Predisposing factors of peptic ulcer includes infection with the gram-negative bacteria Helicobacter pylori which may be acquired through the ingestion of food and water, excessive HCL secretion in the stomach, chronic use of non-steroidal anti-inflammatory drugs (NSAIDs) which weakens the lining of the GI tract by reducing the protective function of the mucosal layer, increased stress associated with illness and surgery, alcohol ingestion and excessive cigarette smoking.
Nursing Care Plans
The nursing goals of a client with a peptic ulcer disease include reducing or eliminating contributing factors, promoting comfort measures, promoting optimal nutrition, decreasing anxiety with increased knowledge of disease, management, and prevention of ulcer recurrence and preventing complications
Here are five (5) nursing care plans (NCP) for peptic ulcer disease:
1. Acute Pain
Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.
May be related to
- - Abdominal distention
- - Abdominal muscle spasm
- - Recent nonsteroidal anti-inflammatory drug (NSAID) or acetylsalicylic acid (ASA) use
Possibly evidenced by
- - Early satiety
- - Nausea and vomiting
- - Pain relieved by food or antacid
- - Weight loss
Desired Outcomes
- - Client will report satisfactory pain control at a level less than 2 to 4 on a scale of 0 to 10.
- - Client uses pharmacological and nonpharmacological pain relief measures.
- - Client will exhibit increased comfort such as baseline levels for HR, BP, and respirations and relaxed muscle tone for body posture.
| Nursing Interventions | Rationale |
|---|
| Assess the client’s pain, including the location, characteristics, precipitating factors, onset, duration, frequency, quality, intensity, and severity. | Clients with gastric ulcer typically demonstrate pain 1 to 2 hours after eating. The client with duodenal ulcers demonstrate pain 2 to 4 hours after eating or in the middle of the night. With both gastric and duodenal ulcers, the pain is located in the upper abdomen and is intermittent. Client may report relief after eating or taking an antacid. |
Encourage the use of nonpharmacological pain relief measures:
- - Acupressure
- - Biofeedback
- - Distraction
- - Guided imagery
- - Massage
- - Music therapy
| Nonpharmacological relaxation techniques will decrease the production of gastric acid, which in turn will reduce pain. |
| Instruct the client to avoid NSAIDs such as aspirin. | These medications may cause irritation of the gastric mucosa. |
| Instruct the client that meals should be eaten ar regularly paced intervals in a relaxed setting. | An irregular schedule of meals may interfere with the regular administration of medications. |
| Encourage the importance of smoking cessation. | Smoking decreases the secretion of bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the duodenum. |
Administer the prescribed drug therapy:
- - Antacids
- - Antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline
- - Histamine receptor antagonists
- - Prostaglandin analogues
- - Proton pump inhibitor
- - Sucralfate
| Antacids buffer gastric acid and prevent the formation of peptin. This mechanism of action promotes of healing of the ulcer. Antibiotics treat the Helicobacter pylori infection and promote healing of the ulcer. As the ulcer heals, the client experience less pain. H2 receptor antagonists block the secretion of gastric acid. Prostaglandin analogue reduces acid secretion and enhance the integrity of the gastric mucosa to resist injury. Proton pump inhibitors block the production and secretion of gastric acid and thereby reduce gastric pain. Sucralfate forms a barrier at the base of the ulcer crater to protect the healing ulcer from gastric acid. |
2. Imbalanced Nutrition: Less Than Body Requirements
Imbalanced Nutrition: Less Than Body Requirements:Intake of nutrients insufficient to meet metabolic needs.
May be related to
- - Abdominal pain
- - Alcohol intake
- - Anorexia
- - Diarrhea
- - Gastrointestinal bleeding
- - Nausea, vomiting
Possibly evidenced by
- - Inadequate dietary intake
- - Malabsorption of irons, minerals, and vitamins
- - Weight loss
Desired Outcomes
- - Client will verbalize and demonstrate selection of foods or meals that will achieve a cessation of weight loss.
- - Client will weigh within 10% of ideal body weight.
| Nursing Interventions | Rationale |
|---|
| Obtain a nutritional history. | Clients may often overestimate the amount of food eaten. The client may not eat sufficient calories or essential nutrients as a way to reduce pain episodes with peptic ulcer disease. Because of this, clients are at high risk for malnutrition. |
| Assess for body weight changes. | Weight loss is an indication of inadequate nutritional intake. Gastric ulcers are more likely to be associated with vomiting, loss of appetite and weight loss than duodenal ulcers. |
| Assist the client with identifying foods hat cause gastric irritation. | Clients need to learn what foods they can tolerate without gastric pain. Soft, bland, non acidic foods cause less gastric irritation. The client is more likely to increase food intake if the foods are not associated with pain. Foods that may contribute to mucosal irritation include spicy foods, pepper, aNd raw fruits and vegetables. |
| Monitor laboratory values for serum albumin. | This test indicates the degree of protein depletion (2.5 g/dL indicates severe depletion; 3.8 to 4.5 g/dL is normal). |
| Instruct in the importance of abstaining from excessive alcohol. | Alcohol causes gastric irritation and increases gastric pain. |
| Encourage the client to limit the intake of caffeinated beverages such as tea and coffee. | Caffeine stimulates the secretion of gastric acid. Coffee, even if decaffeinated, contains a peptide that stimulates the release of gastrin and increases acid production. |
| Teach about the importance of eating a balanced diet with meals at regular intervals. | Specific dietary restrictions are no longer part of the treatment for PUD. During the symptomatic phase of an ulcer the client may find benefit from eating small meals at more frequent intervals. |
3. Anxiety
Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.
May be related to
- - Fear of the unknown
- - Nature of the disease.
- - Situational crisis
- - Stress
Possibly evidenced by
- - Abdominal pain
- - Apprehensive
- - Expressed concerns about changes in life events
- - Fatigue
- - Irritability
Desired Outcomes
- - Client will demonstrate ways of reducing anxiety level.
| Nursing Interventions | Rationale |
|---|
| Assess client’s level of anxiety. | Clients with peptic ulcers are anxious, but their anxiety level is not visible. |
| Acknowledge awareness of the client’s anxiety. | Acknowledgement of the client’s feelings validates the feelings and communicates the acceptance of those feelings. |
| Encourage to express fears openly | Open communication enable the client to develop a trusting relationship that aids in reducing anxiety and stress. |
| Use simple language and brief statements when giving instructions to the client. | When experiencing moderate to severe anxiety, clients may be unable to comprehend anything more than simple, clear, and brief instructions. |
| Decrease sensory stimuli by maintaining a quiet environment. | Anxiety may escalate to a panic state with excessive conversation, noise, and equipment around the client. |
| Provide emotional support to client. | Providing emotional support will give a client calming and relaxing mood that will lower anxiety, and stress related to the condition. |
| Assist the client in developing anxiety-reducing measures such as biofeedback, positive imagery, and behavior modification. | Learning these methods provides the client with a variety of ways to manage anxiety. |
4. Deficient Knowledge
Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.
May be related to
- - Lack of recall of previously learned information
- - New condition, treatment
- - Recurrent episodes of GI bleeding
- - Recurrent peptic ulcer disease
Possibly evidenced by
- - Incorrect responses to questions about peptic ulcer disease
- - Inaccurate follow-through with treatment regimen and lifestyle modifications
- - Lack of questions
- - Multiple questions
Desired Outcomes
- - Client will verbalize understanding of the importance of compliance with medical regimen, knowledge of peptic ulcer disease, and commitment to self-care management.
| Nursing Interventions | Rationale |
|---|
| Assess the client’s knowledge and misconceptions regarding peptic ulcer disease, lifestyle behaviors, and the treatment regimen. | Clients may have inaccurate information about how lifestyle behaviors contribute to peptic ulcer disease. The client needs accurate knowledge to make informed decisions about taking prescribed medications and modifying behaviors that contribute to peptic ulcer disease or GI bleeding. |
| Explain the pathophysiology of disease and how it relates to the functioning of the body. | An understanding of the disease process helps to foster the willingness to follow the recommended treatment plan and modify behaviors to prevent recurrent episodes or related complications. |
| Instruct the client in what signs and symptoms to report to the health care provider. | Recognizing the signs and symptoms can help ensure the early initiation of treatment. |
| Discuss the therapy options and the rationales for using these options. | The correct use of antibiotics and acid suppression medications can promote rapid healing of an ulcer. |
| Discuss the lifestyle changes required to prevent further complications or episodes of peptic ulcer disease. | The modifications of lifestyle behaviors such as alcohol use, coffee, and other caffeinated beverages, and the overuse of aspirin or other nonsteroidal anti-inflammatory drugs is necessary to prevent recurrent ulcer development and prevent complications during the healing phase. |
5. Risk For Deficient Fluid Volume
May be related to
- - Gastrointestinal (GI) bleeding
- - Nausea, vomiting
Possibly evidenced by
Desired Outcomes
- - Client will be normovolemic as evidenced by systolic BP greater than or equal to 90 mm Hg (or client’s baseline), absence of orthostasis, HR 60 to 100 beats/minute, urine output greater than 30 ml/hr, and normal skin turgor.
| Nursing Interventions | Rationale |
|---|
| Assess for the signs of hematemesis or melena. | The client with a bleeding ulcer may vomit bright red blood or coffee grounds emesis. Melena occurs when there is bleeding in the upper GI tract. |
| Monitor the client’s fluid intake and urine output. | The kidney will reabsorb water into circulation to support a decrease in blood volume. This compensatory mechanism results in decreased urine output. A decrease in circulatory blood volume leads to decreased renal perfusion and decreased urine output |
| Monitor the client’s vital signs, and observes BP and HR for signs of orthostatic changes. | The erosion of an ulcer through the gastric or duodenal mucosal layer may cause GI bleeding. The client may develop anemia. If bleeding is brisk, changes in vital signs and physical symptoms of hypovolemia may develop rapidly. A decrease in BP and an increase in HR with changes in position is an early indicator of decreased circulatory volume. |
| Instruct the client to immediately report symptoms of nausea, vomiting, dizziness, shortness of breath, or dark tarry stools. | These assessment findings are signs of GI bleeding and should be reported immediately. |
| Monitor hemoglobin and hematocrit levels. | Erosion of the gastric mucosa by an ulcer results in GI bleeding. A decrease in hemoglobin and hematocrit occurs with bleeding. |
| Administer IV fluids, volume expanders, and blood products as ordered. | Isotonic fluids, volume expanders, and blood products can restore or expand intravascular volume. |
Comments
Post a Comment
Osamaedres7@gmail.com