Peptic Ulcer Disease Management

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Questions and Answers

What is the primary focus of initial interventions in patients with hemorrhage associated with Peptic Ulcer Disease (PUD)?

Restoring and maintaining circulation (correct)

Administering pain relief medications

Providing psychological support

Increasing nutritional intake

Which of the following is NOT a priority in the nursing care for hospitalized patients with PUD?

Preventing potential complications

Restoring fluid volume balance

Maintaining nutritional status

Increasing physical activity levels (correct)

What is a crucial step in the treatment of gastric outlet obstruction due to complications of PUD?

Administration of painkillers

High protein diet

Gastric decompression with nasogastric suction (correct)

Immediate surgery

For patients with PUD who exhibit signs of shock, what is the most appropriate intravenous solution to administer initially?

Normal saline or lactated Ringer's Signup and view all the answers

What medication is commonly administered intravenously to reduce the risk of rebleeding in PUD complications?

Pantoprazole Signup and view all the answers

What is the purpose of inserting a nasogastric tube in patients with PUD who are experiencing a hemorrhage?

To prevent aspiration of vomited gastric contents Signup and view all the answers

In older adults with bleeding complications from PUD, what factor increases their risk of requiring surgical intervention?

Increased likelihood of rebleeding Signup and view all the answers

Which intervention is performed to directly manage bleeding vessels in a patient with PUD?

Laser photocoagulation via gastroscopy Signup and view all the answers

What is the primary purpose of replacing gastric output milliliter for milliliter with a balanced electrolyte solution?

To prevent dehydration and maintain hydration status Signup and view all the answers

What assessment finding may indicate a potential perforation in a patient with acute gastrointestinal bleeding?

Rigid, boardlike abdomen Signup and view all the answers

Which laboratory result is likely to be affected by acute gastrointestinal bleeding?

Lower than normal hemoglobin and hematocrit Signup and view all the answers

What symptom might a patient experience due to orthostatic hypotension resulting from blood volume loss?

Syncope or dizziness upon standing Signup and view all the answers

What is a common change observed in bowel sounds associated with acute gastrointestinal bleeding?

Hyperactive bowel sounds Signup and view all the answers

What indicates that acute hemorrhage is occurring in a patient with PUD?

Bright red gastric drainage with possible clots Signup and view all the answers

What should be a major teaching point regarding medication for patients with PUD?

NSAIDs and aspirin should be avoided due to their potential to exacerbate ulcers Signup and view all the answers

Which sign should be promptly reported by a patient recovering from PUD who experiences it?

Black or tarry stools Signup and view all the answers

In cases of chronic GI bleeding from PUD, what is a likely primary concern?

Anemia and activity intolerance Signup and view all the answers

Which fluid replacement method is critical during acute bleeding episodes in PUD patients?

Intravenous fluid therapy with electrolytes Signup and view all the answers

What is considered a risk factor for complications in patients with PUD?

Smoking and NSAID use Signup and view all the answers

What can be an important lifestyle management technique for PUD patients to prevent exacerbation?

Engaging in stress management techniques Signup and view all the answers

How should gastric drainage be assessed in a patient with an acute hemorrhage?

By estimating the volume and rapidity of hemorrhage Signup and view all the answers

What is the typical timing for pain associated with PUD after eating?

2 to 4 hours Signup and view all the answers

Which medication type is least effective in promoting healing by protecting the mucosa from gastric juices?

Narcotics Signup and view all the answers

What lifestyle modification can help prevent nighttime pain associated with PUD?

Taking medication before bed Signup and view all the answers

Which symptom may indicate the presence of a complication such as perforation in PUD?

Sudden, severe epigastric pain Signup and view all the answers

Why is it important to prioritize rest for patients with PUD?

To minimize the risk of pain disruption during sleep Signup and view all the answers

What may be an impact of stress management techniques in patients with PUD?

Reduction in pain perception Signup and view all the answers

What is an appropriate action to take regarding diet to mitigate symptoms of PUD?

Limiting food intake after dinner Signup and view all the answers

Which factor is least associated with the management of pain in PUD?

Duration of nightly sleep Signup and view all the answers

Study Notes

Peptic Ulcer Disease (PUD) Management

PUD is typically managed in home and community-based settings
Complications of PUD usually require treatment in an acute care setting

Home Care Guidelines for Patients with PUD

Patient teaching is vital to ensure patients adhere to home care guidelines

Nursing Care Priorities for Hospitalized Patients with PUD

Prioritize restoring and maintaining fluid volume balance
Focus on reducing discomfort
Aim to maintain nutritional status
Prevent or rapidly identify and intervene for potential complications

Treatment for Complications of PUD

Patients hospitalized with complications of PUD (e.g., bleeding, GI obstruction, perforation, and peritonitis) require additional interventions to restore homeostasis
Initial interventions for PUD-related hemorrhage focus on restoring and maintaining circulation
- Intravenous administration of normal saline, lactated Ringer's solution, or other balanced electrolyte solutions is used to restore intravascular volume if signs of shock (tachycardia, hypotension, pallor, low urine output, and anxiety) are present.
- Whole blood or packed RBCs may be administered to restore hemoglobin and hematocrit levels
A nasogastric tube is inserted to prevent aspiration of vomited gastric contents
Gastroscopy with direct injection of a clotting or sclerosing agent into the bleeding vessel may be performed
Laser photocoagulation or electrocoagulation can also be performed via gastroscopy to seal bleeding vessels
Patients are kept NPO until bleeding is controlled
PPIs (e.g., 40 mg of pantoprazole [Protonix] per IV push or admixture daily) are administered intravenously to reduce the risk of rebleeding
Surgery may be necessary if medical measures are ineffective in controlling bleeding
Older adults who experience bleeding as a complication of PUD are more likely to rebleed or require surgery to control the hemorrhage

Gastric Outlet Obstruction

Repeated inflammation, healing, scarring, edema, and muscle spasm can lead to gastric outlet (pyloric) obstruction
Treatment involves: Gastric decompression with nasogastric suction, IV normal saline and potassium chloride administration to correct fluid and electrolyte imbalance, and H2-receptor blockers intravenously
Balloon dilation of the gastric outlet may be done via upper endoscopy
If these measures are unsuccessful in relieving obstruction, surgery may be required

Gastric or Duodenal Perforation

Gastric or duodenal perforation resulting in contamination of the peritoneum with GI contents often requires immediate intervention to restore homeostasis and minimize peritonitis
Treatment involves:
- IV fluids to maintain fluid and electrolyte balance
- Nasogastric suction to remove gastric contents and minimize peritoneal contamination
- Placing the patient in Fowler or semi-Fowler position allows peritoneal contaminants to pool in the pelvis.
- IV antibiotics to aggressively treat bacterial infection from intestinal flora
- Laparoscopic surgery or an open laparotomy may close the perforation

Peptic Ulcer Disease (PUD) and Fluid Volume Balance

Risk of hemorrhage: Erosion of blood vessels in PUD patients can lead to significant bleeding.
Hypovolemia and fluid deficit: Acute bleeding can cause hypovolemia, decreasing cardiac output and impairing tissue perfusion.
Monitoring for blood loss: Monitor stools and gastric drainage for both overt (visible) and occult (hidden) blood.
Gastric drainage assessment: Assess gastric drainage (vomitus or nasogastric tube drainage) for volume and rate of hemorrhage.
Blood in gastric drainage: Bright red drainage with clots indicates acute hemorrhage, while dark red or coffee grounds-like drainage suggests blood has been in the stomach for a period.
Stool color: Hematochezia (bright red stool) indicates acute bleeding, while melena (black, tarry stool) suggests less acute bleeding.
Chronic bleeding: Chronic or slow GI bleeding poses a lower risk of fluid volume deficit; anemia and activity intolerance are more worrisome.

Patient Teaching for Home Care

Medication regimen: Emphasize the importance of adhering to prescribed medications, understanding desired effects and potential adverse effects.
Continuation of therapy: Stress the importance of continuing therapy even after symptoms subside.
Ulcer risk factors: Discuss the relationship between ulcers and factors like NSAID use and smoking, recommending smoking cessation resources if necessary.
Avoiding NSAIDs: Instruct patients to avoid aspirin and other NSAIDs and to carefully read labels of over-the-counter medications for potential aspirin content.
Reporting complications: Educate patients on complications requiring immediate medical attention, including:
- Increased abdominal pain or distention
- Vomiting
- Black or tarry stools
- Lightheadedness
- Fainting
Stress management: Recommend stress and lifestyle management techniques to help prevent ulcer exacerbation; refer to resources for stress management such as classes, counseling, or support groups.

Managing Acute Bleeding

Fluid and electrolyte replacement: Maintain IV therapy with fluids and electrolytes to replenish losses from vomiting, nasogastric drainage, and diarrhea.
Blood transfusion: Administer whole blood or packed red blood cells to replace blood volume and restore oxygen-carrying capacity.
Nasogastric tube: Insert and maintain a nasogastric tube to remove blood from the GI tract and prevent vomiting and aspiration.
Gastric output monitoring: Measure and record gastric output hourly initially, decreasing frequency to every 4-8 hours.
Gastric output replacement: Replace gastric output milliliter for milliliter with a balanced electrolyte solution to maintain homeostasis.
Laboratory monitoring: Monitor hemoglobin and hematocrit, serum electrolytes, BUN, and creatinine values, reporting abnormalities.
Abdominal assessment: Assess the abdomen every 4 hours, including bowel sounds, distention, girth, and tenderness, recording findings.
Bedrest with head elevation: Maintain bedrest with head of bed elevated to prevent orthostatic hypotension and associated syncope or dizziness upon standing.
Safety measures: Ensure patient safety to prevent falls or injuries due to potential lightheadedness.

Pain Management for Peptic Ulcer Disease (PUD)

Pain associated with PUD is typically experienced 2 to 4 hours after meals due to gastric acid and pepsin irritating the exposed mucosa.
Medications like PPIs, H2-receptor antagonists, antacids, and mucosal protectors help relieve pain by reducing acid production, neutralizing acid, or protecting the mucosa.
Pain assessment should include location, type, severity, frequency, and duration, as well as its relationship to food intake and other contributing factors.
Stress management techniques, relaxation, and lifestyle modifications can help reduce pain perception and may contribute to ulcer healing.
Safety Alert: Sudden, severe epigastric pain and a rigid abdomen may indicate a complication like perforation, requiring prompt medical attention.
Adequate Rest: Nighttime ulcer pain often disrupts sleep, impacting patient well-being.
Home Care:
- Stress the importance of taking medications as prescribed, especially the bedtime dose of PPIs or H2-receptor blockers to minimize acid production during sleep.
- Instruct patients to limit food intake after the evening meal to prevent late-night gastric acid stimulation.
- Relaxation techniques and comfort measures like soft music can help promote sleep and reduce anxiety.

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Description

This quiz covers key concepts in managing Peptic Ulcer Disease (PUD), including home care guidelines, nursing priorities, and treatments for complications. It emphasizes the importance of patient education and interventions necessary for both outpatient and hospitalized settings.