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.  

LeMone/Burke/Bauldoff/Gubrud Medical-Surgical Nursing: Clinical Reasoning in Patient Care 6th edition © 2015, Pearson Education, Inc.

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.The endoscopic procedure is done to identify the point of bleeding and treatment of the same. Since the patient is having the heavy bleeding, that may leads to shock and anemia which can be corrected by transfusion of PRBC

2.Since the patient is having bleeding duodenal ulcer ,the nurse should regularly monitor the vitals and recognize the danger signs and inform it to the physician at the earliest. Zantac is ranitidine, that is used to treat peptic ulcer. Fluid volume should be treated according to bp.

3.Nurse can understand that the cause for peptic ulcer as H. Pylori. Also there is an increased risk for malignancy in H. Pylori infection related peptic ulcer.

4.Severe pain in the epigastrium, which is burning in nature. Sensation of nausea, giddiness.