xPeptic Ulcer

8/11/2019 xPeptic Ulcer

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PEPTIC ULCERPEPTIC ULCERDISEASEDISEASE

PEPTIC ULCERPEPTIC ULCERDISEASEDISEASE


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Introduction


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Peptic Ulcer

Ulcers average between one- uarter and one-!al" inc! india#eter$ T!e% develop w!en digestive &uices produced int!e sto#ac!' intestines' and digestive glands da#age t!elining o" t!e sto#ac! or duodenu#$

T!e two i#portant digestive &uices are !%droc!loric acid andt!e en(%#e pepsin $ )ot! substances are critical in t!ebrea*down and digestion o" starc!' "at' and proteins in"ood$ T!e% pla% di""erent roles in ulcer+

,%droc!loric Acid$ A co##on #isbelieve is t!at e cess!%droc!loric acid' w!ic! is secreted in t!e sto#ac!' issolel% responsible "or producing ulcers$


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Patient Pro"ile


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Patient/s 0a#e+ Criselda Llorente Siangco Se + 1e#ale Age+ 23 %$o$ Status+ 4arried Address+ Pigcarangan' Tubod' Lanao Del 0orte Religion+ Ro#an Cat!olic 5ccupation+ !ousewi"e Citi(ens!ip+ 1ilipino C!ie" Co#plaints+ Palpitation 3#ont!s PTA 67S+ Date Ad#itted+ 8an$9':;


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NURSING ASSESSMENT


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Previous Illness

,6D 5ver "atigue T!e% give t!eir care

Reactions about Treatment &ia!nostic Proce"ures

It can relieve t!e painand cure #% illness

Is it reall% #a*e #e"eeling well

A"raid


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Nursin! Histor#Normal Patterns o$%unctionin! prior toa"mission'

(linicalInspectionobservation on%irst a# o$"ut#

)n*!oin! Appraisalobservation + n" "a# o$"ut#

)t,er sources- lab. ExamResults

Patterns o""unctioning+RespirationTac!%pneaPersonal ,%giene+Dail% )at!)rus!ing o" teet!3 a da%

0or#al

Dr% S*in Dr% scalp

0or#al


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Nursin! Histor# NormalPatterns o$ %unctionin!

prior to a"mission'

(linical Inspectionobservation on%irst a# o$ "ut#


)t,er sources- lab.Exam Results

Co##unication FSpecial senses+0o di""iculties inspea*ing' !earing'seeing andunderstandingSlig!tl% read F writeEnglis!Coping wit! Stress+

Rest1a#il%

Circulation+tac!%cardiaTa*e #edication

@ea* 6oice

Irritable

0or#al PR0or#al )P

Irritable' tense


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(linical Inspectionobservation on %irst

a# o$ "ut#

)n*!oin!Appraisalobservation + n" "a# o$ "ut#

)t,er sources- lab. ExamResults

1ood F 1luidInta*e+4eals 3 a da%Snac* Seldo#Content Rice Fvegetables

< cup o" co""eeever% #orningLi*e all *inds o""ood

9G *g9/2pale s*in

poor appetiteD9 0SS


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a# o$ "ut#



E ercise+,i*ing F stretc!ingwit!in 3; #ins$Twice a wee*Rig!t ,andedPain7Disco#"ort+

Epigastric painTa*e #edication

Regulator%4ec!anis#

Di((%

Acute Pain

Te#p- 3>$


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a# o$ "ut#



Rest and sleep+Sleep ? !ours ada%Retiring


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a# o$ "ut#



Recreational7Diversion+Done "or "unPla%ing cardsPast ti#e w!ile illSleep,ealt! Supervision+Ta*e 4edicine asprescribedIllness send tobed 1ever' ,P0'epigastric painReason "orconsulting DoctorTo relieve pain F toHnow #% !ealt!

statusDo w!en angr%


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ANAT)M/ & PH/SI)0)G/


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Digestive S%ste#Digestive s%ste# is t!e series o" tube-li*e organ t!at converts our #ealsinto c!e#ical co#pound t!at can be absorbed b% t!e bod%/s cells$ It alsoseparates out unneeded #aterials and "lus!ed t!e# out o" t!e bod%$ In allt!ere/s about 3;-"oot-long.=-#eter-long tube t!at begins wit! t!e #out!'w!ere "ood enters t!e bod%' and ends wit! t!e anus' w!ere solid wastesare e pelled$ Along t!e wa%' "ood is bro*en down' sorted' and reprocessed

be"ore being circulated around t!e bod% to nouris! and replace cells andsuppl% energ% to our #uscles$Mout, & T,roat

T!e digestive process begins !ere' w!ere "ood is grind into pieces andprepared "or deliver% to t!e sto#ac!$ It t!en enters t!e p!ar%n ' ort!roat a #uscular "unnel t!at pus!es t!at c!ewed "ood into t!e esop!agus

w!ile si#ultaneousl% bloc*ing o"" t!e trac!ea. @ind pipe $


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Salivar# Glan"s* T!ree pairs o" salivar% glands secrete saliva' a #i ture o"water' en(%#es and glue% protein called 4ucin' into t!e #out! to #oistent!e "ood$ En(%#es in t!e saliva interact wit! "ood and begin t!e process o"c!e#ical digestion$

Teet,* )on% structures t!at tear' c!op' and grind "ood "or swallowing$S!arp incisors and pointed canines in t!e "ront o" t!e #out! are designedto tear into toug! "oods' w!ile "lattened pre#olars and #olars in t!e bac*grind grains and plant #atter$

Ton!ue - T!is #uscular organ #aneuvers "ood around during c!ewing and#i es it wit! saliva to "or# a wet lu#p called a )5LUS$ T!e top and sideso" t!e tongue are covered wit! little pro&ection called papillae' #an% o"w!ic! contains taste buds$

Esop,a!us* T!e esop!agus is


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Stomac,* t!is #uscular' e pandable 8-s!aped pouc! is responsible "or!olding and digesting "ood' as well as re#oving it/s nutrients$ @!en "oodenters t!e sto#ac!' its #uscular walls contact and c!urn t!e "ood wit!power"ul gastric acids t!at *ill bacteria and brea* down proteins$ T!eresult is a crea#% substance called C, 4E w!ic! t!e sto#ac! stores until

it is read% "or release into t!e s#all intestine$ 0iver - weig!ing in at 3 pounds.


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uo"enum* T!is is t!e "irst portion o" t!e s#all intestine' w!ere secretion"ro# t!e liver and pancreas are received and #ost o" t!e c!e#icaldigestion ta*es place$

2e3unum* T!is is t!e long' coiled #iddle portion o" t!e s#all intestine t!atstretc!es "ro# t!e duodenu# to t!e ileu#$

Ileum* t!is is t!e "inal portion o" t!e s#all intestine' w!ere re#ainingnutrients are absorbed and utili(ed$

T!e Large Intestine absorb t!e last bits o" nutrients and water "ro#

indigestible "oods' co#pacts t!e re#aining #atter' and eli#inates it as"eces$ Ascen"in! (olon* t!e large intestine surrounds t!e s#all intestine li*e an

inverted $ T!e "irst portion o" t!e large intestine' t!e ascending colon' issti#ulated verticall% on t!e rig!t side o" t!e bod%$ T!e ascending colone tracts re#aining #oisture "ro# "ood be"ore its e cretion$

Transverse (olon* Connecting t!e ascending and descending colons' t!ispart o" t!e large intestine is situated !ori(ontall% above t!e s#allintestine$


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escen"in! (olon* 1ound on t!e le"t side o" t!e bod%' t!e descending'or le"t colon' stores stool t!e will be e#ptied into t!e rectu#

Rectum* 5nl% 9 inc!es.


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Damage to mucosa withalcohol abuse, smoking, use

of NSAIDs

Infection with HelicobacterPylori

Damaged mucousal

Erosion of mucousmembrane

ow function of mucosalcells! low "uality of

mucous


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Erosi#e gastritis

Se#ere ulcerations$Signs and symptoms:%E&igastric &ain%Hematemesis%&ale%&yrosis

'ucosal ulcerations


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DIA 05STIC TEST


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)ariu# 4eal K-ra%astroscop%

Endoscop%Upper astrointestinal . I series)lood ,$ P%lori Test)reat! ,$ P%lori Test,elicobacter p%lori Stool Antigen .,pSATestSto#ac! biops%Tissue ,$ P%lori Test


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A0TI)I5TICS

-#etrodina(ole ' a#o icillin 'clarit!ro#%cin -to eradicate !$p%lori

-surgical intervention

PR5T50 PU4P I0,I)IT5RS -clansopra(ole ' o#epra(ole


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Proton pump in,ibitors .or PPI s are agroup o" drugs w!ose #ain action is

pronounced and long-lasting reduction o"gastric acid production$)is#ut! salts

-suppress or eradicate !$p%loriS#o*ing reduction and restDietar% #odi"ication

Surgical procedure -vagoto#% -)illrot! I and )illrot! II
http://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Gastric_acidhttp://en.wikipedia.org/wiki/Gastric_acidhttp://en.wikipedia.org/wiki/Medication


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4a!otom#

-A va!otom# is a surgicalprocedure t!at is per"or#ed onl%in !u#ans$ It is resection .re#oval o"' or at least severingo" part o" t!e vagus nerve $
http://en.wikipedia.org/wiki/Resectionhttp://en.wikipedia.org/wiki/Vagus_nervehttp://en.wikipedia.org/wiki/Vagus_nervehttp://en.wikipedia.org/wiki/Resection


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Antrecto#% .billrot! I

- is t!e resection ' or surgicalre#oval' o" a part o" t!e sto#ac!*nown as t!e antru# $ T!e antru# is

t!e lower t!ird o" t!e sto#ac! t!atlies between t!e bod% o" t!e sto#ac!and t!e p%loric canal' w!ic! e#pties

into t!e "irst part o" t!es#all intestine $
http://www.answers.com/topic/resectionhttp://www.answers.com/topic/antrumhttp://www.answers.com/topic/pyloric-canalhttp://www.answers.com/topic/small-intestinehttp://www.answers.com/topic/small-intestinehttp://www.answers.com/topic/pyloric-canalhttp://www.answers.com/topic/antrumhttp://www.answers.com/topic/resection


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astro&e&unosto#% .)illrot! II

- I surger% A procedure in w!ic!t!e duodenu# is e cised or b%passed

and t!e sto#ac! is end-to-endanasto#osed to t!e &e&unu#

15LL5@ UP C,ECH UP


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Cessation o" S#o*ingEncourage bed rest

Provide s#all "re uent #eals@atc! "or diarr!ea caused b% antacids F ot!er#eds$Advice pt$ to avoid e tre#el% !ot F cold "oods' toc!ew t!oroug!l% F to eat in a leisurel% "as!ion


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Ad#inister #eds$ Properl% F to teac!pt$ do set duration o" eac!#edicationStress relie"E ercisesLi"est%le c!anges


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Instead o" #eat c!ange it to 1ruits F vegetablest!at are ric! in "iber diet

4oderate a#ount in drin*ing o" #il* .:-3 cups ada%4ini#i(e drin*ing o" co""ee F carbonatedbeverages

0o to spices F peppers4ini#i(e use o" garlic in "oodsEncourage olive oil in coo*ing o" "oods$


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Drug Stud%


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Drug 0a#e Classi"ication Indication Contraindication Adverse E""ect 0sg$Consideration

Dose' route'"re uenc%

1erose#ide Diuretices'loop

Ede#a "ro# !eart"ailure' !epatics%ndro#eM #ild-to-#oderate ,P0Mad&unct treat#ent inacute pul#onar%ede#a or!%pertensive crisis$

Contraindicatedinpatients!%pertensive tot!ese drugs F inpt$ wit! anuria'!epatic co#a orsevereelectrol%tedepletion$

T!erapeuticdose co##onl%causes#etabolic Felectrol%tedisturbance'particularl%potassiu#depletion$ It

also #a% cause!%pergl%ce#ia'!%perurece#ia'!%poc!lore#ical*alosis F!%po#agnese#ia$

ive diureticsin #orning toensure t!at#a&or diuresisoccurs be"orebedti#e$Ta*e sa"et%#easures "orall a#bulator%

pt$ untilresponse todiuretics in*nown


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Drug 0a#e Classi"ication Indication Contraindication Adverse E""ect 0sg$ Consideration Dose' route'"re uenc%

Captopril Angiotensive-convertingen(%#ein!ibitors

,%pertension'!eart "ailure'L6D' 4I' anddiabeticnep!ropat!%

Contraindicated inpt$ !%persensitiveto t!ese drugs

Angioede#a o"t!e "ace Fli#its' drugs'coug!'d%sgeusia'"atigue'!eadac!e'!%per*ate#ia'!%potension'proteinuria'ras! Ftac!ucardia

I" pt$ !as i#pairedrenal "unction' givea reduced dosageI" pt$ beco#espregnant' stop ACEin!ibitors

ive captopril


4etoprolol Antianginale.)eta )loc*ers

4oderate toserve angina.beta bloc*ersclassic' e""ort-induced angina'Prin(#etal

angina'recurrentangina' acuteangina' unstableangina

)eta )loc*ersarecontraindicatedin pt$!%persensitiveto t!e# and in

pt$ wit!cardiogenics!oc*' sinusbrad%cardia'!eat bloc*greater t!an"irst degree orbronc!ialast!#a

)eta bloc*ers#a% causebrad%cardia'coug!' diarr!ea'disturbingdrea#s'

di((iness'd%spnea'"atigue' "ever'!eart "ailure'!%potension'let!arg%'nausea'perip!eralede#a' Fw!ee(ing$

Don/t give a betabloc*er or calciu#c!annel bloc*er torelieve acute angina@arn pt$ not tostop drug abruptl%wit!out prescriber/sapproval@it!!old t!e doseF noti"%prescriber/s i" pt$!eart rate is slowert!an G; bp# ors%stolic )P is slowert!an =; ##,gTell Pt$ to reportpervious7 persistentadverse reaction

9; #g' < tab now


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Drug 0a#e Classi"ication Indication Contraindication

Adverse E""ect 0sg$Consideration


Ci#etidine ,ista#ine :-receptorantagonist

Acute duodenalor gastric ulcer'Nollinger-Ellisons%ndro#e'gastroesop!agealre"lu

Contraindicated in pt$!%persensitiveto t!ese drugs

,:-receptorantagonistsrarel% causeadversereactions$Cardiacarr!%t!#ias'di((iness'"atigue'g%neco#astia'!eadac!e' #ild Ftransientdiarr!ea Ft!ro#boc%tose#ia are possible

Ad&ust dosage"or pt$ wit!renal disease$Don/t e ceedreco##endedin"usion ratesw!en giving I6Mdoing soincreases ris* o"adverse C6e""ects$Caution pt$ toavoid s#o*ingduring t!erap%

2;; #g' < tab PC


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Drug 0a#e Classi"ication Indication Contraindication AdverseE""ect

0sg$Consideration


Losartan Anti!%pertensives

Essential Fsecondar% ,P0

Contraindicatedin pt$!%persensitive tot!ese drugs F int!ose wit!!%potension

Co##onl%causesort!ostaticc!anges in ,R'!eadac!e'!%potension'nausea Fvo#iting

ive drug wit!"od at bedti#e'as indicated@!en #i ing Fgiving parenteraldrugs' 1ollow#anu"acturer/sguidelinesTo prevent

di((iness' lig!t!eadedness or"ainting advicec!anges inposition$

9; #g' < tab 5Dever% ? a#


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Drug 0a#e Classi"ication Indication Contraindication Adverse E""ect0sg$Consideration


Aspirin Anti Platelet'antip%retic

1or art!ritis'#ild pain or

"ever'prevention o"t!ro#bosis'reduction o" 4Iris* in Pt$ wit!previous 4Iorun stableangina' Hawasa*is%ndro#eMprop!%la is "orattac*'r!eu#atic"ever' periceuditis a"etacute 4I' Fstenti#plantation

Contraindicated inpt$ !%persensitive

to drug F t!osewit! bleedingdisorder suc! as!e#op!ilia' von@illebrand diseaseF telangiectasia' or0SAID- inducedsensitivit%reactions

,earing loss'tinnitus'

d%spepsia' Ibleeding' Idistress'nausea' occultbleeding'vo#iting'transient renalinsu""icienc%'t!ro#boc%topenia'bruising' ras!'uticaria'angioede#aRe%e s%ndro#e

ive aspirinwit! "ood #il*'

antacid or largeglass o" waterto reduce Ireactions$I" pt$ !astroubleswallowing'crus! aspirin'co#bine wit!so"t "ood ordissolve it inli uid$ Don/tcrus! enteric-coated aspirin$

ive PR a"ter abowel #ove#entor at nig!t to#a i#i(eabsorptionStop aspirin 9->da%s be"oreelective surger%


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0ursing Care Plan

Cues F Evidence+ 0sg$ Diagnosis 5b&ective Intervention Rationale Evaluation


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SO Sa*it a*ongHuto*utoQ asverbali(ed b% t!e pt$5O Seen l%ing on bedwit! gri#aced "aceand pressing !erepigastric area @ea* Restless Unable to responsewell Loss o" appetite Pain scale+ G

Acute7 c!ronicpain related tolesions secondar%to increasedgastric secretions

A"ter ? !ours o"nsg$ F #edical #gt$pt$ will+a$ verbali(e relie" o"painb$ able to sleep well

Independent+


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Cues F Evidence 0sg$ Diagnosis 5b&ective Intervention Rationale EvaluationSO wala a*ongganang *u#ainQ asverbali(ed b% t!ept$5O "acial ri#aceRestlessness

Anore ia+ pt$ notable to consu#e"oods serve67S+TO3>$9 CPROG9 )P4RRO


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Prognosis


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@!en t!e underl%ing cause "or peptic ulcer disease is success"ull%treated' t!e prognosis .e pected outco#e "or patients wit! t!econdition is e cellent$To !elp prevent peptic ulcers' avoi" t!e"ollowing+

Alco!ol Co##on sources o" ,elicobacter p%lori bacteria .e$g$'

conta#inated "ood and water' "loodwater' raw sewage Long-ter# use o" nonsteroidal anti-in"la##ator% drugs .0SAIDs S#o*ing Goo" ,#!iene can !elp reduce t!e ris* "or peptic ulcer disease

caused b% ,elicobacter p%lori in"ection$ 5as,in! t,e ,an"s t!oroug!l% wit! war# soap% water a"ter using t!e restroo# andbe"ore eating and avoiding s!aring eating utensils and drin*ingglasses also can reduce t!e spread o" bacteria t!at can cause PUD$


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Prepared b%+Li#pango' 8oan0udalo' Rai(a

Paradero' DesireePison' @ilsan

Puno' Rebe*a! AnnTan' Cristali

Tina#isan' 8o!nn%Santillan' 8uliet

Su#ile' Dais% 4aeSawit' 8o!nderic*

Res#a' RosalieRudie' Aldin

Urian' Pedro

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xPeptic Ulcer