Management for peptic ulcer?

[plethoraldork]

what are the nursing management and medical management for peptic ulcer?

[Daytonite, BSN, RN]

medical management:

• http://www.fpnotebook.com/gi/pud/pptculcrds.htm - outline overview of causes, symptoms, tests and treatment
  
• http://emedicine.medscape.com/article/181753-overview - peptic ulcer disease (gives pathophysiology, tests, and surgical and medical treatment including medications and dosages)
  

nursing management: to manage this means to care plan for it. that means you must engage the nursing process to break down the disease into its signs and symptoms because that is essentially what nursing interventions will target as well as how the patent's reactions to these signs and symptoms affect their ability to perform their activities of daily living (adls). follow the steps of the nursing process to do all of this:

step 1 assessment - collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology - much of this information can be collected from the two references i supplied above as well as from your textbooks.

• peptic ulcer causes: nsaids, helicobacter pylori (90-100% in duodenal ulcers; 70-90% in gastric ulcers), acid induced, chronic disease (stress ulcers in chronic debilitated conditions, copd, cystic fibrosis, alpha-1-antitrypsin deficiency, systemic mastocytosis, basophilic leukemia, chronic renal failure, cirrhosis)
  
• gnawing or burning sensation, occurs 2-3 hours after meals, relieved by food or antacids
  
• patient awakens with pain at night, may radiate to the back (possible penetration)
  

step #2 determination of the patient's problem(s)/nursing diagnosis part 1 - make a list of the abnormal assessment data

• duodenal ulcer
  
  • mid-epigastric pain, deep recurring ache
    
  • pain relieved with food or antacids
    
  • nocturnal pain is present
    

  [*]gastric ulcer

  • mid-epigastric pain
    
  • pain relieved by antacids
    
  • anorexia
    
  • weight loss
    
  • nausea or vomiting
    

  [*]dyspepsia (epigastric burning, abdominal bloating, belching, flatulence, nausea, halitosis)

  [*]fatty food intolerance

  [*]hematemesis or melena and/or guaiac-positive stool (from gastrointestinal bleeding)

step #2 determination of the patient's problem(s)/nursing diagnosis part 2 - match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use

• deficient fluid volume r/t gi bleeding aeb hematemesis or melena and/or guaiac-positive stool [+ other symptoms of dehydration or the effects of hemorrhage]
  
• imbalanced nutrition: less than body requirements r/t inability to ingest food, nausea & vomiting aeb weight loss, anorexia and intolerance of fatty foods
  
• nausea r/t gastric irritation and distension aeb reports of nausea and vomiting, abdominal bloating, belching, flatulence and halitosis
  
• acute pain r/t gi irritation aeb mid-epigastric pain and may be relieved with food or antacids, epigastric burning sensation, and presence of epigastric pain at night
  

step #3 planning (write measurable goals/outcomes and nursing interventions) - goals/outcomes are the predicted results of the nursing interventions you will be ordering and performing - interventions specifically target the etiology of the problem or abnormal data/signs and symptoms/evidence that supports the existence of the problem - your overall goal is always aimed to alter or change something about the problem

example:

nausea r/t gastric irritation and distension aeb reports of nausea and vomiting, abdominal bloating, belching, flatulence and halitosis

goal:

the patient will report no nausea and improvement of intestinal gas.

nursing interventions:

• assess/monitor/evaluate/observe (to evaluate the patient's condition)
  
  
  • assess frequency, character and amount of any nausea
    
    
  • assess the duration of nausea
    
    
  • assess what conditions cause or make the nausea worse
    
    
  [*]care/perform/provide/assist (performing actual patient care)
  • place an emesis basin within patient's reach
    
    
  • assist with or offer mouth care after each episode of emesis or q4h
    
    
  • offer ice chips, ginger ale or warm both if allowed per diet
    
    
  • if allowed, offer dry (toast, crackers) and bland foods (broth, rice, bananas, jell-o)
    
    
  • do not give fried or greasy foods
    
    
  • give antiemetics as ordered by the doctor
    
    
  • give antacids as ordered by the doctor
    
    
  [*]teach/educate/instruct/supervise (educating patient or caregiver)
  • teach the patient that his symptoms of distension, belching and flatulence are a result of the disease process and as medical treatment is effective they will disappear. (
    http://www.webmd.com/a-to-z-guides/flatulence-gas
    )
    
    
  • teach the patient to change positions slowly
    
    
  • teach the patient about the appropriate foods to eat when nauseated and those to avoid
    
    
  • teach the patient the importance of maintaining fluid intake
    
    
  • teach the patient that they need to contact the doctor if vomiting persists for more than 24 hours
    
    
  [*]manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)
  • notify the doctor if the patient vomits black or bloody emesis or develops a fever
    
    

this is done for each nursing diagnosis (problem) with attention to the symptoms of the problem since that is what you are aiming your nursing treatments at. so, you will be looking for nursing interventions for the following:

• hematemesis
  
• melena
  
• symptoms of dehydration
  
• symptoms of hemorrhage
  
• weight loss
  
• anorexia
  
• intolerance of fatty foods (you don't want the patient eating fried or greasy food anyway!)
  
• mid-epigastric pain (burning sensation) sometimes presence at night
  

and this is how you use the nursing process to think critically and work out the answer to your question.

[lovehospital]

Stay away from irritating foods such as spicy,fatty foods,extremely cold or hot foods.

[C. Thinking]

Most important thing is to let the client choose foods that is "comfortable" to them.