Chapter 46, Management of Patients With Gastric and Duodenal Disorders

1. A 70-year-old woman is diagnosed with chronic H. pylori gastritis after experiencing fatigue,
mild epigastric discomfort, anorexia, and occasional nausea for several months. She is started
on treatment for H. pylori with triple therapy, including amoxicillin (Amoxil), clarithromycin
(Biaxin), and omeprazole (Prilosec). The patient asks you if taking these medications will be
successful in treating her infection.
a. How would you respond to this patient?
The nurse would begin with education about H. pylori infection. Explain to the patient
that H. pylori is a bacterium that colonizes the gastric mucosa. H. pylori infection is a
major risk factor for the development of gastric cancer. The introduction of antibiotics to
eradicate H. pylori and of H2 blockers as treatment for ulcers has greatly reduced the need
for surgical intervention.
The most commonly used therapy for peptic ulcers is a combination of antibiotics, proton
pump inhibitors, and sometimes bismuth salts that suppress or eradicate H. pylori.
Recommended combination drug therapy is typically prescribed for 10 to 14 days and
may include triple therapy with two antibiotics. She has been prescribed a triple
combination with two antibiotics.
Amoxil is a bactericidal antibiotic that assists with eradicating H. pylori bacteria in the
gastric mucosa. Biaxin exerts bactericidal effects to eradicate H. pylori bacteria in the
gastric mucosa.
Prilosec decreases gastric acid secretion by slowing the H+, K+-ATPase pump on the
surface of the parietal cells.

b. On what evidence do you base your response?

The students may base their response based on evidence of information from the
following resources:
 American Cancer Society (ACS). (2015a). Stomach cancer. Retrieved on 5/5/2016
at: www.cancer.org/cancer/stomachcancer/
 Epelboym, I., & Mazeh, H. (2014). Zollinger-Ellison syndrome: Classical
considerations and current controversies. The Oncologist, 19(1), 44--55.
 Fock, K. M. (2014). The epidemiology and prevention of gastric cancer.
Alimentary Pharmacology & Therapeutics, 40(3), 250–260.

2. A 55-year-old female patient returns to your unit following a partial gastrectomy for the
treatment of gastric cancer. Upon admission, she is awake, alert, and oriented. Her pain level
is 2 (on a 0 to 10 numeric pain scale). She denies nausea. Her blood pressure is 128 /78 mm
Hg, heart rate is 98 bpm, respiratory rate is 16 breaths/min and regular, and temperature is
36.7°C (98.1°F). Her nasogastric (NG) tube is patent and draining scant amounts of bloody
secretions. Two hours later, you observe that her NG tube has drained 200 mL of bright red
blood.
a. What is your first nursing action?

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 The presence of 200 mL of bright red NG drainage after surgery indicates possible
postoperative hemorrhage, and immediate actions such as blood transfusion and/or return
to surgery are needed. The physician is notified immediately. Because the patient could
go into hypovolemic shock, rapid response may be activated.

b. Describe the priorities of care for this patient.

Monitor airway, breathing, and circulation. Administer oxygen as ordered. Maintain an
IV line for fluids. Take the blood pressure and pulse then remaining vital signs.

3. You are caring for a 67-year-old man with chronic lower back pain who was recently
diagnosed with peptic ulcer disease. As you are providing discharge education, the patient
asks if he can continue to take ibuprofen (Motrin) to manage his lower back pain.
a. How would you respond to this patient?
The nurse would strongly recommend the patient avoid using ibuprofen for pain until he
checked with his primary care provider. He will most likely need a change in his pain
medication regimen. Use of NSAIDs, such as ibuprofen, is a major risk factor for peptic
ulcers. The patient could worsen his peptic ulcer disease if continuing to use ibuprofen.
The damaged mucosa cannot secrete enough mucus to act as a barrier against excessive
HCl and the use of NSAIDs inhibits the secretion of mucus that protects the mucosa.

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