38622470 Peptic Ulcer Disease

8/18/2019 38622470 Peptic Ulcer Disease

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A Case StudyonPEPTIC ULCER DISEASE

In Partial Fulfillment OfNursing Care Management !Related Learning E"#erien$e

Su%mitted %y&

BSN 3A - GROUP 3

Date of Defense&Mar$' !( !)!

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Introduction

Peptic Ulcer

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A peptic ulcer may be referred to as a gastric, duodenal, oresophageal ulcer, depending on its location. A person who has a peptic

ulcer has peptic ulcer disease. A peptic ulcer is an excavation

(hollowed-out area) that forms in the mucosal wall of the stomach, in

the pylorus (the opening between the stomach and duodenum), or inthe esophagus. Erosion of a circumscribed area of mucous membraneis the cause. This erosion may extend as deeply as the muscle layers

or through the muscle to the peritoneum.eptic ulcers are more li!ely to be in the duodenum than in

the stomach. As a rule they occur alone, but they may occur in

multiples. "hronic gastric ulcers tend to occur in the lesser curvatureof the stomach, near the pylorus. Esophageal ulcers occur as a result

of the bac!ward flow of #"l from the stomach into the esophagus( gastroesophageal reflux disease $%E&' ).

eptic ulcer disease occurs with the greatest freuency in

people between *+ and + years of age. t is relatively uncommon inwomen of childbearing age, but it has been observed in children and

even in infants. After menopause, the incidence of peptic ulcers inwomen is almost eual to that in men. eptic ulcers in the body of the

stomach can occur without excessive acid secretion.

n the past, stress and anxiety were thought to be causes

of ulcers, but research has documented that peptic ulcers result frominfection with the gram-negative bacteria H. pylori , which may be

acuired through ingestion of food and water. erson-to-person

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transmission of the bacteria also occurs through close contact andexposure to emesis. t is not !nown why H. pylori infection does not

cause ulcers in all people, but most li!ely the predisposition to ulcerformation depends on certain factors, such as the type of H. pylori and

other as yet un!nown factors (oss / 0ood, 1++2).

n addition, excessive secretion of #"l in the stomach maycontribute to the formation of peptic ulcers, and stress may be

associated with its increased secretion. The ingestion of mil! andcaffeinated beverages, smo!ing, and alcohol also may increase #"l

secretion. 0tress and eating spicy foods may ma!e peptic ulcers

worse.3amilial tendency also may be a significant predisposing

factor. eople with blood type 4 are more susceptible to peptic ulcersthan are those with blood type A,5, or A56 this is another genetic lin!.

There also is an association between peptic ulcers and chronic

pulmonary disease or chronic renal disease. 4ther predisposing factorsassociated with peptic ulcer include chronic use of 70A's, alcohol

ingestion, and excessive smo!ing.

eptic ulcers are found in rare cases in patients with

tumors that cause secretion of excessive amounts of the hormonegastrin. The 8ollinger-Ellison syndrome (8E0) consists of severe peptic

ulcers, extreme gastric hyperacidity, and gastrin-secreting benign or

malignant tumors of the pancreas.

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For the past year, the patient had been experiencing abdominalpain, feeling of weakness, tarry stool and vomiting that hindered himfrom doing his daily activities. Because pain was becoming moreintense, patient decided to seek medical advice at E!"#. After which,patient was given medication for his complaint, but still the patient$s

condition did not improved. %ue to &nancial di'culty, "r. (onatoendured the illness that he was experiencing until the time that hecould no longer bear the pain.

)n February **, *++, patient was transferred by the -ananga"unicipal ealth #enter to )% for further evaluation in considerationof the symptoms that the patient manifested. /t was decided upon by%r. Agudo based on the physical examination that the patient was tobe admitted and to be closely monitored.

PAST ME!CA" H!ST#$%:Patient claimed that he experienced common childhood diseases

and minor illnesses, such as common cold, chicken pox, mumps andmeasles. owever, patient also mentioned that in year *+++ heac0uired P1B and underwent treatment for six months and was curedwithout being hospitali2ed.

From then on, whenever he complained of coughing he wouldimmediately submit a sample of his sputum to be examined, and so farthe results were negative. Patient does not recall of having any historyof allergies.

FAM!"% H!ST#$%:Both of his parents passed away due to old age. 1he patient is

&fth among the nine siblings of which four are females and &ve aremales. 1wo of his siblings died one because of hypertension and theother one was murdered.

is wife abandoned him leaving their six kids behind. #urrently,the patient lives with his new partner who has one kid.

Except for himself, he claimed that his family members arehealthy.

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GEG$AM:

"e'ends:

3 Patient

- Male

- Female

- Deceased Male Relative

- Deceased Female Relative

HEA"TH PE$CEPT!#& ( HEA"TH MA&AGEME&T:

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Medi$al Diagnosis& Pe#ti$ Ul$erDisease


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As stated by the client, he perceived himself not so healthyindividual for he had a history of P1B and currently su4ering from P5%.!ight now his normal activities are a4ected due to his present illness.

Every time the patient has a health problem, he would usuallyself medicate with over the counter drugs such as biogesic for fever,

kremil 6 for his abdominal pain. And if the symptoms persist then heseeks medical assistance at the barangay health center in theirmunicipality. e considers his work as a farmer as his daily exercise.

1he patient used to drink beer or sioktong but only on occasionalbasis. e also smoked but was motivated to stop due to healthreasons.

&UT$!T!#& ( META)#"!SM PATTE$&:

)efore Hospitali*ation:

*73hour dietary intake review 8her usual daily menu9• Breakfast: ;* cup of rice, < cup vegetables

• 6nacks: pc. 6aging, pc. camote

• =unch: ;* cup of rice, < cup vegetables

• %inner: ;* cup of rice, < cup vegetables

1he patient normally ate his meal before hospitali2ation at >am3pm3?pm. %ue to the far distance between the farm and his home, thepatient would rather skip meals and &nish his work. e didn$t take anyvitamin supplements. e occasionally drank beer and alcoholicbeverages. 1he patient took @ to > glasses of water daily.

urin' Hospitali*ation:

*73hour dietary intake review 8her usual daily menu9

• Breakfast: * cup of rice porridge

• =unch: * cup of rice porridge

• %inner: * cup of rice porridge

1he patient was advised by the doctor to have a soft diet meal. 1hepatient ate his meal at ?am3am3@pm. e was given ferrous sulfate

and multivitamins to supplement his dietary intake. 1he patient took @to > glasses of water daily.

After Hospitali*ation:

*73hour dietary intake review 8her usual daily menu9

• Breakfast: cup of rice, cup vegetables

• 6nacks: Biscuits and cup of "ilo

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• =unch: cup of rice, pc of &sh

• 6nacks: Biscuits and cup of "ilo

• %inner: cup of rice, cup vegetables

1he patient normally eats her meals >am3*nn3?pm. e takes his

multivitamins and ferrous sulfate daily. Patient now eats anything hewants. is appetite improved since he left the hospital. 1his indicatesthat his recovery is doing well. e is drinks @ to > glasses of watereveryday.

)"AE$ E"!M!&AT!#& PATTE$&:

)efore Hospitali*ation: 1he patient had normal bladder elimination before

hospitali2ation. e voided three to four times a day. 1he amount of hisdaily voiding was approximately three to four glasses of urine with

yellow clear color. According to patient, he experienced no paineverytime he urinated.

urin' Hospitali*ation: 1here was no change with regards to his bladder elimination

pattern.

After Hospitali*ation:Bladder elimination pattern still appeared normal.

)#+E" E"!M!&AT!#& PATTE$&:

)efore Hospitali*ation: 1he patient had a regular bowel elimination twice daily. 1he color

of his stool was tarry black with a normal consistency as amanifestation of (/ bleeding.

urin' Hospitali*ation:e only had one bowel elimination during his four days stay in

the hospital. 1he color of his stool was still tarry black with normalconsistency.

After Hospitali*ation:e had a regular bowel elimination once daily but still the stool

was color tarry black and with normal consistency as a manifestation of (/ bleeding and the e4ect of taking Ferrous 6ulfate supplement.

S"EEP,$EST PATTE$&:

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)efore Hospitali*ation: 1he patient usually sleeps only two hours every night before

hospitali2ation and didn$t take nap during the day. 1his was due toabdominal pain.urin' Hospitali*ation:

is sleeping pattern increased from two hours to fours hours butstill he didn$t take nap due to heat and discomforts in theirenvironment. e was still experiencing pain but it was relieved due tothe medication given to him.

After Hospitali*ation: 1he patient$s health condition has improved, which led to a

normal sleeping pattern of @ to > hours everynight. e now takesoccasional naps in the afternoon.

ACT!-!T% ( E.E$C!SE PATTE$&:

Acti/ity of aily "i/in':

• )efore Hospitali*ation: Patient was restricted of doing hisnormal daily activities due to increasing pain.

• urin' Hospitali*ation: Patient was con&ned in the hospitalfor recovery thus his daily activities were altered.

• After Hospitali*ation: e was still recovering from his illnessand con&ned himself to bed most of the time.

E0ercise $outine: 1he patient didn$t have any exercise routine.

#ccupational Acti/ities: 1he patient$s activities focus on farmingonly.

C#G&!T!#& ( PE$CEPT!#& PATTE$&:A1ility to Understand: 1he patient could understand and

express his feelings well. e couldn$t read and write well due to lack of education. e only &nished grade four. is best way to learnsomething new was by listening to a radio.

A1ility to Communicate: 1he patient could interpret hisphysical condition with regards to his illness and doesn$t have di'cultyexpressing himself to his family and others.

A1ility to $emem1er: e informed that he could recallimportant events of her life.

A1ility to Ma2e ecisions: 1he patient informed that inmaking maor decisions, the whole family discussed and togetherdecides. Patient did not have di'culty in decision making regarding hiscon&nement.

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SE"F,PE$CEPT!#& ( SE"F C#&CEPT PATTE$&: 1he patient describes himself as a happy person. is family gives

him strength. is family feels saddened with his illness but theylearned to accept it.

e is satis&ed with his physical appearance and feels saddened

with other people who had disabilities and illness.

$#"ES ( $E"AT!#&SH!P PATTE$&:As the head of the family, his maor responsibility was to provide

&nancial support to his family. is family is the most important in hislife.

is neighborhood is peaceful and good community and they livedthere a long time already. e didn$t participate in any social groups orneighborhood activities.

C#P!&G ( ST$ESS T#"E$A&CE PATTE$&:

is present condition is his most stressful situation in his lifebecause it a4ects them &nancially and emotionally.

1he maor change in his life is being incapable of earning moneyto sustain his family needs. is family supports him to cope up with hispresent condition. 1he patient is not so religious, but he often prays to(od for guidance and blessings. is family serves as his motivation inlife.

SE.UA"!T% ( $EP$#UCT!#& PATTE$&: 1he patient used condoms when he was younger. 6ince he was

living with her + year old live in partner, he was not using condoms

anymore.is level of sexual satisfaction now is @ out of +, as + being the

highest level of satisfaction. 1he patient didn$t feel any pain everytime he has a sexual

contact with his partner, but he experienced shortness of breath.e informed that he is having a hard time achieving orgasm due

to delayed erection. 1he patient never experienced any sexuallytransmitted disease.

-A"UES ( )E"!EF PATTE$&: 1he most important for him is to have a good life together with

his family and be able to provide their needs. e also believed in (odand prays for good health, guidance and blessings.

is maor source of hope and strength in life is (od and (od.

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PhysicalAssessment

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GENERAL APPEARANCE

February 27, 2010: First Assessment

The patient is 9 years old, male with fair complexion, with aheight of :;< ft. and weighs *:.* !ilos.

#e loo!ed frail and pale, slouching posture, slow gait and wea!

motor activity. #e was not well-groomed and lac! personal hygienewith slight odor of the body and breath.

The patient had a pleasant facial expression and manner. #e

welcomed our intrusion very well and answered our uestions without

any apprehensions. 'espite the patient;s advance age, he could stillconverse and listen well, had good comprehension and level of

consciousness.

March 07, 2010: Second Assessment

The patient now weighs *.* !ilos, height was still the same. #is

condition had improved since our last visit. #e was now well-groomed,

not so much pallor and frail anymore, although still with slouchingposture due to old age, but his s!in color returned to normal.

I!AL "IGN"


Temperature - 2.=>" axillary

#eart &ate - 9 bpm&espiratory &ate - 1+ cpm

5lood ressure - ?1+@+ mm#g ta!en at & arm


Temperature - 2.*>" axillary

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#eart &ate - 2 bpm&espiratory &ate - ? cpm

5lood ressure - ?2+@9+ mm#g ta!en at & arm

MEN!AL "!A!#"


atient was conscious and alert to all uestions being as!ed. #e

could answer promptly, but not able to expand his answers. #e wasoriented to time, place, person and present situation. #e was also able

to recall both long term and short term memories. The 'igit 0pan

cognitive function was tested on the patient, and resulted to a verypoor performance.


7o changes in the patient;s assessment as of this date.

"$IN% &AIR AND NAIL"


0!in was pale, dry, wrin!led, cool to touch and rough due to

aging. 7o signs of edema, lesions or dehydration noted.

#air was grey due to aging and eually distributed with finetexture.

3ingernails and toenails were pale in color and cool to touch. 7olesions or abnormalities noted except for the right big toenail that was

colored blac! due to trauma.



&EAD AND "$#LL


#air was all grey, eually distributed and with fine texture.

0calp was smooth and a little bit oily. #is scalp appeared cleanand no lumps or lesions noted.

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0!ull sie and contour was normal with no lumps or lesions.3ace was wrin!led, suare and semi-symmetrical in shape. #e

had a flat facial expression because of depression related to his illness.A large vein protruded in the left frontal region of his face, and

occasionally gave him pain that radiates behind his left ear, but

according to him the pain was tolerable.#e was as!ed to elevate and lower his eyebrows, close his eyes

tightly, puff his chee!s, smile and show his teeth. mpressively hemade these procedures with ease, despite his advancing age.

0ymmetric facial movements were also noted.



'("ERE &EAD M'EMEN!


The client;s head movements were still functioning well. #e could

move his chin to his chest, his chin can points upward, move his head

towards his shoulders and turned his head left and right with lesseffort.



E)E"


The patient;s eyes were positioned and aligned symmetrically.

Eyebrows were grey in color and thin, symmetrical and evenly

distributed.Eyelashes were short and straight. 7o lesions, swelling and

secretions noted on both eyelids, inner and outer cantus. 7oted alsowas the pale color of the eyelids, due to % bleeding. 7o edema on the

lacrimal glands also. 5oth eyes could move in coordination, with theouter cantus parallel with the pinna of the ears.

The peripheral and visual field tests were assessed to the

patient, and diminished eye movements and reflexes were noted.

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0ix cardinal field of gae was assessed to the patient, and hewas as!ed to performed functional vision test, light perception, hand

movements and counting fingers, but without success due to thepatients diminished eye motor reflexes and vision.

The pupil reaction to light test were made to the patient;s, and

the result was both eyes dilated at 2mm diameter.The patient;s pupils were color gray, possibly due to cataract.

The sie and shape were symmetrical. The sclera was color white andno lesions noted.

The patient informed us that he had a problem with his visual

acuity. #e was nearsighted and cannot clearly see far obBects.Cnderstandably this was due to his old age.


7o changes in the patient;s assessment as of this date,except for his eyelids which were not so pallor anymore, due to the

improvement of his health condition.

EAR" AND &EARING


Ears were eual in sie. "olor was the same with that of thes!in. 7o lesions, abnormalities, swelling or tenderness were found in

the auricles and earlobes. Tympanic membrane was pearly gray color."erumen was visible in the ear canal of both ears.

Auditory acuity to whispered or spo!en voice was assessed to

the patient, including watch tic! test. The result was patient;s hearingability was slightly diminished.



N'"E AND "IN#"E"


7ose was slightly pointed and symmetrical. 7asal septum was

normal and with no signs of flaring, lesions and swelling. #e was able

to smell well.

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t had the same color with the s!in of the face, no tenderness orlesions noted in the external nose. Air moves freely as the client

breathes. The internal nasal cavity was normal, the mucosa was pin!,and has clear, watery discharge. The sinuses were palpated and no

evidence of swelling or lumps noted, and no pain felt by the patient

either.March 07, 2010: Second Assessment


M'#!& AND 'R'P&AR)N*


Dips were dry and slightly pale. 5oth upper and lower teeth wereyellowish and several cavities noted. #ard and soft palates were intact.

The gums were slightly dar! in color, moist and firm.The tongue was pale in color, moist, slightly rough, thic! and had

whitish coating, and had lateral margins and no lesions noted. t waslocated at the center of the mouth, and was freely movable.

Tongue resistant test was performed by the patient and proven

normal in functioning.nspection of the oropharynx and tonsils were made and gag

reflex was tested and assessed as functioning well.



NEC$


The muscles in the nec! were eual in sie, head was centered,

and had coordinated smooth movements with no discomforts felt.#ead flexes at *:>, hyperextends at +>, head laterally flexes at *+>

and head laterally rotates at least 9+>. "arotid artery was palpable, aswell as the lymph nodes in the left supraclavicular region.

The trachea was in normal placement in the midline of the nec!

and spaces were eual on both sides. The thyroid gland was not visibleon inspection. The gland ascends normally during swallowing.

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0till the same assessment on our second visit, except that the

lymph nodes in the left supraclavicular region cannot be felt anymore.t was an indication that the patient;s condition was improving.

"arotid artery was still palpable, a finding that needs furtherassessment, could be a manifestation of a cardiovascular disease.

!&'RA* AND L#NG"


atient has a pigeon chest, a deformity of the chestcharacteried by a protrusion of the sternum and ribs. The chest was

not so symmetrical.

The spine was vertically aligned. 0pinal column was straight,right and left shoulders and hips are at same height. The s!in and

chest wall are intact, with no tenderness and masses noticed.Tactile fremitus was performed, full and symmetric chest

expansion was observed.Auscultation of the chest posterior and anterior was done and let

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M'!'R F#NC!I'N


The following otor 3unction Tests were performed by thepatientF

• +al,in ait - atient had poor posture and unsteady irregular

staggering gait with wide stance and wal!s with arm movements

• Rom.er !est / The patient showed loss of balance when eyes

were closed, suggesting poor position sense. #e may have a

sensory ataxia, that couldn;t maintain balance with the eyes shut.

• "tandin on one 0oot / #e had mild swaying with this test.• &eel to toe 1al,in / atient could not maintain balance on toes

and heels

• Alternatin supination and pronation / #e performed with slow,

clumsy movements and irregular timing, had difficulty alternatingfrom supination and pronation, incoordinated movements and poor

position sense

• Finer to nose test G #e missed the nose and gave slow

response.

• Finer to 0iner / atient moved slowly and was unable to touch

fingers consistently.• Finer to thum. / #e couldn;t coordinate well and loss focus

• &eel do1n% opposite chin / #e couldn;t perform, suggest poor

position sense

• Liht touch sensation - #e couldn;t distinguish the place touched

• Palm sensation / atient couldn;t identify well the letter drawn on

the patient;s palm with blunt end of a pen.

• !emperature sensation / He did not able to performed

• !actile discrimination / The client showed diminish sensation

• Re0le2es

Corneal / 5oth of patient;s eyelids fail to respond(a.ins,i / Cnresponsive and loss of sensation



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La.oratories

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"A)#$AT#$% F!&!&GS

FINDIN*S+ NORMALDATE LA, RESULT -ALUE INTERPRETATION

02-23-10 Fecalysis Black/Watery Brown Tarry stool (Melena)Hookworm: Oa! "#e to $lee"in%

02-23-10 &rinalysis:'olor: ellow ellow-straw ormalTrans*arency clear clear ormal

+eaction ,. .0-0 ormal* raity 101. 100.-1030 ormall$#min ne%atie#%ar ne%atie#s 'ells 0-1+B' 0-14*it5elial 'ells rareBacteria rareM#c#s T5rea"smor*5o#s

&rates rare

02-2.-10 Hematolo%y:+B'WB' ,6 .-100 7108/9 $acterial inectionHB 112 16-1%m; < $lee"in%H'T 012 60-.0; Bloo" loss

=ierential 'o#nt:e#tro*5ils >.; 60-,0;/9 $acterial inection9ym*5ocytes 2.; 20-60;/9 $acterial inection

Bloo" Ty*e O!

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Anatomy

and

Physioloy

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Anatomy and Physioloy

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EsophausThe esophagus or oesophagus, sometimes !nown as the gullet,

is an organ in vertebrates which consists of a muscular tube throughwhich food passes from the pharynx to the stomach. The word

esophagus is derived from the Datin Isophagus, which derives fromthe %ree! word oisophagos, lit. Jentrance for eating.J n humans the

esophagus is continuous with the laryngeal part of the pharynx at thelevel of the " vertebra. The esophagus passes through a hole in the

diaphragm at the level of the tenth thoracic vertebrae (T?+). t is

usually about 1:G2+ cm long and connects the mouth to the stomach.t is divided into abdominal parts.

DiaphramA thin dome-shaped s!eletal muscle that separates the thoracic

and abdominal cavities. The diaphragm plays an important role inbreathingF it contracts with each inspiration, becoming flatteneddownward and increasing the volume of the thoracic cavity so that air

is drawn into the respiratory tract, and then, with expiration, it relaxes

and is restored to its dome shape.

LiverThe liver is a vital organ present in vertebrates and some other

animals. t has a wide range of functions, including detoxification,

protein synthesis, and production of biochemicals necessary for

digestion. The liver is necessary for survival6 there is currently no wayto compensate for the absence of liver function.

This organ plays a maBor role in metabolism and has a numberof functions in the body, including glycogen storage, decomposition of

red blood cells, plasma protein synthesis, hormone production, and

detoxification. t lies below the diaphragm in the thoracic region of theabdomen. t produces bile, an al!aline compound which aids in

digestion, via the emulsification of lipids. t also performs andregulates a wide variety of high-volume biochemical reactions

reuiring highly specialied tissues, including the synthesis and

brea!down of small and complex molecules, many of which are

necessary for normal vital functions.

"tomachThe stomach is a muscular organ of the digestive tract. t is

located between the esophagus and the small intestine. The stomach

is hollow and sac-shaped. t is involved in the second phase of digestion, following mastication (chewing). The stomach releases a

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protein-digesting enyme (protease) and hydrochloric acid, which !illor inhibit bacteria and provide the acidic p# for the protease to wor!.

The word stomach is derived from the Datin stomachus which isderived from the %ree! word stomachos, ultimately from stoma,

JmouthJ. The words gastro- and gastric (meaning related to the

stomach) are both derived from the %ree! word gaster. The stomachchurns food before it moves on to the rest of the digestive system. The

stomach lies between the esophagus and the duodenum (the first partof the small intestine). t is on the left upper part of the abdominal

cavity. The top of the stomach lies against the diaphragm. Dying

behind the stomach is the pancreas. The greater omentum hangsdown from the greater curvature.

Two smooth muscle valves, or sphincters, !eep the contents of the stomach contained. They are the esophageal sphincter (found in

the cardiac region) dividing the tract above, and the yloric sphincter

dividing the stomach from the small intestine.The stomach is surrounded by parasympathetic (stimulant) and

orthosympathetic (inhibitor) plexuses (networ!s of blood vessels andnerves in the anterior gastric, posterior, superior and inferior, celiac

and myenteric), which regulate both the secretions activity and themotor (motion) activity of its muscles.

Di!e the other parts of the gastrointestinal tract, the stomach walls aremade of the following layers, from inside to outsideF

• Mucosa-The first main layer. This consists of an epithelium, the

lamina propria composed of loose connective tissue and whichhas gastric glands in it underneath, and a thin layer of smooth

muscle called the muscularis mucosae.

• "u.mucosa-This layer lies over the mucosa and consists of

fibrous connective tissue, separating the mucosa from the nextlayer. The eissnerKs plexus is in this layer.

• Muscularis E2terna-4ver the submucosa, the muscularis

externa in the stomach differs from that of other % organs in

that it has three layers of smooth muscle instead of two.

o inner obliue layerF This layer is responsible for creatingthe motion that churns and physically brea!s down the

food. t is the only layer of the three which is not seen in

other parts of the digestive system. The antrum hasthic!er s!in cells in its walls and performs more forceful

contractions than the fundus.

o middle circular layerF At this layer, the pylorus is

surrounded by a thic! circular muscular wall which is

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normally tonically constricted forming a functional (if notanatomically discrete) pyloric sphincter, which controls the

movement of chyme into the duodenum. This layer isconcentric to the longitudinal axis of the stomach.

o outer longitudinal layerF AuerbachKs plexus is found

between this layer and the middle circular layer.

• "erosa-This layer is over the muscularis externa, consisting of

layers of connective tissue continuous with the peritoneum.

"pleenThe spleen is an organ found in virtually all vertebrate animals

with important roles in regard to red blood cells and the immunesystem.$? n humans, it is located in the left upper uadrant of the

abdomen. t removes old red blood cells and holds a reserve in case of

hemorrhagic shoc!, especially in animals li!e horses (not in humans),while recycling iron.$1 t synthesies antibodies in its white pulp and

removes, from blood and lymph node circulation, antibody-coatedbacteria along with antibody-coated blood cells.$1$2 &ecently, it has

been found to contain, in its reserve, half of the bodyKs monocytes,

within the red pulp, that, upon moving to inBured tissue (such as theheart), turns into dendritic cells and macrophages while aiding Jwound

healingJ, or the healing of lacerations.$*$:$ t is one of the centersof activity of the reticuloendothelial system and can be considered

analogous to a large lymph node as its absence leads to a

predisposition toward certain infections.

PancreasThe pancreas is a gland organ in the digestive and endocrine

system of vertebrates. t is both an endocrine gland producing several

important hormones, including insulin, glucagon, and somatostatin, as

well as an exocrine gland, secreting pancreatic Buice containingdigestive enymes that pass to the small intestine. These enymes

help in the further brea!down of the carbohydrates, protein, and fat inthe chyme.

Gall.ladderThe gallbladder (or cholecyst or gall bladder) is a small non-vital

organ that aids in the digestive process and stores bile produced in theliver. The gallbladder is a hollow organ that sits in a concavity of the

liver !nown as the gallbladder fossa. n adults, the gallbladder

measures approximately L cm in length and * cm in diameter whenfully distended.$1 t is divided into three sectionsF fundus, body, and

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nec!. The nec! tapers and connects to the biliary tree via the cysticduct, which then Boins the common hepatic duct to become the

common bile duct.The adult human gallbladder stores about :+ millilitres (?.L imp

fl o6 ?.9 C0 fl o) of bile, which is released when food containing fat

enters the digestive tract, stimulating the secretion of cholecysto!inin(""M). The bile, produced in the liver, emulsifies fats in partly digested

food.

"mall intestineThe small intestine is the part of the gastrointestinal tract (gut)

following the stomach and followed by the large intestine, and is wherethe vast maBority of digestion and absorption of food ta!es place. n

invertebrates such as worms, the terms Jgastrointestinal tractJ and

Jlarge intestineJ are often used to describe the entire intestine.

The small intestine in an adult human measures on averageabout : meters (? feet), with a normal range of 2 - 9 meters6 it canmeasure around :+N longer at autopsy because of loss of smooth

muscle tone after death. t is approximately 1.:-2 cm in diameter.

Although the small intestine is much longer than the large intestine(typically around 2 times longer), it gets its name from its

comparatively smaller diameter. Although as a simple tube the lengthand diameter of the small intestine would have a surface area of only

about +.:m1, the surface complexity of the inner lining of the small

intestine increase its surface area by a factor of :++ to approximately1++m1, or roughly the sie of a tennis court.

The small intestine is divided into three structural partsF O 'uodenum 1 cm (=.L in) in length

O PeBunum 1.: m (L.1 ft) O leum 2.: m (??.: ft)

Lare intestineThe large intestine is the second to last part of the digestive

systemQthe final stage of the alimentary canal is the anus Qin

vertebrate animals. ts function is to absorb water from the remainingindigestible food matter, and then to pass useless waste material from

the body.$? This article is primarily about the human gut, though theinformation about its processes are directly applicable to mostmammals.

The large intestine consists of the cecum and colon. t starts inthe right iliac region of the pelvis, Bust at or below the right waist,

where it is Boined to the bottom end of the small intestine. 3rom here it

continues up the abdomen, then across the width of the abdominalcavity, and then it turns down, continuing to its endpoint at the anus.

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The large intestine is about ?.: metres (*.= ft) long, which isabout one-fifth of the whole length of the intestinal canal.

Appendix'igestion ta!es place almost continuously in a watery, slushy

environment. The large intestine absorbs water from its inner contents

and stores the rest until it is convenient to dispose of it. Attached tothe first portion of the large intestine is a troublesome pouch called the

(veriform) appendix. The appendix has no function in modern humans6however it is believed to have been part of the digestive system in our

primitive ancestors.

RectumThe rectum (from the Datin rectum intestinum, meaning straight

intestine) is the final straight portion of the large intestine in some

mammals, and the gut in others, terminating in the anus. The human

rectum is about ?1 cm long.$citation needed ts caliber is similar tothat of the sigmoid colon at its commencement, but it is dilated nearits termination, forming the rectal ampulla.

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Pathophysioloy

PA!&'P&)"I'L'G)

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Predisposing Factors Precipitating FactorsOAge *+-+ O alignant tumors

O%ender O %astric hyperacidityODifestyle (alcohol ingestion) O 0tress

O3amilial tendency O rritating foods

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Ideal "ins

and"ymptoms

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Summary ofSi'ni3cantFindin's

Signifi$ant Normal Findings -alue Nursing Diagnosis Clini$al Signifi$an$e

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WB' ,6 .-100 7108/9

HB 112 16-1%m; Fl#i" ?ol#me =eicit+elate" to Blee"in%

H'T 012 60-.0; Fl#i" ?ol#me =eicit+elate" to Blee"in%

=ierential 'o#nt: e#tro*5ils >.; 60-,0;/9 +isk or inection

+elate" to

9ym*5ocytes 2.; 20-60;/9

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Dru "tudy

Generic Name 3 ET&47'A84DE(rand Name 3

Patient4s dose 3 :++ mgR bedtime as single dose-9 doseClassi0ication 3 Anti-5acterial, Antibiotic,

Antiprotooal, AmoebacideMechanism o0 Action

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• 5actericidal, inhibits '7A synthesis in specific amoerobes, causing

cell death6 antiprotooal-trichomonicidal, amoebicidal.

Indications

• Acute infection susceptible anaerobic bacteria

• Acute intestinal amoebiasis• Amoebic Diver abscess

• Trichomoniasis (acute and partners of patient with acute infection)

• 5acterial Saginosis

• re-operative, intra-operative, post-operative prophylaxis for

patient undergoing colorectal surgery

• Topical application6 treatment of inflammatory popules, pustules

and erethyma of the rosacea.

• Cnlabeled uses6 rophylaxis for patient undergoing gynecologic

abdomen surgery.

Contraindications

• "ontraindicated with hypersensitivity to metronidaole6

pregnancy(do not use in first trimester)

• Cse cautiously with "70 disease, hepatic disease, candidiasis,

blood dysurias, and location.

"ide E00ects

• "70- headache, diiness, vertigo, insomnia, incoordination,

seiures, peripheral neuropathy, fatigue.

• %- unpleasant metallic taste, anorexia, nausea, vomiting, diarrhea,% upset and cramps.

• %C- 'ysuria, incontinence, dar!ening of the urine.

• D4"AD- Thrombophlebitis, redness, burning dryness and s!in

irritation.

• 4T#E&- 0evere, disufiram-li!e-interactions with alcohol,

candidiasis(super infection)

Nursin Interventions

• Administer oral doses with food

•Apply topically (metrogel) after cleansing the area. Advice patientthat cosmetics may be used over the area after application.

• &educe dosage in hepatic disease.

Generic Name 3 A&A"ETA4D(rand Name 3

Patient4s Dose 3

Classi0ication 3

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Mechanism o0 Action

• aracetamol has long been suspected of having a similar

mechanism of action of aspirin because of similarity in structure.

That is it has been assumed that paracetamol acts by reducingproduction of prostaglandins, which are involved in the pain and

fever processes, by inhibiting the cyclooxegenase ("4) enymes.

Indications

• The preparation is indicated in disease manifesting with pain and

fever6 toothache, mild and moderate post-operative and inBury pain,

high temperature, infectious diseases and chills (acute catarrhal

inflammations of the upper respiratory tract, flu, small-pox,parotitis, etc.)

Contraindications

•

aracetamol should not be used in hypersensitivity to thepreparation and in severe liver disease.

"ide E00ects

• n rare cases hypersensitivity reactions, predominantly s!in allergy

(itching / rash) may appear, long term treatment with high doses

may cause a toxic hepatitis with following initial symptoms6 nausea,

vomiting, sweating and discomfort. 4ccasionally, a gastrointestinaldiscomfort may be seen.


• onitor for 0@s ofF hepatotoxicity, even with moderate

acetaminophen doses, especially in individuals with poor nutrition

or who have ingested alcohol over long periods6 poisoning, usuallyfrom accidental ingestion or suicide attemptsF potential abuse from

psychological dependence (withdrawal has been associated withrestless and excited response).

• atient;s and family education

• 'o not ta!e other medications (e.g. cold preparations) containing

acetaminophen without medical advice6 overdosing and chronic usecan cause liver damage and other toxic effects.

• 'o not medicate adults for pain more than ?+ days (: days inchildren) without consulting a physician.

• 'o not use this medication without medical direction for6 3ever

persisting longer than 2 days, fever over 2=.: " (?+2 3), or

recurrent fever.

• 'o not give children more than : dose in 1* hours unless

prescribed by physician.

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• 'o not breastfeed while ta!ing this drug without consulting a

physician.

Generic Name 3 "#D4&#E7&A7E ADEATE

(rand Name 3Patient4s dose 3

Classi0ication 3

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Mechanism o0 Action

• "ompetitively bloc!s the effects of histamine at #1-receptor sites6

has atropine-li!e, antipruritic, and sedatives effects.

Indications

• 0ymptomatic relief symptoms associated with perennial andseasonal allergic rhinitis6 vasomotor rhinitis6 allergic conBunctivitis.

Contraindications

• "ontraindicated with allergy to any anti-histamines, narrow angle

glaucoma, stenoring peptic ulcer, symptomatic prostatic

hypertrophy, asthmatic attac!, bladder nec! obstruction,

pyloroduodenal obstruction, third trimester of pregnancy, andlactation.

• Cse cautiously in pregnancy.

"ide E00ects

• "70- drowsiness, sedation, diiness, disturbed coordination,

fatigue, confusion, restlessness, excitation, nervousness, tremor,headache, blurred vision, dyplopia, vertigo, tinnitus, acute

labyrinthitis, hysteria, tingling, heaviness, and wea!ness of hands.

• "S- hypotension, palpitation, bradycardia, tachycardia,

extrasystoles.

• %- Epigastric distress, anorexia, increase appetite / weight gain,

nausea, vomiting, diarrhea@constipation.

•

%C- urinary freuency, urinary retention, dysuria, early menses,deacrease libido, impotence.

• #EAT4D4%"- hymolytic anemia, aplastic anemia,

thrombocytopenia.

• &E0&AT4&U- thic!ening of bronchi secretions, chest tightness,

wheeing, nasal stiffness, dry mouth, dry nose, dry throat, sorethroat.

• 4T#E&- urticaria, rash, anaphylactic shoc!, photosensitivity,

excessive respiration, chills.


• Administer with food if % upset occurs

• "aution patient not to crush or chew 0& preparations

• Arrange for periodic blood tests during therapy

Generic Name 3 "&43D4A"7

(rand Name 3Patient4s dose 3 :++ mg ? tab bid for days

Classi0ication 3

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Mechanism o0 Action

Indications• "omplicated intraabdominal complication6 severe or complicted

bone or Boint infection, severe respiratory tract infection, severe

s!in or s!in structure infection6 severe or complicated CT6 mild tomoderate respiratory infection6 mild to moderate s!in or s!in

structure infection6 infectious diarrhea, fever.

• "omplicated CT or pyelonephritis6 nosocomial pneumonia, mild to

moderate CT6 uncomplicated CT, chronic bacterial prostatitis6

acute uncomplicated cystitis.

• ild to moderate acute sinusitis6 empirical therapy in febrile

neutropenic patients6 inhalation anthrax.

Contraindications

• "ontraindicated in patients sensitive to fluorouinolones6 use

cautiously in patients with cns disorders, such as severe cerebralarteriosclerosis, or seiure disorder, and in those at ris! for

seiures. 'rug may cause cns stimulation6 drug is associated with

increase ris! of adverse reaction involving Boints tendon, andsurrounding tissues in children younger than age ?L.

"ide E00ects

• "70- seiures, confusion, depression, diiness, drowsiness,

fatigue, hallucinations, headach, insomnia, light-headedness,

paresthesia, restlessness, tumor.

• "S- chest pain, edema, thrombophlebitis.

• %- pseudomembranous colitis, diarrhea, nausea, abdominal pain or

discomforts, constipation, dyspepsia, flatulence, oral candidiasis,vomiting.

• %C- crystalluria, interstitial nephritis.

• #EAT4D4%"- Deu!openia, neutropenia, thrombocytopenia,

eosinophilia.

• C0"CD40MEDETAD- aching, arthralgia, arthtropathy, Bointinflammation, Boints or bac! pain, Boints stiffness, nec! pain, tendonrupture.

• 0M7- rash6 steven-Bohnson syndrome, toxic epidermal necrolysis,

burning, erythema, exfoliative dermatitis, photosensitivity, pruritus.

• 4T#E&0- hypersensitivity reactions.

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Nursin Considerations

• 4btain specimen for culture and sensitivity tests before giving first

dose. 5egin therapy, awaiting results.

• 0ome drugs reuire waiting up to hours after giving these drugs

to avoid decreasing its effect.

• onitor patient;s inta!e and output and observe patient for signs of crystalluria.

• Tendon rupture may occur in patients receiving uinolones.

• Dong-term therapy may result in overgrowth of organism resistant

to drug.

• "utaneous anthrax patients with signs of systemic involvement,

extensive edema, or lesions on the head or nec!, need S therapyand a multi drug approach

• Additional Anti-microbials for anthrax multi drug regimens can

include rifampicin, vancomycin, penicillin, and ampicillin.

• 0teroids may be used as adBunctive therapy for anthrax patientswith severe edema and for meningitis.

• 3ollow current "5" recommendation for anthrax

• regnant women and immunocompromised patients shoul receive

the usual dosage and regimens for anthrax.

Patient !eachin

• Tell patient to ta!e drug as prescribed, even after he feels better.

• Advise patient not to crush, split or chew the extended-release

tablets.

Generic Name 3 DA704&A84DE

(rand Name 3 revacid (- proton-pump inhibitor)Patient4s Dose 3 2+ mg (tab6 4' for 1 wee!s) V?*

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Classi0ication 3

Mechanism o0 Action

• nhibits activity of proton-pump / to hydrogen-potassium

adenosine triphosphatase (#WMWATase), located at secretorysurface of gastric parietal cells, to bloc! secretions of gastric acids.

• Adverse EffectF

• %- abdominal pain, diarrhea and nausea

Indications

• 0hort-term treatment of active duodenal.

• aintenance of healed duodenal ulcers.

• 0hort-term treatment of active benign gastric ulcer

Contraindications• #ypersensitive to drugs

Nursin Considerations3

• atients with severe liver disease may need dosage adBustment, but

don;t adBust dosage for elderly patients or those with renal

insufficiency

• 3or best effect, instruct patient to ta!e drugs no more than 2+

minutes before eating.

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Dischare Plan

MEDICA!I'N3

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• Advise patient and significant others regarding his home

medicationsF

o #emobion :++ g ? tab tid pc p.o.

o Danopraole 2+g ? tab 4' p.o. x 1 wee!s

o etronidaole :++ mg ? tab R #0 as single dose p.o.

o "iprofloxacin :++ mg ? tab 5' p.o. x days

ENIR'NMEN!3

• Encourage client and 04 to provide a peaceful and well-

ventilated environment conducive for recovery and healthy

living.

• Advise client and 04 to !eep the surroundings clean and free

from stress.

• Encourage client to have a regular rest periods during the day.

!REA!MEN!5I"I!3• &eview medication that will be ta!e home and stress importance

of following prescribed regimen.

• 0tress the importance of having follow-up examinations and

treatment to the patient and presence of changing physical

status.

&EAL!& !EAC&ING5ED#CA!I'N3

• 'iscuss with patient his understanding of his condition and how

it affects his body.

• Advise patient to limit physical activity and to have adeuate

rest and sleep.

• 0tress the importance and advantages of compliance with

medication regimen and dietary restrictions.

• Encourage patient to have a good personal hygiene.

• Advise the 04 to give the client the whole support needed.

• Advise patient to follow the discharge instructions given by the

doctor.

• &emind patient and family of the importance of participating in

health promotion activities and recommend health screening.

'("ERA!I'N3

• Encourage patient to have immediate consultation if the

following signs and symptoms occurs which may lead to

potential complicationsF#emorrhage

• 3aintness

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• 'iiness

• 7ausea

• Tachycardia

• #ypotension

• Tachypnea

erforation

• 0udden,severe upper abdominal pain ( persisting an

increasing intensity)6 pain may be referred to the

shoulders, especially right shoulder

• Somiting and collapse (fainting)

• Extremely tender and rigid (boardli!e) abdomen

• #ypotension and tachycardia,indivating shoc!

enetration

• 5ac! and epigastric pain not relieved by medications

that were effective in the past

yloric obstruction

• 7ausea and vomiting

• "onstipation

• Epigastric fullness

• Anorexia

• And later weight loss

Diet3

• Encourage patient to eat and informed him that nutrition is

very important at any medication.

• 0tress to patient the importance of adeuate inta!e of caloric

and nutrient food rich in calcium and vitamin ' to increase

bone density.

• Advise patient to exclude alcohol, carbonated beverages,

coffee, spicy foods and meat extracts from his diet.

• Encourage patient to eat three regular meals per day and in a

relaxed setting and to avoid overeating.• Advise 04 to provide attractive meals and an aesthetically

pleasing setting at meal time.

"PIRI!#AL3

• Encourage the client to pray every day.

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• Encourage the client to have faith and trust %od that

everything will be alright.

• Encourage client to participate in religious activities and to

have contact with spiritual advisers.

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Nursin CarePlans

Table of "ontents46


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eptic Clcer 'isease

• ntroduction

• %ordon;s 3unctional

#ealth attern

• hysical

Assessment

• Daboratory 3indings• Anatomy and

hysiology

• athophysiology

• deal 0igns and

0ymptoms

• 0ummary of

0ignificant 3indings

• 'rug 0tudy

• 'ischarge lan

• 7ursing "are lans

7

+

7>

*CD

DD

D@7>*

38622470 Peptic Ulcer Disease

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Transcript of 38622470 Peptic Ulcer Disease