Question

Nursing Care of Patient with Peptic Ulcer Disease

Abstract: Cedric Filmore, age 40, is transferred to the medical-surgical unit from the emergency department following an episode of vomiting a large amount of blood. He has been diagnosed with peptic ulcer disease.

Objectives:  

• Distinguish manifestations and diagnostic test results and correlate with pathophysiologic processes involved in upper gastrointestinal disorders.
• Determine priority nursing diagnoses, problems, and interventions based on assessed data.

Administer medications and prescribed care knowledgeably and safely.  

Patient's Name: Cedric Filmore  

Cedric Filmore, age 40, came to the emergency department after reportedly vomiting a large amount of bright red blood. His bleeding was controlled via an endoscopic procedure, and the presence of a large duodenal ulcer was noted at that time. Mr. Filmore received 2 units of packed red blood cells (PRBC’s) after undergoing the endoscopic procedure.  

This is Mr. Filmore’s third episode of ulcer disease. He is employed as a truck driver and has difficulty maintaining a normal eating schedule. His ulcer biopsy was positive for Helicobacter pylori (H. pylori), and he is now admitted to the medical-surgical floor for further treatment. His vital signs on admission to the medical-surgical floor include are T 96°F, P 64, R 18, and BP 122/60. His current hemoglobin and hematocrit levels (following the 2 units of packed red blood cells) are 10.2 gm/dL and 33%, respectively. He is 5 feet, 8 inches tall, and weighs 185 pounds.  

This activity contains 5 questions.  

1. What does the nurse understand as the rationale for the transfusions of PRBC’s and the endoscopic procedure performed soon after admission?  

2. Mr. Filmore has a nasogastric tube connected to intermittent suction and an intravenous (IV) solution of D5 1/2 normal saline with potassium chloride 20 mEq/liter @ 100 mL/hour via infusion pump. There is an order to irrigate the NG tube with 30 mL normal saline as needed. (The nurse notes that the NG tube is draining coffee ground material). Other treatments include the administration of ranitidine (Zantac) 50 mg IV every 12 hours, and oxygen via nasal cannula @ 2 liters/min. The nursing diagnosis is Risk for Deficient Fluid Volume related to blood loss secondary to ulcer disease. What are the important nursing implementations and rationale related to Mr. Filmore’s current condition and treatments?

3. What does the nurse understand about the significance of the presence of H. pylori in the biopsy obtained at the time of Mr. Filmore’s endoscopy?  

4. The nurse questions Mr. Filmore about the symptoms he experienced prior to the episode of acute bleeding. What symptoms does the nurse expect Mr. Filmore to describe, as the classic picture of peptic ulcer disease?  

5. Mr. Filmore tells the nurse that he normally drives his truck at least 12 hours every day and eats only after stopping for the night. He generally eats fast foods and smokes 2 packs of cigarettes per day. When he was getting stomach pains during the night, he would take a “couple of aspirin.” The nursing diagnosis established is Ineffective Health Maintenance related to lack of knowledge about contributing factors manifested by repeated occurrences of peptic ulcer disease. What teaching does the nurse provide for Mr. Filmore prior to discharge?  

Answer 1

1. What does the nurse understand as the rationale for the transfusions of PRBC’s and the endoscopic procedure performed soon after admission?

Answer : Packed red blood cells are transfused to prevent tissue hypoxia. As the clinical manifestations of large amount of blood in vomiting represents patient can become anemic. Endoscopic procedure is performed to know the exact place from where bleeding is taking place and endoscopic procedure is used both in diagnostic and therapeutic procedures.

2. Mr. Filmore has a nasogastric tube connected to intermittent suction and an intravenous (IV) solution of D5 1/2 normal saline with potassium chloride 20 mEq/liter @ 100 mL/hour via infusion pump. There is an order to irrigate the NG tube with 30 mL normal saline as needed. (The nurse notes that the NG tube is draining coffee ground material). Other treatments include the administration of ranitidine (Zantac) 50 mg IV every 12 hours, and oxygen via nasal cannula @ 2 liters/min. The nursing diagnosis is Risk for Deficient Fluid Volume related to blood loss secondary to ulcer disease. What are the important nursing implementations and rationale related to Mr. Filmore’s current condition and treatments?

Answer :

Intervention	Rationale
Assessment of decreased vital functions of vital organs	To understand renal and cerebral functions
Obtaining I.V access and administering prescribed fluids and blood products.	To prevent delay in IV transfusion
Two large diameter peripheral i/v catheter should be inserted	To facilitate the rapid administration of prescribed fluid.
Strict intake and output charting is done	To assess the impaired functioning of multiple system.
Lavage with cold	To promote vasoconstriction

3. What does the nurse understand about the significance of the presence of H. pylori in the biopsy obtained at the time of Mr. Filmore’s endoscopy?  

Answer : Presence of  Helicobacter pylori (H. pylori) which is a major human pathogen suggests progressive gastroduodenal damage it can also be confirmed by using urea breath test

4. The nurse questions Mr. Filmore about the symptoms he experienced prior to the episode of acute bleeding. What symptoms does the nurse expect Mr. Filmore to describe, as the classic picture of peptic ulcer disease?  

Answer : The classic picture of peptic ulcer disease are:

• Dull Pain  in the chest or upper abdomen
• Belching
• Heartburn
• Indigestion
• Nausea
• Passing excessive amounts of gas, or vomiting
• Fatigue
• Loss of appetite