Sandra Adjei 777777

PATIENT AND FAMILY CARE STUDY ON A PATIENT WITH
PEPTIC ULCER DISEASE (PUD)
AT
BAPTIST MEDICAL CENTRE (BMC) - NE/R
WRITTEN
BY
SANDRA ADJEI
INDEX NUMBER: (6220190007)
A FINAL YEAR STUDENT OF THE COLLEGE OF NURSING AND MIDWIFERY,

NALERIGU- NE/R
SUBMITTED TO THE NURSING AND MIDWIFERY COUNCIL OF GHANA IN

PARTIAL FULFILMENT OF THE REQUIREMENT OF THE AWARD OF
CERTIFICATE IN REGISTERED GENERAL NURSING (DIPLOMA)
AUGUST, 2022
PREFACE
The patient/family care study is an assessment tool the nursing student uses to assess his/her
knowledge of the nursing process which is based on scientific methodology. The nursing process
is dynamic and employs the problem-solving approach with a series of steps which include;
assessment, nursing diagnosis, planning, implementation, and evaluation. This is to care for the
patient’s physiological, psychological, and social needs.
The nursing student uses patient/family care study as a means of improving his/her
communication and interpersonal relationship with the patient, family, and other members of the
health team.
It also offers an opportunity for the student to translate his/her theoretical knowledge into
practice to render the needed health care to the patient. Moreover, it gives the nursing student an
insight into research work.
The care study also forms part of the requirements by the student in fulfillment of the award of a
certificate in Registered General Nursing (RGN) by the Nursing and Midwifery Council of
Ghana.
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ACKNOWLEDGEMENT
The final product of this study would have been impossible without the support and contributions
of others. First of all, I thank the Almighty God for the knowledge and strength he granted me
throughout this work.
I wish to express my profound gratitude to my patient Mrs. A.M and her family for their
understanding and cooperation throughout this work.
I owe a great debt of gratitude to my supervisor Mr. Yakubu Mohammed Sheriff, a tutor at
Nursing and Midwifery Training College Nalerigu for his directions, guidance, and corrections
in making this work a reality
My sincere thanks also go to the nurses of the Females Medical Ward at the Baptist Medical
Center in the North East Region of Ghana for their support, supervision, and guidance
throughout my patient's care in the ward.
Finally, my acknowledgment will be incomplete if I failed to acknowledge the authors and
publishers of various books I used for the literature review of my patient condition.
I will conclude by thanking all my colleagues, friends, and family members who have supported
me morally and financially, especially my parents
God bless you all.
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INTRODUCTION
In using modern concept of nursing, which is based on the nursing process where a patient’s
physical, emotional, psychological, social and spiritual problems are identified with finding
realistic solutions to these problems, I chose Mrs. A.M as the subject of this carestudy.
This patient/family care study was conducted on Mrs. A.M a 33year old woman diagnosed with
Peptic Ulcer Disease. She was admitted into the female’s medical ward of Baptist Medical
Center on 13th March, 2022 at 6:30 pm.
For effective nursing care to be given, her health problems were identified and prioritized and a
care plan was drawn and implemented from the day of admission till discharge which lasted for
four (4) days. At the time of discharge, signs, and symptoms presented by patient during
admission were controlled. Home visits were made to patient’s home before and after discharge
to assess her environment, how patient was faring and education given accordingly.
This script has been organized into five (5) chapters based on the nursing process. Chapter one
consists of information on patient and family, patient particulars, lifestyle/hobbies, past and
present medical history, admission of the patient, patient’s concept of illness as well as a
literature review of the condition. Chapter two deals with data analysis covering comparisons
between the data collected from patient family and standards. It also looked at patient strength,
health problems and nursing diagnosis. Chapter three is on planning for patient and family care.
Chapter four also talks about implementation of patient and family care and chapter five finally
captures the evaluation of care rendered to the patient
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TABLE OF CONTENTS
PREFACE.........................................................................................................................................i
ACKNOWLEDGEMENT...............................................................................................................ii
INTRODUCTION..........................................................................................................................iii
TABLE OF CONTENTS...............................................................................................................iv
LIST OF TABLES..........................................................................................................................vi
CHAPTER ONE..............................................................................................................................1
ASSESSMENT OF PATIENT AND FAMILY..............................................................................1
1.0 Introduction................................................................................................................................1
1.1 Patient’s particulars...................................................................................................................1
1.2 The Patient’s Family Medical and Socioeconomic History......................................................1
1.3 Patient's Developmental History................................................................................................2
1.4 Patient’s Lifestyle and Hobbies.................................................................................................3
1.5 Patient's Past Medical/ Surgical History....................................................................................3
1.6 Patient’s Present Medical History.............................................................................................4
1.7 Admission of Patient..................................................................................................................4
1.8 Patient’s Concept of Illness.......................................................................................................6
1.9 Literature review of Peptic ulcer...............................................................................................7
1.10 Validation of Data..................................................................................................................19
CHAPTER TWO...........................................................................................................................20
ANALYSIS OF DATA.................................................................................................................20
2.0 Introduction..............................................................................................................................20
CHAPTER THREE.......................................................................................................................27
PLANNING FOR PATIENT AND FAMILY CARE...................................................................27
3.0 Introduction..............................................................................................................................27
CHAPTER FOUR.........................................................................................................................36
IMPLEMENTING PATIENT/FAMILY CARE...........................................................................36
4.0 Introduction..............................................................................................................................36
4.1 Summary of Actual Nursing Care Rendered to Patient and Family........................................36
4.2 Preparation of Patient / Family for Discharge and Rehabilitation...........................................45
4.3 Follow-up/home visit/ continuity of care................................................................................45
CHAPTER FIVE...........................................................................................................................49
EVALUATION OF CARE RENDERED TO PATIENT/FAMILY.............................................49
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5.0 Introduction..............................................................................................................................49
5.1 Statement of Evaluation...........................................................................................................49
5.2 Amendment of Nursing Care Plan...........................................................................................51
5.3 Termination of Care.................................................................................................................51
5.4 Summary of Care and Conclusion...........................................................................................52
Conclusion.....................................................................................................................................52
BIBIOGRAPHY............................................................................................................................53
SIGNATORIES.............................................................................................................................54
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LIST OF TABLES
Table one: Diagnostic Investigations and Tests Compared to Standards
Table two Clinical features
Table three Pharmacology of drugs administered to Mrs. A.M
Table four Nursing Care Plan for Mrs. A.M
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CHAPTER ONE
ASSESSMENT OF PATIENT AND FAMILY
1.0 Introduction
Nursing assessment initiates the nursing process with evaluation of the health status of the
patient. Through observation, questioning, and examination, data about the patient and her
family are collected and analyzed. This chapter consist of data that was obtained during
interaction with Mrs. A.M during the assessment phase of the nursing process. It entails
biographical data, developmental, past and present medical history, the family’s medical and
socioeconomic history as well as the patient’s lifestyle. Literature review on peptic ulcers and
validation of the data obtained were also discussed.
1.1 Patient’s particulars
Mrs. A.M, the subject of this care study, is a 33year old woman. She was born on 4 th April, 1989.
She is dark in skinned complexion. She is about 94cm in height and weighs 72kg. She stays at
Ngabo in the North East Region of Ghana. Mrs. A.M speaks Mampruli and English only. Mrs.
A.M is a Muslim. She comes from Nagbo in the North East Region of Ghana. She lives with her
husband Mr. R.M who is her next of Kin. She has two children, a boy, and a girl. She is a trader
by occupation. At the Baptist Medical Center (BMC) where Mrs. A.M was admitted on 13 th
March, 2022, she was diagnosed with Peptic Ulcer Disease (PUD). Mrs. A.M. was discharged on
16th March, 2022.
1.2 The Patient’s Family Medical and Socioeconomic History
According to Mrs. A.M, there is no history of hereditary conditions like essential hypertension,
diabetes Mellitus, Asthma, and mental illness but there is a history of sickle cell disease in the
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family. She also said there is no history of communicable diseases like tuberculosis, leprosy, and
others and also there is no known food allergy or drug allergy in the family. On the other hand,
members of her family sometimes suffered from minor ailments such as headache, abdominal
upset and diarrhea for which they sought treatment from the nearest hospital or over-the-counter
(OTC) medications.
According to Mrs. A.M, she and her husband are both traders and farmers. They cultivate and
sell maize, yam, millet, and beans. They live in their own house with two bedrooms, kitchen,
toilet, and bathroom. The children also take the responsibility of keeping the environment clean
and also assist on the farm during holidays. Mrs. A.M takes part in social activities such as
funerals, wedding ceremonies, out-dooring (naming ceremonies), and community labor
activities.
1.3 Patient's Developmental History
In an interview with Mrs. A.M, she was born in Nagbo in the North East Region of Ghana. She
was born in the health center with the assistance of a Midwife through Spontaneous Vaginal
Delivery (SVD) on 4th April, 1989. Mrs. A.M said she was vaccinated against Vaccine
Preventable Diseases such as measles, whooping cough, etc. According to her, she went through
the normal developmental periods including sitting at six months, and crawling at eight months.
At this stage of development, she begins to learn the ability to trust others based on the
consistency of the caregivers. This stage of development corresponds to Trust versus Mistrust of
the psychosocial theory of development by Erick Erikson.
She started walking at the age of eighteen (18) months. Mrs. A.M could choose a dress to wear,
food to eat, friends to play with, and socialize with other children. She attained puberty at the age
of fourteen (14) and this was marked by her menarche, growth of pubic hair as well as a
significant change in her breast size (Identity versus role confusion). She has completed Senior
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High School at Nalerigu Senior High School. Her life-shocking experiences include when she
had her first menstrual flow.
1.4 Patient’s Lifestyle and Hobbies
According to Mrs. A.M, she wakes up at 4:00am to prepare for morning prayers according to her
Islamic tradition. Thereafter, she begins by performing oral hygiene. She usually brushes her
teeth only in the morning with toothbrush and close-up toothpaste and bath at least twice a day
with warm water using carbolic soap, sponge, and towel but up to three times when she is in her
menses. She empties her bowels twice daily mostly in the morning and evening; she sweeps the
compound after which she prepares Tea or Porridge as breakfast for the family which is always
ready by 6:30 am. At least she void four times daily.
Mrs. A.M likes to trim her nails short to prevent food contamination and skin bruises. She likes
to take a lot of water and eats three times a day including tea and bread for breakfast, “Jollof” or
plain rice with stew or groundnut soup for lunch, and “Tuo-Zaafi” with vegetables soup for
supper which she prepares by herself. She prefers non-alcoholic beverages such as Fanta and
coca cola. She watches television and local movies occasionally provided the programs are of
interest to her before going to bed.
1.5 Patient's Past Medical/ Surgical History
During my interactions with Mrs. A.M, she indicated that she suffered from malaria which she
was admitted a year ago at the Baptist Medical Center (BMC) for four (4) days which she fully
recovered without complications. However, she had never suffered from any surgical condition
or any childhood illness like chicken pox and mumps. Aside the above-mentioned, Mrs. A.M
used to take over-the-counter (OTC) medications wherever she had minor ailments like headache
and fever.
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1.6 Patient’s Present Medical History
On 13th March, 2022, Mrs. A.M was well without any signs and symptoms of health problems.
During the day as she was performing her normal duties, Mrs. A.M suddenly started feeling mild
epigastric pains and vomiting blood around 6:00 pm. This happened after she had meals. There
was no sign of improvement as she started feeling general body weakness accompanying the
heartburn, nausea, and dizziness. Her condition became severe and decided to visit the hospital.
A relative rushed her to the outpatient department (OPD) of the Baptist Medical Center (BMC)
and was diagnosed with Peptic Ulcer Disease (PUD) on the day of admission.
1.7 Admission of Patient
Mrs. A.M arrived at the Out Patient Department (OPD) of Baptist Medical Center on 13th March,
2022, at 6:30 pm on a motorbike accompanied by her relatives. On arrival, Mrs. A.M was very
weak. She complained of general body weakness, epigastric pain, heart burns, nausea and
vomiting, and loss of appetite. Mrs. A.M and her relatives were welcomed and they were offered
a seat. I helped them retrieve their folder from the records which was paperless. Her vital signs
were taken and recorded as
 Temperature: 36.7 °C
 Respiration: 20 cpm
 Blood Pressure: 120/70 mmHg.
 Pulse: 74 bpm
 SPO2: 97%
 Weight: 72 kg
Mrs. A.M was provisionally diagnosed with Peptic Ulcer Disease (PUD) by Dr. Adu and was
admitted to the female medical ward. The following medications were prescribed;
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1. IV Hyoscine butylbromide 20mg bd x 2 days
2. IV Omeprazole 40mg bd x 2 days
3. Syrup Magnesium Trisilicate 10ms tds x 7 days
4. Tablet Paracetamol 1g tds × 24 hours
5. IV fluid Ringer’s lactate 500ml for 24 hours
6. IV fluid Normal Saline 500ml for 24 hours
7. IV Promethazine 25mg stat
And the following laboratory investigations were to be carried out on the patient
1. Blood Film (BF) for Malaria Parasites (MPs)
2. Full blood count
3. Helicobacter pylori test
I accompanied Mrs. A.M to the ward and collected her medications from the pharmacy. We
arrived at the female medical ward around 7 pm. We were warmly welcomed by a staff nurse at
the nurses’ station. I explained my mission of using Mrs. A.M for my care study. I was granted
permission to go ahead. I assisted to put patient quickly on bed and making her comfortable.
Mrs. A.M’s major complaints on admission were epigastric pain, vomiting, dizziness, and
general body weakness. A vomitus bowl was provided at the bedside. A tray for vital signs was
prepared and baseline vital signs were checked and recorded as follows.
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Mrs. A.M was made comfortable in bed. An intravenous line was passed using aseptic technique
and blood sample was taken. Intravenous Ringers lactate 500ml was administered and
acetaminophen 1g administered at the same time to relieve pain. All other drugs were
administered as prescribed by the physician, observing the six rights of drug administration.
The patient’s belongings were kept based on the hospital policy after I had performed the above
interventions and activities. I went ahead to explain the National Health Insurance Scheme
(NHIS). She was also oriented to the ward and its annexes, especially the wash room and
bathroom. Mrs. A.M was also educated on the following ward routine; time doctors come on
rounds each day at 9:00am, time medications are served, that is 6:00 am, 10:00 am, 2:00 pm,
6:00 pm, and 10:00 pm, as well as the following visiting hours. Morning: 6:00am- 7:00am,
afternoon: 1pm-2pm and evening: 5:30pm- 6:30 pm. I thanked and reassured her of competent
nursing care and made the relatives understand that her hospitalization is meant for proper
observation and management of the condition. The relatives were then asked to see her and share
relevant information and things needed for the hospitalization.
Mrs. A.M’s particulars such as name, sex, age, hometown, occupation, medical diagnoses, in-
patient, and out-patient numbers, marital status and others were documented in the Admission
and Discharge book as well as the daily ward state. Observations made on her and the nursing
interventions rendered to her were written in the nurses’ notes. I also sought for their consent to
use patient for my care study and she agreed.
1.8 Patient’s Concept of Illness
Mrs. A.M was very worried about her condition. On the contrary, she did not attribute her
condition to any supernatural force. She believed that every individual is liable for sickness and
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was hopeful that she was in the care of competent medical personnel. She was therefore looking
forward to being discharged home as soon as possible so that she could meet her family again.
1.9 Literature review of Peptic ulcer
Definition
A peptic ulcer is a defect in the upper gastrointestinal mucosa that extends through the
muscularis mucosa into deeper layers of the gut wall (Drini, 2017). Peptic ulcers are acid-
induced lesions found in the stomach and duodenum characterized by denuded mucosa with the
defect extending into the submucosa or muscularis propria (Feldman et al., 2020)
Types/classifications
A peptic ulcer is classified into a gastric, duodenal, or esophageal ulcer (Belleza, 2016)
1. Gastric ulcer:
Gastric ulcer tends to occur in the lesser curvature of the stomach, near the pylorus. A gastric
ulcer occurs most often in the atrium. It is common in elderly men, especially in chronic users of
Non-Steroidal Anti Inflammatory Drugs or alcohol intake and middle age.
2. Duodenal ulcer:
Peptic ulcers are more likely to occur in the duodenum than in the stomach. It is a chronic
disease characterized by exacerbation and remissions. It accounts for about 80% of peptic ulcer
cases. Although duodenal ulcer still affects men more than women, there is a steady increase in
women.
3. Esophageal ulcer
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An esophageal ulcer occurs as a result of the backward flow of Hydrochloric acid from the
stomach into the esophagus. It is usually located in the lower section of the esophagus.
Incidence
The peptic ulcer has an increased incidence in men than in women. Peptic ulcer disease occurs
with the greatest frequency in people between 40 and 60 years of age. It is uncommon in women
of childbearing age. At the menopausal stage, the incidence of peptic ulcers in women is almost
equal to that in men (Belleza, 2021)
Aetiology
There are three major causes of peptic ulcer disease which include;
1. Infection with Helicobacter pylori: H. pylori are acquired through ingestion of
contaminated food and water. H. pylori damage the mucous coating that protects the
stomach and duodenum.
2. Chronic use of NSAIDs: NSAIDs encourage ulcer formation by inhibiting the secretion
of prostaglandins.
3. Pathologic hypersecretory disorders (e.g., Zollinger-Ellison syndrome): a condition
in which the body produces too much gastrin. This occurs most often as a result of a
tumor.
Other causes of peptic ulcer include;
1. Increased age. Studies show that peptic ulcers occur more commonly in the elderly. This
is true for both sexes and is most probably linked to the use of NSAIDs (e.g. for treating
chronic pain and arthritis)
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2. Family history of ulcers. More than 20% of people with peptic ulcers also have a family
history of the problem (Health24, 2016).
3. Lifestyle factors: Evidence that tobacco use is a risk factor for duodenal ulcers is not
conclusive. Support for a pathogenic role of smoking comes from the finding that
smoking may accelerate gastric emptying and decrease pancreatic bicarbonate
production. However, studies have produced contradictory findings.
4. Type O blood. Research indicated that people with blood type O are more likely to be
hospitalized for peptic ulcers than people with other blood types. The exact mechanism
remains unclear.
5. Too little sleep. Research indicates that people who sleep less than 9 hours are more
likely to develop peptic ulcers than those who sleep more.
6. Smoking and excessive alcohol. Smoking increases acid secretion and the risk of
complications arising from ulcers, such as bleeding, obstruction and perforation of the
stomach.
Pathophysiology
The epithelial cells of the stomach and duodenum secrete mucus in response to irritation of the
epithelial lining and as a result of cholinergic stimulation. The superficial portion of the gastric
and duodenal mucosa exists in the form of a gel layer, which is impermeable to acid and pepsin.
In the event of acid and pepsin entering the epithelial cells, ion pumps in the basolateral cell
membrane help to regulate intracellular pH by removing excess hydrogen ions. Through the
process of restitution, healthy cells migrate to the site of injury. Mucosal blood flow removes
acid that diffuses through the injured mucosa and provides bicarbonate to the surface epithelial
cells (Anand & Katz, 2020).
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Mucosal injury and peptic ulcer occur when the balance between the aggressive factors and the
defensive mechanisms is disrupted (Anand & Katz, 2020). Aggressive factors, such as
nonsteroidal anti-inflammatory drugs (NSAIDs), H pylori infection, alcohol, bile salts, acid, and
pepsin can alter the mucosal defense by allowing back diffusion of hydrogen ions and
subsequent epithelial cell injury. The defensive mechanisms include tight intercellular junctions,
mucus, bicarbonate, mucosal blood flow, cellular restitution, and epithelial renewal. When H
pylori colonize the gastric mucosa, inflammation usually results (Anand & Katz, 2020).
Inhibition of COX-1 in the gastrointestinal tract by prolonged use of NSAIDs leads to a
reduction of prostaglandin secretion and its cytoprotective effects in gastric mucosa. This
therefore increases the susceptibility to mucosal injury.6 Inhibition of COX-2 may also play a
role in mucosal injury (Brune & Patrignani, 2015). Zollinger-Ellison Syndrome (ZES) due to
unopposed gastrin release by the neuroendocrine tumor, gastrinoma results in severe PUD
because of excess gastric acid secretion to the post-bulbar regions of the duodenum from the
esophagus via the trophic effect of gastrin on ECL and parietal cells (Phan et al., 2015). Patients
with duodenal ulcers secrete more acid than normal, while patients with gastric ulcers tend to
secrete normal or decreased levels of acid (Belleza, 2021)
Clinical features
Symptoms of peptic ulcer may last for a few days, weeks, months, and may disappear only to
reappear, often without an identifiable cause (Belleza, 2016). The following clinical
manifestations for peptic ulcers were drafted as;
4. Pain: As a rule, the patient with an ulcer complains of dull, gnawing pain or a burning
sensation in the mid-epigastrium or the back that is relieved by eating.
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5. Pyrosis (heartburn): is a burning sensation in the stomach and esophagus that moves up
to the mouth.
6. Vomiting: Vomiting results from obstruction of the pyloric orifice, caused by either
muscular spasm of the pylorus or mechanical obstruction from scarring.
7. Constipation and diarrhea. Constipation or diarrhea may occur, probably as a result of
diet and medications.
8. Bleeding. 15% of patients may present with GI bleeding as evidenced by the passage of
melena (tarry stools).
According to Malik, Gnanapandithan and Singh (2018), other common signs and symptoms
include Clinical features of peptic ulcers can also be
1. Anaemia
2. Hematemesis
3. Burping or acid reflux
4. Bloating
5. Weight loss
6. Loss of appetite
7. Fever
8. Progressive dysphagia
9. Melena
10. Headache
Table 1.1 Clinical differences between Gastric and Duodenal Ulcers
No. Gastric ulcer Duodenal ulcer

1. Burning, cramp-like, gnawing pain on Burning, cramp-like, gnawing pain on empty
ingestion of food stomach
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2. Pain relieved on vomiting Pain relieved by ingestion of food or antacid
3. Loss of appetite Increase appetite
4. Vomiting common Vomiting uncommon
5. Burning, cramp-like, gnawing pain on Burning, cramp-like, gnawing pain on empty
ingestion of food stomach
6. May have weight loss Weight gain
7. Hemorrhages more likely to occur Hemorrhages less likely to occur
8. Hematemesis Melena more common
9. Dyspepsia More likely to perforate than gastric ulcer
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Diagnostic investigations
Diagnostic studies of peptic ulcers can be
1. Barium study: Barium study of the upper intestinal tract may show an ulcer.
2. Endoscopy: It is the preferable procedure because it allows direct visualization of the
inflammatory changes, ulcers and lesions.
3. History and Physical examination: Physical examination may reveal pain,
epigastric tenderness, or abdominal distention.
4. Esophagogastroduodenoscopy: This may confirm the presence of an ulcer and
allows cytological studies and biopsy to rule out H. pylori or cancer.
5. In endoscopy biopsy a piece of stomach intestine tissue is removed and analyzed in
the lab
6. Occult blood. Stools may be tested periodically until they are negative for occult
blood.
7. Carbon 13 (13C) urea breathe tests: It reflects activity of H. pyloric, if pyloric is
present, the breath sample will contain higher than normal level of carbon dioxide.
8. H. pylori may be determined by biopsy and histology with culture.
9. X-ray of the upper gastrointestinal tract
10. Hemoglobin level estimation
11. Serologic test for antibodies to the Helicobacter pylori infection
12. Histology and biopsy with culture may determine Helicobacter infection
13. Urine test/urinalysis for H. pyloric test
(Belleza, 2016)
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Specific medical management
1. Pharmacologic therapy. Currently, the most commonly used therapy for peptic ulcers is
a combination of antibiotics, proton pump inhibitors, and bismuth salts that suppress or
eradicate the infection.
 Antibiotic medications to kill H. pylori. Amoxicillin (Amoxil), clarithromycin
(Biaxin), Metronidazole (Flagyl), Tinidazole (Tindamax), Tetracycline, and
levofloxacin.
 Proton pump inhibitors (PPIs): These Proton pump inhibitors block acid production.
Example Omeprazole (Prilosec), Lansoprazole (Prevacid), Rabeprazole (Aciphex),
Esomeprazole (Nexium) and Pantoprazole (Protonix).
 Histamine blockers (H-2): They reduce the amount of stomach acid released.
Examples are famotidine (Pepcid AC), cimetidine (Tagamet HB), and Nizatidine
(Axid AR).
 Antacid. They neutralize the stomach Example magnesium Trisilicate and Aluminium
hydroxide. They are available in the form of chewable pills and liquids.
2. Stress reduction and rest. Reducing environmental stress requires physical and
psychological modifications on the patient’s part as well as the aid and cooperation of
family members and significant others.
3. 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.
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4. Dietary modification. Avoiding extremes of the 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.
Specific surgical management
The introduction of antibiotics to eradicate H. pylori and of H2 receptor antagonists as a
treatment for ulcers has greatly reduced the need for surgical interventions.
1. Pyloroplasty. Pyloroplasty involves transecting nerves that stimulate acid secretion and
opening the pylorus.
2. Antrectomy. Antrectomy is the removal of the pyloric portion of the stomach with
anastomosis to either the duodenum or jejunum.
3. Vagotomy: an excision or resection of the valgus nerve that supplies the stomach.
4. Gastrectomy: this is the surgical removal of the lower portion of the stomach and it
could be:
 Billroth I or gastroduodenostomy: where the antrum part of the stomach is resected,
removed and the rest anastomosed to the duodenum.
 Billroth II or gastrojejunostomy: where the antrum and pylorus are removed and the
remaining part anastomosed to the jejunum.
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Nursing management
Nursing management is the step that involves action or doing and actual carrying out of nursing
interventions outlined in the plan of care (Toney-Bulter & Thayer, 2022).
The patient with peptic ulcer should;
 Comply with prescribed therapeutic regimen.
 Experience a reduction or absence of discomfort.
 Have complete healing of the peptic ulcer
 Make appropriate lifestyle changes to prevent recurrence.
 Patient nursing management is categorized into rest and sleep, observation, drug
administration, diet, psychological care, personal hygiene, prevention, and patient/family
education.
Other nursing management may involve;
 Rest and Sleep
1. Plan care to allow uninterrupted rest periods
2. Maintain a well straighten bed, free from creases and crumps to promote comfort.
3. Provide emotional support and diversional therapy.
4. Encourage patient to resume activities gradually.
5. Nurse patient in a warm well-ventilated room.
6. Administer prescribe analgesics to relieve pain.
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 Observation
1. Monitor patient’s vital signs such as temperature, pulse, blood pressure, and
respiration and report.
2. Monitor weight daily and report.
3. Observe patient’s stool for the presence of blood.
4. Monitor fluid intake and output and report.
5. Note the sight of the pain whether epigastric or mid-gastric and whether pain is more
to the left or right. Observe if patient has bowel movements.
6. Monitor the patient’s sleep pattern.
7. Monitor for signs and symptoms of shock such as rapid pulse, and shallow
respiration.
8. Observe for signs of peptic ulcer complications such as rigid board-like abdomen,
severe generalized abdominal and shoulder pain, drawing up of the knees, and
shallow granting respiration.
 Nutrition
1. Advice patient to avoid spicy foods.
2. Advice patient against the intake of alcohol and to avoid smoking.
3. Educate patient to eat at regular intervals.
4. Allow patients to make his/her own choice of food but are advised against milk and
its products as this precipitate the reoccurrence of the condition.
5. If the patient cannot tolerate fluid orally; then intravenous fluids may be given
6. Encourage the patient to eat regularly spaced meals in a relaxed atmosphere
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 Patient/Family Education
1. Patients and relatives should be educated on the need to eat smaller foods at regular
intervals.
2. Patients and relatives should be educated on avoiding highly spiced foods and also
avoid smoking.
3. The patients should be educated not to take NSAIDs.
4. Educate patient on the need for and proper follow-ups.
5. Educate patient on the need to take her medication at prescribed times.
6. Educate patient to avoid foods prescribed to her not to take.
 Prevention of Condition
1. Proper hygiene should be ensured to avoid ingestion of Helicobacter pylori.
2. Avoid ingestion of alcohol and spicy foods.
3. Smoking should be avoided.
4. Abuse of None-Steroidal Anti-Inflammatory drugs should be avoided.
5. Excessive stress should be avoided.
6. Too much fasting without intake of food in-between should be avoided.
7. Advise patient and family to keep follow-up appointments.
8. Educate the patient on the need to take all medications as prescribed to prevent
relapse.
9. Explain the rationale for avoiding over the-counter drugs unless prescribed by the
patient’s care providers or medical doctor.
10. Encourage patient and family to share concerns about changes in lifestyle and living
with a chronic illness.
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 Psychological care
1. Reassure patient to allay anxiety and let patient know that he/she is in safe hands.
2. Explain patient condition to him such as causes, signs and symptoms, and
preventions.
3. Introduce other health team members and their role in caring for him.
4. Explain to patient all procedures to be carried on him to elicit her total co-operation.
5. Introduce patient to other patients with similar conditions who are recovering.
 Personal hygiene
1. Explain the importance of personal hygiene to the patient.
2. Assist patient to clean her mouth morning and evening and encourage patient to clean
her mouth before and after meals.
3. Encourage patient to bath at least once daily and those who are bedridden should be
assisted to bath.
Complications
Below are some of the complications of peptic ulcer (Belleza, 2016).
 Hemorrhage. Hemorrhage, the most common complication, occurs in 10% to 20% of
patients with peptic ulcers in the form of hematemesis or melena.
 Perforation and penetration. Perforation is the erosion of the ulcer through the gastric
serosa into the peritoneal cavity without warning, while penetration is the erosion of the
ulcer through the gastric serosa into adjacent structures.
19
 Pyloric obstruction. Pyloric obstruction occurs when the area distal to the pyloric
sphincter becomes scarred and stenosis from spasm or edema or from scar tissue that
forms when an ulcer alternately heals and breaks down.
 Hour-glass stomach. These are a scar contractions in the center of the stomach dividing
it into two cavities with a narrow opening between them. This is started by parietal
gastrectomy
1.10 Validation of Data
Data were collected from the patient, relatives, patient folder and medical team. The above data
were compared to standard literature. No discrepancies were detected. Hence the data is deem
valid.
20
CHAPTER TWO
ANALYSIS OF DATA
2.0 Introduction
This is the process of collecting detailed information from the Patient’s or relatives and also
identifying any deviation from the normal by comparing with standard values. The comparison
involves the literature review of patients’ health problems and the appropriate nursing diagnosis
made as diagnostic investigations and the pharmacology of drugs.
2.1 Comparison of Data with Standards

Data collected from patient and families were compared to that of diagnostic investigations,
causes, clinical features, treatments, and complications found in the textbooks.
Comparisons made are found in the table below.
21
Diagnostic investigation
Table 2.0: Diagnostic Investigations and Tests Compared to Standards
Date Specimen Investigation Normal value Results Interpretation Remarks

13th Blood. Malaria parasite. Negative No malaria The patient was No treatment was given.
March, parasite was free from malaria The patient was encouraged to sleep under a
2022 seen. treated mosquito net, clean her environment
and avoid going to places that are prone to
mosquito bites
13th Blood Hemoglobin Female: 11-16g/dl 12.8g/dl The patient was No treatment was given.
March, level estimation Male: 12-18g/dl not anemic. The patient was encourage to eat foods that
2022 children: 14-18g/dl are rich in iron like green leafy vegetables
and avoid intake of alcohol
13th Blood. Red blood cell 4.5 -5.5 x 106/L 4.72 x 106/L The patient was No treatment was given
March, count. not anemic The patient was encourage to eat foods that
2022 are rich in iron like green leafy vegetables
and avoid intake of alcohol
13th Blood White blood cell 5 - 10 x 103/uL 6.39 x 103/L The patient had no No treatment was given
March, count signs of infection The patient was encouraged to eat fruits and
2022 vegetables to enhance immune response and
avoid cigarette smoking
13th Blood. Platelet count 150 -400 x -103/L 170 x -103/L Within normal No treatment was given.
March, range The patient was encouraged to eat foods that
2022 contain Vitamin k and avoid intake of alcohol
13th Blood H. pylori test Nonreactive Nonreactive The patient’s ulcer The patient was treated based on the clinical
March, (Negative) (Negative) was not caused by features presented, not based on the laboratory
2022 H. pylori. findings.
22
b. Causes of Peptic ulcer disease
Many books and only publications have it that people who have inadequate sleeping hours are
more likely to get peptic ulcers than those who sleep more than 9 hours (Health24, 2016).
Helicobacter pylori were ruled out during laboratory investigation. Non-Steroidal Anti
Inflammatory Drugs (NSAIDs) were commonly used by Mrs. A.M. Therefore patient’s condition
was caused by stress and NSAIDs.
c. Clinical features
Table 2.3 Clinical features
Clinical features in literature Clinical features exhibited by Mrs. A.M
Mid epigastric pain The patient complained of epigastric pain
Pyrosis The patient presented with pyrosis
Vomiting Patient was vomiting
Hematemesis Not presented
Weight loss Not presented
Melena Not presented
Bloated abdomen Not observed
Anorexia The patient presented with a loss of appetite
Diarrhea Not presented
Constipation Not presented
Headache The patient presented with a headache
Fever Not Presented (T: 36.9 °C)
Cough Not presented
d. Treatment
23
1. IV Hyoscine butylbromide 20mg bd x 2 days
4. IV Paracetamol 1g tds × 24 hours
24
Table 2.4 Pharmacology of drugs administered to Mrs. A.M
Date Drug Standard dosage/ Dosage & route of Classificati Desire effect/ Actual action side effects &
route of administration on mechanism of action observed remedies
administration
13th IV Hyoscine 20mg/1ml bd 20mg bd x 2 days Anti- Prevention of Abdominal Constipation, dry
March, butylbromide Intravenous Intravenous spasmodic abdominal cramps cramp was mouth, rashes.
2022 prevented None was observed
13th IV Omeprazole 40mg bd. 40mg bd x 2 days Proton Reduce stomach acid Gastric secretion Headache, vomiting,
March, Intravenous or Intravenous pump by blocking the action was reduced and constipation,
2022 Intramuscular inhibitor of the part that patient was
produces acid relieved of None was observed
abdominal pain
13th Syrup 10mls tds. 10mls tds x 7 days Oral Antacid Neutralizing the acids The stomach acid Diarrhea, Nausea,
March, Magnesium Oral released in the was neutralized Constipation, Skin
2022 Trisilicate stomach and the patient rash.
was relieved Non was observed
from abdominal
pain.
13th Tab 1g tds. 1g tds x 24hrs. Analgesic Reduction in pain Temperature Nausea, stomach
March, Paracetamol Oral, Intravenous, Oral & Reduction of and pain were pain, dark urine,
2022 Rectal Antipyretic temperature reduced jaundice, clay-
colored stool.
None was observed
13th Ringers lactate 250ml – 1000ml 500ml in 24hrs Isotonic For fluid and Fluid and Over infusion,
March, x 24hrs Intravenous (crystalloid electrolyte electrolyte were muscle cramps,
2022 Intravenously ) replacement. replaced. trouble breathing.
No side effect was
observed
13th Normal saline It depends on the 0.5 liters at 20 drops Isotonic To expand plasma There was an Hypervolemia,
March, individual body per minute in 24 solution volume increase in pulmonary edema
2022 requirement hours intravenously Patient plasma
(intravenous) volume
13th IV 12.5 – 25 mg 25mg stat Antiemetic Stimulates motility The patient was Hyperthermia, muscle
March, Promethazine q4hr Intravenous of the upper GI tract relieved from rigidity, irregular pulse
2022 Intramuscular or and accelerates vomiting or BP, tachycardia,
Intravenous gastric emptying and diaphoresis
None was observed
25
e. Complications
In citation to the complications of Peptic Ulcer Disease as stated in the literature review, Mrs.
A.M did not show any signs and symptoms of any complication, since she reported early to the
hospital.
2.2 Patient’s Health Problems

1. Patient had mid epigastric pain
2. Patient was vomiting
3. Patient was anxious
4. The patient could not sleep
5. Patient was very weak
6. The patient could not eat well
7. The patient had little knowledge of the disease condition
2.3 Patient’s strength

1. The patient could describe the intensity of the pain
2. The patient could sip oral fluids.
3. The patient was committed to express her worries.
4. The patient remained in bed to relax
5. The patient was able to brush his teeth when assisted.
6. The patient could eat small quantities of food at frequent intervals. .
7. The patient was ready to learn about the disease condition.
2.4 Nursing Diagnoses

1. Acute abdominal pain related to excessive secretion of gastric acid and irritation of the
gastric mucosa
2. Risk for fluid volume deficit and electrolyte imbalance related to severe vomiting
26
3. Anxiety related to the unknown outcome of the disease condition and its treatment
4. Sleep pattern disturbance related to change of environment
5. Self-care deficit related to general body weakness
6. Risk for nutritional imbalance (less than body requirement) related to loss of appetite
(Anorexia)
7. Knowledge deficit related to lack of adequate information about the disease condition
27
CHAPTER THREE
PLANNING FOR PATIENT AND FAMILY CARE
3.0 Introduction
The nursing care plan is a systematic approach used in carrying out nursing activities with and
for patient. It brings about the method of primary nursing care. It also enables the health team to
determine the patient’s health status and identify her health problems. After these problems have
been identified, the nurse will formulate diagnosis and plan a care plan that is adequate for the
patient and implement.
3.1 Establishing patient goals and outcome criteria
A goal or an objective of nursing care is the desired outcome of the nursing intervention.
Outcome criteria on the other hand are statements that describe the standard against which the
goal was set. The set goals should be specific, measurable, achievable, realistic and time-bound.
The set goals are;
Short term objectives
1. The patient would achieve relief of pain within 24 hours as evidenced by
a. Patient expressing a relief from pain.
b. Nurse observing patient having a cheerful facial expression.
2. The patient would sleep uninterruptedly for at least 8 hours within 48 hours as evidenced
by
a. Patient verbalizing that she slept well
b. Nurse observing patient having uninterrupted sleep
3. The patient would obtain adequate information on the causes and management of the
disease condition within 4 hours as evidenced by:

28
a. Patient mentioning causes and preventions of her condition.
b. Nurse observing patient abide by treatment and dietary regimen
Long term objectives
4. The patient will maintain body fluid and electrolyte balance throughout hospitalization as
evidenced by:
a. The patient having good skin turgor
b. Nurse observes that patient intake and output are balanced.
5. The patient will demonstrate a relief of anxiety throughout hospitalization as evidenced
by
a. Patient verbalizing a relief from anxiety
b. Nurse observed patient having a cheerful facial expression
6. The patient would regain strength and perform activities of daily living independently
throughout her period of hospitalization as evidenced by
a. Patient verbalizing relief from body weakness
b. Nurse visualizes patient attending to her daily personal hygiene and other needs and
participating in care.
7. The patient would maintain her nutritional pattern throughout her period of
hospitalization as evidenced by
a. The patient being able to eat more than half of the food served
b. Patient verbalizing improved appetite
29
Table 3. 1 Nursing Care Plan for Mrs. A.M
Date Nursing Objective/ Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Outcome Time
Criteria
13th Acute abdominal The patient would 1. Reassure patient of pain 1. Patient was reassured of pain 14th The goal was
achieve relief of relief relief fully met as
pain related to
March pain within 24 March, evidenced by
excessive hours as 2. Assess patient’s pain, 2. Pain was assessed with the pain
, 2022 evidenced by location, and precipitating rating scale. The precipitating 2022 a. Patient
secretion of factors factors and location were also expressed relief
at gastric acid and a. Patient assessed at from pain.
expressing relief 3. Encourage the use of non-
irritation of the pharmacological relaxation 3. Patient was encouraged to listen
6:45 from pain. 6:45 b. Nurse
gastric mucosa techniques such as TV and to songs and watch movies to divert observed the
pm b. Nurse observes music therapy to divert the her attention from the pain. pm patient having a
patient having a patient’s attention to pain cheerful facial
cheerful facial 4. Patient was encouraged to avoid expression
expression. 4. Encourage the patient to frequent use of overthe-counter
avoid self-medication, (OTC) drugs.
especially the use of NSAIDs
5. Patient was encouraged to eat at a
5. Instruct patient that meal regular but frequent interval
should be eaten frequently on
a regular interval 6. Patient was encouraged to avoid
the intake of alcohol, cigarette
6. Encouraged the cessation smoking, and carbonated drinks. The
of cigarette smoking, patient was informed that such
alcohol, and carbonated irritate the ulcer
drinks and state its rationale
7. Prescribed IV Hyoscine butyl
7. Administer prescribed bromide 20mg, IV Omeprazole
medications 40mg, and Syrup Magnesium
Trisilicate 10ms were administered.
30
Time Diagnosis Outcome Criteria Time
13th Risk for fluid The patient would 1. Assess skin integrity 1. Skin elasticity was intact as the skin 16th The goal was
every day for signs of returns fast to normal when released
maintain adequate March, fully met as
March volume deficit dehydration.
body fluid and 2. Intakes like IV fluids, and water were 2022 evidenced by
, 2022 and electrolyte 2. Monitor intake and recorded and outputs like urine, and
electrolyte balance output chart vomitus were recorded in her folder at
at imbalance throughout rightly. 9 am a. Patient had a
3. Encourage small
hospitalization as frequent amount of ice 3. Patient was encouraged to take a good skin
6:45 related to
evidenced by: chips or clear liquids small but frequent amounts of ice chips turgor
pm severe and clear liquids as tolerated
4. Encourage the intake
vomiting a. Patient having a of small meals at frequent 4. Patient was encouraged to take in a b. Nurse
intervals small amounts of meals at frequent
good skin turgor, intervals as tolerated observed that
5. Check and record vital
patient intake
signs thrice daily. 5. Temperature, pulse, respiration, and
b. Nurse observes oxygen saturation were monitored and and output is
6. Restrict liquid with recorded accordingly.
that patient intake meals to avoid over- balance
and output is distention of the stomach. 6. Patient was admonished to finish
eating before drinking water and avoid
balanced. 7. Administer prescribed taking in liquid with meals to avoid over
IV fluids. distention of her stomach.
7. Prescribed IV fluid Ringer’s lactate

500ml was administered
31
13th Anxiety The patient would 1. Assess the patient’s level 1. Patient’s level of anxiety was 16th The goal was
March, related to the demonstrate a of anxiety assessed. March, fully met as
2022 an unknown relief of anxiety 2022 evidenced by
2. Encourage the patient to 2. Patient was allowed to express her
at outcome of throughout at
express her fears and worries fears and worries a. Patient
6:45 the disease hospitalization as 9 am
verbalized relief
pm condition and evidenced by 3. Use simple language and 3. Education conducted in the English
of anxiety
its treatment brief statements when giving language was the simplest mode of
a. Patient
instructions to the patient communication for easy b. The nurse
verbalizing a relief
understanding observed the
of anxiety 4. Introduce the patient to
patient having a
other patients with the same 4. Patient was introduced to others
b. Nurse observed cheerful facial
condition. who had received treatment and had
patient having a expression
recovered from the condition.
cheerful facial 5. Encourage family
expression members to show emotional 5. Family members were allowed to
support to the patient show support to the patient
6. Provide a diversional 6. Patient was encouraged to watch

therapy to patient movies shown on the ward television
to reduce worries
32
Date Nursing Objective/ Outcome Nursing Orders Nursing Intervention Date/ Evaluation Sign
Time Diagnosis Criteria Time
13th Sleep pattern The patient would sleep 1. Assess the sleep 1. Patient’s sleep pattern was assessed 15th The goal was
March, disturbance uninterruptedly for at pattern of the patient and it was observed that patient could March, fully met as
in relation to the pain.
2022 related to least 8 hours within 48 sleep better if the pain subsided 2022 evidenced by
at change of hours as evidenced by 2. Provide a at
comfortable bed. 2. Comfortable bed was provided a. Patient
6:45 environment 6:45
a. Patient verbalizing verbalizing that
pm 3. Position the patient 3. the patient was put in a position that pm
that she slept well in a way that favors she slept well
she found more relaxing and
her relaxation.
b. Nurse observing comfortable b. Nurse
4. Provide dim light
patient having observing
and noise-free 4. Patient was protected from bright
uninterrupted sleep environment. patient having
light and noise.
uninterrupted
5. Organize and carry
5. Nursing care was organized and sleep
out nursing care
(cluster nursing).6. carried out in bulk to prevent sleep
Administer prescribed interruption.
medication to relieve
pain
6. Prescribed Paracetamol 1g and IV
Hyoscine butyl bromide 20mg were
administered to reduce the patient’s
pain
33
14th Self-care The patient would 1. Assist patient to take 1. The patient was given an assisted 16th The goal was
regain self- her bath and bath in the bathroom morning and fully met as
March, deficit related March,
sufficiency within cleaning teeth twice evening and had her teeth cleaned as evidenced by
2022 to general her period of daily. well. 2022
hospitalization as a. Patient
at body 2. Encourage passive 2. The patient was encourage to do at verbalizing
evidenced by
7 am weakness exercise exercise, and move her joints gently 7 am relief from body
a. Patient verbalizing as she is in bed. weakness,
relief from body 3. Encourage the
weakness, patient to take short 3. The patient was assisted to take b. Nurse
walks around the short walks around the ward with a visualizes
b. Nurse visualizes ward. walker. patient
patient attending to attending to her
her daily personal 4. Keep needed items 4. Drinking water, clothes, and needed
within reach of the items were placed closed to the daily personal
hygiene and other patient. patient in her locker. hygiene and
needs and needs and
participating in care. 5. Rearrange schedule 5. Procedures were carried out together participating in
to reduce energy loss to reduce the energy loss of the
care.
Patient.
6. Encourage the
patient to eat foods 6. The patient was encouraged to eat
that enhance energy foods that enhance energy such as
fruits and vegetables
34
15th Risk for The patient would 1. Reassure the patient 1. Patient was reassured. 16th The goal was
March, nutritional maintain her March, fully met as
2. Plan a diet to meet her likes 2. Diet was planned with the
2022 imbalance nutritional pattern 2022 evidenced by
and dislikes. patient to help meet her likes and
at (less than throughout her at
3. Remove nauseating things dislikes. a. Patient being
7 am body period of 7 am
such as bedpan from the able to eat more
requirement) hospitalization as 3. Nauseating items were removed
bedside to improve appetite than half of the
related to loss evidenced by from bed side to improve appetite.
food served
of appetite 4. Perform mouth care using
a. Patient being able 4. Mouth care was performed
(Anorexia) toothpaste. and Patient
to eat more than half before meals.
verbalizing
of the food served 5. Serve food rich in iron to
5. Patient was served foods rich in improved
prevent nutritional deficiency
b. Patient iron. appetite
anemia such as Iron
verbalizing
deficiency anemia.
improved appetite 6. Food was served in bits and at
6. Serve food in bits and at frequent intervals.
frequent intervals.
7. Food was served attractively.
7. Serve food attractively.
35
15th Knowledge The patient would 1. Assess the patient’s level 1. Patient’s level of knowledge 15th Goal was fully
obtain adequate of knowledge about the disease condition was met as
March, deficit related March,
information on the evaluated evidenced by
2022 to lack of causes and 2. Explain the disease 2022
management of the process, especially the 2. Disease process was explained to a. Patient
at adequate clinical features and the patient especially the clinical at mentioned
disease condition
10 am information within 4 hours as complications to the patient features and the complications. 2 pm causes and
evidenced by: preventions of
about the 3. Explain the major causes 3. The causes and predisposing her condition.
disease a. Patient and predisposing factors of factors of the disease condition were
mentioning the peptic ulcers to the patient explained to the patient b. Nurse
condition causes and observed patient
preventions of her 4. Discuss with the patient 4. The medical treatment of the abide by
condition. the treatment regimen of the disease condition was discuss with treatment and
disease condition the patient. dietary regimen
b. Nurse observing
patient abide by 5. Introduce the patient to 5. Patient was introduced to old
treatment and another patient who has patients who have undergone
dietary regimen successfully recovered from treatment with the same disease
the same condition. condition to allay anxiety.
6. Provide the patient with a 6. Patient was provided with a

leaflet that contains leaflet that contains detailed
information about the information about her disease
disease condition. condition
7. Encourage the patient to 7. Patient was encouraged to ask

ask questions and provide questions and all questions asked
appropriate answers were answered
36
CHAPTER FOUR
IMPLEMENTING PATIENT/FAMILY CARE
4.0 Introduction
Implementation is the fourth step of the nursing process which includes putting into action the
actual nursing interventions mentioned in the care plan. These are activities on the patient’s
physiological and spiritual needs. This section of the care study includes;
1. Summary of the actual nursing care rendered
2. Preparation of patient and family for discharge and rehabilitation.
3. Follow-ups, home visits, and continuity of care.
4.1 Summary of Actual Nursing Care Rendered to Patient and Family
The nursing management of the patient started from the day of admission (13 th March, 2022) to
the day of discharge (16th March, 2022). The nursing management aimed at promoting speedy
recovery and also preventing further complications. During the period of admission, daily routine
care was carried out such as bed making, maintaining personal hygiene and feeding of patient,
and serving prescribed medication to the patient. The patient’s vital signs were checked and
recorded. Specific care was carried out according to the patient’s needs on particular days and it
had been narrated as follows,
First Day of Admission: 13th March 2022
On arrival, Mrs. A.M was very weak. She complained of general body weakness, epigastric pain,
heart burns, nausea and vomiting, and loss of appetite. Mrs. A.M and her relatives were
37
welcomed to the hospital and they were offered a seat. I helped the patient to retrieve her folder
from the records which were paperless. Mrs. A.M was led by the medical officer on duty (Dr.
Adu) who after assessment provisionally diagnosed her with Peptic Ulcer Disease (PUD). The
patient was admitted to the females’ medical ward. The following medications were prescribed;
1. IV Hyoscine butyl bromide 20mg bd x 2 days
4. Tablet Paracetamol 1g tds × 24 hours
On admission, the patient’s blood sample was taken for laboratory investigations. Below were
the tests that were requested by the physician:
 Blood Film (BF) for Malaria Parasites (MPs)
 Full blood count
 Helicobacter pylori test
I accompanied Mrs. A.M to the ward. We were warmly welcomed by a staff nurse at the nurses’
station. I explained my mission of using Mrs. A.M for my care study and was granted permission
to go ahead. I was assisted to put my patient quickly on a bed andmaking her comfortable. Mrs.
A.M’s particulars such as name, sex, age, hometown, occupation, medical diagnoses, in-patient
and out-patient numbers, marital status and others were documented in the Admission and
Discharge book as well as the daily ward state. Observations made on her and the nursing
38
interventions rendered to her were written in the nurses’ notes. I also sought for their consent to
use the patient for my care study and she agreed.
Mrs. A.M’s major complaints on admission were epigastric pain, vomiting, dizziness, and
general body weakness. A vomitus bowl was made present at the bedside. A tray for vital signs
was prepared and baseline vital signs were checked and recorded as follows.
 Respiration: 18cpm
 Pulse: 74 bpm
 SPO2: 97%
The patient’s belongings were kept based on the hospital policy. Thereafter, I went ahead to
explain the National Health Insurance Scheme (NHIS). She was also oriented to the ward and its
annexes, especially the wash room and bathroom. Mrs. A.M was also educated on the following
ward routines; time doctors come on rounds each day at 9:00am, time medications are served,
that is 6:00 am, 10:00 am, 2:00 pm, 6:00 pm, and 10:00 pm, as well as the following visiting
hours. Morning: 6:00am- 7:00am, afternoon: 1pm -2pm and evening: 5:30pm- 6:30 pm.
On this day, the patient had epigastric pain. The nursing diagnosis was “Acute abdominal pain
related to excessive secretion of gastric acid and irritation of the gastric mucosa”. The outcome
criteria were to enable the patient to have a satisfactory pain less than 2 on the pain rating scale
within 24 hours. The nursing interventions were as follows; (1) Patient was reassured of pain
relief. (2) Patient’s pain was assessed with the aid of the pain rating scale. (3) Precipitating
factors and location of the pain were also assessed. (4). Patient was encouraged to listen to songs
39
and watch movies to divert her attention from the pain. (5). Patient was encouraged to avoid
frequent use of over-the-counter (OTC) drugs. (5). Patient was encouraged to eat at a regular but
frequent interval. (6) Patient was encouraged to avoid the intake of alcohol, cigarette smoking,
and carbonated drinks. It was explained to the patient that such contents irritate the ulcer.
Moreover, prescribed IV Hyoscine butyl bromide 20mg, IV Omeprazole 40mg, and Syrup
Magnesium Trisilicate 10ms were administered.
The patient was vomiting. As part of the patient’s strength, Mrs. A.M could sip oral fluids. The
nursing diagnosis for Mrs. A.M’s problem was “Risk for fluid volume deficit and electrolyte
imbalance related to severe vomiting. The nursing objective was to enable Mrs. A.M to maintain
adequate body fluid and electrolyte balance throughout hospitalization. The nursing interventions
that were carried out were as follows: (1) to assess Mrs. A.M's skin integrity every day for signs
of dehydration (2). To monitor her intake and output chart. (3). To encourage her to take in a
small but frequent amounts of ice chips or clear liquids (4) She was encouraged to take in a small
amounts of meals at frequent intervals as tolerated (5). Her vital signs such as temperature, pulse,
respiration, and oxygen saturation were monitored and recorded accordingly. (6). Mrs. A.M was
admonished to finish eating before drinking water and avoid taking in liquid with meals to avoid
distention of her stomach (7). Prescribed IV fluid Ringer’s lactate 500ml was administered.
The patient was also observed to be anxious. The nursing diagnosis for the problem was
“Anxiety related to the unknown outcome of the disease condition and its treatment”. The
objective was to relieve. Mrs. A.M off anxiety throughout hospitalization. The following were
the nursing interventions: (1). Mrs. A.M’s level of anxiety was assessed. (2). She was allowed to
express her fears and worries (3). Education spoken in the English language was the simplest
mode of communication for easy understanding (4). Mrs. A.M was introduced to others who had
40
received treatment and had recovered from the condition. (5). her family members were allowed
to show support to Mrs. A.M (6). Mrs. A.M was encouraged to watch movies shown on the ward
television to reduce her worries
The patient complained that she could not sleep due to abdominal pain. The formulated nursing
diagnosis was “Sleep pattern disturbance related to frequent abdominal spasms”. The nursing
objective was to put in place measures that would enable Mrs. A.M to sleep uninterruptedly for
at least 8 hours within 24 hours. The nursing interventions were as follows: (1). Mrs. A.M’s
sleep pattern was assessed and it was observed that she could sleep better if the pain subsided.
(2). Comfortable bed was provided to facilitate sleep (3). Mrs. A.M was put in a position that she
found more relaxing and comfortable (4). She was protected from bright light and noise. (5).
Nursing care was organized and carried out in bulk to prevent sleep interruption. (6). Prescribed
Paracetamol 1g and IV Hyoscine butyl bromide 20mg were administered to reduce the patient’s
pain.
Around 8:30 pm, Mrs. A.M was handed over to the night nurses for continuity of care.
The second day of admission (14th March, 2022)
In the morning, I took over from the night nurses. Assistance was given and Mrs. A.M’s hygiene
was maintained. She was served with tea and bread. Due medications at 6 am were administered
and vital signs were checked and recorded as
1. Temperature: 36.3°C
2. Respiration: 18 cpm
3. Blood Pressure: 120/74 mmHg.
4. Pulse: 78 bpm
5. SPO2: 96%
41
On this day, the patient presented only one health problem. At 7 am, Mrs. A. M reported she had
general body weakness. The nursing diagnosis of the mentioned problem was “Self-care deficit
related to general body weakness.” The nursing objective was to enable Mrs. A.M to perform
activities of daily living independently throughout her period of hospitalization. The nursing
interventions were: (1) to assist Mrs. A.M to take her bath and clean her teeth twice daily. (2) To
encourage her to partake in passive exercise (3) to encourage Mrs. A.M to take short walks
around the ward. (4) Drinking water, clothes, and needed items were placed closed to the patient
her locker. (5) Procedures were carried out together to reduce Mrs. A.M from losing energy. (6)
She was encouraged to eat foods that enhance energy such as fruits and vegetables
In the afternoon during visiting hours, the patient's relatives paid her a visit to the ward. She was
very glad to see them. They supported Mrs. A.M with their words and prayers when the vising
time was over. In the evening, Mrs. A.M was served "rice and stew. Thereafter, she took her bath
and brushed her teeth before she went to bed. Prescribed medications were administered and
vital signs were checked and recorded as;
 Temperature 36.9 °C
 Pulse 94 bpm
 Respiration 20 cpm
 Blood Pressure 121/78 mmHg
 SPO2: 97%
At 7:42 pm, Mrs. A.M was handed over to the night nurse for continuity of care.
The third day of admission (15th March, 2022)
42
In the morning, I took over from the night nurses. At 6 am, due medications were administered
and vital signs were checked and recorded as
 Temperature: 36.5°C
 Pulse: 70 bpm
 BP: 116/76 mmHg
 SPO2: 98 %
The nurses’ report stated that Mrs. A.M had a sound sleep. Greetings were exchanged and the
patient was asked how she was doing.
On this day, Mrs. A.M. presented with two health problems. First of all, she complained of
anorexia. The nursing diagnosis for the problem was “Risk for nutritional imbalance (less than
body requirement) related to loss of appetite (Anorexia)” The nursing objective was to ensure
that Mrs. A.M maintained her nutritional pattern throughout her period of hospitalization. The
nursing interventions were as follows: (1). Mrs. A.M was reassured of improved eating patterns.
(2). her diet was planned with Mrs. A.M. (3). Nauseating items such as a bedpan were removed
from bed side to improve appetite. (4). Mouth care was performed before meals. (5). Mrs. A.M
was served foods rich in iron to prevent nutritional deficiency anemia. (6). Food was served in
bits and at frequent intervals. (7). Food was served attractively.
Moreover, Mrs. A.M was having inadequate information regarding her disease condition. The
nursing diagnosis was “Knowledge deficit related to lack of adequate information about the
43
disease condition”. The nursing objective was to ensure that Mrs. A.M obtained adequate
information on the causes and management of the disease condition within 4 hours. The nursing
interventions were: (1). Patient’s level of knowledge about the disease condition was evaluated
(2). The disease process was explained to the patient especially the clinical features and the
complications. (3). the causes and predisposing factors of the disease condition were explained to
the patient (4). The medical treatment of the disease condition was discuss with Mrs. A.M. (5).
She was introduced to old patients who have undergone treatment with the same disease
condition to allay anxiety. (6). Mrs. A.M was provided with a leaflet that contains detailed
information about her disease condition (7). She was encouraged to ask questions and all
questions asked were answered.
On this very day around 1 pm, I had the opportunity to visit Mrs. A.M’s house at Nagbo in the
North East Region of Ghana. I went there in accompanied with her husband. This visit was made
to get adequate information about the possible factors that would have led to Mrs. A.M's
condition. The distance from the hospital to the patient’s habitation was 30 minutes ride. On my
arrival, I was warmly welcome. I was offered a seat and given water to drink as tradition
demands. I was asked about my purpose for visit. The reason behind my visitation, its
importance in the care of the patient, and its health promotion as a whole were explained.
Upon my assessment, I asked about their source of water. I was informed that they buy water
from water dealers who fetch the water from boreholes. However, I was informed that they do
not treat the water before being used. I encouraged them to prepare the water to avoid water-
borne diseases that can be life-threatening.
I also realized that the house surroundings were generally not tidy. They have no good drainage
and proper waste disposal. There was stagnant bath water at the back of the house. I educated
44
them on good environmental hygiene, good personal hygiene, and their benefits. I encouraged
them to keep the house clean, covering of drinking water and all foods, and washing of cooking
utensils immediately after meals, since it contributes a lot to their health status and also to
observe personal and environmental hygiene to enhance the quick recovery of their relatives
when finally discharged from the hospital. After I got the information I wanted, I thanked them
and left the house at 2:30 pm. I spent 45munites at the house before coming back to the hospital.
In the evening, Mrs. A.M was served with TZ. She was able to eat two-thirds of the food. After
eating, she was aided to take her bath. At 6 pm, prescribed medications were administered and
vital signs were checked and recorded as;
 Temperature: 36.5 ℃
 Pulse: 78 bpm
 BP: 119/78 mmHg
At 7:00 pm, Mrs. A.M was handed over to the night nurse for continuity of care.
The fourth day of admission (16/03/2022)
In the morning, Mrs. A.M. slept well and was fully prepared to be discharged home. At 9:30 am
the Medical practitioner came for rounds. Mrs. A.M was informed that she had been discharged.
She was educated on the need for continuity of care and follow-up. I went to the accounts office
together with her husband to pay her hospital bills. There were no medications ordered on the
day of discharge.
Again, Mrs. A.M and her relatives were educated on the medications and their adverse effects.
The patient was encouraged to ask questions and appropriate answers were given. The patient
45
was informed about the date for review and its importance. Subsequently, they were
accompanied to the taxi. I bid them farewell. Back to the ward, dirty linen was removed and the
bed was disinfected. All patient details were recorded in the admission and discharge book.
4.2 Preparation of Patient / Family for Discharge and Rehabilitation
All plans for the discharge of Mrs. A.M started on the day of admission (13 th March, 2022) until
she was discharged home based on successful treatment. She was certain that hospitalization was
to accelerate her care and monitoring of her condition as she undergoes treatment.
Early in the next morning, the patient bathed and groomed ready for the doctor to discharge her.
The patient was insured by the National Health Insurance Scheme. So her bills were only those
services or drugs that were not covered by the insurance scheme.
Mrs. A.M and her relatives were educated on the causes, predisposing factors, signs and
symptoms, and management, and prevention of peptic ulcer disease. The patient was also
educated to adhere to the treatment regimen to prevent further complications of the condition.
She was encouraged to eat a balanced diet to prevent irritations and help build her immunity.
Education was also given on lifestyle modification and home based management including
choice of food and drinks, and also to avoid indiscriminate use of drugs, especially NSAIDs.
The root of medication administration, desired effects, and side effects were all explained to Mrs.
A.M. She was encouraged to come back to the facility when she experiences any adverse effects.
The need for review and completion of drugs were also discussed with Mrs. A.M. She was
therefore informed about the review date.
46
4.3 Follow-up/home visit/ continuity of care
Follow-up visit is done to ensure continuity of care for the patient after discharge from the
hospital. Most home visits after discharge are to check up to see how the patient is doing and
also to ensure that there are no complications. The home visit is necessary for the nurse to assess
how the patient and family are doing to promote good health, prevent diseases and also to give
health education to the patient and family (Nahealth, 2018).
First home visit – 15th March, 2022
A visit was paid to Mrs. A.M. and her husband at their residence, whom I had firstly informed
before the visit. The main aim was assess the home environment, their health challenges and to
find possible solutions before Mrs. A.M is discharged. Mrs. A.M lives with her in-laws in their
own house at Nagbo. The house is built with mud. It contains six (6) bedroom, a common toilet,
and a bathtoom that all the entire family use. Mrs. A.M and her family occupy one (1) room. The
house is roofed with iron sheets and ceiled with plywood. Each room had one window on the
opposite wall of the rooms. The house has electricity and no source of water.
I asked about their source of water. I was told that they purchase water from water providers.
However, I was informed that they do not treat the water before being used. They were
encouraged to boil or chlorinate the water to avoid water-borne diseases that can be life-
threatening. I also recognized that the house surroundings were generally not tidy. They have no
good drainage and proper waste disposal. There was stagnant bath water at the back of the house.
I educated them on good environmental sanitation, good personal hygiene, and the benefits.
I encouraged them to keep the household tidy, covering drinking water, food, and washing
cooking utensils directly after meals. They were also informed to observe personal and
environmental hygiene to enhance the quick recovery of their relative when she is finally
47
discharged from the hospital. After getting the necessary information, I thanked them and left the
house. I spent 45munites at the house before returning to the hospital.
Second home visit – 21st March, 2022
My second home visit took place on the 21st of March, 2022. This was accomplished when Mrs.
A.M was discharged from the hospital. It was a planned visit, the patient and family had
prepared the house for my visit. During my interaction, Mrs. A.M did not complain of any
problem. She was much improved. I spotted that she was taking her medications as prescribed.
She was prompted about the review date which was on 22 nd March, 2022. During my visit, I took
the opportunity to assess Mrs. A.M’s vital signs which were recorded as
1. Temperature: 36.5 ℃
2. Pulse: 86 bpm
3. Respiration: 18 cpm
4. BP 118/82 mmHg
However, the opportunity was taken to introduce the community health nurse, who would be
visiting them to monitor their health status. The patient and family were reminded of the
previous education given and were pre-informed of termination of care and handing over care to
the community health nurse on the next visit.
Review day on the 22nd March, 2022
On the day of review, I met Mrs. A.M at the outpatient department (OPD) in the morning. On
review, the patient presented no complaint saying that she was feeling better. The doctor asked
Mrs. A.M to go home without giving her any drugs. The physician further told Mrs. A.M to
48
report to the hospital if she has any other health problems. The patient was seen off at the
hospital entrance to board a taxi.
Third Home Visit – 24th March, 2022
The patient was very cheerful to see me. In this instance, I went with the community health nurse
(Imoro Tanko) at Nagbo Health Center. On arrival, Mrs. A.M and her family were in good
health. She was allowed to ask questions and express her feelings. They were advised to report to
the nearest health facility whenever they are sick and avoid self-medications and local treatment.
They were also advised to continue to prevent any predisposing factor that might lead to the
condition again.
I congratulated them for their co-operation throughout the care and also reminded them of ending
the interactions and visits with them. Mrs. A.M’s condition and treatment were explained to the
community health nurse. I finally thanked Mrs. A.M and her relatives for their corporation and
support throughout the care.
49
CHAPTER FIVE
EVALUATION OF CARE RENDERED TO PATIENT/FAMILY
5.0 Introduction
This is where the determination of the patient’s responses to the nursing interventions is done
and the extent to which the outcomes have been achieved. This chapter comprises the following
1. Statement of evaluation
2. Amendment of the nursing care plan for partially met or unmet outcome criteria
3. Termination of care
4. Summary and conclusion
5.1 Statement of Evaluation
This is a report on how the nursing care rendered to Mrs. A.M was evaluated. Mrs. A.M received
maximum standard of nursing care throughout her hospitalization.
14th March, 2022
1. At 6:45 pm on 13th March, 2022, Mrs. A.M complained of severe epigastric pain, the nursing
diagnosis was formulated as ‘Acute abdominal pain related to excessive secretion of the gastric
acid and irritation of the gastric mucosa’. The objective set was, patient will be relieved of
epigastric pain within 24 hours. The goal was fully met by 6:45 pm am on 14 th March, 2022
evidenced by the patient expressed relief from pain.
2. On the same day, Mrs. A.M was vomiting. The nursing diagnosis was ‘Risk for fluid volume
deficit and electrolyte imbalance related to vomiting”. The nursing objective was to enable the
50
patient to maintain adequate body fluid and electrolyte balance throughout. As of 9 am on 16th
March, 2022, the goal was fully met as the patient had a good skin turgor and nurse observed that
patient intake and output was balanced.
3. On this day, the Patient was anxious. The nursing diagnosis was Anxiety related to unknown
outcome of the disease condition and its treatment. The objective set was to relieve the patient
from anxiety throughout hospitalization. The goal was fully met at 9 am on 16 th March, 2022 as
the patient verbalized relief of anxiety.
4. On this day, the Patient was unable to sleep. The nursing diagnosis was Sleep pattern
disturbance related to change of environment. The nursing objective was to enable the patient to
sleep uninterruptedly for at least 8 hours within 48 hours. The goal was fully met at 6:45 pm on
15th March, 2022 as the patient verbalized that she slept well.
14th March, 2022
5. On this day around 7 am, the patient was very weak. The nursing diagnosis was Self-care
deficit related to general body weakness. The nursing objective was “Patient would perform
activities of daily living independently throughout her period of hospitalization.” The goal was
fully met on 16th March, 2022 at 7 am, as the patient verbalized relieve from body weakness and
able to carry self-care activities such as bathing and ambulating.
15th March, 2022
6. On this day around 7 am, the patient had anorexia. The nursing diagnosis was Risk for
nutritional imbalance (less than body requirement) related to loss of appetite (Anorexia). The
nursing objective was “Patient would maintain her nutritional pattern throughout her period of
hospitalization.” The goal was fully met on 16th March, 2022 at 7 am, as the patient was able to
eat all meal served and maintained her normal body weight.
51
7. Around 10 am, the patient had little knowledge about the condition. The nursing diagnosis was
Knowledge deficit related to a lack of adequate information about the disease condition. The
nursing objective was to enable the patient to obtain adequate information on the causes and
management of the disease condition within 4 hours.” The goal was fully met on the same day
15th March, 2022 at 2 pm, as the patient mentioned the causes and preventions of her condition
5.2 Amendment of Nursing Care Plan
Amendment of care is carried out on unmet or partially met goals. There was no partial or unmet
objective. All objectives set were fully met within the specified time frames. Hence, there was no
amendment to the nursing care plan.
5.3 Termination of Care
The termination of care is a gradual process of separation of the nurse-patient relationship. Mrs.
A.M was made aware of the termination of care from the day of admission. She was informed
that, when her condition improves, she will be discharged home. During her stay at the Baptist
Medical Center (BMC), she was fortified to do more self-care to promote wellness. Her relatives
and other caregivers were also involved in her care.
She was informed that there would be continuity of care after discharge through home visits.
Explanation of the etiology, clinical features, and prevention of Peptic Ulcer was discussed with
the patient. Mrs. A.M was encouraged to practice proper personal and environmental hygiene.
She was discharged on 16th March, 2022. Education on drug route, dose, and dosage were
highlighted. She was then handed over to the community health nurse for continuity of care.
52
5.4 Summary of Care and Conclusion
Mrs. A.M, is a thirty-three-year-old woman who was admitted to the Female Medical Ward of
Baptist Medical Center on 13th March, 2022. She was diagnosed with Peptic Ulcer Disease.
During the assessment of the patient, Mrs. A.M was found to have epigastric pain, heartburn,
nausea and vomiting, and general body weakness. Nursing interventions were carried out on
day-to-day basis to address her problems.
The patient spent four (4) days on the ward. Mrs. A.M was well-informed on good nutrition and
proper personal hygiene throughout her admission to the hospital. Her vital signs were checked,
monitored, and recorded. All due medications were served and charted as required. Three Home
visits (15th, 21st, and 24th March) were made to enable continuity of care and also familiarize with
the patient’s home environment. On the third day of the home visit (24 th March, 2022), Mrs. A.M
was finally handed over to a community health nurse in their locality to continue with her care.
Conclusion
This care study has clarified my knowledge of Peptic Ulcer Disease. I am pleased for being able
to transform the little knowledge acquired in the lecture hall into a clinical setting (Hospital). It
has improved me in establishment of rapport with different people from the different socio-
demographical backgrounds. The care study has also improved my interpersonal relationship
with other clinicians.
With the knowledge learned from this exercise, my self-reliance in caring for patients has
advanced. Itherefore, propose that patient-centered nursing should be practiced in all health
sectors in our country since the progress of care is carefully monitored.
53
BIBIOGRAPHY
Anand, B. S., Katz, P. O. (2020). Peptic ulcer disease. Retrieved from
https://emedicine.medscape.com/article/181753-overview
Belleza, M. (2016). Peptic Ulcer Disease. Retrieved from https://nurseslabs.com/peptic-ulcer-
disease/
Belleza, M. (2021). Peptic ulcer disease. Retrieved from nurseslabs.com/peptic-uler-disease/
Brune, K., & Patrignani, P. (2015). New insights into the use of currently available non-steroidal
anti-inflammatory drugs. Journal of pain research, 8, 105.
Drini, M. (2017). Peptic ulcer disease and non-steroidal anti-inflammatory drugs. Australian
prescriber, 40(3), 91.
Feldman, M., Friedman, L. S., & Brandt, L. J. (Eds.). (2020). Sleisenger and Fordtran's
gastrointestinal and liver disease: pathophysiology, diagnosis, management. Elsevier health
sciences.
Health24 (2016). Risk factors for peptic ulcers Retrieved from

https://m.health24.com/Medical/Heartburn/Peptic-ulcers/risk-factors-for-peptic-ulcers-
20160309-2
Malik, T.F and Gnanapandithan, K., Singh, K. (2018). Peptic Ulcer Disease.
Phan, J., Benhammou, J. N., & Pisegna, J. R. (2015). Gastric hypersecretory states: investigation
and management. Current treatment options in gastroenterology, 13(4), 386-397
Toney-Bulter, T.J., & Thayer, J.M. (2018). Nursing process. In StatPearls [internet]. StatPearls
Publishing
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PATIENT AND FAMILY CARE STUDY ON A PATIENT WITH

PEPTIC ULCER DISEASE (PUD)

BAPTIST MEDICAL CENTRE (BMC) - NE/R

INDEX NUMBER: (6220190007)

A FINAL YEAR STUDENT OF THE COLLEGE OF NURSING AND MIDWIFERY,

SUBMITTED TO THE NURSING AND MIDWIFERY COUNCIL OF GHANA IN

patient’s physiological, psychological, and social needs.

insight into research work.

throughout this work.

understanding and cooperation throughout this work.

in making this work a reality

throughout my patient's care in the ward.

Finally, my acknowledgment will be incomplete if I failed to acknowledge the authors and

me morally and financially, especially my parents

God bless you all.

Center on 13th March, 2022 at 6:30 pm.

captures the evaluation of care rendered to the patient

Table one: Diagnostic Investigations and Tests Compared to Standards

Table two Clinical features

Table three Pharmacology of drugs administered to Mrs. A.M

Table four Nursing Care Plan for Mrs. A.M

ASSESSMENT OF PATIENT AND FAMILY

validation of the data obtained were also discussed.

1.1 Patient’s particulars

16th March, 2022.

1.2 The Patient’s Family Medical and Socioeconomic History

funerals, wedding ceremonies, out-dooring (naming ceremonies), and community labor

1.3 Patient's Developmental History

the psychosocial theory of development by Erick Erikson.

had her first menstrual flow.

1.4 Patient’s Lifestyle and Hobbies

ready by 6:30 am. At least she void four times daily.

interest to her before going to bed.

1.5 Patient's Past Medical/ Surgical History

1.7 Admission of Patient

were taken and recorded as

 Blood Pressure: 120/70 mmHg.

2. IV Omeprazole 40mg bd x 2 days

3. Syrup Magnesium Trisilicate 10ms tds x 7 days

4. Tablet Paracetamol 1g tds × 24 hours

5. IV fluid Ringer’s lactate 500ml for 24 hours

6. IV fluid Normal Saline 500ml for 24 hours

7. IV Promethazine 25mg stat

1. Blood Film (BF) for Malaria Parasites (MPs)

2. Full blood count

3. Helicobacter pylori test

 Blood Pressure: 118/76 mmHg.

 Blood Pressure: 120/70 mmHg.

relevant information and things needed for the hospitalization.

use patient for my care study and she agreed.

1.8 Patient’s Concept of Illness

1.9 Literature review of Peptic ulcer

Non-Steroidal Anti Inflammatory Drugs or alcohol intake and middle age.

equal to that in men (Belleza, 2021)

1. Infection with Helicobacter pylori: H. pylori are acquired through ingestion of

stomach and duodenum.

3. Pathologic hypersecretory disorders (e.g., Zollinger-Ellison syndrome): a condition

Other causes of peptic ulcer include;

chronic pain and arthritis)

history of the problem (Health24, 2016).

smoking may accelerate gastric emptying and decrease pancreatic bicarbonate

production. However, studies have produced contradictory findings.

likely to develop peptic ulcers than those who sleep more.