CLIENT CARE STUDY OF A PATIENT WITH PEPTIC ULCER

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 Table of Content
Cover Page i
Title Page ii
Approval/Certification iii
Acknowledgment iv
Introduction 1
Patient’s Bio Data 2
Disease History 3

Anatomy and Physiology of the Stomach 4

Comprehensive Literature Review 7
Incidence 7
Causes 7
Clinical Manifestations 8
Diagnostic Investigation 8

Application of the Nursing Process 11

Nursing History 11
Nursing Management 13
Nursing Diagnoses 15
Nursing Care Plan 16
Pharmacological Review of Drugs Used 23
Progress and Discharge Summary 27
Conclusion 27
Implication of the Study 28
Importance of the Study 28
References 29

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 CHAPTER ONE

INTRODUCTION

Peptic ulcers, also known as stomach ulcers, are open sores that develop on the inner lining of

your stomach or the upper part of your small intestine (duodenum). Peptic ulcers are caused by

an imbalance between the digestive juices produced by the stomach and the various factors that

protect the lining of the stomach. The most common causes of peptic ulcers are: H. pylori

infection, non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and

naproxen, smoking, excessive alcohol consumption. Symptoms of peptic ulcers can include:

burning pain in the abdomen, usually between the breastbone and navel, heartburn, indigestion,

nausea, vomiting, loss of appetite, weight loss.

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Patients Bio Data

Name of Patient: Mr. O.R.M

Age: 73yrs

Sex: Male

Diagnoses Peptic Ulcer

Religion: Christianity

Occupation: Retired Military Personnel

Nationality Nigeria

State of Origin Abia State

Address: 47 Umuchi, Umuahia

Next of Kin: Mr. N. O

Address of Next of Kin: 47 Umuchi, Umuahia

Doctor in charge: Dr. Nwankwo A. E

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Family Composition: Mr. O.R.M is from Akamkpa local Government Area of Cross River

State. Father is a retired soldier and mother: a retired civil servant. He is the second child in a

family of 3, 2 male and 1 female. My client Mr. O.R.M is a monogamist whose family is an

extended family made up of Wife, his two children and their two grand children

Social History: Mr. O.R.M is married and lives in a suburban home with his wife.He enjoys

spending time with his family and friends. He makes occasional use of alcohol. He attends St.

Joseph’s Anglican Church and is actively involved in his community.

Disease History: Mr. O. R. M arrived at the GOPD ward on 25/09/2023 Patient presented with

the following complaints intermittent, burning, epigastric, pain, which radiates to the back,

nausea and vomiting, blood stained sputum for one month.

Treatment Taken So Far: He is said to have taken antacid and Gestid syrup for ulcer treatment.

Client was also sent for investigation such as full blood count, sputum analysis, occult blood,

PCV, malaria parasite, WWBC, ESR, Neutrophils, lymphocytes.

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 CHAPTER TWO

ANATOMY AND PHYSIOLOGY OF THE STOMACH

Anatomy of the Stomach

The stomach is a J-shaped muscular sac-like organ that lies in the upper left part of the abdomen,

just below the diaphragm. It is about the size of a clenched fist and can hold up to 2 liters of

food. The stomach is responsible for storing and breaking down food into a liquid mixture called

chyme.

Parts of the Stomach

The stomach is made up of four main parts:

a. Cardia: The upper part of the stomach where the esophagus joins the stomach.

b. Fundus: The dome-shaped upper part of the stomach.

c. Body: The main part of the stomach, located between the fundus and the antrum.

d. Antrum: The lower part of the stomach where the stomach narrows and connects to the

small intestine.

Structure of the Stomach

The stomach is lined with a thick layer of mucous membrane, which is made up of several

different types of cells. These cells produce gastric acid, pepsinogen, and mucus. Gastric acid is

a strong acid that helps to break down food. Pepsinogen is an enzyme that is converted to pepsin

in the stomach. Pepsin is another enzyme that helps to break down food. Mucus protects the

lining of the stomach from the acid.

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The stomach is also surrounded by a thick layer of muscle, which helps to churn and mix the

food. The muscles of the stomach are controlled by nerves from the autonomic nervous system.

Physiology of the Stomach

The stomach has several important functions in the digestive process. These functions include:

a. Storage: The stomach can store food for several hours, which allows the body to slowly

digest and absorb the nutrients from the food.

b. Breaking down food: The stomach breaks down food into a liquid mixture called

chyme. Chyme is made up of partially digested food, gastric acid, and enzymes.

c. Secreting gastric acid: Gastric acid helps to break down food and kill bacteria.

d. Secreting pepsinogen: Pepsinogen is an enzyme that is converted to pepsin in the

stomach. Pepsin is another enzyme that helps to break down food.

e. Secreting mucus: Mucus protects the lining of the stomach from the acid.

The stomach is also responsible for controlling the rate at which food is emptied into the small

intestine. This is done by a muscular valve called the pyloric sphincter. The pyloric sphincter

opens and closes to allow small amounts of chyme to enter the small intestine at a time.

Digestive Process

The digestive process begins in the mouth, where food is chewed and mixed with saliva. Saliva

contains enzymes that begin to break down the starch in food. The food then travels down the

esophagus to the stomach.

In the stomach, the food is mixed with gastric acid and enzymes, which continue to break down

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the food. The stomach muscles churn and mix the food for several hours, until it is broken down

into a liquid mixture called chyme.

Chyme is then slowly released into the small intestine, where it is further digested and absorbed

into the bloodstream. The nutrients from the food are then used by the body for energy, growth,

and repair.

Arterial Supply

The arterial supply of the stomach is derived from three main sources:

The celiac artery: The celiac artery is the largest branch of the abdominal aorta. It supplies

blood to the stomach, liver, spleen, and pancreas. The celiac artery gives off three branches that

supply the stomach:

o The left gastric artery

o The common hepatic artery

o The splenic artery

The superior mesenteric artery: The superior mesenteric artery is the second largest branch of the

abdominal aorta. It supplies blood to the small intestine and cecum. The superior mesenteric

artery gives off one branch that supplies the stomach:

o The right gastro-omental artery

The inferior phrenic artery: The inferior phrenic artery is a branch of the thoracic aorta. It

supplies blood to the diaphragm and the lower part of the esophagus. The inferior phrenic artery

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gives off one branch that supplies the stomach:

o The left gastro-omental artery

Venous Drainage

The venous drainage of the stomach is to the portal vein. The portal vein is a large vein that

collects blood from the digestive organs, including the stomach, liver, spleen, pancreas, and

small intestine. The portal vein carries blood to the liver, where the blood is filtered and

detoxified. The blood then leaves the liver and enters the inferior vena cava, which carries blood

back to the heart.

The venous drainage of the stomach is provided by several veins:

The left gastric vein: The left gastric vein drains blood from the cardia and fundus of the

stomach.

The right gastro-omental vein: The right gastro-omental vein drains blood from the greater

omentum and the body of the stomach.

The short gastric veins: The short gastric veins drain blood from the fundus of the stomach.

The pyloric vein: The pyloric vein drains blood from the antrum of the stomach.

Nervous Supply

The nervous supply of the stomach is from the autonomic nervous system. The autonomic

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nervous system is responsible for controlling the involuntary functions of the body, such as heart

rate, blood pressure, and digestion.

The stomach is innervated by two branches of the vagus nerve:

The anterior vagal trunk: The anterior vagal trunk supplies parasympathetic innervation to the

stomach. Parasympathetic innervation stimulates the secretion of gastric acid and the movement

of the stomach muscles.

The posterior vagal trunk: The posterior vagal trunk supplies sympathetic innervation to the

stomach. Sympathetic innervation inhibits the secretion of gastric acid and the movement of the

stomach muscles.

Lymph Nodes

The lymph nodes of the stomach are located along the greater and lesser omentum. The greater

omentum is a large fold of peritoneum that is attached to the greater curvature of the stomach.

The lesser omentum is a smaller fold of peritoneum that is attached to the lesser curvature of the

stomach.

The lymph nodes of the stomach are responsible for filtering lymph fluid from the stomach.

Lymph fluid is a clear liquid that contains white blood cells, which are cells that help to fight

infection. The lymph nodes also contain macrophages, which are cells that engulf and destroy

bacteria and other foreign particles.

The lymph nodes of the stomach drain into the celiac lymph nodes, which are located along the

celiac artery. The celiac lymph nodes then drain into the thoracic duct, which is a large vessel

that carries lymph fluid back to the bloodstream.

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 CHAPTER THREE

LITERATURE REVIEW

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Peptic ulcer disease (PUD) is a break in the lining of the stomach, first part of the small intestine

or occasionally the lower esophagus. This is a condition in which painful sores or ulcers develop

in the lining of the stomach or the duodenums.

Normally, a thick layer of mucus protects the stomach lining from the Effects of its digestive

juices. But many thins can reduce this protective layers, allowing stomach acid to damage the

tissue (Julia Fashrner, MD, And Alfred C. Gitu, 2015).

Types of Peptic Ulcer

There are three (3) types of peptic ulcers.

Gastric Ulcers: Ulcers that develop inside the stomach

Oesophageal Ulcers: Ulcers that develop inside the oesophagus

Duodenal Ulcers: Ulcers that develops in the upper section if the small intestine called the

duodenum. The most common symptoms of a duodenal ulcer are waking at night with upper

abdominal pain or upper abdominal pain that progresses with Eating. With a gastric ulcer the

pain may worsen with eating (Snowden, 2018). The pain is often described as a burning. Other

symptoms include belching, vomiting, weight loss, or poor appetite. Complications may include

bleeding, perforation, and blockage of the stomach. Bleeding occurs in as many as 15% of

people (American College of Gastroenterology Peptic Ulcer Disease, 2020).

Causes of Peptic Ulcer

Peptic ulcers can be caused by the following:

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a. A Bacterium: Helicobacter pylori bacteria commonly live in the Mucous layer that

covers and protects tissue that lines the stomach And small intestine. Helicobacter pylori

is a major causative factor (60% of gastric and up to 50-75% of duodenal ulcers) is

chronic Inflammation due to helicobacter pylori that colonizes that antral Mucosa

(Yoman, Mark, 2017 ). The immune system is unable to clear the infection, despite the

appearance of antibodies. Thus, the Bacterium can cause a chronic active gastritis (type 8

gastritis)Gastrin stimulates the production of gastric acid by parietal cells. In H.pylori

colonizationresponses to increased gastrin, the increase in Acid can contribute to the

erosion of the mucosa and therefore ulcer formation.

b. NSAIDs: Another major cause is the use of NSAIDs, Such as Ibuprofen and aspirin. The

gastric mucosa protects itself from gastric Acid with a layer of mucus, the secretion of

which is stimulated by Taine prostaglandins. NSAIDs block the function of cyclo-

Oxygenase (COX-1) which is essential for the production of these Matories (such as

celecoxib or the since withdrawn rofecoxib). Preferentially inhibitsCOX-2 selective anti-

inflammatories (such as Celecoxib, or the since withdrawn refecoxib) preferentially

inhibits Cox-2, which is less essential in the gastric mucosa, and roughly have the risk of

NSAID-related gastric ulceration.

c. Stress: Stress due to serious health problems such as those requiring treatment in an

intensive care unit as well described as a cause of Peptic ulcer which are termed stress

ulcers. While chronic life stress was once believed to be the main cause of ulcers, this is

no longer the case. It is however, still occasionally believed to play a role. This may be

by increasing the risk in those with other causes such as H.pyloti or NSAID use

(Teomans Henry, 2017 ).

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 d. Diet: Dietary factors such as spice consumption were hypothesized to cause ulcer until

late in the20th century, but have been shown to be relatively of minor importance.

Caffeine and coffee, also commonly thought to cause or exacerbate ulcers, appears to

have little effect. Similarly, while studies have found that alcohol consumption increases

risk when associated with H.pylori infection, it does not seem to independently increase

risk. Even when. Couples with H.pylori infection, the increase are modest in comparison

to the primary factors.

e. Smoking: Smoking may increase the risk of peptic ulcer in people who are infected with

H.pylori. Peptic ulcer disease can also occur if you have a rare condition called Zolinger-

Ellison syndrome (gastorinomia). This condition forms a tumor of acid producing cells in

the digestive tract. These tumors can be cancerous or non-cancerous. The cells produce

excessive amount of acid that damages stomach tissue.

Pathophysiology

The mechanism of occurrence of peptic ulcer disease (PUD) results from an imbalance between

gastric mucosal protective and destructive factors. Risk factors predisposing to the development

of PUD are H.Pylori infection, NSAID use, first degree elative with PUD, diet and stress.

With peptic ulcers, there is usually a defect in the mucosa that extends to the muscularis mucosa.

Once the protective superficial mucosal layer is damaged, the inner layers are susceptible to

acidity. Further, the ability of the mucosal ‘cells to secrete bicarbonate is compromised. H.pylori

is known to colonize the gastric mucosa and causes Inflammation. The H.pylori also impairs the

secretion of bicarbonate, promoting the development of acidity and gastric metaplasia.

Signs and Symptoms

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 1. Abdominal pain, classically epigastric strongly correlate mealtimes. In case of duodenal

ulcers the pain appears about three hours after taking a meal.

2. Bloating and abdominal fullness

3. Nausea and copious vomiting

4. Loss of appetite and weight loss

5. Water brash (rush of saliva after an episode of regurgitation to dilute the acid in

oesophagus although this is more associated with Gastroesophageal (reflux disease)

6. Hematemesis (vomiting of blood); this can occur due to bleeding directly from a gastric

ulcer, or from damage to the oesophagus from severe/continuing vomiting.

7. Heart burn

8. Melena (tarry, foul-smelling faeces due to presence of oxidized iron from hemnoglobin).

Diagnostic Investigations

To establish the diagnosis of peptic ulcer. The following assessment and laboratory studies

should be carried out:

a. Endoscopy: Endoscopy is the preferred diagnostic procedure because it allows direct

visualization of inflammatory changes, ulcers and lesion.

b. Esophago-gastro duodenoscopy: It confirms the presence of an ulcer and allows cytologic

studies and biopsy to rule out H.pylori or cancer.

c. Physical examination: A physical examination may reveal pain, epigastric tenderness, or

abdominal distention.

d. Occult blood: Stool may be tested periodically until they are, negative for occult blood

e. Barium study: A barium study of the upper GI tract may show an ulcer.

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 f. Urea breath test. Reflects activity of H.pylori (Yeomans,2017 ).

Management

Medical Management

Once diagnosis is established, the patients are informed that the condition can be controlled.

Pharmacologic Therapy: currently, the most commonly used therapy for peptic ulcers is a

combination ofantibiotics, portion pump inhibitors, and bismuth salts that suppress or eradicate

the infection.

Stress reduction and rest: Reducing environmental stress requires physical and psychological

modifications on the patient’s part as well as the aid and co-operation of family members and

significant others.

Smoking cessation: Studies have shown that smoking decreases the secretion of bicarbonate

from the pancreas into the duodenum resulting in increased acidity of the duodenum.

Dietary modification: Avoid extreme of temperature of food and beverages and overstimulation

from consumption of meat extracts, alcohol, coffee and other caffeinated beverages and diets

rich in Cream and milk should be implemented.

Surgical Management

The introduction of antibiotics to eradicate H.pylori and H2 receptor Antagonists (histamine) as

treatment for ulcers has greatly reduced the need for surgical intervention.

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Pyioroplasty: It involve transecting nerves that stimulate acid secretion and opening the pyloris

Anterectomy: Anterectomy is the removal of the pyloric portion of the stomach with

anastromosis to either the duodenal or jejunum.

Nursing Management

1. Administer prescribed medications, Medications may include antacids, anticholinergics,

histamine-Receptor antagonist, proton-pump inhibitors and mucosal protective agent.

2. Medication for ulcers caused by H.pylori include bismuith, subsalicylate, metronidazole

and tetracycline. These medications administered together eradicate H.pylori bacteria in

the gastric mucosa.

3. Provide client and family teaching

4. Instruct the client to quit smoking, which decreases the secretion of Bicarbonate from the

pancreas into the duodenum, resulting in Increased acidity in the duodenum.

5. Teach the client about necessary lifestyle modifications aimed at decreasing stress and

maximizing effective coping.

6. Teach the client methods to minimize symptoms while maintaining adequate nutrition.

7. Avoid foods that previously have caused pain. Specific dietary restrictions vary from

client to client.

8. Eat three regular meals a day, small, frequent meals are unnecessary as long as the

medication is taken before meals.

9. Avoid a diet rich in milk and creams, which are acid stimulants.

10. Prepare the client for diagnostic procedures and provide post procedure care.

11. Stools are monitored until all barium has been eliminated.

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12. Assist the patient in understanding the condition and factors that help or aggravate it.

13. Teach patient about prescribed medications, including name, dosage, frequency and

possible side effects. Also identify medication such as aspirin that patient should avoid.

14. Instruct patient about particular foods that will upset the gastric ulcer, such as coffee, tea,

colas and alcohol, which have acid-Producing potential.

15. Encourage patient to eat regular meals in a relaxed setting and to avoid overeating

16. Explain that smoking may interfere with ulcer healing: refer patient to programs to assist

with smoking cessation.

17. Alert patient to signs and symptoms of complications to be reported. These complication

includes; hemorrhage (cold skin, confusion, increased heart rate, labored breathing, and

blood in the stool), penetration and perforation (server abdominal pain, rigid and tender

abdomen, vomiting, elevated temperature and increased meal rate), and pyloric

obstruction (nausea, vomiting, distended abdomen and abdominal pain).

18. Advice on discharge: The nurse instructs the patient about factors that relieve and those

that aggravate the condition such as;

- Medications: The nurse reviews information about medications to be taken at home,

including names, dosage, frequency and possible side effects, stressing the

importance of continuing to take medications even after signs and symptoms have

decreased or subsided.

- Diet: Client should be instructed to avoid certain medications and foods that

exacerbate symptoms as well as substances that have acid-producing potential.

- Lifestyle: Counsel Patient to eat meals at regular times and in a relaxed setting and to

avoid overeating.

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Prevention of Peptic Ulcer

The following should be prevented or avoided

a. Alcohol

b. Common Source of Helicobacter pylori bacteria (example contaminated food and water,

flood water, raw sewage)

c. Long term use of non-steroidal anti-inflammatory drugs (NSAIDS), smoking

Complications

There are four main complications of peptic ulcers:

a. Bleeding: This is the most common complication, and it can occur if the ulcer erodes a

blood vessel. Symptoms of bleeding include black, tarry stools, vomiting blood, and

feeling lightheaded or dizzy.

b. Perforation: This is a serious complication that occurs when the ulcer eats a hole through

the wall of the stomach or small intestine. Symptoms of perforation include severe

abdominal pain, fever, and shock.

c. Penetration: This occurs when the ulcer extends beyond the wall of the stomach or small

intestine but does not perforate. Symptoms of penetration are similar to those of a peptic

ulcer, and may include abdominal pain, nausea, and vomiting.

d. Gastric outlet obstruction: This occurs when the ulcer scars and narrows the passage

between the stomach and small intestine. Symptoms of gastric outlet obstruction include

nausea, vomiting, and weight loss.

In addition to these four main complications, peptic ulcers can also increase the risk of

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developing stomach cancer.

CHAPTER FOUR

APPLICATION OF THE NURSING PROCESS

Nursing History

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Mr. O. R. M was brought to the GOPD ward on 25/09/2023. Patient presented with the following

complaints intermittent, burning, epigastric, pain, which radiates to the back, nausea and

vomiting, blood stained sputum for one month. He reported to have taken Gestid syrup for ulcer

treatment. Client was sent for laboratory investigation such as full blood count, sputum analysis,

occult blood, PCV, malaria parasite, WWBC, ESR, Neutrophils, lymphocytes.

History taking from client reveals this;

Family history: Nil history of peptic ulcer in the family

Past medical history: except for malaria and typhoid, client has no record of serious health

disorder or health issues

Vital signs on admission recorded:

- Temperature: 37.2°C

- Pulse: 86b/m

- Respiration: 26c/m

- Blood pressure: 120/80 mmHg

Client was examined and a diagnosis of peptic ulcer was made.

Nursing Diagnosis

1. Acute Pain related to ulceration of the mucosal lining evidenced by patients

verbalization.

2. Imbalanced Nutrition less than body requirements related to loss of appetite evidenced by

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 vomiting and weight loss.

3. Risk for deficient fluid volume related to excessive vomiting.

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 NURSING CARE PLAN OF MR. O.R.M WITH PEPTIC ULCER

S/N Nursing Diagnoses Nursing Objectives Nursing Intervention Scientific Rationale Evaluation

1 Acute Pain related Client will report a 1. Assess pain location, To determine the nature and Client will

to ulceration of the decrease in pain intensity intensity, character, severity of the pain and reported a

mucosal lining from 8/10 to 3/10 on a and identify appropriate decrease in pain

evidenced by pain scale within 30 min aggravating/relieving interventions. intensity from

patients – 1 hour of nursing factors. 8/10 to 3/10 on

verbalization. intervention. 2. Administer prescribed To relieve pain and promote a pain scale

pain medication as comfort. after 1 hour of

ordered. nursing

3. Provide relaxation To promote relaxation and intervention.

techniques such as reduce pain perception.

deep breathing and

guided imagery.

4. Educate client about To empower the client to

pain management manage their pain

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 techniques and effectively.

encourage their use

2 Imbalanced Client will maintain a 1. Assess client's dietary To determine the client's

Nutrition less than healthy weight and intake and identify any nutritional status and

body requirements achieve a balanced diet nutritional develop appropriate

related to loss of within one week of deficiencies. interventions

appetite evidenced nursing intervention. 2. Provide counseling on To educate the client about

by vomiting and healthy eating habits the importance of a balanced

weight loss. and food choices. diet and promote healthy

3. Encourage small, eating behaviors.

frequent meals to To prevent overeating and

minimize gastric reduce the risk of

discomfort. exacerbating symptoms.

4. Monitor weight and To assess the effectiveness

nutritional intake of interventions and make

regularly. adjustments as needed.

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3. Risk for deficient Client will maintain 1. Assess client's fluid - To determine the

fluid volume related adequate fluid intake and intake and output. client's hydration

to excessive demonstrate no signs of 2. Encourage client to status and identify

vomiting. dehydration throughout drink plenty of fluids any potential fluid

the period of throughout the day. deficits.

hospitalization. 3. Monitor intake and - To maintain adequate

output records and hydration and

assess for signs of prevent dehydration

dehydration. - To identify early

4. Educate client about signs of dehydration

the importance of fluid and intervene

intake and encourage promptly.

them to drink fluids - To empower the

regularly. client to manage their

fluid intake

effectively.

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 PHARMACOLOGICAL REVIEW OF THE DRUGS USED

1. Cimetidine

2. Clarithromycin 250mg

3. Omeprazole 20 mg

4. Tinidazole 500mg

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 Name of Group Indication Dosage Rou Side effects Contraindicatio Nursing
drug te ns responsibility
Cimetidine Histamine2 Active Oral Hypersensitivity, Assess for abdominal
800 mg PO hs or Diarrhea,
(H2) duodenal ulcer, , IM, lactation pain, occult blood in
300 mg PO qid dizziness,
antagonist intractable IV stool, and emesis.
with meals and at tiredness, rash,
ulcers Monitor liver
bedtime or 400 headache, CNS
function tests.
mg PO bid; disturbances,
continue for 4–6 arthralgia,
wk unless healing myalgia,
is demonstrated gynecomastia,
by endoscopy. alopecia, blood
For intractable dyscrasias,
ulcers, 300 mg nephritis,
IM or IV q 6–8 hepatitis,
hr. pancreatitis,
granulocytopen
ia,
hypersensitivit
y reactions.

Clarithrom Macrolide Mild-to- 250-500 mg PO Oral Diarrhea, Hypersensitivity, Assess for infection

ycin antibiotic moderate q12hr for 7-14 dizziness, (vital signs;

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 infections days tiredness, rash, lactation appearance of wound,

caused by headache, CNS sputum, urine, and

susceptible disturbances, stool; WBC) at

isolates caused arthralgia, beginning of and

by myalgia, during therapy.

Haemophilus gynecomastia,

influenzae, alopecia, blood

Haemophilus dyscrasias,

parainfluenzae, nephritis,

Moraxella hepatitis,

catarrhalis, or pancreatitis,

Streptococcus granulocytopen

pneumoniae ia,

hypersensitivit

y reactions.

Omeprazol Proton Non cancerous 10mg to 20mg a Kidney Allergy to

Oral Assess patient for epigastric or abdom
pump stomach ulcers, day for problems, omeprazole or

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e inhibitor gastroesophage indigestion, 20mg diarrhea, new other proton
stool, emesis, or gastric aspirate.
al reflux to 40mg a day for or worsening pump inhibitors,

disease heartburn and symptoms of history of

(GERD), acid reflux, 20mg lupus. cholestatic

active to 40mg a day for jaundice/hepatic

duodenal ulcer, stomach ulcers, dysfunction

Zollinger- 20mg to 120mg a associated with

Ellison day for Zollinger- prior use of

syndrome, Ellison syndrome clarithromycin.

erosive

esophagitis

Tinidazole Nitroimidaz Amebiasis, 2 g/day PO for 3- Oral Fever, chills, Hypersensitivity, Assess patient for

ole giardiasis, 5 days for body aches, lactation infection (vital signs,

antibiotic trichomoniasis, amebiasis, 2 g PO numbness, WBC, appearance of

bacterial once for burning pain, wound, sputum,

vaginosis, giardiasis or tingly feeling, urine, and stool) at

amebic liver trichomoniasis, 2 seizure, vaginal beginning of and

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abscess g PO qDay for 2 itching or during therapy.

days OR 1 g PO discharge

qDay for 5 days

for bacterial

vaginosis

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 CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

Summary

This case study was carried out on Mr. O.R.M with the diagnosis of peptic ulcer. This was

predisposal by fasting, alcohol consumption, indiscriminate use of NSAIDs and stressful

conditions. He has predisposing factors of the disease condition; He was duly managed at

Federal Medical Health Center, Umuahia through medications, rests and follow up visit.

Conclusion

The nurse was able to intervene with the problems of Mr. O.R.M after putting in necessary

measures, he was adequately cared for with no complications. This improvement was achieved

through shared effort and cooperation of the family. Mr. O.R.M (client) was properly treated and

follow-up, the family became aware of the measure to prevent peptic ulcer, and improve on their

lifestyle.

Recommendations

To facilitate healing and to decrease the risk of recurrence of gastric and duodenal ulcers,

Helicobacter pylori should be eradicated in patients/client with peptic ulcers disease proton pump

inhibitors offer suppression of acid secretion, healing and symptom relief in patients with peptic

ulcers, that are superior to those associated with other anti-secretory therapies.

Implication of the study

 Improved understanding of the causes of peptic ulcer

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  Development of new treatment options

 Improved patient outcomes:

Importance of the study

 To improve our understanding of the causes of peptic ulcer

 To develop new and more effective treatment options

 To improve patient outcomes

 Identify risk factors for complications and develop strategies to prevent them.

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 References

ACOG. (2022). Peptic Ulcer: Frequently asked questions. Retrieved from:

https://www.acog.org/womens-health/faqs/uterine-fibroids
American College of Gastroenterology Peptic Ulcer Disease, (2020). Peptic Ulcer: Frequently
asked questions. Retrieved from: https://www.acog.org/womens-health/faqs/uterine-
fibroids
Horner A. W (2020) Nursing diagnoses handbook: An evidence- based guide to planning care.
St. Louis, MO: Elsevier.
Julia Fashrner, MD, And Alfred C. Gitu,(2015) Nurrsing diagnoses handbook: An evidence-
based guide to planning care. St. Louis, MO: Elsevier.
Snowden, (2018) Medical-surgical nursing: Concepts for interprofessional; collaborative care.
St. Louis, MO: Elsevier.
The American Academy of Family Physicians. (2022). Peptic Ulcer. Retrieved from:
https://www.aafp.org/pubs/afp/issues/2017/0115/p100.html
Yeomans Henry, (2017 ) Saunders comprehensive review for the NCLEX-RN examinations. St.
Louis, MO: Elsevier.

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