nursing case study on peptic ulcer

4 Peptic Ulcer Disease Nursing Care Plans

Peptic Ulcer Disease Nursing Care Plans and Nursing Diagnosis

Use this nursing care plan and management guide to help care for patients with peptic ulcer disease . Enhance your understanding of nursing assessment , interventions, goals, and nursing diagnosis , all specifically tailored to address the unique needs of individuals facing peptic ulcer disease. This guide equips you with the necessary information to provide effective and specialized care to patients dealing with peptic ulcer disease.

What is peptic ulcer, nursing assessment, nursing diagnosis, nursing goals, 1. providing pain relief and comfort, 2. improving nutritional and fluid balance, 3. reducing anxiety, 4. initiating patient education and health teachings, recommended resources.

A peptic ulcer is ulceration in the mucosal wall of the lower esophagus , stomach , pylorus, or duodenum. The ulcer may be referred to as duodenal, gastric, or esophageal, depending on its location. The most common symptom of both gastric and duodenal ulcers is epigastric pain . It is characterized by a burning sensation and usually occurs shortly after meals with gastric ulcer and 2-3 hours afterward with duodenal ulcer .

Predisposing factors of peptic ulcer include infection with the gram-negative bacteria Helicobacter pylori which may be acquired through the ingestion of food and water, excessive HCL secretion in the stomach, chronic use of non-steroidal anti-inflammatory drugs ( NSAIDs ) which weakens the lining of the GI tract by reducing the protective function of the mucosal layer, increased stress associated with illness and surgery , alcohol ingestion and excessive cigarette smoking.

Nursing Care Plans and Management

Assess for the following subjective and objective data :

Early satiety
Nausea and vomiting
Pain relieved by food or antacid
Weight loss

Following a thorough assessment , a nursing diagnosis is formulated to specifically address the challenges associated with peptic ulcer disease based on the nurse ’s clinical judgement and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.

Goals and expected outcomes may include:

The client will report satisfactory pain control at a level of less than 2 to 4 on a scale of 0 to 10.
The client uses pharmacological and nonpharmacological pain relief measures.
The client will exhibit increased comfort such as baseline levels for HR, BP , and respirations, and relaxed muscle tone for body posture.
The client will be normovolemic as evidenced by systolic BP greater than or equal to 90 mm Hg (or client’s baseline), absence of orthostasis, HR 60 to 100 beats/minute, urine output greater than 30 ml/hr, and normal skin turgor .

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients with peptic ulcer disease may include:

Assess the client’s pain, including the location, characteristics, precipitating factors, onset, duration, frequency, quality, intensity, and severity. Clients with gastric ulcers typically demonstrate pain 1 to 2 hours after eating. The client with duodenal ulcers demonstrates pain 2 to 4 hours after eating or in the middle of the night. With both gastric and duodenal ulcers, the pain is located in the upper abdomen and is intermittent. The client may report relief after eating or taking an antacid.

Encourage the use of nonpharmacological pain relief measures such as acupressure, biofeedback, distraction, guided imagery, massage , and music therapy. Nonpharmacological relaxation techniques will decrease the production of gastric acid, which in turn will reduce pain.

Instruct the client to avoid NSAIDs such as aspirin . These medications may cause irritation of the gastric mucosa.

Instruct the client that meals should be eaten at regularly paced intervals in a relaxed setting. An irregular schedule of meals may interfere with the regular administration of medications.

Encourage the importance of smoking cessation. Smoking decreases the secretion of bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the duodenum.

Administer the prescribed drug therapy:

Antacids Antacids buffer gastric acid and prevent the formation of peptin. This mechanism of action promotes of healing of the ulcer.
Antibiotics such as amoxicillin , clarithromycin , metronidazole , tetracycline Antibiotics treat the Helicobacter pylori infection and promote the healing of the ulcer. As the ulcer heals, the client experience less pain.
Histamine receptor antagonists H2 receptor antagonists block the secretion of gastric acid. Prostaglandin analogue reduces acid secretion and enhances the integrity of the gastric mucosa to resist injury .
Proton pump inhibitor Proton pump inhibitors block the production and secretion of gastric acid and thereby reduce gastric pain.
Sucralfate Sucralfate forms a barrier at the base of the ulcer crater to protect the healing ulcer from gastric acid.

Obtain a nutritional history. Clients may often overestimate the amount of food eaten. The client may not eat sufficient calories or essential nutrients as a way to reduce pain episodes with peptic ulcer disease. Because of this, clients are at high risk for malnutrition .

Assess for body weight changes. Weight loss is an indication of inadequate nutritional intake. Gastric ulcers are more likely to be associated with vomiting , loss of appetite, and weight loss than duodenal ulcers.

Monitor laboratory values for serum albumin. This test indicates the degree of protein depletion (2.5 g/dL indicates severe depletion; 3.8 to 4.5 g/dL is normal).

Assist the client with identifying foods that cause gastric irritation. Clients need to learn what foods they can tolerate without gastric pain. Soft, bland, non-acidic foods cause less gastric irritation. The client is more likely to increase food intake if the foods are not associated with pain. Foods that may contribute to mucosal irritation include spicy foods, pepper, aNd raw fruits and vegetables.

Instruct on the importance of abstaining from excessive alcohol. Alcohol causes gastric irritation and increases gastric pain.

Encourage the client to limit the intake of caffeinated beverages such as tea and coffee. Caffeine stimulates the secretion of gastric acid. Coffee, even if decaffeinated, contains a peptide that stimulates the release of gastrin and increases acid production.

Teach about the importance of eating a balanced diet with meals at regular intervals. Specific dietary restrictions are no longer part of the treatment for PUD. During the symptomatic phase of an ulcer, the client may find benefit from eating small meals at more frequent intervals.

Assess for the signs of hematemesis or melena. The client with a bleeding ulcer may vomit bright red blood or coffee grounds emesis. Melena occurs when there is bleeding in the upper GI tract.

Monitor the client’s fluid intake and urine output. The kidney will reabsorb water into circulation to support a decrease in blood volume. This compensatory mechanism results in decreased urine output. A decrease in circulatory blood volume leads to decreased renal perfusion and decreased urine output

Monitor the client’s vital signs, and observes BP and HR for signs of orthostatic changes. The erosion of an ulcer through the gastric or duodenal mucosal layer may cause GI bleeding. The client may develop anemia . If bleeding is brisk, changes in vital signs and physical symptoms of hypovolemia may develop rapidly. A decrease in BP and an increase in HR with changes in position is an early indicators of decreased circulatory volume.

Monitor hemoglobin and hematocrit levels. Erosion of the gastric mucosa by an ulcer results in GI bleeding. A decrease in hemoglobin and hematocrit occurs with bleeding.

Instruct the client to immediately report symptoms of nausea, vomiting , dizziness, shortness of breath , or dark tarry stools. These assessment findings are signs of GI bleeding and should be reported immediately.

Administer IV fluids , volume expanders , and blood products as ordered. Isotonic fluids, volume expanders, and blood products can restore or expand intravascular volume.

Assess the client’s level of anxiety . Clients with peptic ulcers are anxious , but their anxiety level is not visible.

Acknowledge awareness of the client’s anxiety. Acknowledgment of the client’s feelings validates the feelings and communicates the acceptance of those feelings.

Encourage to express fears openly Open communication enables the client to develop a trusting relationship that aids in reducing anxiety and stress.

Use simple language and brief statements when giving instructions to the client. When experiencing moderate to severe anxiety , clients may be unable to comprehend anything more than simple, clear, and brief instructions.

Decrease sensory stimuli by maintaining a quiet environment. Anxiety may escalate to a panic state with the excessive conversation, noise, and equipment around the client.

Provide emotional support to the client. Providing emotional support will give a client calming and relaxing mood that will lower anxiety and stress related to the condition.

Assist the client in developing anxiety-reducing measures such as biofeedback, positive imagery, and behavior modification. Learning these methods provides the client with a variety of ways to manage anxiety.

Assess the client’s knowledge and misconceptions regarding peptic ulcer disease, lifestyle behaviors, and the treatment regimen. Clients may have inaccurate information about how lifestyle behaviors contribute to peptic ulcer disease. The client needs accurate knowledge to make informed decisions about taking prescribed medications and modifying behaviors that contribute to peptic ulcer disease or GI bleeding.

Explain the pathophysiology of the disease and how it relates to the functioning of the body. An understanding of the disease process helps to foster the willingness to follow the recommended treatment plan and modify behaviors to prevent recurrent episodes or related complications.

Instruct the client on what signs and symptoms to report to the health care provider. Recognizing the signs and symptoms can help ensure the early initiation of treatment.

Discuss the therapy options and the rationales for using these options. The correct use of antibiotics and acid suppression medications can promote rapid healing of an ulcer.

Discuss the lifestyle changes required to prevent further complications or episodes of peptic ulcer disease. The modifications of lifestyle behaviors such as alcohol use, coffee, and other caffeinated beverages, and the overuse of aspirin or other nonsteroidal anti-inflammatory drugs is necessary to prevent recurrent ulcer development and prevent complications during the healing phase.

Recommended nursing diagnosis and nursing care plan books and resources.

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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition) Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

Other recommended site resources for this nursing care plan:

Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ! Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.

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