Pathophysiology
Defects (open sores) in the protective lining of the stomach and upper small intestine. Gastric ulcers occur on the inside of the stomach and duodenal ulcers occur on the inside of the upper portion of the small intestine (duodenum). Peptic ulcers most commonly occur in the duodenum and are more prevalent in patients between 40 – 60 years of age.
Etiology
Chronic use of NSAIDS (aspirin, ibuprofen, naproxen) weakens and thins the mucosal lining of the stomach and duodenum and greatly contributes to the formation of breaks in the protective lining. The primary cause of peptic ulcer disease (approx. 90%) is Helicobacter pylori bacterial infection. Heavy alcohol use and smoking increase the risk of PUD in patients with H. pylori infection. Other contributing factors include various illnesses such as Crohn’s disease, gastritis, hepatic disease and pancreatitis. Complications of peptic ulcers may include anemia, profuse bleeding, perforation, obstruction and certain cancers.
Desired Outcome
Relief of pain, absence of complications, maintain adequate nutrition
Peptic Ulcer Disease (PUD) Nursing Care Plan
Subjective Data:
- Epigastric pain (gnawing or burning) after meals
- Heartburn
- Constipation
- Patient reports tarry stools
- Feeling full
- Unexplained weight loss
- Dysphagia
Objective Data:
- Bleeding, tarry stools
- Anemia
- Vomiting
- Hypovolemia
Nursing Interventions and Rationales
- Assess and Monitor vitals
Monitor for signs and symptoms of infection / inflammation to include:
- Fever
- Tachypnea
- Tachycardia
Monitor for signs and symptoms of hypovolemia to include:
- Perform detailed pain assessment
The most common symptom of peptic ulcers is burning stomach pain that may be worse between meals and at night.
- The pathogen Helicobacter pylori (H. pylori) is responsible for approx 90% of all peptic ulcers reported.
- CBC – anemia or blood loss
- Coagulation panels (aPTT, PT, INR) for patients who are on anticoagulants or have active bleeding
- Electrolytes, BUN, creatinine – to determine if patient requires fluid resuscitation
- Prepare patient for and assist with upper GI Endoscopy
Endoscopy is a procedure that is done by a doctor using a scope that is placed orally to visualize the upper GI tract including the esophagus, stomach, and upper portion of the small intestine. Tissue samples may be taken during the procedure if necessary.
- Withhold anticoagulants for several days prior to procedure if possible to avoid excessive bleeding during procedure
- Patient must be fasting, no food or drink for 4-8 hours prior to procedure to ensure gastric emptying and to reduce risk of aspiration during sedation
- Administer conscious sedation
- Monitor vitals while patient is sedated per facility policy
- Assist with ambulation immediately following procedure until sedation is fully worn off
- Maintain NPO status post procedure until return of gag reflex to avoid aspiration
- Administer medications as ordered
- Proton pump inhibitor (Omeprazole) – to reduce stomach acid
- H2 Histamine blockers (Famotidine) – to reduce stomach acid
- Antacids – may be given for symptom relief, but do not heal the ulcer
- Cytoprotective agents (Sucralfate) – to protect the lining of the stomach and intestine
- Antibiotics – commonly given to treat H. pylori infection
- AVOID NSAIDS (aspirin, ibuprofen, naproxen)
- Limit or avoid foods that cause excess acid production or irritation to the peptic lining:
- Coffee, tea
- Carbonated drinks
- Alcohol
- Citrus
- Peppers, all
- Spicy foods
- Red meat
- Dairy
- Reduce salt intake – Increased risk of developing stomach cancer
- Monitor food labels carefully and make choices that are lower in fat and sodium.
- Include probiotics in regular diet – yogurt, aged cheeses and sauerkraut have healthy probiotics that help restore the natural bacteria in the GI tract
- Eat regular, small meals – complete emptying of the stomach for prolonged amounts of time may cause acid build up in the stomach and increase pain and erosion of tissues
- Avoid overeating – excess pressure from overeating or bloating may cause pressure on the stomach and increase pain
- Encourage lifestyle changes
- Reduce stress – although stress has not been proven to cause peptic ulcers, it may result in overeating or skipping meals which will irritate the peptic lining
- Stop smoking – nicotine increases stomach acid and thins the mucous membranes
- Limit or avoid alcohol – excessive alcohol increases acid production and can irritate and erode the peptic lining
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