Peptic Ulcer Disease Management Quiz

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Questions and Answers

What could sudden, severe epigastric pain and a rigid abdomen indicate?

Gallbladder disease (correct)

Normal digestive discomfort

A common cold

A complication of PUD (correct)

What is the recommended timing for taking medication to minimize nighttime ulcer pain?

After lunch

First thing in the morning

At bedtime (correct)

Before breakfast

Why should patients limit food intake after the evening meal?

To prevent hypoglycemia

To avoid waking up early

To reduce nighttime gastric acid production (correct)

To save calories for breakfast

What dietary issue might patients with PUD face due to discomfort?

Inadequate nutritional status Signup and view all the answers

What effect does taking oral iron replacement have if taken with antacids?

Blocks iron absorption Signup and view all the answers

Which symptom should a patient with PUD report to their healthcare provider?

Persistent symptoms of anorexia Signup and view all the answers

What lifestyle change can help patients restore a normal sleep pattern after pain control?

Use of relaxation techniques Signup and view all the answers

What is an important nutritional consideration for patients with PUD to avoid?

Eating before bedtime Signup and view all the answers

What is the primary goal of initial interventions for a patient experiencing hemorrhage due to peptic ulcer disease (PUD)?

Restore and maintain circulation Signup and view all the answers

Which fluid solution is commonly administered to restore intravascular volume in PUD patients showing signs of shock?

Ringer's lactate solution Signup and view all the answers

In treating pyloric obstruction due to PUD, what is the initial treatment approach?

Gastric decompression with nasogastric suction Signup and view all the answers

What should be done for a patient with persistent bleeding from a PUD complication if medical management fails?

Consider surgical intervention Signup and view all the answers

Which medication is typically administered intravenously to reduce the risk of rebleeding in patients with PUD?

Pantoprazole Signup and view all the answers

What condition is characterized by repeated inflammation, healing, scarring, and can lead to gastric outlet obstruction?

Pyloric obstruction Signup and view all the answers

Which procedure may be performed via gastroscopy to manage bleeding vessels during a PUD complication?

Laser photocoagulation Signup and view all the answers

What is the appropriate nursing priority for a patient hospitalized with PUD complications?

Quickly restore and maintain fluid volume balance Signup and view all the answers

What is a significant risk associated with peptic ulcer disease (PUD) that can lead to severe complications?

Erosion of a blood vessel Signup and view all the answers

Which finding is indicative of acute hemorrhage in a patient with PUD?

Bright red vomitus with possible clots Signup and view all the answers

What role do IV fluids play in the management of patients with PUD who experience bleeding?

They maintain fluid and electrolyte balance Signup and view all the answers

Which position should a patient be placed in to minimize peritoneal contamination?

Fowler or semi-Fowler position Signup and view all the answers

How should a nasogastric tube be utilized in the care of a PUD patient with active bleeding?

To remove blood from the GI tract Signup and view all the answers

What symptom indicates that a patient with PUD should seek immediate care?

Light-headedness or fainting Signup and view all the answers

Which of the following is unlikely to indicate chronic or slow GI bleeding?

Bright red stool Signup and view all the answers

What is the main purpose of administering PPIs or antacids in the management of PUD?

To relieve pain and promote healing Signup and view all the answers

What is a common assessment finding in a patient experiencing acute GI bleeding?

Absence of bowel sounds Signup and view all the answers

What is the importance of teaching patients about avoiding NSAIDs and aspirin?

They contribute to ulcer formation. Signup and view all the answers

Which laboratory values are expected to be affected in a patient with acute bleeding?

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

Why is monitoring the patient’s gastric drainage important?

To assess for the presence of blood Signup and view all the answers

Which lifestyle management technique might help reduce the perception of pain in patients with PUD?

Stress reduction techniques Signup and view all the answers

What should patients be educated about regarding the manifestation of complications associated with PUD?

Increased abdominal pain or distention should be reported. Signup and view all the answers

Study Notes

Peptic Ulcer Disease (PUD) Management

PUD is typically managed in home and community-based settings, with complications requiring treatment in an acute care setting.
Nursing care priorities for hospitalized PUD patients include: restoring/maintaining fluid volume balance, reducing discomfort, maintaining nutritional status, and preventing/identifying/intervening potential complications.

Complications of PUD

Bleeding:
- Initial interventions focus on restoring circulation.
- IV fluids (normal saline, lactated Ringer's) are administered for shock symptoms (tachycardia, hypotension, pallor, low urine output, anxiety).
- Whole blood or packed RBCs may be given to restore hemoglobin/hematocrit.
- Nasogastric tube inserted to prevent aspiration.
- Gastroscopy with clotting/sclerosing agent, laser photocoagulation, or electrocoagulation can be done to seal bleeding vessels.
- Patient kept NPO until bleeding controlled.
- PPIs administered intravenously to reduce rebleeding risk.
- Surgery may be needed if medical measures fail.
- Older adults are more likely to rebleed or require surgery.
Gastric Outlet Obstruction:
- Occurs due to inflammation, healing, scarring, edema, and muscle spasm.
- Initial treatment: gastric decompression with nasogastric suction, IV normal saline and potassium chloride for fluid/electrolyte imbalance.
- H2-receptor blockers are given intravenously.
- Balloon dilation of the gastric outlet may be done.
- Surgery may be required if other measures fail.
Perforation:
- Requires immediate intervention to restore homeostasis and minimize peritonitis.
- IV fluids maintain fluid/electrolyte balance.
- Nasogastric suction removes gastric contents.
- Fowler or semi-Fowler positioning helps drain peritoneal contaminants.
- IV antibiotics are used to treat bacterial infection.
- Laparoscopic surgery or open laparotomy may be needed to close the perforation.

Fluid Volume Balance Management

Erosion of a blood vessel with resultant hemorrhage is a significant risk.
Acute bleeding can cause hypovolemia and fluid volume deficit, leading to decreased cardiac output and impaired tissue perfusion.
Monitor stools and gastric drainage for overt and occult blood.
Gauge the amount and rapidity of hemorrhage by assessing gastric drainage.
Bright red drainage with clots indicates acute hemorrhage; dark red or coffee grounds color suggests the blood has been in the stomach for a period.
Hematochezia (fresh blood in stool) is present in acute hemorrhage; melena (black, tarry stool) indicates less acute bleeding.
Chronic or slow GI bleeding carries a minimal fluid volume deficit risk; anemia and activity intolerance are more likely.

Home Care for Patients with PUD

Educate patients about:
- Prescribed medication regimen and potential side effects.
- Importance of continuing therapy even when symptoms subside.
- Relationship between PUD and factors like NSAID use and smoking.
- Avoiding aspirin and other NSAIDs.
- Reporting complications like increased abdominal pain, distention, vomiting, black/tarry stools, lightheadedness, or fainting.
- Stress and lifestyle management techniques to prevent exacerbations

Pain Management

PUD pain often occurs 2-4 hours after eating due to gastric acid and pepsin irritation.
Medications that neutralize acid, minimize production, or protect mucosa often relieve pain.
Assess pain characteristics: location, type, severity, frequency, duration.
Determine the relationship of pain to food intake or other contributing factors.
Administer PPIs, H2-receptor antagonists, antacids, or mucosal protective agents as ordered.
Teach relaxation, stress reduction, and lifestyle management.

Rest Facilitation

Teach patients about planning for appropriate rest.
Nighttime ulcer pain may disrupt sleep.
Anticipation of pain can lead to insomnia.
Bedtime PPI or H2-receptor blocker dose minimizes nighttime hydrochloric acid production, reducing pain.
Limit food intake after the evening meal; avoid bedtime snacking.
Encourage relaxation techniques and comfort measures for sleep.

Balanced Nutrition Promotion

Assess the patient's current diet: pattern of food intake, schedule, foods triggering pain, avoided foods.
Refer to a dietitian for meal planning to minimize PUD symptoms and meet nutritional needs.
Monitor for anorexia, fullness, nausea, vomiting.
Adjust dietary intake or medication schedule as needed.
PUD and resultant scarring can impair gastric emptying, requiring treatment changes.
Monitor laboratory values for anemia or other nutritional deficits.
Monitor for therapeutic effects and side effects of oral iron replacement.
Instruct patients to avoid antacids within 1-2 hours of taking oral iron.
Anemia can result from poor nutrient absorption or chronic blood loss.
Oral iron supplements may cause GI distress, nausea, and vomiting.

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Description

Test your knowledge on the management and complications of Peptic Ulcer Disease (PUD). This quiz covers nursing care priorities, intervention strategies, and treatment protocols for hospitalized patients. Learn how to effectively address bleeding and manage patient comfort during recovery.