SYNOPSIS
healthcare in patient with peptic ulcer.
Slide 2
Peptic ulcer is an injury of the digestive tract caused by the gastric acid which breaks down the
mucosa, reaching the submucosa.
Slide 3
Peptic ulcers are mostly located in the proximal duodenum and stomach, however, they can
also be found in the Meckel’s diverticulum or oesophagus.
Slide 4
It is a major cause of morbidity and mortality and its most common symptoms include loss of
appetite, epigastric discomfort and weight loss.
Slide 5
It was thought that the hypersecretory acidic environment joined with stress were cause to most
disease cases, but discovering Helicobacter pylori infection and the growing widespread use of
nonsteroidal anti-inflammatory drugs have changed this belief in the second half of the 20th
century.
Slide 6
Historical data shows the uncommonness of peptic ulcers before the beginning of the 19th
century. It wasn’t until 1835. that the disease was first described. Ulcer disease, which was
significantly more common in men until the second half of 20th century, today mostly has the
same incidence in both sexes. The importance of the role of H. pylori in the etiopathogenesis is
best seen in the frequency of H. pylori infection findings among patients with peptic ulcer,
which varies between 80 and 90%.
Slide 7
The stomach is made out of 4 layers: mucosa, submucosa, muscle layer and serosa.
Slide 8
Gastrointestinal mucosa is vulnerable to attacks by the proteolytic enzymes and gastric acid
juices. Pepsins, while breaking down the peptides from food, also destroys the glycoprotein of
the mucosa, therefore causing ulcers. The acid is created by the parietal cells of the stomach,
and its production is inhibited by somatostatin and prostaglandins. Mucus and bicarbonates are
mechanisms which protect the mucosa from pepsin and acid and prostaglandin triggers their
production.
Slide 9
Non-steroidal anti-inflammatory drugs and H. pylori cause the reduction of prostaglandin
synthesis, which decreases glycoprotein and bicarbonate formation and alters mucus
composition, causing disruption of the mucosa barrier.
Slide 10
Research has proven that a dose as low as 10 mg/day of aspirin inhibits PG secretion as much
that it can cause damage. As the dose increases, so does the risk from the onset of clinically
severe mucosal damage. Around 15–30% of regular NSAID users have one or more ulcers
when examined endoscopically.
Slide11
Recovery and normalization period of PG synthesis is considered between 5 to 14 days of
discontinuation of NSAIDs.
Slide 12
Endoscopy is crucial for an accurate diagnosis and differential diagnosis of peptic ulcer disease
and its complications .Detecting the presence of H. pylori is possible with serological tests
because the bacteria triggers the specific humoral reactions immunity, causing the release of
specific antibodies that can be found in serum, saliva and urine of the infected host. Serological
procedures are essential due to low prices and minimal inconvenience to the patients. H .pylori
can also be detected by the urea breath test. The test reveals the presence of the H. pylori, which
breaks urea down into ammonia and carbon dioxide. The testing consists of swallowing a tablet
containing urea and measuring the amount of exhaled carbon dioxide. The testing is simple,
causes minimal inconvenience to the patient, and sensitivity and specificity are very high (>
98%).
Slide 13
Basic therapeutic goals in the treatment of ulcer are curing of the ulcer, disappearance of
symptoms and prevention of recurrence and complication. Treatment of the ulcer disease must
begin with eradication of H. pylori in all infected patients, antisecretory therapy is key in the
treatment of all uninfected patients.
Slide 14
There are four complications of peptic ulcer disease: bleeding, penetration, perforation, and
obstruction. Complications can occur in patients with peptic ulcer of any aetiology and are lifethreatening. Haemorrhage is the most frequent complication. The treatment of choice for
bleeding ulcers is considered the emergency therapeutic endoscopy, reducing the need for
emergent surgical procedures to 10–20% of the cases. However, the re-bleeding ulcers, as well
as perforated ulcers require an immediate surgical procedure.
Slide 15
Now I am going to talk about the nursing care of the patient with peptic ulcer perforation
undergoing surgery. It consists of preoperative, intraoperative and postoperative care.
Slide 16
Slide 17
Perforation of a peptic ulcer causes a dramatical clinical picture. The patient comes with the
excruciating abdominal pain and board-like rigidity in his abdominal muscles. A perforated
peptic ulcer can be repaired by using either laparoscopy or open surgery. The principle applied
in the emergency room is "do as much as necessary, as quickly as possible". Patients are
extremely frightened and worried, and the nurse must explain each procedure and its purpose
in a way that is understandable to them to reduce their fear. When emergency surgery is
required, the nurses' tasks are observation, monitoring and logging vital statistics, establishing
Iv access, drawing blood for diagnostic lab testing, administering the prescribed medication,
inserts the nasogastric tube to drain gastric content, and the urinary catheter.
Slide 18
After the need for surgery is established, the nurse prepares the incision site by washing,
shaving and disinfecting
Slide 19
After removing and storing personal items, the nurse puts on the elastic bandage on patient’s
legs to prevent thrombosis and accompanies the patient to the preparation room, handing him
over to the scrub nurses along with his medical history.
Slide 20
The patient is given premedication in the preparatory room in order to reduce anxiety and pain,
promote amnesia, reduce secretions, reduce postoperative nausea and vomiting, enhance the
hypnotic effects of general anaesthesia, reduce vagal reflexes to intubation, prevent infection.
Slide 21
After the patient is ready for the operation, he is translated into the operating room. The surgical
team is made up of a surgeon, an anesthesiologist, a certified registered nurse anesthetist, and a
scrub nurse and circulating nurse. The operating room nurse positions and prepares the patient
on the operating table, passes medical instruments to the surgeon during operation, and monitor
patient’s vital signs to detect anomalies.
Slide 22
Now I am going to talk about postoperative patient care, the most common diagnoses in the
postoperative period and nursing interventions.
Slide 23
The most common diagnoses in the postoperative period are:
1.
Acute pain related to the effect of surgery.
2.
Anxiety-related to an acute illness.
4.
Deficient knowledge
Slide 24
The patient should be placed in Fowler’s position for easier expectoration and better lung
ventilation. The legs should be flexed at the knees to reduce muscle tension and pain. The nurse
measures vital signs every 15 minutes for the first 3 hours after surgery, and every 30 minutes
followingly.
Slide 25
For patients who underwent ulcer perforation surgery, diet is extremely important.
Slide 26
For the first 48 hours, until peristalsis is established, the patient is on parenteral nutrition. On
the second day, the patient is gradually given small amounts of fluid by mouth. From the 3. To
the 6. Day, the patient switches to a specific post-operation diet. From the seventh day, the
patient is on a special diet that must be followed for 6 months. The nurse needs to teach the
patient about the importance of accepting the special diet that includes 6 small meals a day, not
eating too hot or too cold food and avoiding overeating.
Slide 27
Education plays a great role in a patient's recovery and it is important to assist the patient in
understanding his condition and all of the factors that help or aggravate it.
Slide 28
It I necessary to advise the patient to avoid smoking, NSAIDs, and particular foods which could
upset the gastric mucosa, such as tea, coffee, and alcohol because of their acid-producing
potential.