Buy a Nursing essay from nursingessays.us

Left your Nursing Assignment to the last minute? Let a qualified expert do your Nursing essay for you and deliver it before your deadline!

9.8
Buy Nursing essay Papers
Calculate your paper price
Pages (550 words)
Approximate price: -

Peptic Ulcer Disease


John had been working in a call center for five years. The volume of calls and the number of irate clients he receives every day are enough to stress him out. Even while he is at home, he still stresses out about his job and the kind of calls he would receive on the next shift. One night while he is on the phone with a particularly angry customer, he started to feel a gnawing pain at his back. The burning sensation went on for days and is relieved after John ingests food. When he could not take the pain anymore, he consulted their company doctor, and he was advised that what he is feeling is already due to peptic ulcer disease.

Description


A peptic ulcer may be referred to as a gastric, duodenal, or esophageal ulcer, depending on its location.

  • A peptic ulcer is an excavation that forms in the mucosal wall of the stomach, in the pylorus, in the duodenum, or in the esophagus.
  • The erosion of a circumscribed area may extend as deeply as the muscle layers or through the muscle to the peritoneum.

Classification


Peptic ulcer is classified into gastric, duodenal or esophageal ulcer.

  • Gastric ulcer. Gastric ulcer tend to occur in the lesser curvature of the stomach, near the pylorus.
  • Duodenal ulcer. Peptic ulcers are more likely to occur in the duodenum than in the stomach.
  • Esophageal ulcer. Esophageal ulcer occur as a result pf the backward flow of HCl from the stomach into the esophagus.

Pathophysiology


Peptic ulcers occur mainly in the gastroduodenal mucosa.

Peptic Ulcer Disease Visual Pathophysiology

  • Erosion. The erosion is caused by the increased concentration or activity of acid-pepsin or by decreased resistance of the mucosa.
  • Damage. A damaged mucosa cannot secrete enough mucus to act as a barrier against HCl.
  • Acid secretion. Patients with duodenal ulcers secrete more acid than normal, while patients with gastric ulcer tend to secrete normal or decreased levels of acid.
  • Decreased resistance. Damage to the gastroduodenal mucosa results in decreased resistance to bacteria and thus infection from the H. pylori bacteria may occur.

Statistics and Epidemiology


Peptic ulcer disease may occur in both genders and in all ages.

  • Peptic ulcer disease occurs with the greatest frequency in people between 40 and 60 years of age.
  • It is relatively uncommon in women of childbearing age, but it has been observed in children and even in infants.
  • After menopause, the incidence of peptic ulcers in women is almost equal to that in men.

Causes


There are three major causes of peptic ulcer disease: infection with H. pylori, chronic use of NSAIDs, and pathologic hypersecretory disorders (e.g., Zollinger-Ellison syndrome).

  • Helicobacter pylori. Research has documented that peptic ulcers result from infection with the gram-negative bacteria H. pylori, which may be acquired through ingestion of food and water. H. pylori damages the mucous coating that protects the stomach and duodenum.
  • Salicylates and NSAIDs. Encourages ulcer formation by inhibiting the secretion of prostaglandins.
  • Various illnesses. Pancreatitis, hepatic disease, Crohn’s disease, gastritis, and Zollinger-Ellison syndrome are also known causes.
  • Excess HCl. Excessive secretion of HCl in the stomach may contribute to the formation of peptic ulcers.
  • Irritants. Ingestion of milk and caffeinated beverages and alcohol also increase HCl secretion. These contribute by accelerating gastric emptying time and promoting mucosal breakdown.
  • Blood type. Gastric ulcers tend to strike people with type A blood while duodenal ulcers tend to afflict people with type O blood.

Clinical Manifestations


Symptoms of ulcer may last for a few days, weeks, months, and may disappear only to reappear, often without an identifiable cause.

  • Pain. As a rule, the patient with an ulcer complains of dull, gnawing pain or a burning sensation in the midepigastrium or the back that is relieved by eating.
  • Pyrosis. Pyrosis (heartburn) is a burning sensation in the stomach and esophagus that moves up to the mouth.
  • Vomiting. Vomiting results from obstruction of the pyloric orifice, caused by either muscular spasm of the pylorus or mechanical obstruction from scarring.
  • Constipation and diarrhea. Constipation or diarrhea may occur, probably as a result of diet and medications.
  • Bleeding. 15% of patients may present with GI bleeding as evidenced by the passage of melena (tarry stools).

Complications


Possible complications may include:

  • Hemorrhage. Hemorrhage, the most common complication, occurs in 10% to 20% of patients with peptic ulcers in the form of hematemesis or melena.
  • Perforation and penetration. Perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning, while penetration is the erosion of the ulcer through the gastric serosa into adjacent structures.
  • Pyloric obstruction. Pyloric obstruction occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down.

Assessment and Diagnostic Findings


To establish the diagnosis of peptic ulcer, the following assessment and laboratory studies should be performed:

  • Esophagogastroduodenoscopy. Confirms the presence of an ulcer and allows cytologic studies and biopsy to rule out H. pylori or cancer.
  • Physical examination. A physical examination may reveal pain, epigastric tenderness, or abdominal distention.
  • Barium study. A barium study of the upper GI tract may show an ulcer.
  • Endoscopy. Endoscopy is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, and lesions.
  • Occult blood. Stools may be tested periodically until they are negative for occult blood.
  • Carbon 13 (13C) urea breath test. Reflects activity of H. pylori.

Medical Management


Once diagnosis is established,the patient is informed that the condition can be controlled.

  • Pharmacologic therapy. Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton 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 cooperation 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. Avoiding extremes of temperature of food and beverages and overstimulation from consumption of meat extracts, alcohol, coffee, and other caffeinated beverages, and diets rich in cream and milk should be implemented.

Surgical Management


The introduction of antibiotics to eradicate H. pylori and of H2 receptor antagonists as treatment for ulcers has greatly reduced the need for surgical interventions.

  • Pyloroplasty. Pyloroplasty involves transecting nerves that stimulate acid secretion and opening the pylorus.
  • Antrectomy. Antrectomy is the removal of the pyloric portion of the stomach with anastomosis to either the duodenum or jejunum.

Nursing Management


The management of the patient with peptic ulcer is as follows:.

Nursing Assessment

Nursing assessment includes:

  • Assessment for description of pain.
  • Assessment of relief measures to relieve the pain.
  • Assessment of the characteristics of the vomitus.
  • Assessment of the patient’s usual food intake and food habits.

Nursing Diagnosis

Based on the assessment data, the patient’s nursing diagnoses may include the following:

Nursing Care Planning & Goals

Main Article: 5 Peptic Ulcer Disease Nursing Care Plans

The goals for the patient may include:

  • Relief of pain.
  • Reduced anxiety.
  • Maintenance of nutritional requirements.
  • Knowledge about the management and prevention of ulcer recurrence.
  • Absence of complications.

Nursing Interventions

Nursing interventions for the patient may include:

Relieving Pain and Improving Nutrition

  • Administer prescribed medications.
  • Avoid aspirin, which is an anticoagulant, and foods and beverages that contain acid-enhancing caffeine (colas, tea, coffee, chocolate), along with decaffeinated coffee.
  • Encourage patient to eat regularly spaced meals in a relaxed atmosphere; obtain regular weights and encourage dietary modifications.
  • Encourage relaxation techniques.

Reducing Anxiety

  • Assess what patient wants to know about the disease, and evaluate level of anxiety; encourage patient to express fears openly and without criticism.
  • Explain diagnostic tests and administering medications on schedule.
  • Interact in a relaxing manner, help in identifying stressors, and explain effective coping techniques and relaxation methods.
  • Encourage family to participate in care, and give emotional support.

Monitoring and Managing Complications

If hemorrhage is a concern:

  • Assess for faintness or dizziness and nausea, before or with bleeding; test stool for occult or gross blood; monitor vital signs frequently (tachycardia, hypotension, and tachypnea).
  • Insert an indwelling urinary catheter and monitor intake and output; insert and maintain an IV line for infusing fluid and blood.
  • Monitor laboratory values (hemoglobin and hematocrit).
  • Insert and maintain a nasogastric tube and monitor drainage; provide lavage as ordered.
  • Monitor oxygen saturation and administering oxygen therapy.
  • Place the patient in the recumbent position with the legs elevated to prevent hypotension, or place the patient on the left side to prevent aspiration from vomiting.
  • Treat hypovolemic shock as indicated.

If perforation and penetration are concerns:

  • Note and report symptoms of penetration (back and epigastric pain not relieved by medications that were effective in the past).
  • Note and report symptoms of perforation (sudden abdominal pain, referred pain to shoulders, vomiting and collapse, extremely tender and rigid abdomen, hypotension and tachycardia, or other signs of shock).

Home Management and Teaching Self-Care

  • Assist the patient in understanding the condition and factors that help or aggravate it.
  • Teach patient about prescribed medications, including name, dosage, frequency, and possible side effects. Also identify medications such as aspirin that patient should avoid.
  • Instruct patient about particular foods that will upset the gastric mucosa, such as coffee, tea, colas, and alcohol, which have acid-producing potential.
  • Encourage patient to eat regular meals in a relaxed setting and to avoid overeating.
  • Explain that smoking may interfere with ulcer healing; refer patient to programs to assist with smoking cessation.
  • Alert patient to signs and symptoms of complications to be reported. These complications include hemorrhage (cool skin, confusion, increased heart rate, labored breathing, and blood in the stool), penetration and perforation (severe abdominal pain, rigid and tender abdomen, vomiting, elevated temperature, and increased heart rate), and pyloric obstruction (nausea, vomiting, distended abdomen, and abdominal pain). To identify obstruction, insert and monitor nasogastric tube; more than 400 mL residual suggests obstruction.

Evaluation

Expected patient outcomes include:

  • Relief of pain.
  • Reduced anxiety.
  • Maintained nutritional requirements.
  • Knowledge about the management and prevention of ulcer recurrence.
  • Absence of complications.

Discharge and Home Care Guidelines

The patient should be taught self-care before discharge.

  • Factors that affect. The nurse instructs the patient about factors that relieve and those that aggravate the condition.
  • Medications. The nurse reviews information about medications to be taken at home, including name, dosage, frequency, and possible side effects, stressing the importance of continuing to take medications even after signs and symptoms have decreased or subsided.
  • Diet. The nurse instructs the patient to avoid certain medications and foods that exacerbate symptoms as well as substances that have acid-producing potential.
  • Lifestyle. It is important to counsel the patient to eat meals at regular times and in a relaxed setting and to avoid overeating.

Documentation Guidelines

The focus of documentation should include:

  • Client’s description of response to pain.
  • Acceptable level of pain.
  • Expectations of pain management.
  • Prior medication use.
  • Level of anxiety.
  • Description of feelings (expressed and displayed).
  • Awareness and ability to recognize and express feelings.
  • Caloric intake.
  • Individual cultural or religious restrictions and personal preferences.
  • Learning style, identified needs, presence of learning blocks.
  • Plan of care.
  • Teaching plan.
  • Response to interventions, teaching, and actions performed.
  • Attainment or progress toward desired outcomes.
  • Modifications to plan of care.
  • Long term needs.

Practice Quiz: Peptic Ulcer Disease


Here’s a 6-item quiz about the study guide:

Exam Mode

In Exam Mode: All questions are shown but the results, answers, and rationales (if any) will only be given after you’ve finished the quiz.

Practice Quiz: Peptic Ulcer Disease

Start
Congratulations - you have completed Practice Quiz: Peptic Ulcer Disease. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%
Your answers are highlighted below.

Practice Mode

Practice Mode: This is an interactive version of the Text Mode. All questions are given in a single page and correct answers, rationales or explanations (if any) are immediately shown after you have selected an answer. No time limit for this exam.

Practice Quiz: Peptic Ulcer Disease

Start
Congratulations - you have completed Practice Quiz: Peptic Ulcer Disease. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%
Your answers are highlighted below.

Text Mode

1. Peptic ulcers occur with the most frequency in those between the ages of:

A. 15 and 25 years.
B. 20 and 30 years.
C. 40 and 60 years.
D. 60 and 80 years.

2. The most common site for peptic ulcer formation is the:

A. Duodenum.
B. Esophagus.
C. Pylorus.
D. Stomach.

3. Peptic ulcer disease may be caused by which of the following?

A. Helicobacter pylori
B. Clostridium difficile
C. Candida albicans
D. Staphylococcus aureus

4. Pain control with peptic ulcer disease includes all of the following except:

A. promoting physical and emotional rest.
B. identifying stressful situations.
C. eating meals when desired.
D. administering medications that decrease gastric acidity.

5. A characteristic associated with peptic ulcer pain is a:

A. Burning sensation localized in the back or midepigastrium.
B. Feeling of emptiness that precedes meals from 1 to 3 hours.
C. Severe gnawing pain that increases in severity as the day progresses.
D. Combination of all of the above.

6. The most common complication of peptic ulcer disease that occurs in 10% to 20% of patients is:

A. Hemorrhage.
B. Intractable ulcer.
C. Perforation.
D. Pyloric obstruction.

Answers and Rationale


1. Answer: C. 40 and 60 years.

  • C: Peptic ulcer disease occurs with the greatest frequency in people between 40 and 60 years of age.
  • A, B, and D: These are incorrect.

2. Answer: A. Duodenum.

Peptic ulcers are more likely to occur in the duodenum.

3. Answer: A. Helicobacter pylori

Helicobacter pylori is considered to be the major cause of ulcer formation. Other choices are not related to ulcer formation.

4. Answer: C. eating meals when desired.

Meals should be regularly spaced in a relaxed environment. Choices A, B, and D are proper interventions in providing pain control.

5. Answer: A. Burning sensation localized in the back or midepigastrium.

  • A: As a rule, the patient with an ulcer complains of dull, gnawing pain or a burning sensation in the midepigastrium or the back that is relieved by eating.
  • B: A feeling of emptiness that precedes meals from 1 to 3 hours is not a characteristic associated with peptic ulcer pain.
  • C: A severe gnawing pain that increases in severity as the day progresses is not a characteristic associated with peptic ulcer pain.
  • D: Not all of the options are characteristics associated with peptic ulcer pain.

6. Answer: A. Hemorrhage.

  • A: Hemorrhage, the most common complication, occurs in 10% to 20% of patients with peptic ulcers in the form of hematemesis or melena.
  • B: Intractable ulcer is not the most common complication of peptic ulcer disease.
  • C: Perforation is not the most common complication of peptic ulcer disease.
  • D: Pyloric obstruction is not the most common complication of peptic ulcer disease.

See Also


Posts related to this study guide:

Questions?

Ask our team

Want to contact us directly? No problem. We are always here for you.

Frequently Asked Buy a Nursing essay Questions

See all
Is your service confidential?

When you place an order with our company, we ask you to provide us with such personal information as your name, phone number, and email address. We need this data to keep you updated on the important things related to your order or account, and never share it with any third parties. We also don’t use your contact details for spamming you.

Please note that our support team may contact you using only the phone number(s) stated on our website, such +1 (248) 599-2414 and/+44 (151) 528-2636. In order to secure our mutual cooperation, please do not communicate with those who introduce themselves as essaypapers support staff and reach you from different phone numbers.

Also, remember that we never ask you to provide your credit card information via phone conversations. You should enter this information only on PayPal or Gate2Shop billing forms when making an online payment on our website. The essaypapers support administrator will send a confirmation letter to your personal order page when your payment is received.

We also use a secure encrypted connection and do not store your private data if we do not need it anymore. For more details about how we ensure your confidentiality, check our Privacy Policy, which completely complies with the GDPR.

We offer original model papers that can be used legally in a number of ways if properly referenced:

  • As a source of arguments or ideas for your own research
  • As a source of additional understanding of the subject
  • Direct citing

Nonetheless, check your college’s/university’s policies, including their definition of plagiarism and paraphrasing before using our services. Make conscious decisions in regards to your education.

How do I order a paper from essaypapers?

We take care not only of your academic success, but also of your experience with us. That’s why we have made the process of placing your order as easy and fast as possible—usually, it takes no more than 2-3 minutes.

Let’s have a closer look at the simple steps you need to go through for submitting your order:

Fill in the order form.

Be sure to include specific instructions regarding your paper and to upload any of the required materials. If you have any questions while specifying your paper’s information, just click on the info sign at the end of every field name and you will see a detailed tip on what exact information is required.

Proceed with the payment.

After you are through with the order form, you will need to make a payment via a preferable system. Right after that, you will be automatically provided with your personal order page where you can track your order’s progress, provide additional requirements, and send messages to your writer or support manager.

A personal writer is assigned to your order.

Our qualified staff will choose the most suitable writer whose skills and experience match your field of study and paper’s details. In case the writer must have any particular software or literature in order to get the Nursing Assignment done, please do not forget to mention this in your initial instructions.

Your paper is completed and delivered to your personal order page.

When the writer finishes your paper, it is delivered to your personal order page as a PDF document, available for preview only. You will be able to download an editable MS Word version of the order right after you click the “Approve” button in the “Files” tab of your personal order page. If any changes are to be applied to the paper, you are always welcome to request a free revision with a new deadline for the writer (be sure to check more information about this in our revision policy).

You can check how easy the process is by going to the order page and submitting your paper details right now.

Is there a money-back guarantee? If yes, how can I receive a refund?

You can get more details about possible types and terms of refunds on our official money-back guarantee page.

How will I receive a completed paper?

You will get the first version of your paper in a non-editable PDF format within the deadline. You are welcome to check it and inform us if any changes are needed. If everything is okay, and no amendments are necessary, you can approve the order and download the .doc file. If there are any issues you want to change, you can apply for a free revision and the writer will amend the paper according to your instructions.

If there happen to be any problems with downloading your paper, please contact our support team.

What if I’m not satisfied with my order?

If your paper needs some changes, you can apply for a free revision that is available for 7 days after your paper is approved. To use this option, you have a “Revision” button on your personal page.

After the 7-day period, you cannot apply for a free revision, though you still can use a paid revision option. The price of such a revision will differ depending on the number of amendments needed to be done. Please contact our support team to find out how we can help you with the amendments to your paper.

If you think our writer didn’t manage to follow your instructions, and as a result, your paper is of poor quality, please contact us and we will do our best to solve the problem.

If the revisions didn’t give the desired result, you can apply for a refund. Our dispute department will process your inquiry to find out what kind of refund we can give you. To find out more, please visit our money-back guarantee page.

How do I request a refund?

You can’t apply for a refund on certain stages of your order, like when the order is not finished by the writer yet.

When the paper is delivered, the “Refund” button on your personal order page becomes clickable.

On the relevant tab of your personal order page, you will also be able to choose the type of refund you’re demanding and the reason why you applying for it. As soon as you do that, our dispute department will start working on your inquiry. All kinds of refunds concerning the quality or the lateness of your paper should be requested within 14 days from the time the paper was delivered, as in 14 days your paper, will be automatically approved.

Your inquiry should be submitted by clicking the “Refund” button on your personal order page only.

Order your essay today and save 15% with the discount code NURSINGHELP