Peptic ulcer disease (PUD): Nursing Process (ADPIE)

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Paola Salazar is a 56-year-old hispanic female client admitted to your unit after an esophagogastroduodenoscopy, or EGD, revealed a bleeding gastric ulcer which was controlled by thermal coagulation.

Her recent history includes intermittent upper abdominal pain, and a recent weight loss of five pounds because of nausea and decreased appetite.

After experiencing an episode of hematemesis, her primary care physician, or PCP, ordered an EGD.

A biopsy taken during the procedure is negative for Helicobacter pylori, or H. pylori for short.

Her other health problems include fatigue and chronic back pain.

Peptic ulcer disease, or PUD, is an erosion of the lining of the gastrointestinal, or GI tract, most commonly in the proximal duodenum and stomach.

The lining of the GI tract is made of four layers, the mucosa, which is the innermost layer, followed by the submucosa, muscularis, and serosa.

Cells in the mucosa secrete harsh gastric juices, like hydrochloric acid and pepsin, which help digest food.

Normally the mucosa is protected from self-digestion due to tightly joined epithelial cells that resist penetration, and by prostaglandins that stimulate secretion of a protective layer of mucus and bicarbonate.

When the gastric juices overcome these protective mechanisms and damage the gastric lining, a peptic ulcer develops.

Sometimes PUD is asymptomatic, but often the exposure to irritating gastric juices can cause burning epigastric pain.

Typically, pain from gastric ulcers increases 15-30 minutes after a meal, while pain from duodenal ulcers increases 2-3 hours after a meal and at night.

Other common symptoms include bloating, abdominal fullness, and nausea.

If the erosion extends down to the muscularis level it can damage blood vessels resulting in an upper GI bleed, hematemesis, or melena, when blood passes through the lower GI tract, producing a dark, tarry stool.

Anemia from extensive blood loss causes symptoms like fatigue, pallor, and shortness of breath.


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