Nursing Care Plan (NCP) for Peptic Ulcer Disease (PUD)
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Lesson Objective For Nursing Care Plan (NCP) for Peptic Ulcer Disease (PUD)
- Understanding of Peptic Ulcer Disease (PUD):
- Define Peptic Ulcer Disease and differentiate between gastric and duodenal ulcers.
- Comprehend the etiology and contributing factors leading to the development of PUD.
- Recognition of Signs and Symptoms:
- Identify common clinical manifestations of PUD, including epigastric pain, nausea, vomiting, and gastrointestinal bleeding.
- Recognize the variations in symptoms between gastric and duodenal ulcers.
- Diagnostic Procedures:
- Understand the diagnostic procedures used to confirm the presence of peptic ulcers, such as endoscopy, barium contrast studies, and Helicobacter pylori testing.
- Pharmacological Interventions:
- Explore the pharmacological treatments commonly used in managing PUD, including proton pump inhibitors (PPIs), H2-receptor antagonists, and antibiotics for H. pylori eradication.
- Lifestyle Modifications and Patient Education:
- Discuss lifestyle modifications that promote ulcer healing, such as dietary changes, stress management, and avoidance of NSAIDs and alcohol.
- Provide patient education on the importance of medication adherence, follow-up appointments, and recognizing and reporting worsening symptoms.
Pathophysiology of Peptic Ulcer Disease (PUD)
- Gastric Acid and Pepsin Secretion:
- Peptic Ulcer Disease is characterized by an imbalance between aggressive factors, such as gastric acid and pepsin secretion, and protective factors, such as mucosal integrity.
- Excessive production of gastric acid and pepsin can contribute to the erosion of the mucosal lining of the stomach or duodenum.
- Mucosal Defense Mechanisms:
- The stomach and duodenum have protective mechanisms to resist the harmful effects of gastric acid.
- Mucus production, bicarbonate secretion, and blood flow to the mucosa contribute to maintaining mucosal integrity.
- Breakdown of Mucosal Defense:
- When there is an imbalance, such as increased acid secretion, reduced mucosal blood flow, or disruption of protective mechanisms, the mucosal lining may become compromised.
- Erosions or ulcerations occur in the stomach or duodenum, leading to symptoms such as pain, discomfort, and, in severe cases, gastrointestinal bleeding.
Etiology (Causes) of Peptic Ulcer Disease (PUD)
- Helicobacter pylori Infection:
- H. pylori is a common bacterium that infects the stomach lining and is a primary cause of peptic ulcers.
- The bacterium weakens the mucosal defense, allowing gastric acid to damage the stomach or duodenal lining.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs):
- Chronic use of NSAIDs, including aspirin, ibuprofen, and naproxen, is a significant risk factor for developing peptic ulcers.
- NSAIDs inhibit the production of prostaglandins, reducing the protective mucosal layer and increasing vulnerability to injury.
- Gastric Acid Hypersecretion:
- Conditions associated with increased gastric acid production, such as Zollinger-Ellison syndrome, can lead to the development of peptic ulcers.
- Excessive acid production contributes to mucosal erosion and ulceration.
- Smoking and Alcohol Consumption:
- Smoking and heavy alcohol consumption are considered risk factors for peptic ulcers.
- These behaviors may compromise the protective mechanisms of the gastrointestinal mucosa.
- Genetic Factors:
- Genetic predisposition may play a role in an individual’s susceptibility to peptic ulcers.
- Some people may have a familial tendency toward developing ulcers, suggesting a genetic influence on susceptibility.
- Helicobacter pylori Infection:
- Infection with Helicobacter pylori, a bacterium, is a major cause of peptic ulcers.
- H. pylori colonizes the stomach lining and produces substances that weaken the mucosal defense, making it more susceptible to damage from gastric acid.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs):
- Chronic use of NSAIDs, such as aspirin and ibuprofen, can contribute to the development of peptic ulcers.
- NSAIDs inhibit prostaglandin synthesis, reducing the protective mucosal layer and increasing susceptibility to injury.
Desired Outcomes for the Management of Peptic Ulcer Disease (PUD)
- Ulcer Healing and Symptom Resolution:
- Resolution of peptic ulcers through effective treatment, leading to the healing of mucosal lesions.
- Relief from symptoms such as epigastric pain, nausea, and gastrointestinal discomfort.
- Eradication of Helicobacter pylori:
- Successful eradication of Helicobacter pylori infection through antibiotic therapy.
- Reduction in the risk of recurrent peptic ulcers associated with H. pylori.
- Prevention of Recurrence:
- Implementation of preventive measures to reduce the risk of ulcer recurrence.
- Lifestyle modifications, such as dietary changes and avoidance of NSAIDs, to promote long-term gastrointestinal health.
- Management of Complications:
- Prevention and management of complications associated with PUD, such as gastrointestinal bleeding or perforation.
- Timely intervention to address any complications and minimize their impact on the patient’s health.
- Patient Education and Adherence:
- Patient understanding of the importance of medication adherence, particularly for antibiotics, proton pump inhibitors (PPIs), and other prescribed medications.
- Education on lifestyle modifications, including dietary choices and stress management, to support long-term ulcer prevention.
Peptic Ulcer Disease (PUD) Nursing Care Plan
Subjective Data:
- Epigastric pain (gnawing or burning) after meals
- Heartburn
- Constipation
- Patient reports tarry stools
- Feeling full
- Unexplained weight loss
- Dysphagia
Objective Data:
- Bleeding, tarry stools
- Anemia
- Vomiting
- Hypovolemia
Nursing Assessment in the Context of Peptic Ulcer Disease (PUD)
- Pain Assessment:
- Thorough assessment of pain characteristics, including location, intensity, quality, and duration.
- Utilization of a pain scale to quantify and monitor pain levels over time.
- Gastrointestinal Symptoms:
- Evaluation of gastrointestinal symptoms such as nausea, vomiting, bloating, early satiety, and changes in appetite.
- Documentation of the onset and progression of these symptoms.
- Medication History:
- Comprehensive review of the patient’s medication history, focusing on the use of NSAIDs, aspirin, and other medications that may contribute to PUD.
- Identification of current medications, including acid-suppressing agents and antibiotics.
- Dietary Habits:
- Assessment of dietary habits, including the types of foods consumed and meal patterns.
- Identification of dietary triggers or aggravating factors for peptic ulcers.
- Helicobacter pylori Testing:
- Determination of whether Helicobacter pylori testing has been performed and the results.
- If positive, confirmation of antibiotic therapy adherence for H. pylori eradication.
- Past Medical History:
- Review of past medical history, focusing on any previous episodes of peptic ulcers or gastrointestinal bleeding.
- Identification of comorbid conditions, such as liver disease or chronic kidney disease.
- Lifestyle Factors:
- Exploration of lifestyle factors, including smoking and alcohol consumption, which may contribute to PUD.
- Identification of stressors and assessment of stress management strategies.
- Psychosocial Assessment:
- Evaluation of the patient’s emotional well-being and psychological response to the diagnosis of PUD.
- Identification of coping mechanisms and support systems in place.
Nursing Interventions and Rationales
- Assess and Monitor vitals
Monitor for signs and symptoms of infection / inflammation to include:
- Fever
- Tachypnea
- Tachycardia
Monitor for signs and symptoms of hypovolemia to include:
- Hypotension
- Tachycardia
- Perform detailed pain assessment
The most common symptom of peptic ulcers is burning stomach pain that may be worse between meals and at night.
- Evaluate lab test
- The pathogen Helicobacter pylori (H. pylori) is responsible for approx 90% of all peptic ulcers reported.
- CBC – anemia or blood loss
- Coagulation panels (aPTT, PT, INR) for patients who are on anticoagulants or have active bleeding
- Electrolytes, BUN, creatinine – to determine if patient requires fluid resuscitation
- Prepare patient for and assist with upper GI Endoscopy
- Administer medications as ordered
- Proton pump inhibitor (Omeprazole) – to reduce stomach acid
- H2 Histamine blockers (Famotidine) – to reduce stomach acid
- Antacids – may be given for symptom relief, but do not heal the ulcer
- Cytoprotective agents (Sucralfate) – to protect the lining of the stomach and intestine
- Antibiotics – commonly given to treat H. pylori infection
- AVOID NSAIDS (aspirin, ibuprofen, naproxen)
- Nutrition Education
- Limit or avoid foods that cause excess acid production or irritation to the peptic lining:
- Coffee, tea
- Carbonated drinks
- Alcohol
- Citrus
- Peppers, all
- Spicy foods
- Red meat
- Dairy
- Reduce salt intake – Increased risk of developing stomach cancer
- Monitor food labels carefully and make choices that are lower in fat and sodium.
- Include probiotics in regular diet – yogurt, aged cheeses and sauerkraut have healthy probiotics that help restore the natural bacteria in the GI tract
- Eat regular, small meals – complete emptying of the stomach for prolonged amounts of time may cause acid build up in the stomach and increase pain and erosion of tissues
- Avoid overeating – excess pressure from overeating or bloating may cause pressure on the stomach and increase pain
- Encourage lifestyle changes
- Reduce stress – although stress has not been proven to cause peptic ulcers, it may result in overeating or skipping meals which will irritate the peptic lining
- Stop smoking – nicotine increases stomach acid and thins the mucous membranes
- Limit or avoid alcohol – excessive alcohol increases acid production and can irritate and erode the peptic lining
Nursing Evaluation in the Context of Managing Peptic Ulcer Disease (PUD)
- Symptom Relief:
- Assess for resolution or reduction of symptoms, such as epigastric pain, nausea, and gastrointestinal discomfort.
- Utilize patient reports and observation to determine the effectiveness of prescribed medications and interventions.
- Helicobacter pylori Eradication:
- Confirm the success of Helicobacter pylori eradication through follow-up testing.
- Evaluate the patient’s adherence to the antibiotic regimen and address any concerns or barriers to completion.
- Medication Adherence:
- Assess the patient’s adherence to prescribed medications, including proton pump inhibitors, H2-receptor antagonists, and other medications.
- Identify and address any challenges or side effects that may impact adherence.
- Dietary and Lifestyle Changes:
- Evaluate the patient’s adoption of recommended dietary modifications and lifestyle changes.
- Encourage a follow-up discussion to address any difficulties or barriers in implementing these modifications.
- Prevention of Recurrence:
- Monitor for signs of recurrent ulcers or complications.
- Assess the patient’s understanding of and adherence to long-term preventive measures, including dietary choices, medication compliance, and lifestyle modifications.
References
- https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/diagnosis-treatment/drc-20354229
- https://emedicine.medscape.com/article/181753-clinical
- https://www.webmd.com/digestive-disorders/peptic-ulcer-overview#1
- https://online.epocrates.com/diseases/80/Peptic-ulcer-disease
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Example Nursing Diagnosis For Nursing Care Plan (NCP) for Peptic Ulcer Disease (PUD)
- Acute Pain: Peptic ulcers can cause abdominal pain and discomfort. This diagnosis addresses the pain management needs of the patient.
- Risk for Bleeding: Peptic ulcers may bleed, leading to potential hemorrhage. This diagnosis emphasizes the risk of bleeding and the need for monitoring.
- Altered Nutrition: Less than Body Requirements: Peptic ulcers can affect the patient’s ability to tolerate and digest food. This diagnosis addresses nutritional deficits.
Transcript
In this care plan, we will discuss peptic ulcer disease. In this care plan on peptic ulcer disease, we will cover the desired outcome, the subjective and objective data and the nursing interventions along with the rationales.
Our medical diagnosis is peptic ulcer disease. Peptic ulcer disease consists of open sores in the protective lining of the stomach and in the upper small intestine. Gastric ulcers occur inside the stomach and duodenal ulcers occur in the duodenum, or the upper small intestine. The primary cause of PUD is H pylori infection. Other diseases are practices that weaken the mucosal lining of the stomach and duodenum may also cause PUD such as chronic NSAID use, alcohol abuse, or smoking gastritis hepatic disease. Crohn’s disease or pancreatitis may also cause PUD. Our desired outcome is the relief of pain, the absence of complications, and we want to maintain adequate nutrition.
So let’s take a look at our care plan. The subjective data is epigastric pain that might be gnawing or burning after meals. Remember that the disease includes ulcers in the lining of the stomach, which is super painful and uncomfortable. They might get that heartburn from acid, kind of going back up into the esophagus or even tarry stools from bleeding that might occur in the stomach or duodenum. The patient might feel full if they’re bleeding. They might have some unexplained weight loss and dysphasia from the ulcers and possibly bleeding. Also, they could experience some constipation, especially if they decrease their activity levels in their fluid intake.
Some objective data that you might see in your patient includes bleeding, shown as tarry stools, anemia from the bleeding, vomiting from the stomach irritation, and hypovolemia especially if they aren’t eating or drinking enough and they’re bleeding. So, it’s important to note that bleeding ulcers are not always painful.
Now let’s take a look at our interventions and rationales. You’re going to monitor your patient’s vital signs and their pain level. Look out for signs of infection like fevers, tachypnea, tachycardia. Also, look out for signs of hypovolemia like hypotension or tachycardia. The most common symptom of peptic ulcers is burning stomach pain that might get worse between meals and at night. Our next nursing intervention is to evaluate the lab tests. You’ll test for H pylori per doctor’s order. H pylori is responsible for about 90% of peptic ulcers. Also check the CBC and coagulation panels for signs of bleeding and anemia. If the patient is going to have an upper GI endoscopy procedure, you’ll prepare them for that procedure. You’re going to keep them NPO prior and after the procedure until their gag reflex comes back because you want to avoid aspiration. You might have to hold anticoagulants for several days prior to the procedure because you want to avoid any excessive bleeding during the procedure. Be sure to monitor their vital signs during and after just to make sure that they remain stable.
You will administer medications as ordered by the doctor. So medications might be given to help reduce the stomach acid, protect the stomach lining and or to treat the H pylori bacteria, If they have that. You will educate your patient on nutrition and let them know to avoid foods that cause excessive acid that irritates the stomach lining. This would be like alcohol, caffeine, carbonated drinks, spicy foods, peppers, dairy products, you’d be surprised, they also can cause that. It’s also helpful to include probiotics in their diet, such as yogurt, aded cheese, or even probiotic pills. This kind of just helps to restore that natural bacteria in the GI tract. Eating regular small meals can help to kind of decrease the pressure on the stomach and the acid buildup.
Our last nursing intervention is to encourage lifestyle changes. Try to help them with reducing their stress. I know this is hard, but maybe they can try to find some better coping mechanisms. Encourage them to stop smoking, limit alcohol (avoid it if possible) and these will all help to decrease that stomach irritation from acid.
We love you guys. Now, go out and be your best self today and as always, happy nursing!
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