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Silly question:do most patients receive an antiulcer meds while hospitalized?

When I used to work in a hospital I saw many people on an antiulcer meds;I used to work on the cardiac step down unit,also whenever I read up on some conditions it is recommended to administer histamine 2 blockers,proton pump inhibitors or antacids,is this a common practice on the wards? I know that some more serious conditons would definitely prompt the MD to prescribe an antiulcers meds but I was just wandering do you guys administer a lot of antiulcer meds on your floor and for what conditons? Respiratory failure,heart surgery comes to mind but what else,thanks.

Stress ulcer prophylaxis is not uncommon. It is particularly popular in very sick patient populations. I actually have major trauma and burn ulcer prophylaxis protocols in place when we fly these patients.

You need to think like this? If you're talking about a bed sore ulcer, or a gastric ulcer it doesn't matter.

A tiny injectable of lovenox cost maybe a dollar. The cost to heal a bed sore is insaine maybe $10,000, and the cost of a perforating gastric ulcer leading to peritonitis....... I'm not sure i want to know.

cb_rn

Specializes in CT stepdown, hospice, psych, ortho.

In two of the hospitals I've worked it was protocol for any of the surgery patients. Protonix IV and then PO when taking meds.

I'm also seeing a lot of standard orders for reglan at my lastest hospital gig. Thats a new one for me.

Boog'sCRRN246, RN

Has 9 years experience. Specializes in Utilization Management.

I've seen them administered quite a bit. There is an enormous amount of physical stress during a hospital stay, especially if surgery is involved, and physical stress can increase the risk of developing gastric ulcers. So the MD is going to order H2 blockers, PPIs, etc., to prevent this.

cb_rn

Specializes in CT stepdown, hospice, psych, ortho.

You need to think like this? If you're talking about a bed sore ulcer, or a gastric ulcer it doesn't matter.

A tiny injectable of lovenox cost maybe a dollar. The cost to heal a bed sore is insaine maybe $10,000, and the cost of a perforating gastric ulcer leading to peritonitis....... I'm not sure i want to know.

Lovenox is actually really expensive. Really, really expensive.

But your point is well taken. An ounce of prevention

You need to think like this? If you're talking about a bed sore ulcer, or a gastric ulcer it doesn't matter.

A tiny injectable of lovenox cost maybe a dollar. The cost to heal a bed sore is insaine maybe $10,000, and the cost of a perforating gastric ulcer leading to peritonitis....... I'm not sure i want to know.

Haha,so it is always about the $$$$$$$$$$$$$$....hospitals dont want to get sued for gastric ulcers lol-I wonder if those antiulcer meds will eventually become resistant to ulcers:rolleyes::rolleyes:

In two of the hospitals I've worked it was protocol for any of the surgery patients. Protonix IV and then PO when taking meds.

I'm also seeing a lot of standard orders for reglan at my lastest hospital gig. Thats a new one for me.

Hmm interesting is it prescribed for heartburn or vomitting?!:confused:

Lovenox is actually really expensive. Really, really expensive.

But your point is well taken. An ounce of prevention

Yeah I always thought that lovenox was extremely expensive.

I've seen them administered quite a bit. There is an enormous amount of physical stress during a hospital stay' date=' especially if surgery is involved, and physical stress can increase the risk of developing gastric ulcers. So the MD is going to order H2 blockers, PPIs, etc., to prevent this.[/quote']

Not to mention psychological stress LOL:)

LouisVRN, RN

Specializes in Med/Surg.

Lovenox is very expensive, if i recall correctly, over $100 per injection, still minute to the financial, let alone physical reprocussions of a DVT/PE/MI. That being said, the ever popular protonix is only $30 for the IV and less for the PO, pretty much every patient on our med/surg floor is on either protonix or pepcid, reglan I have not seen used prophylactically other than for nausea and increasing bowel motility. But speaking of protonix, did everyone know it can show up as a false positive for a urine drug screen for THC? Just FYI showing I actually did take the time to read the insert that comes with the vial.

Almost every patient that are hospitalized >1 week receive PPI or H2's. Stress ulcers are serious complications of hospitalizations... I've had more than one that has been hospitalized w/out and it's not the most entertaining thing when one of them perforates...

Almost all of our patients are on Prilosec / Nexium PO or IV... VERY rarely do we have H2's for patients UNLESS they are taking Plavix r/t the decreased bioavailability r/t the combo of Plavix and PPI's.

And we do PRN Maalox Plus for breakthrough ;)

Haha,so it is always about the $$$$$$$$$$$$$$....hospitals dont want to get sued for gastric ulcers lol-I wonder if those antiulcer meds will eventually become resistant to ulcers:rolleyes::rolleyes:

:igtsyt: Mm not really.... it's something that is easily prevented (unless contraindicated), totally reimbursable, and the patients are better in the long run for the administration of these meds. It's not about $$ ... Our job is for the patients (or so I've been told ;) ) :nurse:

locolorenzo22, BSN, RN

Specializes in Ortho, Neuro, Detox, Tele.

we give protonix every evening for patients after joint replacement sx, along with their 325 of asa. we have zofran IV throughout their stay available. We encourage them to stick to blander foods, and not recommend the tomato/acid foods until the last day of their stay.

cb_rn

Specializes in CT stepdown, hospice, psych, ortho.

Lovenox is very expensive, if i recall correctly, over $100 per injection, still minute to the financial, let alone physical reprocussions of a DVT/PE/MI. That being said, the ever popular protonix is only $30 for the IV and less for the PO, pretty much every patient on our med/surg floor is on either protonix or pepcid, reglan I have not seen used prophylactically other than for nausea and increasing bowel motility. But speaking of protonix, did everyone know it can show up as a false positive for a urine drug screen for THC? Just FYI showing I actually did take the time to read the insert that comes with the vial.

I started a thread on that about 3 weeks ago. I was very surprised myself!

I don't know what made our docs start using reglan but from my nursing practice I can see a difference in how fast the bowel sounds return. Not really sure if it results in better outcomes, I've noticed the appetite doesn't come back any quicker.

Ivanna_Nurse, BSN, RN

Has 18 years experience. Specializes in CCU MICU Rapid Response.

Hey there, I work in an large ICU, and we administer protonix IV daily until they transition and are able to take po, then prevacid or po protonix starts. It is part of our vap protocol. :) Ivanna

Hi,

Did someone say Lovenox helps to prevent pressure ulcers?

XingtheBBB, BSN, RN

Has 20 years experience. Specializes in OR, peds, PALS, ICU, camp, school.

There are so many thoughts mixed up in my mind right now. I hate posts that reply in a list but I've gotta do here.

-peptic ulcer prophylaxis and DVT prophylaxis are big these days. It's not really because litigation has increased but because knowledge and awareness has increased. H2 inhibitors and proton pump inhibitors were brand new when I was a student... not even OTC. Lovenox was brand new also.

- VAP prophylaxis is ICU is including chlorhexidine mouthwash as a standard more and more.

- yes, it's cost saving. Saves the hospital $, saves the pt $, saves insurance $, saves everyone who makes a paycheck or pays taxes $. So what? Now, with insurance companies able to turn down payment for hospital acquired conditions, it's a huge deal.

- We stop PUD prophy when the pt is able to tolerate TF at goal rates. Oral PUD prophy continues with PO fed pts. I'd actually like to read more on this rationale. Guess it's time for a lit search.

- Lovenox is pricey. Heparin is pretty cheap. All costs depend on the negotiation skills of hospitals and distribution companies. We use unfractionated heparin when we can. Rarely we use lovenox or fragmin. If we're dealing with HIT, it's a whole 'nother story.

- Heparins, early ambulations, and SCD's prevent DVT. No impact on pressure ulcers in any research I've read. Anyone have a source that says otherwise (for heparins, I mean?) I'm curious.

- Early ambulations, good mattresses, skin care, booties, and good old turn q2 are really neccessary to prevent pressure ulcers. Remember back rubs? Oooh, relaxing! They help, too. Throw a 40 second rub with some cream into your turn routine.

- Maybe when we prevent the preventable and are able to be reimbursed for what we do (and only do what's reimburable) we'll be able to afford more staff again? And have time for the good nursing care that prevents complications. Or maybe we'll be able to afford prettier lobbies and waiting rooms. Yeah. Probably prettier decor. :mad:

RaeRae1997

Has 13 years experience. Specializes in CICU, radiology, psych.

We put all our vent patient's on peptic ulcer meds to decrease incidence of VAP.

Penelope_Pitstop, BSN, RN

Has 13 years experience.

You need to think like this? If you're talking about a bed sore ulcer, or a gastric ulcer it doesn't matter.

A tiny injectable of lovenox cost maybe a dollar. The cost to heal a bed sore is insaine maybe $10,000, and the cost of a perforating gastric ulcer leading to peritonitis....... I'm not sure i want to know.

I read and reread this post, but I still don't understand what Lovenox has to do with anything...

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