nur 120 peptic ulcer disease. pathophysiology normally, a physiologic balance exists between peptic...
TRANSCRIPT
NUR 120 PEPTIC ULCER
DISEASE
Pathophysiology
Normally, a physiologic balance exists between peptic acid secretion and gastric mucosal defense
The gastric mucosal barrier protects the underlying tissue from gastric acids and digestive juices
When a disruption occurs with this protective barrier, the mucosal lining is exposed and corroded by acid, resulting in an ulcer
Causes of PUD
H pylori bacteria Chronic use of NSAIDS Hypersecretion of Stomach Acid Stress Zollinger-Ellison Syndrome
To Test for H Pylori
Endoscopic gastric samples Collect medication history prior Urea breath testingNPO prior to test IgG serologic test can detect antibodies Stool sample
Ulcer Classification
Location:ulcer on stomach=Gastric Ulcer
ulcer on upper intestine=Duodenal Ulcer
ulcer on esophagus=Esophageal Ulcer
Duration:
Acute or Chronic
Signs and Symptoms
o Symptoms vary from person to person
o Can be confused with GERD and dyspepsia
o Common signs and symptoms: o Gnawing, burning and aching in the
epigastrium, and o Dyspepsia that feels like heartburn o Bloating and nausea o Pain
o Less common symptoms:o Pyloric obstruction- vomiting after mealso Vomiting blood that looks like coffee groundso Black stools that looks like tar or that has dark red in them
Gastric Ulcer Duodenal Ulcer
30 to 60 min after meal 1.5 to 3 hr after meal
Rarely occurs at night Often occurs at night
Pain worsens with food ingestion Pain relieved by food ingestion
o Peptic ulcer disease can be differentiated between gastric, duodenal, and stress ulcers.
o Silent ulcers may occur with pts with diabetes, NSAID users such as aspirin and ibuprofen.
o If left untreated, complications may occur such as bleeding, perforation, penetration or the obstruction of the digestion tract.
Combination of lifestyle changes and pharmacotherapy best
Treatment goals Eliminate infection by H. pylori Promote ulcer healing Prevent recurrence of symptoms
Treatment of Peptic Ulcer Disease
Drugs used in treatment H2-receptor antagonists Proton pump inhibitors Antacids Antibiotics and miscellaneous drugs
Treatment of Peptic Ulcer Disease (continued)
Goals of treatment Primary: bacteria completely eradicated Ulcers heal more rapidly Ulcers remain in remission longer
Very high reoccurrence when H. pylori not eradicated Infection can remain active for life if not treated.
Treatment of H. pylori
Slow acid secretion by stomachOften drugs of choice in treating PUD Cimetidine used less frequently Drug-drug interactions are numerous.
Do not take antacids at same time as H2-receptor blockers. Decreases absorption
H2-Receptor Blockers
Prototype drug: ranitidine (Zantac)Mechanism of action: acts by blocking H2-
receptors in stomach to decrease acid production
Primary use: to treat peptic ulcer diseaseAdverse effects: possible reduction in number
of red and white blood cells and platelets, impotence or loss of libido in men
H2-Receptor Blockers
Dysrhythmias and hypotension have occurred with IV cimetidine Ranitidine (Zantac) or famotidine (Pepcid)
can be administered intravenouslyAssess kidney and liver functionEvaluate client’s CBC for possible anemia
during long-term use
H2-Receptor Antagonist Therapy
Prototype drug: omeprazole (Prilosec) Mechanism of action: reduces acid secretion in
stomach by binding irreversibly to enzyme H+, K+-ATPase
Primary use: for short-term, 4- to 8-week therapy for peptic ulcers and GERD
Adverse effects: headache, nausea, diarrhea, rash, abdominal pain Long-term use associated with increased risk of
gastric cancer
Proton Pump Inhibitors
Take 30 minutes prior to eating, usually before breakfast
May be administered at same time as antacids
Often administered in combination with clarithromycin (Biaxin)
Proton Pump Inhibitor Therapy for PUD
Prototype drug: aluminum hydroxide (Amphojel)Mechanism of action: neutralizes stomach acid by
raising pH of stomach contentsPrimary use: in combination with other antiulcer
agents for relief of heartburn due to PUD or GERDAdverse effects: minor; constipation
Antacids
Administered to treat H. pylori infections of gastrointestinal tract
Two or more antibiotics given concurrently Increase effectiveness Lower potential for resistance
Regimen often includes Proton pump inhibitor Bismuth compounds
Inhibit bacterial growthPrevent H. pylori from adhering to gastric
mucosa
Antibiotics
Several additional drugs are beneficial in treating PUD Sucralfate
Coats ulcer and protects it from further erosion Misoprostol
Inhibits acid and stimulates production of mucus Pirenzepine
Inhibits autonomic receptors responsible for gastric-acid secretion
Miscellaneous Drugs
Peptic Ulcer Disease
• Pain Management:• Assess location, characteristics, onset/duration, frequency, quality,
intensity or severity of pain, and precipitating factors to determine appropriate intervention
• Provide client with optimal pain relief by using prescribed analgesics to provide comfort.
• Use a variety of measures of relief such as pharmacologic, nonpharmacologic, and interpersonal techniques to facilitate pain relief.
• Teach the use of nonpharmacologic techniques which include relaxation, music therapy, guided imagery, distraction, acupressure, and massage before after and if possible during painful activities before pain occurs or increases.
• Relaxation helps decrease acid production and reduces pain
Nursing Interventions:
•Nursing Interventions cont’d:– Treament Regimen:
• Explain the pathophysiology of the disease and how it relates to anatomy and physiology to help the patient understand the disease.
• Discuss lifestyle changes that may be required to prevent future complications and/or control the disease process.
• Instruct patient on which signs and symptoms to report to the health care provider to ensure early initiation of treatment.
– Hemorrhage/Bleeding:• Assess for evidence of hematemesis, bright red or melena stool, abdominal pain or
discomfort, symptoms of shock (decreased BP, cool/clammy skin, dyspnea, tachycardia, decreased urine output)
• If ulcer is actively bleeding, observe NG tube aspirate or emesis for amount and color to assess degree of bleeding.
• Take vital signs every 15-30 mins to help determine patient’s hemodynamic status and as indicators for shock.
• Maintain IV infusion line to provide ready access for blood and fluid replacement.• Monitor hematocrit and hemoglobin as indicators of severity of hemorrhage and need for
fluid and blood replacement.
•Nursing Interventions cont’d:–Perforation:• Observer for manifestations of perforation such as sudden,
severe abdominal pain; rigid, boardlike abdomen; radiating pain to shoulders; increasing distention; decreasing bowl sounds.• Take vital signs every 15-30 mins.• Maintain NG tube to suction to provide continuous
aspiration and gastric decompression.• Administer pain medication to promote comfort and
reduce anxiety.
Dietary modifications
Avoid foods that cause epigastric distress.
Avoid milk, sweets, or sugars
Small, frequent meals rather than large meals.
Limit the fluid intake at one time.
Avoid Cigarettes and alcohol.
Avoid OTC drugs unless approved by HCP.
Take all medications as provided.
Report any of the following:
Increased nausea and or vomiting.Increase in epigastric pain.Bloody emesis or tarry stools.Encourage stress reducing activities or
relaxation strategies.