Peptic Ulcer Disease: Nursing Interventions and Medications

Introduction

• Presented by SAR register nurse rn.com
• This is part 2 focusing on nursing interventions and medications
• Part 1 covers pathophysiology, complications, and signs/symptoms
• Free review quiz available in the YouTube description or at the end

Nursing Interventions

Main Goals

1. Assess
2. Monitor
3. Educate
4. Administer Medications per physician's orders

Assessing the Patient

• Vital Signs: Ensure they are normal
• Bowel System: Monitor carefully
  • Bowel sounds: hyperactive, hypoactive, absent
  • Palpation: Check for tenderness, masses, lumps
  • Pain: Location and severity
  • Bowel Movements: Look for bright blood or coffee ground blood
• Specific Questions Regarding Pain
  • When do you have the worst pain? (Gastric vs. Duodenal Ulcers)
  • Onset of pain, nighttime awakening?
• Health History
  • Medications: NSAIDs, salicylates, corticosteroids, anticoagulants
  • Family history of peptic ulcers or H. pylori infection
  • Lifestyle: Alcohol, smoking, caffeine use

Monitoring for Complications

1. GI Bleeding
   • Signs: Increased heart rate, low BP, weakness, low H/H, pale appearance, bloating, dark tarry stools, coffee ground emesis
2. Perforation & Peritonitis
   • Signs: Severe bloating, pain, vomiting, increased heart rate, increased respirations, fever
3. Obstruction of Pylorus
   • Signs: Vomiting, abdominal pain, bloating (specific to duodenal ulcers)
4. Dumping Syndrome
   • Early dumping: 15-30 minutes post-meal, causes distension, bloating, diarrhea, hypotension
   • Late dumping: 3 hours post-meal, leads to hypoglycemia, sweating, weakness, dizziness

Patient Education for Dumping Syndrome

• Eat small, frequent meals (6 small meals vs. 3 large ones)
• Lie down for 30 minutes after eating
• Avoid drinking fluids with meals (wait 30 minutes after eating)
• Avoid sugary foods/drinks, very hot or cold foods
• Diet: High protein, high fiber, low carbs

Diet for Ulcers

• Avoid: Spicy, acidic foods (tomatoes, citrus, caffeine products, chocolate, alcohol, fried foods)
• Prefer: Low fiber, bland foods (white rice, bananas)

Medications

Categories

1. Antacids
2. Mucosa Healing Drugs
3. H2 Receptor Blockers
4. Bismuth Subsalicylate
5. Proton Pump Inhibitors (PPIs)
6. Antibiotics

Antacids

• Examples: Magnesium hydroxide, calcium carbonate
• Action: Neutralize stomach acid
• Administration: 1-2 hours before other medications

Mucosa Healing Drugs

• Example: Sucralfate (Carafate)
• Action: Lines the stomach and covers ulcerated sites
• Administration: On an empty stomach, 1-2 hours before meals

H2 Receptor Blockers

• Examples: Ranitidine (Zantac), Famotidine (Pepcid)
• Note: Drugs often end in 'tidine'
• Action: Reduce stomach acid production
• Administration: Wait 30-45 minutes after antacids

Bismuth Subsalicylate

• Example: Pepto Bismol
• Action: Covers ulcer and helps kill H. pylori
• Use: Along with antibiotics, PPIs, or H2 blockers

Proton Pump Inhibitors (PPIs)

• Examples: Omeprazole (Prilosec), Pantoprazole (Protonix)
• Note: Drugs often end in 'prazole'
• Action: Block proton pump in parietal cells, reducing acid

Antibiotics

• Use: Treat H. pylori infection
• Examples: Clarithromycin (Biaxin), Metronidazole (Flagyl), Tetracycline, Amoxicillin

Conclusion

• Complete part 1 for a comprehensive understanding
• Take the free quiz and subscribe for more educational content