A Case Study on patient with Peptic Ulcer Disease

In Partial Fulfillment to the Requirements in

Competency Appraisal 2

Submitted to:

Mrs. Leny Baguio RN, MN

Mrs. Mary Grace Paayas RN, MAN
Mrs. Renzi Pepito RN, MN
Mrs. Mildred Pinque RN, MN
Mr. Philip Eli Nalzaro RN, MN

Submitted by:

Labalan, Kimberly Charmagne M.

BSN 4 - NB

December 2, 2017
Case Study:

Harold, a fifty-eight year old grocery store manager, had recently been waking up

in the middle of the night with abdominal pain. This was happening several nights a

week. He was also experiencing occasional discomfort in the middle of the afternoon.

Harold decided to schedule an appointment with his physician. The doctor listened as

Harold described his symptoms and then asked Harold some questions. He noted that

Harold's appetite had suffered as a result of the pain he was experiencing and as a

result of the fear that what he was eating may be responsible for the pain. Otherwise,

Harold seemed fine. The doctor referred Harold to a physician that specialized in

internal medicine and had Harold make an appointment for a procedure called an

endoscopy. The endoscopy was performed at a hospital later that week. During the

procedure, a long, thin tube was inserted into Harold's mouth and directed into his

digestive tract. The end of the tube was equipped with a light source and a small

camera which allowed the doctor to observe the interior of Harold's stomach. The

endoscope was also equipped with a small claw-like structure that the doctor could use

in order to obtain a small tissue sample from the lining of Harold's stomach, if required.

The endoscopy revealed that Harold had a peptic ulcer. Analysis of a tissue sample

taken from the site showed that Harold also had an infection that was caused

by Helicobacter pyloribacteria. The doctor who performed the endoscopy gave Harold

prescriptions for two different antibiotics and a medication that would decrease the

secretion of stomach acid. The doctor also instructed Harold to schedule an

appointment for another endoscopy procedure in 6 months.

Reaction:

Peptic ulcer is a sore throat that occurs in the lining of a part of the

gastrointestinal tract that is exposed to pepsin and acid secretions. Most peptic ulcers

occur in the lining of the stomach or duodenum. Most of the duodenal ulcers and gastric

ulcers are caused by H. pylori infection. And most of the remaining peptic ulcers are

caused by long-term usage of certain anti-inflammatory medications like aspirin. The

most common peptic ulcer symptom is burning stomach pain. Stomach acid makes the

pain worse, as does having an empty stomach. The pain can often be relieved by eating

certain foods that buffer stomach acid or by taking an acid-reducing medication, but

then it may come back. The pain may be worse between meals and at night. If peptic

ulcers is left untreated, I can result to internal bleeding. Bleeding can occur as slow

blood loss that leads to anemia or as severe blood loss that may require hospitalization

or a blood transfusion. Severe blood loss may cause black or bloody vomit or

black/bloody stools. Treatment for peptic ulcers depends on the cause. Since H pylori

is present, the doctor will recommend a combination of antibiotics to kill the bacterium.

These may include Amoxicillin, Tetracycline, and levofloxacin.

Reference:

Case Study: Peptic Ulcer. (n.d.). Retrieved December 01, 2017, from

http://highered.mheducation.com/sites/0072943696/student_view0/chapter16/case_stud

y__peptic_ulcer.html
Questions:

1. A patient with a peptic ulcer is suddenly vomiting dark coffee ground emesis. On
assessment of the abdomen you find bloating and an epigastric mass in the
abdomen. Which complication may this patient be experiencing?
A. Obstruction of pylorus
B. Upper gastrointestinal bleeding
C. Perforation
D. Peritonitis
Answer: B
Rationale: This patient is most likely experiencing an upper GI bleeding. Signs and
symptoms of a possible GI bleeding with a peptic ulcer include: vomiting coffee ground
emesis along with bloating, and abdominal mass.

2. A patient is recovering from discomfort from a peptic ulcer. The doctor has
ordered to advance the patients diet to solid foods. The patient's lunch tray
arrives. Which food should the patient avoid eating?
A. Orange
B. Milk
C. White rice
D. Banana
Answer: A
Rationale: When an ulcer is actively causing signs and symptoms, the patient should
avoid acidic foods like tomatoes or citric fruits/juices, chocolate, alcohol, fried foods and
caffeine. These foods can irritate the ulcer site. Instead the patient should consume
alkalotic or bland foods like milk, white rice or bananas.

3. A patient with chronic peptic ulcer disease underwent a gastric resection 1 month
ago and is reporting nausea, bloating, and diarrhea 30 minutes after eating. What
condition is this patient most likely experiencing?
A. Gastroparesis
B. Fascia dehiscence
C. Dumping Syndrome
D. Somogyi effect
Answer: C
Rationale: After a gastric resection the stomach is not able to regulate the movement of
food due to the removal of sections of the stomach (usually the pyloric valve and
duodenum). Therefore, the food enters into the small intestine too fast before the
stomach can finish digesting it. The partially digested food will act hypertonically and
cause water from the blood to enter jejunum. This will cause a fluid shift leading to
bowel swelling, diarrhea, and nausea etc.

4. A patient arrives to the clinic for evaluation of epigastric pain. The patient
describes the pain to be relieved by food intake. In addition, the patient reports
awaking in the middle of the night with a gnawing pain in the stomach. Based on
the patient's description this appears to be what type of peptic ulcer?
A. Duodenal
B. Gastric
C. Esophageal
D. Refractory
Answer: A
Rationale: The patient signs and symptoms describe a duodenal ulcer. Gastric ulcer
tend to not cause pain in the middle of the night and epigastric pain in worst with food.

5. Your patient is diagnosed with peptic ulcer disease due to h.pylori. This
bacterium has a unique shape which allows it to penetrate the stomach mucosa.
You know this bacterium is:
A. Rod shaped
B. Spherical shaped
C. Spiral shaped
D. Filamentous shaped
Answer: C
Rationale: Helicobacter pylori (h. pylori) are spiral shaped which all them to penetrate
down into the stomach lining to reside.