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Pain: 30-60 min. after a meal
–Rarely occurs at night
–Exacerbated by food ingestion
Gastric Ulcer
Interventions Pernicious Anemia
•Assessment Bowel Sounds
•VS
•Routine lifelong Vitamin B₁₂ injections
Dumping syndrome interventions
•Monitor Vasomotor symptoms:
•Early- 30min. After eating, s/s- N/V, Dizziness, Tachycardia, Palpitations
•Late- 90min.-3hour after eating, s/s- Hunger, dizziness, sweating, tachycardia, palpitations, shakiness, anxiety, confusion
•Lie down after symptoms occur
•Administer meds are prescribed: Powdered pectin, Antispasmodics, Acarbose
•Nutrition, fluid & electrolyte balance
–Eliminate H. pylori infection
•Instruct client to complete full course of medication
Antibiotics (Metronidazole, Amoxicillin, Bismuth, Biaxin, Tetracycline)
(contraindicated in a sulfa allergy), take w/ food, avoid sun exposure, urine may appear yellow or brown, soft contact lenses may be damaged
Sulfasalazine
Diagnostics PUD
•H.pylori testing
•Hemoglobin/Hematocrit
•Stool sample for occult blood
•Esophagogastroduodenoscopy (EGD)
•Upper GI series
•Endoscopy/Biopsy
•Fecal H. pylori antigen tests
•Gastric analysis via NGT
PUD Interventions for Perforation/Hemorrhage
•Assessments (Pain, VS)
•Report findings- prepare for endoscopic/surgical interventions
•Replace fluid/blood loss
•Insert NG tube
•Maintain BP
Client Teaching: Dumping Syndrome
•Lying down after vasomotor symptoms occur, aids to slow movement
•Limit amount of fluid ingested at one time
•Eliminate liquids with meals one hour prior to & following a meal
•Consume high-protein, high fat, low-fiber & low-moderate carbohydrate diet
•Avoid milk, sweets, or sugars
•Small, frequent meals
•Stimulate gastric mucosal defenses; aid in ulcer healing
•Given 1-3 hours after meals
•*Give 1 hour apart from other medications
•Take medications 1 hour before or after antacids
Antacids (Aluminum carbonate, magnesium hydroxide)
•Darkening of tongue/stool
•Caution when giving to children & teens recovering from chickenpox/influenza– Reye’s Syndrome
Bismuth Subsalicylate (Pepto-Bismol)
Pain: 1.5-3 hours after a meal
–Occurs at night
–Relieved by ingestion of food or antacid
Duodenal Ulcer
PUD Complications
Perforation
Hemorrhage
Pernicious Anemia
Dumping Syndrome
S/S Reye's syndrome
–Stage I: Lethargy, vomiting, drowsiness, liver dysfunction
–Stage II: Disorientation, combativeness, aggressiveness, delirium, hyperactive reflexes, hyperventilation, shallow breathing, stupor, liver dysfunction
–Stage III: Obtundation, coma, decorticate posturing, hyperventilation
–Stage IV: Deepening coma, large fixed pupils, decerebrate posturing, loss of ocular reflexes, liver dysfunction
–Stage V: Loss of DTR’s, seizures, flaccidity, resp. arrest, no liver function
–Suppress secretion of gastric acid by blocking H₂ Receptors in stomach lining
•Used in conjunction with antibiotics
•Monitor for drug interactions
•Notify MD if obvious GI bleeding (coffee-ground emesis)
Histamine₂ Receptor Antagonists (Ranitidine hydrochoride, famotidine)
Take oral dose w/ food, do not discontinue suddenly, report unexpected increase in weight, avoid crowds & exposure to infectious diseases
Corticosteroids
PUD Complications
Hemorrhage
Obstruction
Perforation
Non-Pharmacological Treatments PUD
•Health Promotion
•Nutrition- Dietary consult; restrict acid-producing foods, vitamin/mineral supplementation after surgical procedures (B₁₂, Vitamin D, calcium, iron, & folate)
•Therapeutic Procedures
•EGD (epinephrine, laser coagulation)
•Surgery
Diagnostic Reye's Syndrome
•H/P: Inquire about most recent viral illnesses & use of medications
•Neurological Assessment (LOC, Seizure Activity, Reflex Function)
•Labs: Liver Enzymes, Blood Glucose, Ammonia Level, Coagulation Studies
•Lumbar Puncture
•Forms protective barrier
•Stimulates secretion of mucus, bicarbonate & prostaglandin
•Give 1 hour before meals & at HS
•Monitor for constipation
Mucosal Protectant (Sucralfate)
•Avoid crowds/exposure to infection
•Monitor s/s of bleeding/liver function/infection
Immunosuppressants
s/s PUD
•Pain
•Dyspepsia
•Heartburn
•Bloating
•Nausea/Vomiting
•Uncomfortable fullness/hunger
•Epigastric pain upon palpation, radiates to back-may indicate perforation!
•Bloody emesis (hematemesis) or stools (melena)
•Weight loss
Intervention PUD
–Relaxation & stress reduction management counseling
–Administer PPI’s, H₂-Receptor antagonists, antacids, or mucosal protective agents as ordered.
–Limit food intake after evening meal
–Relaxation techniques & comfort measures
•Dietary consult
•Monitor stools & gastric drainage for occult/overt blood- Hematochezia, Melena
•Maintain IV therapy
•Nasogastric tube patency
•Labs- Hemoglobin/Hematocrit, Electrolytes, BUN/Creatine
•Abdominal assessment (bowel sounds, distention, girth, tenderness)
•Bed rest, elevated HOB
Interventions Reye's Syndrome
•Liver Biopsy: definitive diagnosis; monitor for bleeding!* (post biopsy)
–Child positioned to lie on Rt. Side x2 hours after biopsy*
•Adm. IV Fluids
•Monitor Oxygen Saturation
•Implement Seizure Precautions (If Increased ICP)
•Emotional Support to child & family
•Hemodynamic Monitoring (Arterial Line)
•Inhibits gastric acid enzymes, reduces basal & stimulated acid production
•Do not crush, chew, or break sustained released capsules
•Omeprazole- once daily before am meal
•Avoid alcohol & NSAID’s
Proton Pump Inhibitors (Pantoprazole, Esomeprazole)
•Aminosalicylates
•Antimicrobials
•Corticosteroids
•Immunosuppressants
•Antidiarrheals
•Hematinics
•Vitamins
Ulcerative Colitis
Crohn's disease