Digestive Poster - Select appropriate nursing interventions for clients with lower gastrointestinal PDF

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Select appropriate nursing interventions for clients with lower gastrointestinal disorders.



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Patient and family education is important in increasing adherence. To provide education to patient and families, you are going to create a poster about a gastrointest...

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Digestive Poster

Rasmussen University NUR2392 Multidimensional Care II

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Digestive Poster

PEPTIC ULCER DISEASE (PUD)

A peptic ulcer is a mucosal lesion of the stomach or duodenum. Peptic ulcer disease (PUD) results when mucosal defences become impaired and no longer protect the epithelium from the effects of acid and pepsin.PUD affects millions of adults across the world. The mortality rate for PUD has decreased in the past few decades due in part to the use of proton pump inhibitors and earlier treatment for H. pylori.

Types of peptic Ulcers   

Gastric ulcers: usually develop in the antrum of the stomach near acid-secreting mucosa. Duodenal ulcers: occur in the upper portion of the duodenum stress ulcers (less common): are acute gastric mucosal lesions occurring after an acute medical crisis or trauma, such as sepsis or a head injury (Ignatavicius, D. et al., 2021).

CAUSES OF PEPTIC ULCER DISEASE ( PUD) 

Peptic ulcer disease is caused most often by bacterial infection with H. pylori and NSAIDs. NSAIDs (e.g., ibuprofen) break down the mucosal barrier and disrupt the mucosal protection mediated systemically by cyclooxygenase (COX) inhibition.

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GI complications from NSAID use can occur at any time, even after long-term uncomplicated use

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Certain substances may contribute to gastroduodenal ulceration by altering gastric secretion, which produces localized damage to the mucosa and interferes with the healing

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process. For example, corticosteroids (e.g., prednisone), theophylline (Theo-Dur), and caffeine stimulate hydrochloric acid production. The most common complications of PUD are    

bleeding, perforation, pyloric obstruction, and intractable disease.

Bleeding is the most severe complication. It tends to occur more often in patients with gastric ulcers and older adults. Gastric and duodenal ulcers can perforate and bleed, As seen in the picture below. Perforation occurs when the ulcer becomes so deep that the entire thickness of the stomach or duodenum is worn away. The amount of pain correlates with the amount and type of GI contents spilt.

(Ignatavicius, D. et al., 2021).

DIAGNOSTIC TESTS FOR PEPTIC ULCERS There are three simple, noninvasive tests to detect H. pylori in the patient's blood, breath, or stool.   

Serologic testing for H. pylori antibodies is the most common method to confirm H. pylori infection. The urea breath test involves swallowing a capsule, liquid, or pudding that contains urea with a particular carbon atom. The stool antigen test is performed on a stool sample provided by the patient and is tested for H. pylori antigens.

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The primary diagnostic test for PUD is esophagogastroduodenoscopy (EGD), the most accurate means of establishing a diagnosis. Direct visualization of the ulcer crater by EGD allows the health care provider to take specimens for H. pylori testing and biopsy and cytologic studies for ruling out gastric cancer.

ASSESSMENT FINDINGS

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Physical assessment findings may reveal epigastric tenderness, usually located at the midline between the umbilicus and the xiphoid process.

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Auscultation of the abdomen may reveal hyperactive bowel sounds, but these may diminish with the disorder's progression.

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If perforation into the peritoneal cavity is present, the patient typically has a rigid, boardlike abdomen accompanied by rebound tenderness and pain.

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Dyspepsia (indigestion) is the most reported symptom associated with PUD. It is typically described as sharp, burning, or gnawing pain.

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Some patients may perceive discomfort as a sensation of abdominal pressure or fullness or hunger (Ignatavicius, D. et al., 2021). MULTIDIMENSIONAL NURSING CARE INTERVENTION FOR PUD

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Care of the patient with PUD generally occurs in the community setting unless the patient develops a more severe condition such as upper GI bleeding, which requires hospitalization for management.

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In the hospital, Collect data related to the causes and risk factors for peptic ulcer disease (PUD). Question the patient about factors that can influence the development of PUD, including alcohol intake and tobacco use.

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PUD causes significant discomfort that impacts many aspects of daily living. Interventions to manage pain focus on drug therapy and dietary changes.

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The primary purposes of drug therapy in the treatment of PUD are to (1) provide pain relief, (2) eliminate H. pylori infection, (3) heal ulcerations, and (4) prevent a recurrence.

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A typical drug regimen for H. pylori infection is PPI–triple therapy, which includes a proton pump inhibitor (PPI) such as lansoprazole (Prevacid) plus two antibiotics such as

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metronidazole (Flagyl, Novonidazol) and tetracycline (Ala-Tet, Panmycin, Nu-Tetra) or clarithromycin (Biaxin, Biaxin XL) and amoxicillin (Amoxil, Amoxi) for 10 to 14 days. 

Teach the patient with peptic ulcer disease to avoid substances that increase gastric acid secretion. This includes caffeine-containing beverages (coffee, tea, cola). Both caffeinated and decaffeinated coffees should be avoided because coffee contains peptides that stimulate gastrin release

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Teach the patient to exclude any foods that cause discomfort. A bland, non-irritating diet is recommended during the acute symptomatic phase. Bedtime snacks are avoided because they may stimulate gastric acid secretion.

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Teach patients about complementary and integrative therapies that can reduce stress, including hypnosis and imagery. For example, yoga and meditation techniques have positively affected anxiety disorder(Ignatavicius, D. et al., 2021).

References

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Ignatavicius, D.D., & Workman, M.L., Rebar, C.R., Heimgartner, N.M (2021). Medical-surgical nursing: Medical-surgical nursing: Concepts for interprofessional collaborative care (10th ed.). St. Louis, Missouri: Elsevier....