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NUR 120 PEPTIC ULCER DISEASE. Pathophysiology. Normally, a physiologic balance exists between peptic acid secretion and gastric mucosal defense The gastric mucosal barrier protects the underlying tissue from gastric acids and digestive juices

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nur 120 peptic ulcer disease
NUR 120

PEPTIC ULCER DISEASE

pathophysiology
Pathophysiology

Normally, a physiologic balance exists between peptic acid secretion and gastric mucosal defense

The gastric mucosal barrier protects the underlying tissue from gastric acids and digestive juices

When a disruption occurs with this protective barrier, the mucosal lining is exposed and corroded by acid, resulting in an ulcer

causes of pud
Causes of PUD
  • H pylori bacteria
  • Chronic use of NSAIDS
  • Hypersecretion of Stomach Acid
  • Stress
  • Zollinger-Ellison Syndrome
to test for h pylori
To Test for H Pylori
  • Endoscopic gastric samples
  • Collect medication history prior
  • Urea breath testing
  • NPO prior to test
  • IgG serologic test can detect antibodies
  • Stool sample
ulcer classification
Ulcer Classification

Location:

ulcer on stomach=Gastric Ulcer

ulcer on upper intestine=Duodenal Ulcer

ulcer on esophagus=Esophageal Ulcer

Duration:

Acute or Chronic

signs and symptoms
Signs and Symptoms
  • o Symptoms vary from person to person
  • o Can be confused with GERD and dyspepsia
  • o Common signs and symptoms:
      • o Gnawing, burning and aching in the epigastrium, and
      • o Dyspepsia that feels like heartburn
      • o Bloating and nausea
      • o Pain
slide8

o Less common symptoms:

    • o Pyloric obstruction- vomiting after meals
    • o Vomiting blood that looks like coffee grounds
    • o Black stools that looks like tar or that has dark red in them
slide9

o Peptic ulcer disease can be differentiated between gastric, duodenal, and stress ulcers.

slide10

o Silent ulcers may occur with pts with diabetes, NSAID users such as aspirin and ibuprofen.

  • o If left untreated, complications may occur such as bleeding, perforation, penetration or the obstruction of the digestion tract.
slide11

Treatment of Peptic Ulcer Disease

  • Combination of lifestyle changes and pharmacotherapy best
  • Treatment goals
    • Eliminate infection by H. pylori
    • Promote ulcer healing
    • Prevent recurrence of symptoms
slide12

Treatment of Peptic Ulcer

Disease (continued)

  • Drugs used in treatment
    • H2-receptor antagonists
    • Proton pump inhibitors
    • Antacids
    • Antibiotics and miscellaneous drugs
slide13

Treatment of H. pylori

  • Goals of treatment
    • Primary: bacteria completely eradicated
    • Ulcers heal more rapidly
    • Ulcers remain in remission longer
  • Very high reoccurrence when H. pylori not eradicated
  • Infection can remain active for life if not treated.
slide14

H2-Receptor Blockers

  • Slow acid secretion by stomach
  • Often drugs of choice in treating PUD
  • Cimetidine used less frequently
    • Drug-drug interactions are numerous.
  • Do not take antacids at same time as H2-receptor blockers.
    • Decreases absorption
slide15

H2-Receptor Blockers

  • Prototype drug: ranitidine (Zantac)
  • Mechanism of action: acts by blocking H2-receptors in stomach to decrease acid production
  • Primary use: to treat peptic ulcer disease
  • Adverse effects: possible reduction in number of red and white blood cells and platelets, impotence or loss of libido in men
slide16

H2-Receptor Antagonist Therapy

  • Dysrhythmias and hypotension have occurred with IV cimetidine
    • Ranitidine (Zantac) or famotidine (Pepcid) can be administered intravenously
  • Assess kidney and liver function
  • Evaluate client’s CBC for possible anemia during long-term use
slide17

Proton Pump Inhibitors

  • Prototype drug:omeprazole (Prilosec)
  • Mechanism of action: reduces acid secretion in stomach by binding irreversibly to enzyme H+, K+-ATPase
  • Primary use: for short-term, 4- to 8-week therapy for peptic ulcers and GERD
  • Adverse effects: headache, nausea, diarrhea, rash, abdominal pain
    • Long-term use associated with increased risk of gastric cancer
slide18

Proton Pump Inhibitor Therapy for PUD

  • Take 30 minutes prior to eating, usually before breakfast
  • May be administered at same time as antacids
  • Often administered in combination with clarithromycin (Biaxin)
slide19

Antacids

  • Prototype drug: aluminum hydroxide (Amphojel)
  • Mechanism of action: neutralizes stomach acid by raising pH of stomach contents
  • Primary use: in combination with other antiulcer agents for relief of heartburn due to PUD or GERD
  • Adverse effects: minor; constipation
slide20

Antibiotics

  • Administered to treat H. pylori infections of gastrointestinal tract
  • Two or more antibiotics given concurrently
    • Increase effectiveness
    • Lower potential for resistance
  • Regimen often includes
    • Proton pump inhibitor
    • Bismuth compounds
      • Inhibit bacterial growth
      • Prevent H. pylori from adhering to gastric mucosa
slide21

Miscellaneous Drugs

  • Several additional drugs are beneficial in treating PUD
    • Sucralfate
      • Coats ulcer and protects it from further erosion
    • Misoprostol
      • Inhibits acid and stimulates production of mucus
    • Pirenzepine
      • Inhibits autonomic receptors responsible for gastric-acid secretion
slide22

Peptic Ulcer Disease

Nursing Interventions:

  • Pain Management:
    • Assess location, characteristics, onset/duration, frequency, quality, intensity or severity of pain, and precipitating factors to determine appropriate intervention
    • Provide client with optimal pain relief by using prescribed analgesics to provide comfort.
    • Use a variety of measures of relief such as pharmacologic, nonpharmacologic, and interpersonal techniques to facilitate pain relief.
    • Teach the use of nonpharmacologic techniques which include relaxation, music therapy, guided imagery, distraction, acupressure, and massage before after and if possible during painful activities before pain occurs or increases.
    • Relaxation helps decrease acid production and reduces pain
slide23

Nursing Interventions cont’d:

    • Treament Regimen:
      • Explain the pathophysiology of the disease and how it relates to anatomy and physiology to help the patient understand the disease.
      • Discuss lifestyle changes that may be required to prevent future complications and/or control the disease process.
      • Instruct patient on which signs and symptoms to report to the health care provider to ensure early initiation of treatment.
    • Hemorrhage/Bleeding:
      • Assess for evidence of hematemesis, bright red or melena stool, abdominal pain or discomfort, symptoms of shock (decreased BP, cool/clammy skin, dyspnea, tachycardia, decreased urine output)
      • If ulcer is actively bleeding, observe NG tube aspirate or emesis for amount and color to assess degree of bleeding.
      • Take vital signs every 15-30 mins to help determine patient’s hemodynamic status and as indicators for shock.
      • Maintain IV infusion line to provide ready access for blood and fluid replacement.
      • Monitor hematocrit and hemoglobin as indicators of severity of hemorrhage and need for fluid and blood replacement.
slide24

Nursing Interventions cont’d:

    • Perforation:
      • Observer for manifestations of perforation such as sudden, severe abdominal pain; rigid, boardlike abdomen; radiating pain to shoulders; increasing distention; decreasing bowl sounds.
      • Take vital signs every 15-30 mins.
      • Maintain NG tube to suction to provide continuous aspiration and gastric decompression.
      • Administer pain medication to promote comfort and reduce anxiety.
slide25

Dietary modifications

  • Avoid foods that cause epigastric distress.
  • Avoid milk, sweets, or sugars
  • Small, frequent meals rather than large meals.
  • Limit the fluid intake at one time.
slide26

Avoid Cigarettes and alcohol.

  • Avoid OTC drugs unless approved by HCP.
  • Take all medications as provided.
slide27

Report any of the following:

  • Increased nausea and or vomiting.
  • Increase in epigastric pain.
  • Bloody emesis or tarry stools.
  • Encourage stress reducing activities or relaxation strategies.
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