Peptic Ulcer Disease
2 most common causes of PUD?
H. pylori bacteria & NSAIDS
H. pylori weakens stomach tissue and duodenum, leading to inflammation and ulceration. NSAIDS decrease pain by inhibiting prostaglandins which is needed for gastric mucus development that protects the stomach lining.
What is the hallmark sign of GI bleeding?
Hematemesis (bright red, coffee ground) or Melena (black, tarry stools)
What is peritonitis?
Inflammation of the peritoneum (lining of abdominal cavity), most commonly caused by E. coli, klebsiella, proteus, pseudomonas, streptococcus
What are 2 risk factors for stomach cancer?
H. pylori infection
Autoimmune-related inflammation
Repeated exposure to irritants (bile, anti-inflammatory agents, tobacco use)
Diets high in smoked foods, salted fish and meat, pickled vegetables
Name a complication in Peptic ulcer disease.
Hemorrhage, perforation, gastric outlet syndrome
Name at least 3 contributing factors to PUD.
Stress, alcohol, excess caffeine intake, smoking
Name 2 potential causes of upper Gi bleeding.
PUD (most common), drugs, (aspirin, NSAIDS, corticosteroids), esophageal or gastric varices, GI cancers
What is a priority nursing diagnosis for a patient with acute peritonitis.
Acute pain, risk for infection, risk for deficient fluid volume..
Name 2 clinical manifestations of esophageal cancer.
Progressive dysphagia is most common symptom
Pain develops late in substernal, epigastric, back areas
Weight loss
Regurgitation of blood-flecked esophageal contents
6 small meals per day
No fluids with meals
Avoid concentrated sweets
Increase protein and fat
Short rest period after eating
Name the main clinical manifestation of peptic ulcers.
Pain!
Gastric ulcers cause epigastric pain directly after meals while duodenal ulcers cause pain 2-3 hours after eating. There are also silent peptic ulcers without pain which occur most commonly in older adults taking NSAIDS.
Name at least 3 things that should be included in a focused assessment of someone with a suspected GI bleed.
level of consciousness, vital signs and pulse ox, skin color, temperature, cap refill, assess abdomen for distention, guarding, bowel sounds
Name at least 3 clinical manifestations.
Diffuse pain at first, then constant and intense localized pain.
Aggravated by movement
Abdominal tenderness, distention, muscle rigidity
Anorexia, nausea, vomiting
Increased temperature and heart rate
What is a major complication of esophageal cancer?
Hemorrhage (if cancer erodes the esophagus into aorta)
Esophageal perforation with fistula formation
Esophageal Obstruction
There is a risk for shock with GI Bleeds. What are signs of shock?
Cool, moist skin, decreasing BP, increasing HR, delayed cap refill, decreasing urine output
What is the diagnostic study for PUD?
Upper endoscopy.
To confirm H. pylori, a biopsy, rapid urease test, urea breath test, stool antigen test, and serum antibody test may be used.
Name a priority intervention to maintain adequate intravascular volume.
Establishing 2, 18g IV sites. Give IV NS or LR (priority), whole blood, pRBCs, or FFP.
This is the most common cause of secondary peritonitis?
Perforation of an abdominal organ (think appendix)
Primary would be spontaneous bacterial peritonitis and tertiary is typically caused by a suprainfection in those immunocompromised.
What is the treatment for stomach cancer?
Surgery- partial or total gastrectomy
Pre-op: treat malnutrition and anemia
Post-op: NG tube until peristalsis returns and advancing diet slowly
A patient with GUD suddenly complains of severe upper abdominal pain. Upon assessment, the abdomen is rigid without bowel sounds and patient has shallow respirations. What do you suspect is occurring?
Perforation - very lethal and the nurse should prep for emergency surgery
Name the drug therapy most commonly used for H. Pylori related ulcers and other medications to treat ulcers.
H. Pylori: a combination of antibiotics and acid-lowering meds (Commonly amoxicillin, clarithromycin, PPI OR tetracycline, metronidazole, PPI, bismuth)
Acid-lowering: proton pump inhibitors and H2-receptor blockers
Other drugs of note are sucralfate, misoprostol, and antacids.
What is an important assessment to do in older clients at risk for fluid overload?
Auscultate breath sounds and observe respiratory effort. Keep the HOB elevated for comfort and to prevent aspiration.
Fluid, colloid, and electrolyte replacement (major focus)
Analgesics/pain management
NG suction and antiemetics
Monitoring for respiratory distress due to fluid in abdomen.
What are late symptoms of oral cavity cancer?
Increased salvation, slurred speech, dysphagia, toothache, earache
Earlier manifestations are ulcers, changes in mucosa, sore throat, sore mouth, voice changes
What drug can be given before or with meals for bile reflux gastritis.
Cholestyramine: binds with bile salts in gastric juice to reduce mucosal damage