hey everyone it's SAR register nurse rn.com and in this video I'm going to be doing part two of peptic ulcer disease and I want to be concentrating on the nursing interventions and the medications used to treat this disease now be sure to check out part one because that's where I cover the pathopysiology the complications and the signs and symptoms and as always in the YouTube description below or at the end of this YouTube video you can access the free review quiz that will test you on PUD so let's get started first let's start out talking about nursing interventions what are we going to be doing for this patient who has peptic ulcer disease as the nurse well our goal is to assess them monitor them educate them and administer medications per the physician's order so first let's talk about assessing what are we going to be assessing of course we're going to be assessing those Vital Signs making sure they're normal next we want to make sure we are assessing that bowel system very carefully we're going to be monitoring bowel sounds listening to them with our stethoscope how they sound are they hyperactive hypoactive are they absent we're going to be palpating the abdomen um does the patient have tenderness where at we're going to be really inspecting it making sure we don't see any masses any lumps and we're going to be asking the patient how's their pain where's it at things like that and we're going to be really monitoring their bowel movements looking at the stools and if they're growing up we're going to carefully inspect that to see if there's any bright blood or coffee ground looking blood in it because that could represent a GI bleed so you really want to pay attention to those things next we're going to be asking our patients some specific questions like the onset of pain and because this is going to help us distinguish is this possibly a gastric ulcer or a dood dental ulcer like for instance with gastric um when do you have the worst pain is it when you eat food they say yes that makes us think gastric or they say well actually whenever I eat food it helps we may be thinking it's more duod dental and we want to know when is this pain happening are you awaking at night with it and again that's one of those signs with dood dental and we want to ask them about their health history what medications are they using are they using ineds regularly um and have they been doing that over a period of time because remember in the other lecture we learned that incets is a cause of peptic ulcer disease and we don't want them taking those if they have peptic ulcer if they have an active ulcer um are they using salicylates corticosteroids anticoagulants um especially antag coagulants if they have an ulcer um because they're at risk for GI bleeding it may exacerbate a GI bleed because the blood's so thin or corticosteroids lowers the system's ability to fight infection um and heal so using cortico steroids could have make the ulcer worse and do they have a family history of peptic ulcers or do they have a family history or someone in their familyes been recently diagnosed with H pylori which is one of those bacteria that can get in the stomach and cause peptic ulcer disease and um they think that it's transmitted from oral to oral or fecal oral and you can get it from someone who possibly has it also do they drink um smoke or use caffeine um drinking alcohol or using tobacco procs or caffeine can prolong healing of an ulcer and make it worse so we want to ask them those questions next we want to monitor them specifically for complications that they can experience with peptic ulcer disease or a specific complication after surgery which is dumping syndrome okay so GI bleeding they're at risk for this what can happen is that that ulcer erodes so much in those specific layers of the stomach we know that in some of those layers they have vessels it can get in there and those vessels cause it to bleed signs and symptoms of gastrointestinal bleeding is an increased heart rate low blood pressure the heart can't compensate so it needs to get the blood pumping so it'll increase that heart rate you'll see Tac cardia um but they'll have a low blood pressure because there's not a lot to pump they'll be weak they'll have a low H&H they'll be pel they may have bloating in their abdomen or a mass in there from where the blood is pulling in there um also they may have dark tar stools or um they may have coffee ground emesis or bright blood they're throwing up so you really want to educate your patient who does have peptic ulcer disease to watch out for those telltale signs and symptoms especially are you having dark tar sticky looking black stools and um when you throw up or what does your vomit look like does it look like coffee grounds and I have seen this coffee ground it it's very unique looking had a patient um just all of a sudden just started throwing up they weren't even there for peptic ulcer disease and just throwing up and it was coffee grounds turns out they had a peptic ulcer and it looks just like coffee grounds um and also as an she may be collecting ult stools testing the stools for blood present another complication is perforation which can lead to peritonitis this is where um the ulcer has eroded the stomach line so much that has formed a hole and it's allowing all those gastric juices everything in the stomach to leak out into the abdominal cavity which um is peritonitis you may see um whenever patient has this they have severe abdominal bloating and pain uh with vomiting increased heart rate rate increased respirations and fever so if your patient has this you see this that could be it um another complication is obstruction of that pyloris and remember the pylorus is that muscular like structure that connects the stomach to the doo denim that allows F food to flow down through the dood Denim and it can become scarred and obstructed so um you may see vomiting in your patient abdominal pain or bloating that's really um specific to patients who have dood ulcers now let's talk about dumping syndrome okay if a patient um one of the treatments for chronic peptic ulcer disease is a gastric reection there's various types and they can go in and remove certain disease portions of the stomach and reconnected so they can get rid of those ulcer areas now whenever they do that you need to really watch your patient and teach them about this for dumping syndrome and this is what happens um the stomach is not able to regulate the movement of food like it used to so um it does the food doesn't get as digested as it normally would and it enters too soon into the small intestines specifically the gunum because they normally remove the pyloric valve and the dood denum and um whenever that substance the food enters into the Jenum it's like a hypertonic solution because it's not all the way really digested and um we learned from from our hyper hypotonic video that hyperonic Solutions will pull the fluid so what happens is that water will shift from the blood to the gut and this can happen 15 to 30 minutes after eating and when the patient presents with signs and symptoms around that time it's considered early dumping and what's happened is that this fluid shift causes the small bowel to get distended and um it increases motility So the patient's going to get bloating and they're going to get some diarrhea then from that sudden shift of fluid the heart tries to compensate so um the patient will get some hypotension um they may pass out things like that so they may report to you man after I get done eating 30 minutes I feel horrible I get um my stomach starts rumbling I get diarrhea I get really bloed I feel like I'm going to pass out my blood pressure drops I don't know what's going on and they've had a gastric Ree probably this now this can happen also and it's called late dumping 3 hours after eating patients can have both some have either or so it really depends but this is when that food has entered too soon into that small intestine and it's rich in carbs and sugars and what happens because normally it shouldn't enter that shouldn't enter there with all that carbs and sugars the pancreas releas es insulin so whenever that sudden release of insulin happens the patient gets a drop in blood sugar because that's what insulin does and they get hypoglycemia so the patient may report that um about 3 hours after eating all of a sudden out of nowhere they start getting sweaty weak and dizzy and that is what is going on they're probably experiencing light dumping now let's look at the patient education that you can give a patient who has dumping syndrome to help de increase those signs and symptoms that they get whenever they eat a meal um and for testing purposes I would remember these points okay one thing you want to tell them is to eat small but frequent meals throughout the day rather than three large ones because if you eat a big breakfast lunch and dinner that's a lot of food entering into the stomach at once um which is going to go to the small intestine and have a bigger effect than if you just eat really small ones throughout the day like six small ones instead of three large ones also if they can it's a good idea to lie down for 30 minutes after eating lying down helps slow down that emptying process and um to not drink fluids with meals instead eat the food then wait about 30 minutes and then consume some fluids next avoid sugary Foods or drinks um because remember we learned that that fluid that hits that small intestine is hypertonic in nature and it um has a lot of sugars and carbs in it which causes that pancreas to release that insulin so if you can decrease the amount of sugar that you're taking in it can decrease those signs and symptoms that you may get and to try to avoid very hot or very cold foods another thing is to eat a diet high in protein high in fiber and low in carbs okay now let's talk about diet a person should follow if they have an ulcer um that's hurting them what they should eat okay as we learned from the other lecture we learned that Foods don't cause peptic ulcer disease instead they can irritate an ulcer that's already there and prolong the healing because if you have these certain types of foods going onto that eroded tissue in the stomach and cause more pain cause issues so they want to avoid foods that are spicy and acidic for instance like tomatoes tomato juice Citrus um fruits or juices and caffeine products chocolate alcohol or fried foods because they're really greasy on the flp side they should consume foods that are low in fiber that are bland and really easy for the gut to digest like white rice bananas things that don't require a lot of digestion now let's look at the medications just talked about nursing interventions let's look at the medication regimen as a nurse you need to be familiar with the drug categories specific uh ways of maybe how you would administer it and things to watch out for okay to help you memorize the category of drugs used for peptic ulcer disease let's remember this pneumonic ant acid medications help basic peptic elements and each word will correlate with the drug category okay we have ant acids we have mucosa healing drugs we have H2 receptor blockers bismuth sub solos Salat ppis which are proton pump inhibitors and antibiotics and right beside these you will see blue asteris um we're going to go over these in depth here in a second but hpylori these drugs are used to treat the H pylori infection which is that bacterium that gets in there causes breakdown of that mucosa and then we get ulcer formation and depending on what kind of regimen The Physician wants to use they may use like it's always antibiotics but they may throw on a PPI which will decrease gastric secretion and throw in um a bismuth subisolate which is is pepto to help Co that ulcer and it does help kill the H pylori too so be familiar with that as well now let's look at these medications in depth let's start with an acids okay some popular an acids prescribed are magnesium hydroxide or calcium carbonate and these medications neutralize stomach acid so you'll give them to the patient they will chew them thoroughly and then swallow um the thing with ant acids that you want to remember is that they really interfere with other medications so it's best to give them a loan about one to two hours before any other medicines and because they can interfere with po antibiotics the mucosal healing drugs like Carafate histamine receptor blockers and they can affect how those drugs work so you want to give them a loan okay the next category of drugs is called mucosa healing and um what drug is called sucralfate also known as Carafate and what this drug does is that it lines the stomach and it actually will adhere to that ulcerated sight and just act as a little protective coating around it and protect it from all that acid and whenever you give carit it's best to give on an empty stomach just because how it works we want that sight to be nice and protected before we throw food in there which will stimulate the gut to produce acid more acid to digest the food so we want to make sure that it's coated before we give food so about 1 to two hours before meals now you don't want to give um carate with an acids like we just said or H2 blockers because they interfere don't give them at the same time another group of drugs are known as histamine receptor blockers and this includes drugs like renadine also known as Zantac oradine also known as pepid and these drugs as you can see here tend to end in the letters TI d i in E so pay attention if You' seen that see those letters think of histamine receptor blockers now some things you'll remember about these drugs don't give them at the same time as an acids ever see an an acid just give it all by itself or with the Cara you want to wait at least 30 to 45 minutes in between administering those drugs next bismo subsol solat and this is like pepto bismal and um this is used whenever a patient has an hpylori infection which will be given along with antibiotics maybe some protein pump inhibitors or H2 blockers and what this does is that it covers the ulcer um so the anabolics can work and do its job and can actually plays a little bit of a role of killing the bacteria that is present next are proton pump inhibitors popular one it's called omeprazol also known as pyc or pantozol also known as protonics and these drugs tend to end in p r a z l so if you see that think PP I remember the p r a z o l the P for proton pump inhibitor so that's how I remember them um and how these drugs work is that attach to the proton pump on that prodal cell remember what does prodal cells release we learned from lecture one and part one hydrochloric acid and um which has hydrogen and potassium hence protons the positive charge and it blocks the release of the hydrogen ions which would have mix with chloride to make hyro HD chloric acid so whenever that's blocked you're going to decrease that acid because we're blocking um the ability of that proton pump to do its job hence why it's called a proton pump inhibitor okay um last drug category are our antibiotics and as you can see here these purple little asteris I just wanted to give those to you so you can see that depending on how the physician orders the regimen um whenever you are using for HP Lori they will give antibiotics maybe a PPI with that the Bismuth sub solos solat and we'll throw different types of drugs together and that's usually what's included so the antibiotics are given to kill the hpylori so they may throw in a PPI to decrease the gastric secretion so everything can work together to kill that bacteria um some typical antibiotics shoes again this is physician preference is like Chorro also called bin or another one metrol also known as flagel tetracyclin or amoxicillin okay so that wraps up this lecture on peptic ulcer disease part two now be sure to watch the part one of the series as well thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos