Peptic Ulcer

Samar State University[pic 1][pic 2]

College of Nursing and Health Sciences

Catbalogan City

Case Study:

          Peptic Ulcer Disease

Presented by : Domalaon, Noyne Francis

                     Verzosa, Emily Antonette

Presented to : Juniel B. Tagarino, RN, MAN, EMT-B

TABLE OF CONTENTS:

1. Introduction….……………………………………….3

A. Patient Information………..…………………..5

1. Pathophysiology… …………………………………...6

1. History…………………………………………………7

1. Nursing Physical Assessment…………………………7

1. Pharmacology………………………………………….7

1. Nursing Care Plan…………………………………….7

1. Nursing Diagnosis and Patient Goal
2. Nursing Interventions
3. Evaluation
4. Recommendations

1. Introduction:

Anatomy and Physiology

[pic 3]

• Peptic ulcers are open sores in the upper part of the digestive tract that can cause stomach pain or stomach upset, and that can lead to internal bleeding. There are two types of peptic ulcers:

• Gastric ulcers, which form on the lining of the stomach

• Duodenal ulcers, which form on the lining of the upper part of the small intestine (called the “duodenum”)

• In some cases, peptic ulcers heal without treatment, but ulcers that have not been treated tend to recur. Many people with ulcers (sometimes called “peptic ulcer disease”) need treatment to relieve symptoms and prevent complications.

• There are two major causes of peptic ulcers, bacterial infection and the use of pain relievers called nonsteroidal anti-inflammatory medications (NSAIDs). NSAIDs include aspirin, ibuprofen, and naproxen.

• NSAIDs — The use of NSAIDs can also cause peptic ulcers in some people. They are commonly used to relieve pain and reduce inflammation.

• NSAIDs can cause changes in the protective mucous layer of the digestive tract, leading to ulcers in some people. The risk of ulcer formation depends on multiple factors, including the NSAID type, dose, and duration of use.

1. Patient Information:

Patient O, a 57-year-old patient, presents with 3-month history of difficult ambulating secondary-to-left knee pain. She had been using extra-strength acetaminophen(500 mg tablets) with minimal relief. In the last 2 months, she have been performed the following investigations:

•CBC,  chemistry panel, renal function, ESR: all normal

•X-Ray left knee : Asymmetrical  joint-space narrowing, subchondral osteosclerosis consistent  with osteoarthritis.

Then recommended using Acetaminophen 1g QID daily, and scheduled follow-up for today.

Today, she reported minimal improvement in pain and mobility. Aside from her knee symptoms , she has no other complaints.

Current Medication:

        Acetaminophen 1g QID daily                    

Physical Examination:

Patient appears generally well

BP: 118/64   Pulse: 72

No conjunctival pallor

Cardiorespiratory and abdominal exam : Normal

Left knee: No evidence of effusion, no redness/warmth. Decreased active and passive ROM in flexion secondary to pain.

Initiated therapy with daily NSAID.

1. Pathophysiology

Peptic ulcer is commonly caused when acid erodes the lining of the digestive tract. This can happen when there is excess acid in the system, or when the protective layer of mucus on the lining is broken down. The most common cause of peptic  ulcer  is  Helicobacter  pylori do not develop ulcers, but some do. This is because the bacteria can cause the  increase in the amount of acid in the stomach and small intestine, Inflammation of the lining of the digestive tract, and  breakdown of the protective mucous layer.

        But in this case the patient is risk for NSAID-induced peptic ulcer.

NSAID-induced peptic ulcer happens when a patient is taking NSAID medication which causes ulcer. NSAID causes the protective mucous layer to change in pH(decreases in alkalinity) which in turn decreases its ability to stabilize the pH in the stomach thus it causes the protective mucous membrane to be more susceptible to damage and this causes the ulcer.

      Non-steroidal Anti-Inflammatory Drugs

        [pic 4]

Affects the protective mucous membrane

[pic 5]

Gastric and Intestinal lining erodes[pic 6]

Ulcer forms

1. History

1. The patient has 3-month history of difficulty in ambulating secondary to left knee pain.
2. No history of reflux or ulcers
3. Non-smoker; no alcohol
4. Had been using extra-strength acetaminophen 500mg tablets.

1. Physical Assessment