stomach makes. These medicines
include cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid) and nizatidine
(Axid). A single bedtime dose starts healing a duodenal ulcer in four weeks and a
gastric ulcer in six to eight weeks.
Proton-pump inhibitors modify the stomach's production of acid by stopping the
stomach's acid pump - the final step of acid secretion. The recently approved and
now available drug, omeprazole (Prilosec), is 10 times more powerful in suppressing
stomach acid production than the H2-blockers, able to promote duodenal ulcer
healing in two to four weeks. This potent acid-inhibitor can suppress about 95
percent of stomach acid production. It is especially useful for treating people whose
ulcers fail to respond to H2-receptor blockers or other medications and those with
Zollinger-Ellison syndrome.

Mucosal protective agents protect the stomach's mucous lining from acid. The
prescription medications are sucralfate (Sulcrate or Carafate) and misoprostol
(Cytotec). The non-prescription medications are antacids (such as Tums and Rolaids)
and bismuth subsalicylate (Pepto-Bismol).

 Antibiotics. With the discovery of the link between ulcers and H. pylori peptic ulcers
can be treated by a short course of combined high dose antibiotic therapy rather
than acid-suppression alone. Without antibacterial therapy, there is a 75 percent
chance of the ulcer reoccurring. With antibacterial therapy, there is a 1 percent
chance of the ulcer reoccurring. There are two types of combination therapies
currenly being used: triple therapy and dual therapy.

Surgery

 The most common types of surgery for ulcers are vagotomy, antrectomy and
pyloroplasty.

Vagotomy involves cutting the vagus nerve that transmits messages from the brain
to the stomach. This interruption reduces acid secretion.

 Antrectomy removes the lower part of the stomach (antrum) which produces a

hormone that stimulates the stomach to secrete digestive juices. This enlarges the
opening into the duodenum and small intestine (pyloris), enabling contents to pass
more freely from the stomach.

Pyloroplasty may be performed with a vagotomy.

Nursing Responsibilities and Preventive Measures

III. Client Profile

Date of Assessment: December 9, 2009 Time: 9:00

am

Room /Ward & Bed #: Female Ward Bed # 10

A case of Beltran , Rommula 84 years old female, roman catholic , widowed,

currently residing at Maguikay, Mandaue City, Cebu, was born on November 4,
1925, was admitted last December 5, 2009 at Eversley Child Sanitarium
Female Ward due to Peptic Ulcer.

Past Medical History

She was immunized by BCG, AMV, Hep B and OPV

Previous Hospitalization

Her previous hospitalization when she was still 18 years old and got 3 rd degree
burns on her right arm and was admitted at VSMMC for 2 months.
 Past Illness

She doesn’t have any illnesses except aching of the stomach.

Environmental History

 They owned their house and also their lot, and their house was made of light
materials, and the no. of storey they had is only one and their house is located
near the mountain, and the type of toilet they used is flushed type, and they
have living room, and a bedroom and their kitchen was located outside their
house. And she lives together with her grandparents and aunties because
when she was still small her parents died.

 Their drainage system was open and they disposed their garbage by means of 
burning it, they have electricity on their house and the type of water they
used is type 2 or the artesian well, they have domestic animals like cats and
dogs and they don’t have health centers and the location of their market was
too far from their house, and their church was located near their house.

Perception to Place

She said that the place was so hot and the people were too noisy.

IV. Gordon’s Functional Health Pattern

1. Health Perception / Health Management

- From 1-10 she rates her health is 4

- From 1-10 again she rates the importance of her health 8

- She actually had her medical checked-up when she was 80 and due to
aching of the stomach

Perceived ability to control and manage health:

- Health center are present but not commonly used because of the far
distance to their house. She never uses any seat belt because they
don’t have a car, she never drink alcoholic beverages and never
smoke. She said she feels alright because she drinks her medicine. She
took multivitamins regarding with her condition. She never performs
BSE but as far as my assessment to her she said she doesn’t have any
masses or lumps on her breast. She is fond of hilot or massaging. And
usually uses herbal medicine.

2. Nutritional-Metabolic

- She eats 3 times a day breakfast, lunch and dinner and she drinks 5-6
glasses of water a day.Their usual time for breakfast is around 9:00
am, for lunch time its around 12:00 pm and for the dinner it stars
around 6:00-7:00 pm, they just eat when they feel like hungry around
3:00 pm, their usual foods are rich in carbohydrate and protein like for.
She usually likes to eat bread together with coffee. She doesn’t have
 dislikes regarding with foods she eats whatever food is it. She doesn’t
have any problem with her appetite, she never had dental check-ups
but she merely had dental problems. She weight 155 kilograms before
but today she weight 160 in kilograms and stands 5’3’’, she never had
problems in swallowing and masticating foods.

3. Elimination

- She voids 4 times a day and with the color of pale yellow, and she
defecate every morning and the amount of feces is equivalent to a one
cup and without any difficulty in defecating, and with color of light
brown semi-formed. She sweats whenever she feels hot and tense.

4. Activity-Exercise

- Her usual activity first in the morning she wake up around 5:30 and go
to their bathing area and bath herself and second she goes to their
eating area and next she eats her breakfast and then after it she will
clean the house and with all those activity she finds time to mingle
with the neighbor, But during the afternoon she just sleep or watch
television or chit chat with their other people.

- She doesn’t have any problem regarding with her activity of daily
living, she can perform ambulation, bathing dressing up her self,
toileting and last feeding only herself without the help of the
caretakers or any student nurse, but she had difficulty in breathing
somehow during activity and fatigue as well, that’s why she got this
disease

5. Sleep-Rest

- She sleeps around 8:00-9:00 pm in the evening and wakes up at

around 5:30 am without any problems in falling asleep and staying
asleep, and she had her nap at 1:00 pm, and never uses any sleeping
aids and sleeping regimens.

6. Cognitive-Perceptual

- She can understand every words I say but the thing is she always had
this verbigeration, self rating of intelligence around 1-10 she rate
herself 6 out of 10, she merely can communicate to me.

- She never uses eyeglasses and hearing aids, she can identify whether
its painful or not, she can identify smells whether its bad or not, she
can speak clear but sometimes slurry, she can identify whether its
rough or smooth, when I interviewed her she narrated everything
about her and when I saw the chart it coordinates with her narration
about herself, so she merely have long-term memory but with the
disorder she had she cant merely remember some other things about
her.

7. Sexuality-Reproductive

Level of Satisfaction with male/female role:

- She had her menarche at the age of 11 yrs. old and her menstrual
period is regular, she had her menopause, and the onset of her
 thelarche was at the age of 9, , she sometimes experienced
dysmenorrhea but she just don’t care about it.

- She never had complications during pregnancy

2. Self-Perception / Self-Concept

Description of Self:

- Her strengths are those people she love, like her sons and daughters
her weaknesses are those things she never didn’t get and those people
who always makes her feel down. Her major concern is all about her
health she wants to get out in the hospital to experienced a healthier
life..

Body image and feelings about self:

- She thinks that she’s beautiful because of she married the right man.
She had a beautiful life because of her children

3. Role-Relationship

- Her role in their family is the harmonizer because she always

harmonized whenever there is chaos in their family

Interpersonal relationship within the family:

- She was close to her family.

Support system within the family:

- Not assessed

Family Related problems:

- Financial crisis is their primary source of problem.

Problems at work:

- She always do the household chores.

Societal relationship:

- She wants to mingle with other people and chit chat with them, but the
most important person in her life was her sons and daughter. She was
the only girl in the family.

GENOGRAM – Not Assessed

4. Coping & Stress Tolerance

- She decides for herself. Her minor stressor is that when she cannot do
what she wants to do, To cope up with stress. But now, he usually
would watch television, sleep and listen to music. Sometimes she
would just go out and enjoy herself with the passers-by. She would
chat to her neighbors and also gossip.
5. Values & Belief 

-  The most important value for her to be kind to others and love all
people. She perceives the most important thing in life is to love and to
be love by a person. The source of her strength are those people she
loved. She value her religion the most because she always pray that
god would guide her. The value belief conflicts related to her health is
that she can’t eat at the right time because she might get tired. And
regarding with her religious practices she will pray before she eats and
pray before she sleeps.
Anatomy and Physiology

 The stomach is located in the upper part of the abdomen just beneath the
diaphragm (Figure 1). The stomach is distensible and on a free mesentery,
therefore, the size, shape, and position may vary with posture and content. An
empty stomach is roughly the size of an open hand and when distended with
food, can fill much of the upper abdomen and may descend into the lower
abdomen or pelvis on standing. The duodenum extends from the pylorus to the
ligament of Treitz in a sharp curve that almost completes a circle. It is so
named because it is about equal in length to the breadth of 12 fingers, or
about 25 cm. It is largely retroperitoneal and its position is relatively fixed. The
stomach and duodenum are closely related in function, and in the
pathogenesis and manifestation of disease.

 The stomach may be divided into seven major sections. The cardia is a 1–2 cm
segment distal to the esophagogastric junction. The fundus refers to the
superior portion of the stomach that lies above an imaginary horizontal plane
that passes through the esophagogastric junction. The antrum is the smaller
distal one-fourth to one-third of the stomach. The narrow 1–2 cm channel that
connects the stomach and duodenum is the pylorus. The lesser curve refers to
the medial shorter border of the stomach, whereas the opposite surface is the
greater curve. The angularis is along the lesser curve of the stomach where
the body and antrum meet, and is accentuated during peristalsis (Figure 2).

 The duodenum extends from the pylorus to the ligament of Treitz in a circle-
like curve and is divided into four portions. The superior portion is
approximately 5 cm in length, beginning at the pylorus, and passes beneath
the liver to the neck of the gallbladder. The first part of the superior portion (2–
3 cm) is the duodenal bulb. The descending or second part of the duodenum
takes a sharp curve and goes down along the right margin of the head of the
pancreas. The common bile duct and the pancreatic duct enter the medial
aspect of this portion of the duodenum at the major papilla either separately or
together. The duodenum turns medially, becoming the horizontal portion, and
passes across the spinal column, inclining upward for 5–8 cm. The ascending
portion begins at the left of the spinal column, ascending left of the aorta for
2–3 cm, and ends at the ligament of Treitz, where the intestine angles forward
and downward to become the jejunum.
Protective vs. Hostile Factors

“No gastric acid, no peptic ulcer” is a misconception. Excessive gastric acid secretion
is only one factor in the pathogenesis of peptic ulcer disease. Decreased mucosal
defense against gastric acid is another cause. The integrity of the upper
gastrointestinal tract is dependent upon the balance between “hostile” factors such
as gastric acid, H. pylori, NSAIDs and pepsin, and “protective” factors such as
prostaglandins, mucus, bicarbonate, and blood flow to mucosa affecting

gastrointestinal
mucosa (Figure 3).

Figure 3. A, Protective factors; B, hostile factors.

Injury to gastric and duodenal mucosa develops when deleterious effects of gastric
acid overwhelm the defensive properties of the mucosa. Inhibition of endogenous
prostaglandin synthesis leads to a decrease in epithelial mucus, bicarbonate
secretion, mucosal blood flow, epithelial proliferation, and mucosal resistance to
injury. Lower mucosal resistance increases the incidence of injury by endogenous
factors such as acid, pepsin, and bile salts as well as exogenous factors such as
NSAIDs, ethanol and other noxious agents (Figure 4).

Helicobacter pylori

H. pylori is the etiologic factor in most patients with peptic ulcer disease and may
predispose individuals to the development of  gastric carcinoma. H. pylori colonizes in
the human stomach (Figure 5). The method of H. pylori transmission is unclear, but
seems to be person-to-person spread via a fecal-oral route. The prevalence of H.
pylori in adults appears to be inversely related to the socioeconomic status. It is also
thought that water is a reservoir for transmission of H. pylori.

Figure 5. A, H. pylori resident on the gastric epithelium; B, electron

micrograph.

H. pylori is prevalent among 22–63% of patients taking NSAIDs. Most studies do not
show a significant difference in H. pylori prevalence between NSAID users and
nonusers. Gastritis in patients on NSAID therapy appears to be related to underlying
H. pylori rather than drug use. The lower incidence of H. pylori among patients with
gastric ulcers than those with duodenal ulcers is presumably the result of NSAID use.
NSAIDs are more likely to cause gastric than duodenal ulcers. NSAIDs appear to
cause ulcers by a mechanism independent of H. pylori based on the inhibition of 
prostaglandin synthesis.

Gastrinoma (Zollinger-Ellison Syndrome)

 The classic triad of Zollinger-Ellison syndrome involves peptic ulcers in unusual

locations (i.e., the jejunum), massive gastric acid hypersecretion, and a gastrin-
producing islet cell tumor of the pancreas (gastrinoma). Gastrinoma in the pancreas
appears in approximately 50% of patients. Another 20% of patients have it in the
duodenum and others have it in the stomach, peripancreatic lymph nodes, liver,
ovary, or small-bowel mesentery.

Zollinger-Ellison syndrome accounts for only 0.1% of all duodenal ulcer disease. One
fourth of patients have this syndrome as part of the multiple neoplasia syndrome
 Type I (MEN I).

Patients with gastrinoma may have intractable ulcer disease. Because gastrin is
trophic to the gastric mucosa, endoscopy or x-ray may demonstrate hypertrophy of 
the gastric rugae. Patients may also experience diarrhea (including steatorrhea from
acid inactivation of lipase) and gastroesophageal reflux. These symptoms are
episodic in 75% of patients.

Hypercalcemia

Hypercalcemia has a direct bearing on the gastric acid hypersecretory state found in
patients with Zollinger-Ellison syndrome and MEN I. Intravenous calcium infusion in
normal volunteers induces gastric acid hypersecretion. Additionally, calcium has
been demonstrated in vivo and in vitro to stimulate gastrin release directly from
gastrinomas. Resolution of hypercalcemia (by parathyroidectomy) reduces the basal
acid output and serum gastrin concentration in fasting gastrinoma patients and those
with MEN I, suggesting that resolution of hypercalcemia plays an important role in
the therapy of this subgroup of patients.

Genetic Factors

Genetic factors play a role in the pathogenesis of ulcer disease. The lifetime
prevalence of developing ulcer disease in first-degree relatives of ulcer patients is
about three times greater than the general population. Approximately 20–50% of 
duodenal ulcer patients report a positive family history; gastric ulcer patients also
report clusters of family members who are likewise affected.

Smoking

 The literature reveals a strong positive correlation between cigarette smoking and
the incidence of ulcer disease, mortality, complications, recurrences and delay in
healing rates. Smokers are about two times more likely to develop ulcer disease than
nonsmokers. Cigarette smoking and H. pylori are co-factors for the formation of 
peptic ulcer disease. There is a strong association between H. pylori infection and
cigarette smoking in patients with and without peptic ulcers. Cigarette smoking may
increase susceptibility, diminish the gastric mucosal defensive factors, or may
provide a more favorable milieu for H. pylori infection.

Stress

Numerous studies have revealed conflicting conclusions regarding the role of 
psychological factors in the pathogenesis and natural history of peptic ulcer disease.
 The role of psychological factors is far from established. Acute stress results in
increases in pulse rate, blood pressure and anxiety, but only in those patients with
duodenal ulcers did acute stress actually result in significant increases in basal acid
secretion. There is no clearly established “ulcer-type” personality. Ulcer patients
typically exhibit the same psychological makeup as the general population, but they
appear to perceive greater degrees of stress. In addition, there is no evidence that
distinct occupational factors influence the incidence of ulcer disease.

Alcohol and Diet

Although alcohol has been shown to induce damage to the gastric mucosa in
animals, it seems to be related to the absolute ethanol administered (200 proof).
Pure ethanol is lipid soluble and results in frank, acute mucosal damage. Because
most humans do not drink absolute ethanol, it is unlikely there is mucosal injury at
ethanol concentrations of less than 10% (20 proof). Ethanol at low concentrations
(5%) may modestly stimulate gastric acid secretions; higher concentrations diminish
 acid secretion. Though physiologically interesting, this has no direct link to
ulcerogenesis or therapy.

Some types of food and beverages are reported to cause dyspepsia. There is no
convincing evidence that indicates any specific diet causes ulcer disease.
Epidemiologic studies have failed to reveal a correlation between caffeinated,
decaffeinated, or cola-type beverages, beer, or milk with an increased risk of ulcer
disease. Dietary alteration, other than avoidance of pain-causing foods, is
unnecessary in ulcer patients.

VII. Pathophysiology of Peptic Ulcer Disease

A peptic ulcer is a sore in the lining of your

stomach or duodenum.

Predisposing Factors:
Stomach acids
Genetic factors (hydrochloric acid and
Stomach or
pepsin) contributed to
Increasing age
the majority of ulcer
Alcohol abuse formation. Today,
however, research
Lifestyle factors, shows that most
including chronic stress, Dx. Test: ulcers develop as a
coffee drinking (even result of infection with
- Gastroscopy a bacterium called
decaf), and smoking,
- Endoscopy
Diabetes may increase - Upper
your risk of having H. gastrointestinal Nursing
pylori (GI) series Interventions:
- Barium meal x-ray
- Blood H pylori test 1. Assess, report , and
- Breath H pylori test record signs and
- Helicobacter pylori symptoms and
stool antigen (HpSA) reactions to
test treatment.
- Stomach bio s
2. Monitor fluids input
and output closely.

3. Administer antacid
Signs and Symptoms:
agents, analgesics,
Medical H2-receptors
Interventions: I. abdominal pain, classically antagonists,
epigastric with severity relating to anticholinergics,
mealtimes, after around 3 hours of 
sedatives as
taking a meal (duodenal ulcers are
Surgery classically relieved by food, while prescribed, monitor
gastric ulcers are exacerbated by for side effects.
it);
Medications
II. bloating and abdominal fullness; 4. Monitor client’s
III. waterbrash (rush of saliva after an vital signs and signs
episode of regurgitation to dilute of possible GI
the acid in esophagus);
bleeding or
IV. nausea, and copious vomiting;
V. loss of appetite and weight loss; perforation closely.
VI. hematemesis (vomiting of blood);
this can occur due to bleeding 5. Monitor laboratory
directly from a gastric ulcer, or tests results (CBC,
from damage to the esophagus electrolytes, Hb
from severe/continuing vomiting. levels) for abnormal
VII. melena (tarry, foul-smelling feces values.
due to oxidized iron from
hemoglobin); 6. Undertake
VIII. rarely, an ulcer can lead to appropriate
a gastric or duodenal perforation.
intervention in case of 
GI bleeding, vomiting,
or perforation.

7. Provide prescribed
diet – avoid irritating
foods, coffee, etc.

8. Prepare client and

 Complications:

Bleeding

Perforation

Narrowing and obstruction

Cancer

Bibliography:

Peptic Ulcer - A Medical Dictionary, Bibliography, And Annotated

Research Guide To Internet References(Paperback - Sep 2004)
by Icon Health Publications, Icon Health PublicationsWrite a Review

Peptic Ulcer Medical Guide (Paperback)

~ Qontro Medical Guides (Author)

50 Ways to Relieve Heartburn, Reflux, and Ulcers (English)

ISBN: 9780737304725 Publisher: McGraw-Hill

Healthy Digestion the Natural Way

Preventing and Healing Heartburn, Constipation, Gas, Diarrhea,
Inflammatory Bowel and Gallbladder Diseases, Ulcers, Irritable
Bowel Syndrome, Food all - ISBN: 9780471349624
Publisher: John Wiley & Sons Inc

Mayo Clinic on Digestive Health

Publisher: Mayo Clinic Proceedings / Published Date: April 2004

Good Food for Bad Stomachs (English)

ISBN: 9780195126556 Publisher: Oxford Univ Pr / Published Date:
November 1998
Learning Insights:

Nowadays in our society having a dreadful disease is a burden in our

part and as well as in our family, we cant deny the fact that with a

disease that is not well initiated in our mind, that we cant accept

that we have this kind of illness is not so easy to handle with, and

being admitted in the hospital is such a strenuous part in our selves,

I as a nurse should have a lot of patience in dealing with these kind

of patient I know that this is so hard for them, like my patient who

was diagnosed with a peptic ulcer disease, she cant merely accept

that she was admitted in the hospital and suspected to have this

kind of illness she just thought that it was an ordinary stomach

ache, but as time goes by she can feel the pain that is penetrating

her whole body, she merely wants to die rather than experiencing

this terrifying disease. I do understand this kind of patient, I have

learned that u should take good care of yourself eat a lot of healthy

foods don’t starved yourself to death because this is one of the

manifestation of having peptic ulcer, don’t drink to much alcohol,

and don’t stress up yourself. Live a healthy life.

 Discharge Plan

OBJECTIVES NURSING INTERVENTIONS

MEDICATION
Advise SO to facilitate will patient is at
•

•   To be aware of the importance of his home in taking his prescribed medications.

medications Inform SO the actions of each medicines.
•

•   To take his medications regularly as Discuss the importance of taking the

•

prescribed by his physician drugs.

Discuss the possible contraindications
•

and side effects on the drugs.

ENVIRONMENT
• To stay in a calm and stress free
environment
•   To provide a surrounding conducive to
rest or sleep and recovery
• Advise SO to minimize noise in the area
while at home
• Advise SO to provide the client a properly
tucked bed for comfort
• Keep the room of the patient clean and
well ventilated
• Keep the patient away from influential
neighbors who smokes and drinks

 TREATMENT
• Encourage the patient to have regular
•  To visit the rural health center for vital vital signs taking
signs check up and monitoring for untoward Explain the importance of vital signs
•

symptoms observed
monitoring
•   To have a regular check up to asses • Advise patient not to mingle friends who
patient if there are any improvements smokes and drinks
in health • Encourage patient to take his medication
on time
• Discuss the harmful effects of not taking
or skipping the medicine

• Advise patient to have adequate

HEALTH TEACHING
sleep,exercise and balanced diet
•  Teach the client proper hand washing
•  To obtain optimum health
• Instruct the client to take a bath everyday
•  To promote proper hygiene
• Discuss the action of drugs taken to the
•  To discuss the action of drugs taken
patient's body

OBSERVATION • Advised the patient to call or refer

immediately to the physician for any
unusualities
• Be able to identify danger signs of his
current situation • Instruct the patient and SO what to do if 
unusualities arise
•  To know relevant signs and symptoms of 
pulmonary tuberculosis
DIET
•  To follow the prescribed diet given.
SPIRITUAL
•   To believe in the miraculous healing
power of God for his early recovery
•   To establish a close companionship and
bonding to his family
Complete Blood Count
• Instruct the patient to eat healthy foods
such as dark green leafy vegetables and
fruits. To limit intake of meat.
• Advise patient to refrain from alcoholic
beverages and from smoking.
• Encourage patient to attend mass
• Advise patient to pray in the morning
upon waking up and in the evening before
sleeping
• Advise the SO to pray together with the
client
 HEMATOLOGY PATIENT'S NORMAL VALUES INTERPRET CLINICAL
RESULT ATION SIGNIFICANCE
WBC 12,200/cu. mm 4,800-10,800/cu. mm High Increased no. of WBC
indicates:
• Infection
• Inflammation
•  Trauma

Decreased no. of WBC

would indicate:
• Autoimmune
• Drug toxicity
• Bone marrow
failure
RBC 6.2 4.7-6.1 Normal Increased no. of RBC
indicates:
• stress
• Acute infection

Decreased no. of RBC

would indicate:
• Plastic anemia
• Dietary
deficiency

Platelet 244,000 /cu. 140,000-440000/cu. Normal Increased no. of  

mm mm platelet indicates:
• malignant
disorder
• polycythemia
• rheumatoid
arthritis
• Iron deficiency
anemia

Decreased no. of  
platelet would
indicate:
• Hemorrhage
• Leukemia
• Pernicious
Anemia
• Hemolytic
Anemia
• Chemotheraph
y

Hemoglobin 18.0 mg/dt 14-18 mg/dt Normal Increased no. of  

Hemoglobin indicates:
• polycythemia
• Dehydration
• COPD

Decreased no. of  
Hemoglobin would
indicate:
• hemorrhage
• anemia
• Cancer
• Kidney disease
• Sickle cell
anemia

Hematocrit 54 41-53 Normal Increased no. of  

Hematocrit indicates:
• Polycythemia
• Dehydration
• COPD

Decreased no. of  
Hematocrit would
indicate:
• hemorrhage
• anemia
• Hyperthyroidis
m
• Dietary
deficiency

Cholesterol 31 mg/dl 35-55 mg/dl Normal High cholesterol would