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.
Normal Patterns Inspection observation 2nd day of Exam Results
of Functioning observation on duty
(prior to First Day of
admission) duty

Patterns of
functioning:
Respiration
•Tachypnea *Normal *Normal
Personal
Hygiene:
•Daily Bath *Dry Skin
•Brushing of * Dry scalp
teeth 3x a day
Nursing History Normal Clinical On-going Appraisal Other sources, lab.
Patterns of Functioning Inspection observation 2nd day Exam Results
(prior to admission) observation on of duty
First Day of
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.
Normal Patterns of observation on Appraisal Exam Results
Functioning (prior First Day of duty observation 2nd
to 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-
•1 cup of coffee clear
every morning Specificity- 1.005
•Like all kinds of pH 6.5
Albumin-negative
food 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 Exam Results
Functioning (prior Day of duty of duty
to 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 Exam Results
Functioning (prior Day of duty of duty
to admission)

Elimination:
Void?- 3-5x a day * Void- 2x * Void- 2x Results U/A
Color-light yellow
Bowel Movement?
Transparency-
Once a day
clear
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 Exam Results
Functioning (prior Day of duty of duty
to 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 Exam Results
Functioning (prior Day of duty of duty
to 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?
Went to quite
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 Classificati Indication Contraindicati Adverse Nsg. Dose, route,
on on Effect Considerati frequency
on

Ferosemide Diuretices, Edema from heart Contraindicate Therapeutic Give 10 mg slow

loop failure, hepatic d inpatients dose diuretics in IVTT
syndrome; mild-to- hypertensive commonly morning to
moderate HPN; to these causes ensure that
adjunct treatment drugs & in pt. metabolic & major
in acute pulmonary with anuria, electrolyte diuresis
edema or hepatic coma disturbance, occurs
hypertensive crisis. or severe particularly before
electrolyte potassium bedtime.
depletion. depletion. It Take safety
also may measures
cause for all
hyperglycemi ambulatory
a, pt. until
hyperurecem response to
ia, diuretics in
hypochloremi known
c alkalosis &
hypomagnese
mia.
Drug Name Classificati Indication Contraindication Adverse Effect Nsg. Consideration Dose,
on route,
frequency

Captopril Angiotens Hypertensio Contraindicated Angioedema If pt. has 25 mg,

ive- n, heart in pt. of the face & impaired renal 1tab now
convertin failure, LVD, hypersensitive limits, drugs, function, give a
g enzyme MI, and to these drugs cough, reduced dosage
inhibitors diabetic dysgeusia, If pt. becomes
nephropathy fatigue, pregnant, stop
headache, ACE inhibitors
hyperkatemia Give captopril 1
, hypotension, hour before
proteinuria, meals
rash &
tachucardia
Drug Name Classification Indication Contraindicati Adverse Nsg. Dose, route,
on Effect Consideration frequency
Metoprolol Antianginale Moderate to Beta Blockers Beta blockers Don’t give a beta 50 mg, 1 tab
(Beta serve angina are may cause blocker or now
calcium channel
Blockers) (beta contraindicat bradycardia, blocker to
blockers) ed in pt. cough, relieve acute
classic, hypersensitiv diarrhea, angina
effort- e to them and disturbing Warn pt. not to
induced in pt. with dreams, stop drug
abruptly without
angina, cardiogenic dizziness, prescriber’s
Prinzmetal shock, sinus dyspnea, approval
angina, bradycardia, fatigue, Withhold the
recurrent heat block fever, heart dose & notify
angina, acute greater than failure, prescriber’s if
pt. heart rate is
angina, first degree hypotension, slower than 60
unstable or bronchial lethargy, bpm or systolic
angina asthma nausea, BP is slower than
peripheral 90 mmHg
edema, & Tell Pt. to report
pervious/
wheezing. persistent
adverse reaction
Drug Name Classification Indication Contraindica Adverse Nsg. Dose, route,
tion Effect Consideration frequency

Cimetidine Histamine 2- Acute Contra H2-receptor Adjust 400 mg, 1 tab

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

Losartan Anti Essential & Contraindicate Commonly Give drug 50 mg, 1 tab
hypertensives secondary d in pt. causes with fod at OD every 8
HPN hypersensitive orthostatic bedtime, as am
to these drugs changes in indicated
& in those with HR, When mixing
hypotension headache, & giving
hypotension, parenteral
nausea & drugs, Follow
vomiting manufacturer’
s guidelines
To prevent
dizziness,
light
headedness
or fainting
advice
changes in
position.
Drug Name Classification Indication Contraindication Adverse Nsg. Dose, route,
Effect Consideration frequency

Aspirin Anti Platelet, For arthritis, Contraindicated Hearing loss, Give aspirin 100 mg 1 tab
antipyretic mild pain or in pt. tinnitus, with food OD P.C.
fever, hypersensitive dyspepsia, GI milk, antacid
prevention of to drug & those bleeding, GI or large glass
thrombosis, with bleeding distress, of water to
reduction of disorder such as nausea, reduce GI
MI risk in Pt. hemophilia, von occult reactions.
with previous Willebrand bleeding, If pt. has
MI orun disease & vomiting, trouble
stable angina, telangiectasia, transient swallowing,
Kawasaki or NSAID- renal crush aspirin,
syndrome; induced insufficiency, combine with
prophylaxis sensitivity thrombo soft food or
for attack, reactions cytopenia, dissolve it in
rheumatic bruising, liquid. Don’t
fever, peri rash, crush
ceuditis afet uticaria, enteric-
acute MI, & angioedema coated
stent Reye aspirin.
implantation syndrome Give PR after
a bowel
movement 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
Kutokuto” as pain related to nsg. & medical 1. Explain the relationship acid(HCL) evidence by PT;
verbalized by the lesions mgt. pt. will: between hydro chronic presumably is an 1.verbalized relief
pt. secondary to a. verbalize relief acid secretion and onset important variable of pain
O= Seen lying on increased of pain of pain in the appearance 2.able to sleep
bed with grimaced gastric b. able to sleep 2. Explain the risks of of peptic ulcer dse,
face and pressing secretions well nonsteroidal anti- because of this
her epigastric area inflammatory drugs relationship,
Weak (NSAIDs) control of HCL
Restless (e.g. Motrin, Aleve, secretion is
Unable to Relafen) considered an
response well 3. Help the pt. to identify essential aim of
Loss of appetite irritating substances( E.g. treatment.
Pain scale: 6 Fried food, spicy foods, 2. NSAIDs cause
coffee) superficial
4. Encourage the pt. to irritation of the
avoid smoking and alcohol gastric mucosa and
use. inhibit the
5. Encourage the pt. to production of
reduce intake of prostaglandins that
caffeine- containing and protect gastric
alcoholic beverages, if mucosa
indicated 3. Avoidance of
6. Teach Pt. the irritating
importance of continuing substances can help
treatment even in the to prevent the pain
absence of pain. response.
Dependent: 4. Smoking
1. administer drug decreases
therapy as prescribed pancreatic
a. antacids secretion of
b. histamine 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
Cues & Evidence Nsg. Diagnosis Objective Intervention Rationale Evaluation
S= “wala akong Nutrition After 8 hours of Independent: 1. As baseline Patient will be
ganang kumain” Imbalace less nsg. & medical mgt. 1. Monitor V/S as data in cases of able to consume
pt. will: ordered.
as verbalized by than body a. Will be able to
alterations from served food.
the pt. weight related 2. Instruct pt. to the normal.
consume served
increase the
O= facial to loss of food 2. Water is
intake of water
Grimace appetite considered as a
3. Identify and
Restlessness limit foods that good antacid.
Anorexia: pt. not create discomfort 3. Food has acid
able to consume 4. Encourage neutralizing
foods serve small, frequent effects &
V/S: meals. dilutes.
T=37.5 C 5. Provide 4. Small meals
PR=65 BPM prescribed diet. prevent
RR=14 CPM Dependent: distention & the
BP=110/80 Administer drug release of
therapy:
mmHg gastrin.
a.Antacid
5. To avoid
b.Histamine-2
Antagonist gastric irritation
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