Critical Thinking Exercise No.

4 (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. How
would you respond to this patient? On what evidence do you base your response?
Questions Answer
a) How would you  Educate the patient about the prescribed
respond to this medication, and the importance of compliance
patient? On what with the course of the medication to manage and
evidence do you base treat digestive disorder. The medication is
your response? commonly prescribed for 10-14 days.
 Antibiotics have antimocrobial activity agains
most H. plory strains. Proton Pump Inhibitor do
not exhibit anticholinergic or H2 antagonistic
activities but suppress acid secretion by specific
inhibition of the H+/K+ –adenosine
triphosphatase (ATPase) enzyme system on the
secretory surface of parietal cells. (Marcus, 2019)
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 mmHg, 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. What is your first
nursing action? Describe the priorities of care for this patient.
Questions Answer
a) What is your first  The initial nursing action is to assess the patient
nursing action? for possible presence of bleeding and to manage
Describe the priorities any blood loss in the patient.
of care for this  Assess the patiet’s v/s
patient.  Assess the patient’s I&O
 Assess the patient for nausea and possibility
of fainting
 Assess s/sx of bleeding: HYPOtension,
TACHYcardia, and TACHYpnea
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. How would you respond to this patient? On what evidence do you base your
response?
Questions Answer
 How would you respond  Explain that the medication ibuprofren is
to this patient? On what contraindicated due to their condition. Inform the
evidence do you base patient that NSAIDs (e.g ibuprofen) can cause
your response? inflammation, injury, and subsequent erosion of the
mucosa. This medication is a major eisk factor for
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 peptic ulcer and is known to have a synergistic effect
with the infection H. pylori which causes peptic ulcer.
 According to Annand, 2015; Grossman & Porth, 2014
“The use of NSAIDs inhibits prostaglandin synthesis,
which is associated with a disruption of the normally
protective mucosal barrier. Damage to the mucosal
barrier results in decreased ressitance to bacteria,
and thus infection from H. pylori bacteria may occur.

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