1. Objectives
• Introduction of Peptic Ulcer Disease
• Classification
• Pathophysiology
• Causes
• Risk factors
• Clinical Manifestations
• Assessment and Diagnostic Findings
• Medical Management
• Surgical Management
• Nursing Management
– Nursing Assessment
– Nursing Diagnosis
– Nursing Care Planning & Goals
– Nursing Interventions
– Evaluation
– Discharge and Home Care Guidelines

2. peptic ulcer disease
• Peptic ulcer disease is a condition in which painful
sores or ulcers develop in the lining of the stomach or
the first part of the small intestine (the duodenum).
Normally, a thick layer of mucus protects the stomach
lining from the effect of its digestive juices. But many
things can reduce this protective layer, allowing
stomach acid to damage the tissue.

3. Causes
• 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 damage 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.

4. peptic ulcer disease
Nursing instructor:
Alia Rafique

7. Risk factors
• One in 10 people develops an ulcer.
• Risk factors that make ulcers more likely include:
• Frequent use of nonsteroidal anti-inflammatory
drugs (NSAIDs), a group of common pain
relievers that includes ibuprofen.
• A family history of ulcers.
• Regularly drinking alcohol.
• Smoking.

8. Types
• There are three types of peptic ulcers:
Gastric ulcers: ulcers that develops in side the
stomach
Esophageal ulcers: ulcers that develop in
esophagus
Duodenal ulcers: ulcers that develop in the
upper section of the small intestines, called the
duodenum

10. Zollinger-Ellison syndrome
• Zollinger-Ellison syndrome is a rare condition
in which one or more tumors grow in the
pancreas or in the upper part of the small
intestine. The tumors are called gastrinomas.
These gastrinomas produce large amounts of
the hormone gastrin. Gastrin causes the
stomach to produce too much acid, which
leads to peptic ulcers. High gastrin levels also
can cause diarrhea, belly pain and other
symptoms.

13. Assessment and Diagnostic Findings
• Esophagogastroduodenoscopy. Confirms the presence of
an ulcer and allows cytological 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.

14. Medical Management
• Antibiotic medications to kill H. pylori. If H. pylori is found in
your digestive tract, your doctor may recommend a combination of
antibiotics to kill the bacterium. These may include amoxicillin
(Amoxil), clarithromycin (Biaxin), metronidazole.
• ▸ Proton pump inhibitors also called PPIs reduce stomach acid by
• blocking the action of the parts of cells that produce acid. These
drugs include ;omeprazole (Prilosec),
• lansoprazole (Prevacid).
• Acid blockers - also called histamine (H-2) blockers - reduce the
amount of stomach acid released into your digestive tract, which
relieves ulcer pain and encourages healing....ex. Ranitidine
• Antacids neutralize existing stomach acid and can provide rapid
pain relief.

15. Surgical Management
• The introduction of antibiotics to eradicate H.
pylori and of H2 receptor antagonists as a
treatment for ulcers has greatly reduced the need
for surgical interventions.
• Pyloroplasty. Pyloroplasty involves
transecting nerves that stimulate the 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.

16. Nursing Management
• Nursing Assessment
Nursing assessment includes:
• Assessment for a 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.

17. Nursing Diagnosis
Based on the assessment data, the patient’s nursing
diagnoses may include the following
• Acute pain related to the effect of gastric acid
secretion on damaged tissue.
• Anxiety related to an acute illness.
• Imbalanced nutrition related to changes in the
diet.
• Deficient knowledge about prevention of
symptoms and management of the condition.

18. Nursing Care Planning & Goals
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.

19. Nursing Interventions
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.

20. • 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.

21. 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.

22. 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.

23. 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.

24. Any Question?

25. THANK YOU