PEPTIC

PEPTIC ULCER
ULCER
DISEASE
DISEASE
Introduction
 Peptic Ulcer

• Ulcers average between one-quarter and one-half inch in

diameter. They develop when digestive juices produced in
the stomach, intestines, and digestive glands damage the
lining of the stomach or duodenum.
The two important digestive juices are hydrochloric acid and
the enzyme pepsin. Both substances are critical in the
breakdown and digestion of starch, fat, and proteins in
food. They play different roles in ulcer:
• Hydrochloric Acid. A common misbelieve is that excess
hydrochloric acid, which is secreted in the stomach, is
solely responsible for producing ulcers.
• H. pylori- the bacteria that has been the cause of
most peptic ulcers.
• Pepsin. Is an enzyme that breaks down proteins in
food. Since the stomach and duodenum are also
composed of protein, however, they too are
susceptible to the actions of pepsin.
• Bicarbonate, which the mucous layer secretes,
neutralizes the digestive acids. Hormone like
substances called prostaglandins help keep the blood
vessels in the stomach dilated, ensuring good blood
flow and protecting against injury.
(Prostaglandins are also believed to stimulate
bicarbonate and mucus production.
Patient Profile
• Patient’s Name: Criselda Llorente Siangco Sex: Female
• Age: 43 y.o.
• Status: Married
• Address: Pigcarangan, Tubod, Lanao Del Norte
• Religion: Roman Catholic
• Occupation: housewife
• Citizenship: Filipino
• Chief Complaints: Palpitation 3months PTA V/S:
• Date Admitted: Jan.5,2010 BP:100/120 mmHg
• Time Admitted:9:34 Pm Temp. : 37.1 C
• Impression/Diagnosis: HVD/UTI/Acid PR: 84 Bpm
Peptic Disease RR: 24 Cpm
• Physician: Dra. Marjueta Opamen
• Room: Critical Ward
NURSING ASSESSMENT
General Information:
Patient’s Name: Criselda L. Siangco
Sex: F Age: 43 y.o.
Religion: Roman Catholic
Occupation: Housewife
Address: Pigcarangan, Tubod, LDN
Status: Married
Date Admitted: Jan.5,2010
Chief Complaints: Palpitation 3 Months
PTA
Med: Metropolol Previously admitted
last Nov. Secondary to palpitation/Dx
HVD
Impression/Diagnosis: HVD/UTI/ Acid
Peptic Disease
Physician: Dra. Marjueta Opamen
 Reaction to & Expectations
Present Illness about Hospitalization

• Palpitation 3 mos. PTA • HPN/ Ulcer

• Jan.5,2010 @ 9:30 PM • It can be treated
through hospitalization
• It can affect their daily
living
• Yes, it can change my
ability to function as a
mother and a wife
• Sad and irritable
• Lonely and sad
 Reactions about Treatment &
Previous Illness Diagnostic Procedures

• HVD • It can relieve the pain

• Over fatigue and cure my illness
• They give their care • Is it really make me
feeling well?
• Afraid
Nursing History Clinical On-going Appraisal Other sources, lab. Exam
Normal Patterns of Inspection observation 2nd day of Results
Functioning (prior to observation on duty
admission) First Day of
duty
Patterns of
functioning:
Respiration
•Tachypnea *Normal *Normal
Personal Hygiene:
•Daily Bath
•Brushing of teeth *Dry Skin
3x a day * Dry scalp
Nursing History Normal Clinical Inspection On-going Appraisal Other sources, lab.
Patterns of Functioning observation on observation 2nd day ofExam Results
(prior to admission) First Day of duty duty

Communication &
Special senses:
•No difficulties in *Weak Voice
speaking, hearing,
seeing and
understanding
•Slightly read & write
English
Coping with Stress:
*Rest *Irritable *Irritable, tense
*Family
Circulation:
*tachycardia *Normal PR
*Take medication *Normal BP
Nursing History Clinical Inspection On-going Other sources, lab. Exam
Normal Patterns of observation on First Appraisal Results
Functioning (prior to Day of duty observation 2nd
admission) day of duty

Food & Fluid

Intake:
•Meals? 3x a day *56 kg *poor appetite •DAT
*D5 NSS 1L @20
•Snack? Seldom *5’4 gtts/mins
•Content? Rice & *pale skin Results U/A
vegetables Color-light yellow
Transparency- clear
•1 cup of coffee Specificity- 1.005 pH
every morning 6.5
•Like all kinds of Albumin-negative
Sugar- negative
food PUS 1-2
RB 1-2
WBC- 10.12
Hgb. -116
Hct. -0.35
Neutrophil- 0.73
Lymphocyte- 0.25
Eosinophils- 0.02
Nursing History Clinical Inspection On-going Appraisal Other sources, lab.
Normal Patterns of observation on First observation 2nd day ofExam Results
Functioning (prior to Day of duty duty
admission)

Exercise:
•Hiking & stretching
within 30 mins.
Twice a week
•Right Handed
Pain/Discomfort:
* Epigastric pain
*Take medication •Acute Pain
Regulatory
Mechanism
*Dizzy
•Temp- 37.1C
•Dry skin
Nursing History Clinical Inspection On-going Appraisal Other sources, lab.
Normal Patterns of observation on First observation 2nd day ofExam Results
Functioning (prior to Day of duty duty
admission)

Elimination:
Void?- 3-5x a day * Void- 2x * Void- 2x Results U/A
Color-light yellow
Bowel Movement?
Transparency- clear
Once a day
Specificity- 1.005
pH 6.5
Albumin-negative
Sugar- negative
PUS 1-2
RB 1-2
WBC- 10.12
Hgb. -116
Hct. -0.35
Neutrophil- 0.73
Lymphocyte- 0.25
Eosinophils- 0.02
Nursing History Clinical Inspection On-going Appraisal Other sources, lab.
Normal Patterns of observation on First observation 2nd day ofExam Results
Functioning (prior to Day of duty duty
admission)

Rest and sleep:

•Sleep 8 hours a •8 hours
day •Nature of sleep?
•Retiring? 10PM Normal
•Arising? 5PM
•No difficulty in
sleeping
•Staying sleep with
husband
•Interferes sleep
with noise
•2 Pillows
Nursing History Clinical Inspection On-going Appraisal Other sources, lab.
Normal Patterns of observation on First observation 2nd day ofExam Results
Functioning (prior to Day of duty duty
admission)

Recreational/
Diversion:
•Done for fun?
Playing cards
•Past time while ill?
Sleep
Health Supervision:
•Take Medicine as
prescribed
•Illness send to
bed? Fever, HPN,
epigastric pain
•Reason for
consulting Doctor?
To relieve pain & to
Know my health
status
•Do when angry?
ANATOMY & PHYSIOLOGY
 Digestive System
 Digestive system is the series of tube-like organ that converts our meals
into chemical compound that can be absorbed by the body’s cells. It also
separates out unneeded materials and flushed them out of the body. In all
there’s about 30-foot-long(9-meter-long) tube that begins with the mouth,
where food enters the body, and ends with the anus, where solid wastes
are expelled. Along the way, food is broken down, sorted, and reprocessed
before being circulated around the body to nourish and replace cells and
supply energy to our muscles.
Mouth & Throat
 The digestive process begins here, where food is grind into pieces and
prepared for delivery to the stomach. It then enters the pharynx, or
throat a muscular funnel that pushes that chewed food into the esophagus
while simultaneously blocking off the trachea( Wind pipe).
• Salivary Glands- Three pairs of salivary glands secrete saliva, a mixture of
water, enzymes and gluey protein called Mucin, into the mouth to moisten
the food. Enzymes in the saliva interact with food and begin the process of
chemical digestion.
• Teeth- Bony structures that tear, chop, and grind food for swallowing.
Sharp incisors and pointed canines in the front of the mouth are designed
to tear into tough foods, while flattened premolars and molars in the back
grind grains and plant matter.
• Tongue- This muscular organ maneuvers food around during chewing and
mixes it with saliva to form a wet lump called a BOLUS. The top and sides
of the tongue are covered with little projection called papillae, many of
which contains taste buds.
• Esophagus- The esophagus is 10-inch-long(25-cm-long) muscular tube that
connects the pharynx to the stomach . When food enters the esophagus, a
wave of muscular contractions called PERISTALSIS push and pull the food
to the stomach. Mucus secretion keep the lump of food, or bolus sliding a
mere four to eight seconds.
• Upper Esopahageal Sphincter- This valve, found just below the
intersection of the throat and esophagus, is a ring of muscles that relaxes
to let food enter the esophagus.
• Stomach- this muscular, expandable J-shaped pouch is responsible for
holding and digesting food, as well as removing it’s nutrients. When food
enters the stomach, its muscular walls contact and churn the food with
powerful gastric acids that kill bacteria and break down proteins. The
result is a creamy substance called CHYME which the stomach stores until
it is ready for release into the small intestine.
• Liver- weighing in at 3 pounds(1.3Kg), this wedge-shaped organ is the body’s
largest gland. The liver is an accessory organ for the digestive system.
Among its many roles is detoxification of the blood. It also creates bile,
which is used to break down fats.
• Gall Bladder- this plum-size, green, muscular sac hangs from the liver. The
gall bladder collects, stores, and concentrate bile from the liver.
• Pancreas- This long organ, positioned behind the stomach, produces insulin
and enzymes that aid digestion. Pancreatic enzymes help digest food in the
small intestine, while insulin helps regulate the amount of sugar in the
blood.
• Intestines- The small intestine measures 20 feet(6meters) in length and 1
inch(2.5cm) in diameter. Thousands of folds and millions of finger-like
projection called VILL increase the surface are of the small intestine
,which absorb 90% of nutrients and water the body will receive from
digested food.
• Duodenum- This is the first portion of the small intestine, where secretion
from the liver and pancreas are received and most of the chemical
digestion takes place.
• Jejunum- This is the long, coiled middle portion of the small intestine that
stretches from the duodenum to the ileum.
• Ileum- this is the final portion of the small intestine, where remaining
nutrients are absorbed and utilized.

• The Large Intestine absorb the last bits of nutrients and water from
indigestible foods, compacts the remaining matter, and eliminates it as
feces.
• Ascending Colon- the large intestine surrounds the small intestine like an
inverted Y. The first portion of the large intestine, the ascending colon, is
stimulated vertically on the right side of the body. The ascending colon
extracts remaining moisture from food before its excretion.
• Transverse Colon- Connecting the ascending and descending colons, this
part of the large intestine is situated horizontally above the small
intestine.
• Descending Colon- Found on the left side of the body, the descending,
or left colon, stores stool the will be emptied into the rectum
• Rectum- Only 5 inches(12cm) long, the rectum sits just above the anal
canal. Feces are stored here briefly prior to defecation.
• Anus- This ring of muscles is the external opening of the rectum,
through which fecal matter is expelled. Peristaltic waves in the colon
and contraction of the abdominal muscles trigger defecation.
PATHOPHYSIOLOGY
 Damage to mucosa with Infection with Helicobacter
alcohol abuse, smoking, use Pylori
of NSAID’s

Damaged mucousal

Erosion of mucous
membrane

Low function of mucosal

cells; low quality of
mucous
 Erosive gastritis

Mucosal ulcerations

Severe ulcerations:
Signs and symptoms:
•Epigastric pain
•Hematemesis
•pale
•pyrosis
DIAGNOSTIC TEST
 Barium Meal X-ray
 Gastroscopy
 Endoscopy
 Upper Gastrointestinal (GI) series
 Blood H. Pylori Test
 Breath H. Pylori Test
 Helicobacter pylori Stool Antigen (HpSA)
Test
 Stomach biopsy
 Tissue H. Pylori Test
MEDICAL MANAGEMENT
 ANTIBIOTICS
-metrodinazole , amoxicillin ,
clarithromycin
-to eradicate h.pylori
-surgical intervention

 PROTON PUMP INHIBITORS

-clansoprazole , omeprazole
• Proton pump inhibitors (or "PPI"s) are a
group of drugs whose main action is
pronounced and long-lasting reduction of
gastric acid production.
Bismuth salts
-suppress or eradicate h.pylori
Smoking reduction and rest
Dietary modification
Surgical procedure
-vagotomy
-Billroth I and Billroth II
Vagotomy

-A vagotomy is a surgical
procedure that is performed only
in humans. It is resection
(removal of, or at least severing)
of part of the vagus nerve.
 Antrectomy (billroth I)
- is the resection, or surgical
removal, of a part of the stomach
known as the antrum. The antrum is
the lower third of the stomach that
lies between the body of the stomach
and the pyloric canal, which empties
into the first part of the
small intestine.
 Gastrojejunostomy (Billroth II)

-GI surgery A procedure in which

the duodenum is excised or bypassed
and the stomach is end-to-end
anastomosed to the jejunum

 FOLLOW UP CHECK UP
NURSING MANAGEMENT
 Monitor I & O
 Monitor the pt. hgb, hct, &
electrolytes level
 Administered prescribed IV fluids &
blood replacement if acute bleeding
is present
 Cessation of Smoking
 Encourage bed rest
 Provide small frequent meals
 Watch for diarrhea caused by antacids & other
meds.
 Advice pt. to avoid extremely hot & cold foods, to
chew thoroughly & to eat in a leisurely fashion
Administer meds. Properly & to teach
pt. do set duration of each
medication
Stress relief
Exercises
Lifestyle changes
 Instead of meat change it to Fruits & vegetables
that are rich in fiber diet
 Moderate amount in drinking of milk (2-3 cups a
day)
 Minimize drinking of coffee & carbonated
beverages
 No to spices & peppers
 Minimize use of garlic in foods
 Encourage olive oil in cooking of foods.
Drug Study
Drug Name Classification Indication Contraindication Adverse Effect Nsg. Dose, route,
Consideration frequency

Ferosemide Diuretices, Edema from heartContraindicated Therapeutic Give diuretics10 mg slow

loop failure, hepaticinpatients dose commonlyin morning toIVTT
syndrome; mild-to-hypertensive tocauses ensure that
moderate HPN;these drugs & inmetabolic &major diuresis
adjunct treatment inpt. with anuria,electrolyte occurs before
acute pulmonaryhepatic coma ordisturbance, bedtime.
edema orsevere particularly Take safety
hypertensive crisis. electrolyte potassium measures for
depletion. depletion. Itall ambulatory
also may causept. until
hyperglycemia, response to
hyperurecemia, diuretics in
hypochloremic known
alkalosis &
hypomagnesemi
a.
Drug Name Classification Indication Contraindication Adverse Effect Nsg. Consideration Dose, route,
frequency

Captopril Angiotensiv Hypertension, Contraindicated inAngioedema ofIf pt. has impaired25 mg,
e- heart failure,pt. hypersensitivethe face &renal function, give1tab now
converting LVD, MI, andto these drugs limits, drugs,a reduced dosage
enzyme diabetic cough, If pt. becomes
inhibitors nephropathy dysgeusia, pregnant, stop ACE
fatigue, inhibitors
headache, Give captopril 1
hyperkatemia, hour before meals
hypotension,
proteinuria,
rash &
tachucardia
Drug Name Classification Indication Contraindication Adverse Effect Nsg. Dose, route,
Consideration frequency
Metoprolol Antianginale Moderate toBeta BlockersBeta blockersDon’t give a beta50 mg, 1 tab now
(Beta Blockers) serve anginaare may causeblocker or calcium
channel blocker to
(beta blockers)contraindicated bradycardia, relieve acute angina
classic, effort-in pt.cough, diarrhea,Warn pt. not to
induced angina, hypersensitive disturbing stop drug abruptly
Prinzmetal to them and indreams, without prescriber’s
approval
angina, pt. withdizziness,
Withhold the dose
recurrent cardiogenic dyspnea, & notify
angina, acuteshock, sinusfatigue, fever,prescriber’s if pt.
angina, unstablebradycardia, heart failure,heart rate is slower
angina heat blockhypotension, than 60 bpm or
systolic BP is slower
greater thanlethargy,
than 90 mmHg
first degree ornausea, Tell Pt. to report
bronchial peripheral pervious/ persistent
asthma edema, &adverse reaction
wheezing.
Drug Name Classification Indication Contraindicatio Adverse Effect Nsg. Dose, route,
n Consideration frequency

Cimetidine Histamine 2-Acute duodenalContra H2-receptor Adjust dosage400 mg, 1 tab PC

receptor or gastric ulcer,indicated in pt.antagonists for pt. with
antagonist Zollinger-Ellison hypersensitive rarely causerenal disease.
syndrome, to these drugs adverse Don’t exceed
gastro reactions. recommended
esophageal Cardiac infusion rates
reflux arrhythmias, when giving IV;
dizziness, doing so
fatigue, increases risk of
gynecomastia, adverse CV
headache, mild &effects.
transient Caution pt. to
diarrhea &avoid smoking
thrombocytosemi during therapy
a are possible
Drug Name Classification Indication Contraindication Adverse Nsg. Dose, route,
Effect Consideration frequency

Losartan Anti Essential &Contraindicated Commonly Give drug with50 mg, 1 tab OD
hypertensives secondary HPN in pt.causes fod at bedtime,every 8 am
hypersensitive toorthostatic as indicated
these drugs & inchanges in HR,When mixing &
those withheadache, giving parenteral
hypotension hypotension, drugs, Follow
nausea &manufacturer’s
vomiting guidelines
To prevent
dizziness, light
headedness or
fainting advice
changes in
position.
Drug Name Classification Indication Contraindication Adverse Effect Nsg. Dose, route,
Consideration frequency

Aspirin Anti Platelet,For arthritis,Contraindicated inHearing loss,Give aspirin100 mg 1 tab

antipyretic mild pain orpt. hypersensitivetinnitus, with food milk,OD P.C.
fever, to drug & thosedyspepsia, GIantacid or large
prevention ofwith bleedingbleeding, GIglass of water
thrombosis, disorder such asdistress, to reduce GI
reduction of MIhemophilia, vonnausea, occultreactions.
risk in Pt. withWillebrand diseasebleeding, If pt. has
previous MI& telangiectasia, orvomiting, trouble
orun stableNSAID- inducedtransient renalswallowing,
angina, Kawasakisensitivity insufficiency, crush aspirin,
syndrome; reactions thrombo combine with
prophylaxis for cytopenia, soft food or
attack, bruising, rash,dissolve it in
rheumatic uticaria, liquid. Don’t
fever, peri angioedema crush enteric-
ceuditis afet Reye syndrome coated aspirin.
acute MI, & Give PR after a
stent bowel movement
implantation or at night to
maximize
absorption
Stop aspirin 5-7
days before
elective surgery
Nursing Care Plan
Cues & Evidence: Nsg. Diagnosis Objective Intervention Rationale Evaluation

S= “ Sakit akong Acute/ chronic After 8 hours of Independent: 1. Hydrochloric Goal met as evidence
Kutokuto” as pain related to nsg. & medical mgt. 1. Explain the relationship acid(HCL) presumably by PT;
verbalized by the pt. lesions secondary pt. will: between hydro chronic acid is an important 1.verbalized relief of
O= Seen lying on bed to increased a. verbalize relief of secretion and onset of pain variable in the pain
with grimaced face gastric secretions pain 2. Explain the risks of appearance of peptic 2.able to sleep
and pressing her b. able to sleep well nonsteroidal anti- ulcer dse, because of
epigastric area inflammatory drugs this relationship,
•Weak (NSAIDs) control of HCL
•Restless (e.g. Motrin, Aleve, Relafen) secretion is
•Unable to response 3. Help the pt. to identify considered an
well irritating substances( E.g. essential aim of
•Loss of appetite Fried food, spicy foods, treatment.
•Pain scale: 6 coffee) 2. NSAIDs cause
4. Encourage the pt. to avoid superficial irritation
smoking and alcohol use. of the gastric mucosa
5. Encourage the pt. to and inhibit the
reduce intake of caffeine- production of
containing and alcoholic prostaglandins that
beverages, if indicated protect gastric
6. Teach Pt. the importance mucosa
of continuing treatment even 3. Avoidance of
in the absence of pain. irritating substances
Dependent: can help to prevent
1. administer drug therapy asthe pain response.
prescribed 4. Smoking decreases
a. antacids pancreatic secretion
b. histamine of bicarbonate; this
c. h2 blocker increase duodenal
d. anticholinergics acidity. Tobacco
delays the healing of
gastric duodenal ulcer
and increases their
frequency
5. Gastric acid
secretion may be
stimulated by caffeine
Cues & Evidence Nsg. Diagnosis Objective Intervention Rationale Evaluation
S= “wala akong Nutrition Imbalace After 8 hours of nsg. & Independent: 1. As baseline data Patient will be able
medical mgt. pt. will: 1. Monitor V/S as
ganang kumain” as less than body in cases of to consume served
a. Will be able to
verbalized by the weight related to consume served food ordered. alterations from food.
pt. loss of appetite 2. Instruct pt. to the normal.
increase the intake
O= facial Grimace 2. Water is
of water
Restlessness considered as a
3. Identify and limit
Anorexia: pt. not good antacid.
foods that create
able to consume discomfort 3. Food has acid
foods serve 4. Encourage small, neutralizing
V/S: frequent meals. effects & dilutes.
T=37.5 C 5. Provide prescribed4. Small meals
PR=65 BPM diet. prevent distention
RR=14 CPM Dependent: & the release of
BP=110/80 mmHg Administer drug gastrin.
therapy: 5. To avoid gastric
a.Antacid
irritation
b.Histamine-2
Antagonist
Prognosis
• When the underlying cause for peptic ulcer disease is successfully
treated, the prognosis (expected outcome) for patients with the
condition is excellent.To help prevent peptic ulcers, avoid the
following:
• Alcohol
• Common sources of Helicobacter pylori bacteria (e.g.,
contaminated food and water, floodwater, raw sewage)
• Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs)
• Smoking
• Good hygiene can help reduce the risk for peptic ulcer disease
caused by Helicobacter pylori infection. Washing the hands
thoroughly with warm soapy water after using the restroom and
before eating and avoiding sharing eating utensils and drinking
glasses also can reduce the spread of bacteria that can cause PUD.
Prepared by:
Limpango, Joan
Nudalo, Raiza
Paradero, Desiree
Pison, Wilsan
Puno, Rebekah Ann
Tan, Cristali
Tinamisan, Johnny
Santillan, Juliet
Sumile, Daisy Mae
Sawit, Johnderick
Resma, Rosalie
Rudie, Aldin
Urian, Pedro