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
- Acute Pain
- Imbalanced Nutrition: Less Than Body Requirements
- Deficient Knowledge
- Risk For Deficient Fluid Volume
Risk For Deficient Fluid Volume
- Risk for Deficient Fluid Volume
May be related to
- Gastrointestinal (GI) bleeding
- Nausea, vomiting
Possibly evidenced by
- [not applicable]
- Client will be normovolemic as evidenced by systolic BP greater than or equal to 90 mm Hg (or client’s baseline), absence of orthostasis, HR 60 to 100 beats/minute, urine output greater than 30 ml/hr, and normal skin turgor.
|Assess for the signs of hematemesis or melena.||The client with a bleeding ulcer may vomit bright red blood or coffee grounds emesis. Melena occurs when there is bleeding in the upper GI tract.|
|Monitor the client’s fluid intake and urine output.||The kidney will reabsorb water into circulation to support a decrease in blood volume. This compensatory mechanism results in decreased urine output. A decrease in circulatory blood volume leads to decreased renal perfusion and decreased urine output|
|Monitor the client’s vital signs, and observes BP and HR for signs of orthostatic changes.||The erosion of an ulcer through the gastric or duodenal mucosal layer may cause GI bleeding. The client may develop anemia. If bleeding is brisk, changes in vital signs and physical symptoms of hypovolemia may develop rapidly. A decrease in BP and an increase in HR with changes in position is an early indicator of decreased circulatory volume.|
|Instruct the client to immediately report symptoms of nausea, vomiting, dizziness, shortness of breath, or dark tarry stools.||These assessment findings are signs of GI bleeding and should be reported immediately.|
|Monitor hemoglobin and hematocrit levels.||Erosion of the gastric mucosa by an ulcer results in GI bleeding. A decrease in hemoglobin and hematocrit occurs with bleeding.|
|Administer IV fluids, volume expanders, and blood products as ordered.||Isotonic fluids, volume expanders, and blood products can restore or expand intravascular volume.|
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Gastrointestinal Care Plans
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