Peptic ulcer is an ulceration in the mucosal wall of the lower esophagus, stomach, pylorus, or duodenum. The ulcer may be referred to as duodenal, gastric, or esophageal, depending on its location. The most common symptom of both gastric and duodenal ulcers is epigastric pain. It is characterized by a burning sensation and usually occurs shortly after meals with gastric ulcer and 2-3 hours afterward with duodenal ulcer.
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:
- Acute Pain
- Imbalanced Nutrition: Less Than Body Requirements
- Anxiety
- Deficient Knowledge
- Risk For Deficient Fluid Volume
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:
|
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 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. |
