Nursing Care of A Patient With Peptic Ulcer
Nursing Care of A Patient With Peptic Ulcer
Nursing Care of A Patient With Peptic Ulcer
PAGE \* MERGEFORMAT 8
Table of Content
Cover Page i
Title Page ii
Approval/Certification iii
Acknowledgment iv
Introduction 1
Patient’s Bio Data 2
Disease History 3
PAGE \* MERGEFORMAT 8
CHAPTER ONE
INTRODUCTION
Peptic ulcers, also known as stomach ulcers, are open sores that develop on the inner lining of
your stomach or the upper part of your small intestine (duodenum). Peptic ulcers are caused by
an imbalance between the digestive juices produced by the stomach and the various factors that
protect the lining of the stomach. The most common causes of peptic ulcers are: H. pylori
naproxen, smoking, excessive alcohol consumption. Symptoms of peptic ulcers can include:
burning pain in the abdomen, usually between the breastbone and navel, heartburn, indigestion,
PAGE \* MERGEFORMAT 8
Patients Bio Data
Age: 73yrs
Sex: Male
Religion: Christianity
Nationality Nigeria
PAGE \* MERGEFORMAT 8
Family Composition: Mr. O.R.M is from Akamkpa local Government Area of Cross River
State. Father is a retired soldier and mother: a retired civil servant. He is the second child in a
family of 3, 2 male and 1 female. My client Mr. O.R.M is a monogamist whose family is an
extended family made up of Wife, his two children and their two grand children
Social History: Mr. O.R.M is married and lives in a suburban home with his wife.He enjoys
spending time with his family and friends. He makes occasional use of alcohol. He attends St.
Disease History: Mr. O. R. M arrived at the GOPD ward on 25/09/2023 Patient presented with
the following complaints intermittent, burning, epigastric, pain, which radiates to the back,
Treatment Taken So Far: He is said to have taken antacid and Gestid syrup for ulcer treatment.
Client was also sent for investigation such as full blood count, sputum analysis, occult blood,
PAGE \* MERGEFORMAT 8
CHAPTER TWO
The stomach is a J-shaped muscular sac-like organ that lies in the upper left part of the abdomen,
just below the diaphragm. It is about the size of a clenched fist and can hold up to 2 liters of
food. The stomach is responsible for storing and breaking down food into a liquid mixture called
chyme.
a. Cardia: The upper part of the stomach where the esophagus joins the stomach.
c. Body: The main part of the stomach, located between the fundus and the antrum.
d. Antrum: The lower part of the stomach where the stomach narrows and connects to the
small intestine.
The stomach is lined with a thick layer of mucous membrane, which is made up of several
different types of cells. These cells produce gastric acid, pepsinogen, and mucus. Gastric acid is
a strong acid that helps to break down food. Pepsinogen is an enzyme that is converted to pepsin
in the stomach. Pepsin is another enzyme that helps to break down food. Mucus protects the
PAGE \* MERGEFORMAT 8
The stomach is also surrounded by a thick layer of muscle, which helps to churn and mix the
food. The muscles of the stomach are controlled by nerves from the autonomic nervous system.
The stomach has several important functions in the digestive process. These functions include:
a. Storage: The stomach can store food for several hours, which allows the body to slowly
b. Breaking down food: The stomach breaks down food into a liquid mixture called
chyme. Chyme is made up of partially digested food, gastric acid, and enzymes.
c. Secreting gastric acid: Gastric acid helps to break down food and kill bacteria.
e. Secreting mucus: Mucus protects the lining of the stomach from the acid.
The stomach is also responsible for controlling the rate at which food is emptied into the small
intestine. This is done by a muscular valve called the pyloric sphincter. The pyloric sphincter
opens and closes to allow small amounts of chyme to enter the small intestine at a time.
Digestive Process
The digestive process begins in the mouth, where food is chewed and mixed with saliva. Saliva
contains enzymes that begin to break down the starch in food. The food then travels down the
In the stomach, the food is mixed with gastric acid and enzymes, which continue to break down
PAGE \* MERGEFORMAT 8
the food. The stomach muscles churn and mix the food for several hours, until it is broken down
Chyme is then slowly released into the small intestine, where it is further digested and absorbed
into the bloodstream. The nutrients from the food are then used by the body for energy, growth,
and repair.
Arterial Supply
The arterial supply of the stomach is derived from three main sources:
The celiac artery: The celiac artery is the largest branch of the abdominal aorta. It supplies
blood to the stomach, liver, spleen, and pancreas. The celiac artery gives off three branches that
The superior mesenteric artery: The superior mesenteric artery is the second largest branch of the
abdominal aorta. It supplies blood to the small intestine and cecum. The superior mesenteric
The inferior phrenic artery: The inferior phrenic artery is a branch of the thoracic aorta. It
supplies blood to the diaphragm and the lower part of the esophagus. The inferior phrenic artery
PAGE \* MERGEFORMAT 8
gives off one branch that supplies the stomach:
Venous Drainage
The venous drainage of the stomach is to the portal vein. The portal vein is a large vein that
collects blood from the digestive organs, including the stomach, liver, spleen, pancreas, and
small intestine. The portal vein carries blood to the liver, where the blood is filtered and
detoxified. The blood then leaves the liver and enters the inferior vena cava, which carries blood
The left gastric vein: The left gastric vein drains blood from the cardia and fundus of the
stomach.
The right gastro-omental vein: The right gastro-omental vein drains blood from the greater
The short gastric veins: The short gastric veins drain blood from the fundus of the stomach.
The pyloric vein: The pyloric vein drains blood from the antrum of the stomach.
Nervous Supply
The nervous supply of the stomach is from the autonomic nervous system. The autonomic
PAGE \* MERGEFORMAT 8
nervous system is responsible for controlling the involuntary functions of the body, such as heart
The anterior vagal trunk: The anterior vagal trunk supplies parasympathetic innervation to the
stomach. Parasympathetic innervation stimulates the secretion of gastric acid and the movement
The posterior vagal trunk: The posterior vagal trunk supplies sympathetic innervation to the
stomach. Sympathetic innervation inhibits the secretion of gastric acid and the movement of the
stomach muscles.
Lymph Nodes
The lymph nodes of the stomach are located along the greater and lesser omentum. The greater
omentum is a large fold of peritoneum that is attached to the greater curvature of the stomach.
The lesser omentum is a smaller fold of peritoneum that is attached to the lesser curvature of the
stomach.
The lymph nodes of the stomach are responsible for filtering lymph fluid from the stomach.
Lymph fluid is a clear liquid that contains white blood cells, which are cells that help to fight
infection. The lymph nodes also contain macrophages, which are cells that engulf and destroy
The lymph nodes of the stomach drain into the celiac lymph nodes, which are located along the
celiac artery. The celiac lymph nodes then drain into the thoracic duct, which is a large vessel
PAGE \* MERGEFORMAT 8
CHAPTER THREE
LITERATURE REVIEW
PAGE \* MERGEFORMAT 8
Peptic ulcer disease (PUD) is a break in the lining of the stomach, first part of the small intestine
or occasionally the lower esophagus. This is a condition in which painful sores or ulcers develop
Normally, a thick layer of mucus protects the stomach lining from the Effects of its digestive
juices. But many thins can reduce this protective layers, allowing stomach acid to damage the
Duodenal Ulcers: Ulcers that develops in the upper section if the small intestine called the
duodenum. The most common symptoms of a duodenal ulcer are waking at night with upper
abdominal pain or upper abdominal pain that progresses with Eating. With a gastric ulcer the
pain may worsen with eating (Snowden, 2018). The pain is often described as a burning. Other
symptoms include belching, vomiting, weight loss, or poor appetite. Complications may include
bleeding, perforation, and blockage of the stomach. Bleeding occurs in as many as 15% of
PAGE \* MERGEFORMAT 8
a. A Bacterium: Helicobacter pylori bacteria commonly live in the Mucous layer that
covers and protects tissue that lines the stomach And small intestine. Helicobacter pylori
chronic Inflammation due to helicobacter pylori that colonizes that antral Mucosa
(Yoman, Mark, 2017 ). The immune system is unable to clear the infection, despite the
appearance of antibodies. Thus, the Bacterium can cause a chronic active gastritis (type 8
b. NSAIDs: Another major cause is the use of NSAIDs, Such as Ibuprofen and aspirin. The
gastric mucosa protects itself from gastric Acid with a layer of mucus, the secretion of
Oxygenase (COX-1) which is essential for the production of these Matories (such as
inhibits Cox-2, which is less essential in the gastric mucosa, and roughly have the risk of
c. Stress: Stress due to serious health problems such as those requiring treatment in an
intensive care unit as well described as a cause of Peptic ulcer which are termed stress
ulcers. While chronic life stress was once believed to be the main cause of ulcers, this is
no longer the case. It is however, still occasionally believed to play a role. This may be
by increasing the risk in those with other causes such as H.pyloti or NSAID use
PAGE \* MERGEFORMAT 8
d. Diet: Dietary factors such as spice consumption were hypothesized to cause ulcer until
late in the20th century, but have been shown to be relatively of minor importance.
Caffeine and coffee, also commonly thought to cause or exacerbate ulcers, appears to
have little effect. Similarly, while studies have found that alcohol consumption increases
risk when associated with H.pylori infection, it does not seem to independently increase
risk. Even when. Couples with H.pylori infection, the increase are modest in comparison
e. Smoking: Smoking may increase the risk of peptic ulcer in people who are infected with
H.pylori. Peptic ulcer disease can also occur if you have a rare condition called Zolinger-
Ellison syndrome (gastorinomia). This condition forms a tumor of acid producing cells in
the digestive tract. These tumors can be cancerous or non-cancerous. The cells produce
Pathophysiology
The mechanism of occurrence of peptic ulcer disease (PUD) results from an imbalance between
gastric mucosal protective and destructive factors. Risk factors predisposing to the development
of PUD are H.Pylori infection, NSAID use, first degree elative with PUD, diet and stress.
With peptic ulcers, there is usually a defect in the mucosa that extends to the muscularis mucosa.
Once the protective superficial mucosal layer is damaged, the inner layers are susceptible to
acidity. Further, the ability of the mucosal ‘cells to secrete bicarbonate is compromised. H.pylori
is known to colonize the gastric mucosa and causes Inflammation. The H.pylori also impairs the
PAGE \* MERGEFORMAT 8
1. Abdominal pain, classically epigastric strongly correlate mealtimes. In case of duodenal
ulcers the pain appears about three hours after taking a meal.
5. Water brash (rush of saliva after an episode of regurgitation to dilute the acid in
6. Hematemesis (vomiting of blood); this can occur due to bleeding directly from a gastric
7. Heart burn
8. Melena (tarry, foul-smelling faeces due to presence of oxidized iron from hemnoglobin).
Diagnostic Investigations
To establish the diagnosis of peptic ulcer. The following assessment and laboratory studies
abdominal distention.
d. Occult blood: Stool may be tested periodically until they are, negative for occult blood
e. Barium study: A barium study of the upper GI tract may show an ulcer.
PAGE \* MERGEFORMAT 8
f. Urea breath test. Reflects activity of H.pylori (Yeomans,2017 ).
Management
Medical Management
Once diagnosis is established, the patients are informed that the condition can be controlled.
Pharmacologic Therapy: currently, the most commonly used therapy for peptic ulcers is a
combination ofantibiotics, portion pump inhibitors, and bismuth salts that suppress or eradicate
the infection.
Stress reduction and rest: Reducing environmental stress requires physical and psychological
modifications on the patient’s part as well as the aid and co-operation of family members and
significant others.
Smoking cessation: Studies have shown that smoking decreases the secretion of bicarbonate
from the pancreas into the duodenum resulting in increased acidity of the duodenum.
Dietary modification: Avoid extreme of temperature of food and beverages and overstimulation
from consumption of meat extracts, alcohol, coffee and other caffeinated beverages and diets
Surgical Management
treatment for ulcers has greatly reduced the need for surgical intervention.
PAGE \* MERGEFORMAT 8
Pyioroplasty: It involve transecting nerves that stimulate acid secretion and opening the pyloris
Anterectomy: Anterectomy is the removal of the pyloric portion of the stomach with
Nursing Management
4. Instruct the client to quit smoking, which decreases the secretion of Bicarbonate from the
5. Teach the client about necessary lifestyle modifications aimed at decreasing stress and
6. Teach the client methods to minimize symptoms while maintaining adequate nutrition.
7. Avoid foods that previously have caused pain. Specific dietary restrictions vary from
client to client.
8. Eat three regular meals a day, small, frequent meals are unnecessary as long as the
9. Avoid a diet rich in milk and creams, which are acid stimulants.
10. Prepare the client for diagnostic procedures and provide post procedure care.
11. Stools are monitored until all barium has been eliminated.
PAGE \* MERGEFORMAT 8
12. Assist the patient in understanding the condition and factors that help or aggravate it.
13. Teach patient about prescribed medications, including name, dosage, frequency and
possible side effects. Also identify medication such as aspirin that patient should avoid.
14. Instruct patient about particular foods that will upset the gastric ulcer, such as coffee, tea,
15. Encourage patient to eat regular meals in a relaxed setting and to avoid overeating
16. Explain that smoking may interfere with ulcer healing: refer patient to programs to assist
17. Alert patient to signs and symptoms of complications to be reported. These complication
includes; hemorrhage (cold skin, confusion, increased heart rate, labored breathing, and
blood in the stool), penetration and perforation (server abdominal pain, rigid and tender
abdomen, vomiting, elevated temperature and increased meal rate), and pyloric
18. Advice on discharge: The nurse instructs the patient about factors that relieve and those
including names, dosage, frequency and possible side effects, stressing the
importance of continuing to take medications even after signs and symptoms have
decreased or subsided.
- Diet: Client should be instructed to avoid certain medications and foods that
- Lifestyle: Counsel Patient to eat meals at regular times and in a relaxed setting and to
avoid overeating.
PAGE \* MERGEFORMAT 8
Prevention of Peptic Ulcer
a. Alcohol
b. Common Source of Helicobacter pylori bacteria (example contaminated food and water,
Complications
a. Bleeding: This is the most common complication, and it can occur if the ulcer erodes a
blood vessel. Symptoms of bleeding include black, tarry stools, vomiting blood, and
b. Perforation: This is a serious complication that occurs when the ulcer eats a hole through
the wall of the stomach or small intestine. Symptoms of perforation include severe
c. Penetration: This occurs when the ulcer extends beyond the wall of the stomach or small
intestine but does not perforate. Symptoms of penetration are similar to those of a peptic
d. Gastric outlet obstruction: This occurs when the ulcer scars and narrows the passage
between the stomach and small intestine. Symptoms of gastric outlet obstruction include
In addition to these four main complications, peptic ulcers can also increase the risk of
PAGE \* MERGEFORMAT 8
developing stomach cancer.
CHAPTER FOUR
Nursing History
PAGE \* MERGEFORMAT 8
Mr. O. R. M was brought to the GOPD ward on 25/09/2023. Patient presented with the following
complaints intermittent, burning, epigastric, pain, which radiates to the back, nausea and
vomiting, blood stained sputum for one month. He reported to have taken Gestid syrup for ulcer
treatment. Client was sent for laboratory investigation such as full blood count, sputum analysis,
Past medical history: except for malaria and typhoid, client has no record of serious health
- Temperature: 37.2°C
- Pulse: 86b/m
- Respiration: 26c/m
Nursing Diagnosis
verbalization.
2. Imbalanced Nutrition less than body requirements related to loss of appetite evidenced by
PAGE \* MERGEFORMAT 8
vomiting and weight loss.
PAGE \* MERGEFORMAT 8
NURSING CARE PLAN OF MR. O.R.M WITH PEPTIC ULCER
S/N Nursing Diagnoses Nursing Objectives Nursing Intervention Scientific Rationale Evaluation
1 Acute Pain related Client will report a 1. Assess pain location, To determine the nature and Client will
to ulceration of the decrease in pain intensity intensity, character, severity of the pain and reported a
mucosal lining from 8/10 to 3/10 on a and identify appropriate decrease in pain
verbalization. intervention. 2. Administer prescribed To relieve pain and promote a pain scale
ordered. nursing
guided imagery.
PAGE \* MERGEFORMAT 8
techniques and effectively.
2 Imbalanced Client will maintain a 1. Assess client's dietary To determine the client's
Nutrition less than healthy weight and intake and identify any nutritional status and
appetite evidenced nursing intervention. 2. Provide counseling on To educate the client about
PAGE \* MERGEFORMAT 8
3. Risk for deficient Client will maintain 1. Assess client's fluid - To determine the
fluid volume related adequate fluid intake and intake and output. client's hydration
fluid intake
effectively.
PAGE \* MERGEFORMAT 8
PHARMACOLOGICAL REVIEW OF THE DRUGS USED
1. Cimetidine
2. Clarithromycin 250mg
3. Omeprazole 20 mg
4. Tinidazole 500mg
PAGE \* MERGEFORMAT 8
Name of Group Indication Dosage Rou Side effects Contraindicatio Nursing
drug te ns responsibility
Cimetidine Histamine2 Active Oral Hypersensitivity, Assess for abdominal
800 mg PO hs or Diarrhea,
(H2) duodenal ulcer, , IM, lactation pain, occult blood in
300 mg PO qid dizziness,
antagonist intractable IV stool, and emesis.
with meals and at tiredness, rash,
ulcers Monitor liver
bedtime or 400 headache, CNS
function tests.
mg PO bid; disturbances,
continue for 4–6 arthralgia,
wk unless healing myalgia,
is demonstrated gynecomastia,
by endoscopy. alopecia, blood
For intractable dyscrasias,
ulcers, 300 mg nephritis,
IM or IV q 6–8 hepatitis,
hr. pancreatitis,
granulocytopen
ia,
hypersensitivit
y reactions.
Clarithrom Macrolide Mild-to- 250-500 mg PO Oral Diarrhea, Hypersensitivity, Assess for infection
PAGE \* MERGEFORMAT 8
infections days tiredness, rash, lactation appearance of wound,
Haemophilus gynecomastia,
Haemophilus dyscrasias,
parainfluenzae, nephritis,
Moraxella hepatitis,
catarrhalis, or pancreatitis,
Streptococcus granulocytopen
pneumoniae ia,
hypersensitivit
y reactions.
PAGE \* MERGEFORMAT 8
e inhibitor gastroesophage indigestion, 20mg diarrhea, new other proton
stool, emesis, or gastric aspirate.
al reflux to 40mg a day for or worsening pump inhibitors,
erosive
esophagitis
Tinidazole Nitroimidaz Amebiasis, 2 g/day PO for 3- Oral Fever, chills, Hypersensitivity, Assess patient for
ole giardiasis, 5 days for body aches, lactation infection (vital signs,
PAGE \* MERGEFORMAT 8
abscess g PO qDay for 2 itching or during therapy.
days OR 1 g PO discharge
for bacterial
vaginosis
PAGE \* MERGEFORMAT 8
CHAPTER FIVE
Summary
This case study was carried out on Mr. O.R.M with the diagnosis of peptic ulcer. This was
conditions. He has predisposing factors of the disease condition; He was duly managed at
Federal Medical Health Center, Umuahia through medications, rests and follow up visit.
Conclusion
The nurse was able to intervene with the problems of Mr. O.R.M after putting in necessary
measures, he was adequately cared for with no complications. This improvement was achieved
through shared effort and cooperation of the family. Mr. O.R.M (client) was properly treated and
follow-up, the family became aware of the measure to prevent peptic ulcer, and improve on their
lifestyle.
Recommendations
To facilitate healing and to decrease the risk of recurrence of gastric and duodenal ulcers,
Helicobacter pylori should be eradicated in patients/client with peptic ulcers disease proton pump
inhibitors offer suppression of acid secretion, healing and symptom relief in patients with peptic
ulcers, that are superior to those associated with other anti-secretory therapies.
PAGE \* MERGEFORMAT 8
Development of new treatment options
Identify risk factors for complications and develop strategies to prevent them.
PAGE \* MERGEFORMAT 8
References
PAGE \* MERGEFORMAT 8
Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.
Alternative Proxies: