Nursing Care Plan (NCP) for Peptic Ulcer Disease (PUD)

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Outline

Pathophysiology

Defects (open sores) in the protective lining of the stomach and upper small intestine. Gastric ulcers occur on the inside of the stomach and duodenal ulcers occur on the inside of the upper portion of the small intestine (duodenum). Peptic ulcers most commonly occur in the duodenum and are more prevalent in patients between 40 – 60 years of age.

Etiology

Chronic use of NSAIDS (aspirin, ibuprofen, naproxen) weakens and thins the mucosal lining of the stomach and duodenum and greatly contributes to the formation of breaks in the protective lining. The primary cause of peptic ulcer disease (approx. 90%) is Helicobacter pylori bacterial infection. Heavy alcohol use and smoking increase the risk of PUD in patients with H. pylori infection. Other contributing factors include various illnesses such as Crohn’s disease, gastritis, hepatic disease and pancreatitis. Complications of peptic ulcers may include anemia, profuse bleeding, perforation, obstruction and certain cancers.

Desired Outcome

Relief of pain, absence of complications, maintain adequate nutrition

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 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

 

Endoscopy is a procedure that is done by a doctor using a scope that is placed orally to visualize the upper GI tract including the esophagus, stomach, and upper portion of the small intestine. Tissue samples may be taken during the procedure if necessary.

  • Withhold anticoagulants for several days prior to procedure if possible to avoid excessive bleeding during procedure
  • Patient must be fasting, no food or drink for 4-8 hours prior to procedure to ensure gastric emptying and to reduce risk of aspiration during sedation
  • Administer conscious sedation
  • Monitor vitals while patient is sedated per facility policy
  • Assist with ambulation immediately following procedure until sedation is fully worn off
  • Maintain NPO status post procedure until return of gag reflex to avoid aspiration

 

  • 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

Writing a Nursing Care Plan (NCP) for Peptic Ulcer Disease (PUD)

A Nursing Care Plan (NCP) for Peptic Ulcer Disease (PUD) starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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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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