peptic ulcer disease.pptx

definition
types
treatment
causes

1. Objectives Introduction of Peptic Ulcer Disease Classification Pathophysiology Causes Risk factors Clinical Manifestations Assessment and Diagnostic Findings Medical Management Surgical Management Nursing Management Nursing Assessment Nursing Diagnosis Nursing Care Planning & Goals Nursing Interventions Evaluation Discharge and Home Care Guidelines

2. peptic ulcer disease Peptic ulcer disease is a condition in which painful sores or ulcers develop in the lining of the stomach or the first part of the small intestine (the duodenum). Normally, a thick layer of mucus protects the stomach lining from the effect of its digestive juices. But many things can reduce this protective layer, allowing stomach acid to damage the tissue.

3. Causes Helicobacter pylori .  Research has documented that peptic ulcers result from infection with the gram-negative bacteria H. pylori, which may be acquired through ingestion of food and water. H. pylori damage the mucous coating that protects the stomach and duodenum. Salicylates and NSAIDs.  Encourages ulcer formation by inhibiting the secretion of prostaglandins. Various illnesses.  Pancreatitis, hepatic disease, Crohn’s disease, gastritis, and Zollinger -Ellison syndrome are also known causes. Excess HCl .  Excessive secretion of HCl in the stomach may contribute to the formation of peptic ulcers. Irritants.  Ingestion of milk and caffeinated beverages and alcohol also increase HCl secretion. These contribute by accelerating gastric emptying time and promoting mucosal breakdown.

4. peptic ulcer disease Nursing instructor: Alia Rafique

5. Risk factors One in 10 people develops an ulcer . Risk factors that make ulcers more likely include: Frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs), a group of common pain relievers that includes ibuprofen. A family history of ulcers. Regularly drinking alcohol. Smoking.

6. Types There are three types of peptic ulcers: Gastric ulcers : ulcers that develops in side the stomach Esophageal ulcers : ulcers that develop in esophagus Duodenal ulcers : ulcers that develop in the upper section of the small intestines, called the duodenum

7. Zollinger -Ellison syndrome Zollinger -Ellison syndrome is a rare condition in which one or more tumors grow in the pancreas or in the upper part of the small intestine. The tumors are called gastrinomas . These gastrinomas produce large amounts of the hormone gastrin. Gastrin causes the stomach to produce too much acid, which leads to peptic ulcers. High gastrin levels also can cause diarrhea, belly pain and other symptoms.

8. Assessment and Diagnostic Findings Esophagogastroduodenoscopy.  Confirms the presence of an ulcer and allows cytological studies and  biopsy  to rule out H. pylori or  cancer . Physical examination.  A physical examination may reveal pain, epigastric tenderness, or abdominal distention. Barium study.  A barium study of the upper GI tract may show an ulcer. Endoscopy.  Endoscopy is the preferred  diagnostic procedure  because it allows direct visualization of inflammatory changes, ulcers, and lesions. Occult blood.  Stools may be tested periodically until they are negative for occult blood .

9. Medical Management Antibiotic medications to kill H. pylori. If H. pylori is found in your digestive tract, your doctor may recommend a combination of antibiotics to kill the bacterium. These may include amoxicillin ( Amoxil ), clarithromycin ( Biaxin ), metronidazole. ▸ Proton pump inhibitors also called PPIs reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include ;omeprazole (Prilosec), lansoprazole ( Prevacid ). Acid blockers - also called histamine (H-2) blockers - reduce the amount of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing....ex. Ranitidine Antacids neutralize existing stomach acid and can provide rapid pain relief.

10. Surgical Management The introduction of antibiotics to eradicate H. pylori and of H2 receptor antagonists as a treatment for ulcers has greatly reduced the need for  surgical  interventions. Pyloroplasty .   Pyloroplasty involves transecting  nerves  that stimulate the acid secretion and opening the pylorus. Antrectomy . Antrectomy is the removal of the pyloric portion of the stomach with anastomosis to either the duodenum or jejunum.

11. Nursing Management Nursing Assessment Nursing  assessment  includes: Assessment for a description of pain. Assessment of relief measures to relieve the pain. Assessment of the characteristics of the vomitus. Assessment of the patient’s usual food intake and food habits.

12. Nursing Diagnosis Based on the assessment data, the patient’s  nursing diagnoses  may include the following Acute pain  related to the effect of gastric acid secretion on damaged tissue. Anxiety  related to an acute illness. Imbalanced  nutrition  related to changes in the diet. Deficient knowledge  about prevention of symptoms and management of the condition.

13. Nursing Care Planning & Goals The goals for the patient may include : Relief of pain. Reduced anxiety. Maintenance of nutritional requirements. Knowledge about the management and prevention of ulcer recurrence. Absence of complications.

14. Nursing Interventions Relieving Pain and Improving Nutrition Administer prescribed medications. Avoid  aspirin , which is an anticoagulant, and foods and beverages that contain acid-enhancing caffeine (colas, tea, coffee, chocolate), along with decaffeinated coffee. Encourage patient to eat regularly spaced meals in a relaxed atmosphere; obtain regular weights and encourage dietary modifications. Encourage relaxation techniques.

15. Reducing Anxiety Assess what patient wants to know about the disease, and evaluate level of anxiety; encourage patient to express fears openly and without criticism. Explain diagnostic tests and administering medications on schedule. Interact in a relaxing manner, help in identifying stressors, and explain effective coping techniques and relaxation methods. Encourage family to participate in care, and give emotional support.

16. Monitoring and Managing Complications If hemorrhage is a concern: Assess for faintness or dizziness and nausea, before or with bleeding; test stool for occult or gross blood; monitor vital signs frequently (tachycardia, hypotension, and tachypnea). Insert an indwelling urinary catheter and monitor intake and output; insert and maintain an IV line for infusing fluid and blood. Monitor laboratory values (hemoglobin and hematocrit). Insert and maintain a nasogastric tube and monitor drainage; provide lavage as ordered. Monitor oxygen saturation and administering oxygen therapy. Place the patient in the recumbent position with the legs elevated to prevent hypotension, or place the patient on the left side to prevent aspiration from vomiting. Treat hypovolemic shock as indicated.

17. Home Management and Teaching Self-Care Assist the patient in understanding the condition and factors that help or aggravate it. Teach patient about prescribed medications, including name,  dosage , frequency, and possible side effects. Also identify medications such as aspirin that patient should avoid. Instruct patient about particular foods that will upset the gastric mucosa, such as coffee, tea, colas, and alcohol, which have acid-producing potential. Encourage patient to eat regular meals in a  relaxed setting  and to  avoid overeating . Explain that smoking may interfere with ulcer healing; refer patient to programs to assist with smoking cessation. Alert patient to signs and symptoms of complications to be reported. These complications include hemorrhage (cool skin,  confusion , increased heart rate, labored breathing, and blood in the stool), penetration and perforation (severe abdominal pain, rigid and tender abdomen, vomiting, elevated temperature, and increased heart rate), and pyloric obstruction (nausea, vomiting, distended abdomen, and abdominal pain). To identify obstruction, insert and monitor nasogastric tube; more than 400 mL residual suggests obstruction.

18. Evaluation Expected patient outcomes include: Relief of pain. Reduced anxiety. Maintained nutritional requirements. Knowledge about the management and prevention of ulcer recurrence. Absence of complications.

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