Lecture Notes: Peptic Ulcer Disease (PUD) - Part 2

Presented by: SAR, Registered Nurse

Nursing Interventions and Medications

Nursing Interventions

1. Assessment:

   • Vital Signs: Ensure they are within normal range.
   • Bowel Assessment:
     • Sounds: Listen for hyperactive, hypoactive, or absent bowel sounds.
     • Palpation: Check for abdominal tenderness, location of pain, masses, or lumps.
     • Stool and Vomit Inspection: Look for presence of bright blood or coffee-ground appearance (indicates GI bleed).
   • Patient History:
     • Onset and description of pain (helps differentiate between gastric vs. duodenal ulcers).
     • Medication use (NSAIDs, salicylates, corticosteroids, anticoagulants).
     • Family history of PUD or H. pylori.
     • Lifestyle habits (alcohol, smoking, caffeine).

2. Monitoring:

   • GI Bleeding: Look for increased heart rate, low blood pressure, weakness, low Hemoglobin & Hematocrit, abdominal bloating.
   • Perforation and Peritonitis: Severe abdominal bloating, pain, vomiting, increased heart rate and respiration, fever.
   • Pyloric Obstruction: Vomiting, abdominal pain, bloating (specific to duodenal ulcers).
   • Dumping Syndrome: Post-gastro resection complications.
     • Early Dumping (15-30 mins after eating): Fluid shifts to the gut, causing distention, diarrhea, hypotension, and potential fainting.
     • Late Dumping (3 hours after eating): Hypoglycemia due to excessive insulin release; symptoms include sweating, weakness, dizziness.

Patient Education for Dumping Syndrome

• Eat small, frequent meals throughout the day.
• Lie down for 30 mins after eating.
• Avoid drinking fluids with meals; wait 30 mins after eating before consuming fluids.
• Avoid sugary foods and drinks.
• Avoid very hot or cold foods.
• Consume a diet high in protein and fiber, and low in carbs.

Dietary Recommendations for PUD

• Avoid foods that can irritate the ulcer:
  • Spicy and acidic foods (e.g., tomatoes, citrus, caffeine, chocolate, alcohol, fried foods).
• Consume bland, low-fiber foods that are easy to digest (e.g., white rice, bananas).

Medications

• Mnemonics: "Ant Acid Medications Help Basic Peptic Elements"
  • Antacids (e.g., magnesium hydroxide, calcium carbonate)
  • Mucosa healing drugs (e.g., sucralfate)
  • H2 receptor blockers (e.g., ranitidine, famotidine)
  • Bismuth subsalicylate (e.g., Pepto-Bismol)
  • PPI (Proton Pump Inhibitors) (e.g., omeprazole)
  • Antibiotics (e.g., clarithromycin, metronidazole)

Medication Details

1. Antacids:

   • Neutralize stomach acid.
   • Should be taken alone 1-2 hours before other meds.

2. Mucosa Healing Drugs:

   • Example: Sucralfate (Carafate)
   • Forms a protective coating on ulcers.
   • Best given on an empty stomach.
   • Avoid giving with antacids or H2 blockers.

3. H2 Receptor Blockers:

   • Examples: Ranitidine (Zantac), Famotidine (Pepcid)
   • Avoid giving with antacids.

4. Bismuth Subsalicylate:

   • Example: Pepto-Bismol
   • Used in H. pylori treatment.
   • Forms a protective barrier over ulcers and aids in killing H. pylori.

5. Proton Pump Inhibitors (PPI):

   • Examples: Omeprazole (Prilosec), Pantoprazole (Protonix)
   • Inhibit the proton pump to decrease acid production.

6. Antibiotics:

   • Used for H. pylori eradication.
   • Common choices: Clarithromycin (Biaxin), Metronidazole (Flagyl), Tetracycline, Amoxicillin.
   • Often combined with PPI and Bismuth subsalicylate in treatment regimens.

Conclusion

• Remember to review part one for complete understanding of the pathophysiology, complications, and symptoms of PUD.
• Take the free review quiz for practice.
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