17 Oct Peptic ulcer disease (PUD)

Peptic ulcer disease (PUD) is an erosion of the gastrointestinal (GI) mucosa resulting from the digestive action of hydrochloric (HCl) acid and pepsin. Any portion of the GI tract that comes in contact with gastric secretions is susceptible to ulcer development, including the lower esophagus, stomach, duodenum, and margin of gastrojejunal anastomosis after surgical procedures. Peptic ulcers can be classified as acute or chronic, depending on the duration and degree of mucosal involvement, and gastric or duodenal, according to the location. PUD development is associated with a variety of factors, including taking ulcerogenic drugs and the presence of H. pylori infection or chronic gastritis. Treatment for PUD is focused on decreasing gastric acidity and enhancing mucosal defense mechanisms. 

Instructions:

• Answer each objective thoroughly below in your own words, you will receive a zero for copy and pasting
• Cite all references. References must be from a Medical Surgical Nursing Textbook
• Please reply by evaluating 1 other students’ post; what you learned or add additional relative information 

Case Study

A.D., a 48-year-old business executive, is brought to the emergency department by a co-worker. At work he started vomiting a large amount of coffee-ground emesis and requested to go to the hospital. A.D. has a 9-year history of PUD and was hospitalized with upper GI bleeding 4 years ago. At that time, specimens obtained via fiberoptic endoscopy were positive for H. pylori, so he was treated with triple antibiotic therapy. His PUD has been controlled with medications since that time, but he states he has recently been under much more stress than usual because of company merger negotiations. He started smoking again after having quit for 7 years, and his alcohol consumption in the last 3 months has increased, especially when meeting with other business executives. Because of his work demands, he has not taken his medications routinely, eaten a healthy diet, or slept well. He has a chronic but intermittent headaches. He has been careful not to use aspirin, instead taking ibuprofen for headache relief. He reports that he has had increasingly dark stools for the past week and developed severe nausea before he started vomiting this morning. He says he has no sharp pain, only mild upper abdominal discomfort and nausea.

Your initial assessment reveals the following vital signs: BP 102/62 mm Hg, heart rate (HR) 98 beats/min, respiratory rate (RR) 24 breaths/min, temperature 98.0F (36.7C); capillary refill at 4 sec; skin cool and slightly moist, no distention of jugular veins, clear lung sounds, and a soft abdomen with hyperactive bowel sounds.

Objectives

• Identify risk factors for PUD.
• Differentiate between the characteristics of gastric and duodenal ulcers.
• Evaluate results of diagnostic testing in a patient with PUD.
• Identify relevant assessment data for a patient with PUD.
• Prioritize nursing care of a patient with a bleeding peptic ulcer.
• Describe the interprofessional care of a patient with PUD.
• Develop an individualized teaching plan for a patient with PUD.
• Describe interprofessional care of a patient with a perforated ulcer requiring surgical intervention.
• Appropriately delegate nursing care for a postoperative patient following surgery for PUD.