peptic ulcers ( management , nursing intervention )

Nursing management of peptic ulcer

Assessment:

• The nurse asks the patient to describe the pain and strategies used to relieve it (e.g, food, antacids).

• The patient usually describes peptic ulcer pain as burning; it occurs about 2 hours after a meal and frequently awakens the patient between midnight and 3 am. o Taking antacids, eating, or vomiting often relieves pain.

• If the patient reports a recent history of vomiting, the nurse determines how often emesis has occurred and notes important characteristics of the vomits. o The nurse asks the patient about food habits.

• The nurse asks about lifestyle and other habits.

1. Does the patient use irritating substances?
2. Does he or she smoke cigarettes? If yes, how many/day?
3. Does the patient ingest alcohol? If yes, how much and how often? Are NSAIDs used?

• The nurse inquires about the patient's level of anxiety.

• How does the patient express anger or cope with stressful situations?

• Is the patient experiencing occupational stress or problems within the family? o Is there a family history of ulcer disease?

Nursing Interventions

1/ Reducing Anxiety:

•  If the patient has ingested acids or alkalis, emergency measures may be needed. The nurse offers supportive therapy to the patient and family during treatment and after it.

• The patient usually feels anxious about the pain and the treatment modalities.

•  The nurse uses a calm approach to assess the patient and to answer all questions as completely as possible.

•  It is important to explain all procedures and treatments according to the patient's level of understanding.

2/ Promoting Optimal Nutrition:

•   The patient should take no foods or fluids by mouth—possibly for days—until the acute symptoms subside, thus allowing the gastric mucosa to heal.

•   If IV therapy is necessary, the nurse monitors it regularly, along with serum electrolyte values.

•   After the symptoms subside, the nurse can offer the patient ice chips followed by clear liquids.

•   Introducing solid food as soon as possible will provide oral nutrition, decrease the need for IV therapy, and minimize irritation to the gastric mucosa.

•   As food introduced, the nurse evaluates and reports any symptoms that suggest a repeated episode of gastritis.

•   The nurse discourages the intake of caffeinated beverages, because caffeine increases gastric activity and pepsin secretion.

•   It also is important to discourage alcohol use and cigarette smoking.

3/ Promoting Fluid Balance:

•  Daily fluid intake and output are monitored to detect early signs of dehydration 

• If food and fluids are withheld, IV fluids (3 L/day) usually are prescribed.

• Electrolyte values (sodium, potassium, chloride) are assessed every 24 hours to detect imbalance.

• The nurse must always be alert for any indicators of hemorrhagic gastritis, which include hematemesis (vomiting of blood), tachycardia, and hypotension.

4/ Relieving Pain:

• Instructing the patient to avoid foods and beverages that may be irritating to the gastric mucosa (described earlier)

• Give medications to relieve chronic gastritis.

• To follow up, the nurse assesses the patient's level of pain and the extent of comfort attained from the intervention.

5/ Teaching Patients Self-Care:

•   The nurse evaluates the patient's knowledge about gastritis and develops an individualized teaching plan that includes information about stress management, diet, and medications such as:

1. Antibiotics,
2. Medications to decrease gastric secretion,
3. Medications to protect mucosal cells from gastric secretions can help the patient recover and prevent recurrence.

•   Patients with pernicious anemia need information about long-term vitamin B 12 injections;

•   Finally, the nurse emphasizes the importance keeping follow-up.