What are some good Nursing Dx for a pt. with peptic ulcer?

[Animaniacs, BSN, RN]

I need at least 5 good ones, but 3 good ones will suffice. I have to do a careplan, which is the most comprehensive careplan I will have ever done, 3 outcome criteria, 2 interventions per outcome criteria for each Nursing diagnosis with rationale, So yeah its awful for me. And I have to do 4 Nursing Dx on the same patient.

The careplan book i am looking at by ackley and ladwig only lists these nursing dx for peptic ulcer:

Pain

Nausea

Ineffective health maintenance

Ineffective therapeutic regimen management, readiness for enhanced for.

Fatigue

1) I really like Ineffective therapeutic regimen management, I think I'll go with that one, especially since this patient had a previous history of ulcer, and now he is in again for the 2nd time. I really feel I can do a good careplan with that.

2) Pain is also a good one, but I feel that is way too easy, especially since all patients with peptic ulcer will exhibit pain, but I wont mind doing it. The only thing I am worried is the assessment data, what kind of assessment data can i write down, theres a few, and pain is the only one i can think of, pain at 8/10 due to ulceration, surgery. This patient has been in the hospital for 12 days, and I think she is going home tomorrow. But i got to spend my clinical day with her today since she was my patient; she was able to get up and walk, do am care with minimal assist, she did complain of pain, 8/10, gave her pain meds with that. But I feel i cant do 3 outcome criteria and 6 interventions with rationales, and my assessment data will be so minimal.

3)? I dont know, I'm out of ideas. This patient is pretty much all better now, just waiting for her doctor to give the order for discharge, so I didnt get much out of her today. But this patient has a history of smoking, alcohol, drug abuse, currently unemployed if that helps.

[not now, RN]

My book has peptic ulcers seperated as either duodenal or gastric but the nursing diagnosis are pretty much the same the only difference was #2 was listed for gastric ulcers but not duodelal ulcers.

1. Anxiety r/t situational crisis

2. Nurition alteration: Less than body requirements r/t inability to digest or absorb nuritents or inefficient intake

3. Nutrition alteration: Less than body requirements r/t inability to digest or absorb nutrients because of biological factors

4. Pain r/t physical, biological, or chemical agents

5. Tissue perfusion alteration (GI) r/t decreased cellular exchange

Hope this helps.

[Animaniacs, BSN, RN]

I like that, Imbalance nutrition less than body requirements, that's a good one.

this patient has been on NPO status for a while, for almost 10 days, and yesterday the patient was switched onto a clear liquid diet. and has had 2 surgery done during the last 12 days.

I think they did an exploratory laparatomy to remove multiple abscess as a result of the peptic ulcer, the patient stated that there were a lot of air pockets in his abdomen, so they removed those, and now he has a huge dressing covering his abdomen.

what is a good dx for a person who has had an exploratory laparatomy, the patient had it 2 days ago.

Looks like I'll go back to the hospital and get more information from the chart, man the stresses of nursing school.

[not now, RN]

what is a good dx for a person who has had an exploratory laparatomy, the patient had it 2 days ago.

Infection, risk for r/t surgical incision

[JimmyMallo]

I think one important Dx that has not been mentioned here is Knowledge deficit r/t risk factors for GI ulcer and post operative GI complications. This patient smokes AND drinks and with those habits I would guess her diet isn't good either. These are some of the leading factors for aggravation of GI problems. Sometimes the best thing you can do is help them understand how to help themselves. Nursing is teaching :)

[not now, RN]

I think one important Dx that has not been mentioned here is Knowledge deficit r/t risk factors for GI ulcer and post operative GI complications. This patient smokes AND drinks and with those habits I would guess her diet isn't good either. These are some of the leading factors for aggravation of GI problems. Sometimes the best thing you can do is help them understand how to help themselves. Nursing is teaching :)

Good point. I tend to lean heavily on physiological factors and ignore/forget the emotional and educational aspects (I think it's the biology major in me). I still need to work on that.

The only time I notice is when it's painfully obvious like my last pt with multiple chronic illnesses who came from a SNF. The SNF called to inform the staff that while cleaning her room they found 100+ pills stashed away, she wanted to stay sick so she didn't have to go home.