Peptic

Ulcer
1. Acute pain related to irritation of the mucosa and muscle spasms.
Goal: Client expressed pain diminished or disappeared.
Intervention:
1. Give drug therapy according to the program:
2. Instruct to avoid drugs are sold freely, especially those containing salicylates.
R /: Medicines containing salicylates may irritate the gastric mucosa.
3. Encourage clients to avoid foods / drinks that irritate the gastric mucosa:
caffeine and alcohol.
R /: to stimulate the secretion of hydrochloric acid.
4. Encourage clients to use the meals and snacks at regular intervals.
R /: Schedule regular eating helps retain food particles in the stomach that
helps neutralize the acidity of gastric secretions.
5. Instruct patient to stop smoking
R /: Smoking can stimulate ulcer recurrence.
2. Anxiety related to the nature of the disease and long-term management.
Goal: Decrease anxiety.
Intervention:
1. Encourage clients to express their problems and fears and ask questions as
needed.
R /: Open communication helps clients develop trusting relationships that help
reduce anxiety and stress.
2. Explain the reasons for the planned treatment schedule obey, such as
pharmacotherapy, dietary restrictions, modification of activity levels, reduce or stop
smoking.
R /: Knowledge reduce anxiety appears to be a sense of fear due to ignorance.
Knowledge can have a positive effect on behavior change.
3. Assist clients to identify situations that cause anxiety.
R /: stressors need to be identified before it can be overcome.
4. Teach stress management strategies: eg drugs, distraction, and imagination.
R /: decrease anxiety decrease the secretion of hydrochloric acid.
3. Imbalanced Nutrition, Less Than Body Requirements related to pain, which is
related to food.
Goal: Getting optimal nutrition.
Intervention:
1. Encourage eating foods and drinks that do not irritate.
R /: Food and drinks are not irritating to help reduce epigastric pain.
2. Encourage eating on a regular schedule, avoid snacks before bedtime.
R /: Eating regularly helps neutralize gastric acid secretion; snack before bedtime
increases the secretion of gastric acid.
3. Encourage eating food in a relaxed environment
R /: less relaxed environment cause anxiety. Decreased anxiety helps reduce the

secretion of hydrochloric acid.

4. Knowledge Deficit: the prevention and treatment of symptoms related to the
condition of inadequate information.
Goal: Clients gain knowledge about prevention and management.
Intervention:
1. Assess the level of knowledge and readiness to learn from clients.
R /: Desire to learn depends on the physical condition of the client, the level of
anxiety and mental readiness.
2. Teach the required information: Use words that correspond with the level of
knowledge of the client. Choose a time when most convenient and interested
clients. Limit counseling sessions to 30 minutes or less.
R /: Individualization counseling improve learning.
3. Assure the client that the disease can be overcome.
R /: Gives confidence can have a positive influence on behavior change.

EXPECTED OUTCOMES
Maintains normal blood pressure, pulse, and urine output (>30 mL/hr). Remains
free of injury. Seeks information to reduce fear. Identifies and uses coping
strategies to manage fear. Describes prescribed therapeutic regimen. Verbalizes
ability to manage prescribed regimen
Nursing Diagnosis
1. Increased risk of GI bleeding and perforation of stomach, related to gastric or intestinal wall erosion.
2. Increased risk of pyloric obstruction as complication of the peptic ulcer.
3. Increased risk of anemia due to acute or chronic GI bleeding, related to ulcer.
4. Pain and heartburn, related to diagnosis of peptic ulcer.
5. Appetite changes and weight changes due to symptoms of the ulcer.
6. Increased risk of aspiration due to vomiting, related to ulcer.
7. Anxiety related to the symptoms of disease and fear of the unknown.
Nursing Plan and Interventions
Goals
1. Reduce or completely eliminate contributing factors.
2. Assist with stress management.
3. Promote adequate nutrition.
4. Prevent avoidable injury.
5. Then surgical intervention prescribed, prevent postoperative complications.
6. Relief or diminish symptoms.
7. Decreased anxiety with increased knowledge of disease, it treatment, way of prevention and follow-up.

Interventions
1. Assess, report , and record signs and symptoms and reactions to treatment.
2. Monitor fluids input and output closely.
3. Administer antacid agents, analgesics, H2-receptors antagonists, anticholinergics, sedatives as prescribed,
monitor for side effects.
4. Monitor clients vital signs and signs of possible GI bleeding or perforation closely.
5. Monitor laboratory tests results (CBC, electrolytes, Hb levels) for abnormal values.
6. Undertake appropriate intervention in case of GI bleeding, vomiting, or perforation.
7. Provide prescribed diet avoid irritating foods, coffee, etc.
8. Prepare client and his family for surgical intervention if required for recurrent ulcer, hemorrhage, or
perforation.
9. For client after surgical intervention provide postoperative care and inform about possible postoperative
complications, such as dumping syndrome.
10. Provide emotional support to client, explain all procedures to decrease anxiety and to obtain
cooperation.
11. Instruct client regarding disease progress, diagnostic procedures, treatment and its complications, home
care, daily activities, diet, restrictions and follow-up.
Evaluation
1. Reports increased comfort, decreased anxiety.
2. Verbalizes absence of heartburn and pain.
3. No evidence of nausea, vomiting, GI bleeding, or acute abdomen.
4. Maintains stable vital signs, fluid balance, and body weight.
5. Laboratory tests results shows no abnormalities.
6. No postoperative complications.
7. Demonstration of understanding of disease progress, diagnostic and treatment procedures, prevention,
and need for follow-up.

Nursing Interventions
1.

Monitor the patient for signs of bleeding through fecal occult

blood, vomiting, persistent diarrhea, and change in vital signs.

2.

Monitor intake and output.

3.

Monitor the patients hemoglobin, hematocrit, and electrolyte

levels.

4.

Administered prescribed I.V. fluids and blood replacements if

acute bleeding is present.

5.

Maintain nasogastric tube for acute bleeding, perforation, and

postoperatively, monitor tube drainage for amount and color.

6.

Perform saline lavage if ordered for acute bleeding.

7.

Encourage bed rest to reduce stimulation that may enhance

gastric secretion.

8.

Provide small, frequent meals to prevent gastric distention if

not actively bleeding.

9.

Watch for diarrhea caused by antacids and other medications.

10. Restrict foods and fluids that promote diarrhea and encourage
good perineal care.
11. Advise patient to avoid extremely hot or cold food and fluids, to
chew thoroughly, and to eat in a leisurely fashion to reduce pain.
12. Administer medications properly and teach patient dose and
duration of each medication.
13. Advise patient to modify lifestyle to include health practices
that will prevent recurrences of ulcer pain and bleeding.
14. Gastric Ulcer
Gnawing epigastric pain
occurring 30 minutes to 1 hour
after meals

Duodenal Ulcer

Gnawing epigastric pain

occurring 2-3 hours after meals

Relieved by food (because the

Aggravated by eating (because
acid secretion increase at meal
time) leads to weight loss

pyloric sphincter, at the junction

of stomach and duodenum,
closes upon eating to
concentrate food in the stomach)
causes weight gain

Relieved by vomiting (because

acid is expelled out)

Not relived

No pain at hours of sleep (HCl

Pain at hours of sleep (because

production decreases at hours of

gastric emptying continuous at

sleep)

hours of sleep)

More common in persons older

More common between ages 25

than age 50

and 50