The Roles Of Nurse In Managing And Treating Peptic Ulcer Disease In Regards To Interventions Research Paper
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Interventions for patients with Peptic ulcer disease (PUD) are intended to reduce gastric irritation, reduce pain, heal the ulcer and prevent recurrence. In order to achieve these objectives, interventions proposed in this paper deal with promoting proper diet pattern, pain management, ensure hydration (fluid balance), and educating patients to ensure good knowledge on the cause of PUD, as well as the relevant treatments. Interventions for PUD focus on the roles of nurse in ensuring proper administration of prescribed medication and educating the patients.
Specific dietary restrictions are no longer part of the treatment for PUD. However, a patient with PUD needs to understand the importance of consuming a balanced diet meal at regular intervals. The patient may find the benefit from this meal pattern (eating small meals at more frequent intervals) during the symptomatic phase of an ulcer. The first step in managing the diet is to identify foods that cause gastric irritation such as spicy foods, pepper, and raw fruits and vegetables. The soft, bland, non-acidic foods cause less gastric irritation, and consequently this encourages the patient to increase food intake. The patient should also limit or avoid consumption of coffee (or caffeinated beverages) and excessive alcohol. These beverages increase acid production in the stomach that eventually leads to stomach irritation and increase in pain.
Pain always accompanies PUD, so pain management is an important part of the interventions required to respond to this disease. Pain management involves administration of prescribed drug therapy consisting of proton pump inhibitors, antibiotics (such as metronidazole, tetracycline, clarithromycin, or amoxicillin), H2 histamine receptor antagonists, prostaglandin analogues, antacids, and sucralfate. The goals of pain management are to inhibit gastric acid production to reduce the pain, treating bacteria (H. Pylori) infection, and promote healing of ulcers. Furthermore, H2 histamine antagonists block secretion of gastric acid, while the prostaglandin analogues reduce acid secretion and enhance the integrity of the gastric mucosa to resist injury. The antacids buffer gastric acid and prevent the formation of pepsin to promote healing of the ulcers. Sucralfate forms a barrier at the base of the ulcer crater to protect the healing ulcer from further exposure to gastric acid. Additionally, PUD patient can also use non-pharmacological pain relief strategies such as guided imagery, relaxation, distraction, music therapy, or acupressure to decrease the production of gastric acid, and to reduce pain.
Hydration is an important factor in providing interventions for PUD patients. Gastrointestinal bleeding is a risk in PUD and it can cause rapid changes in the vital signs and physical symptoms. A decrease in blood pressure with changes in position is an early indicator of decreased circulatory volume.
Fluid intake and urine output need to be monitored closely to ensure that fluid is in balance. The kidney will reabsorb water into circulation to support a decrease in blood volume as a compensatory mechanism. This mechanism results in the decrease of urine output. Similarly, a decrease in circulatory blood volume leads to decreased renal perfusion and decreased urine output. Moreover, bleeding is also associated with the decrease in hemoglobin and hematocrit. Therefore, monitoring the laboratory values of the two blood components should be part of ensuring the fluid balance in PUD patients.
Hematemesis or melena needs to be assessed, as they indicate bleeding ulcer (characterized by bright red blood vomit) or bleeding in the upper gastrointestinal tract respectively. Therapeutic Interventions may include: instructing the patient to report symptoms of nausea, vomiting, dizziness, shortness of breath, or dark tarry stool immediately. Upon occurrence of these symptoms, intravenous fluids should be administered with volume expanders and blood products as ordered. Isotonic fluids, blood products, and volume expanders such as albumin can restore or expand intravascular volume.
Education is a part of intervention in PUD, as patients may have misconceptions regarding peptic ulcer disease, lifestyle behaviors, and treatment regimen. Patients may not be aware of the etiology of PUD, and may not have accurate knowledge to make informed decisions about taking prescribed medications and modifying behaviors that contribute to peptic ulcer disease or gastrointestinal bleeding.
Therefore, it is important to explain to the patient regarding the pathophysiology of disease and how it relates to the functioning of the body. Understanding of the disease process helps to foster willingness to follow recommended treatment plan and modify behaviors to prevent recurrent episodes or related complications. Discussing lifestyle changes may be able to help prevent further complications or episodes of peptic ulcer disease. Modification of lifestyle behaviors such as alcohol use, coffee (and other caffeinated beverages), and overuse of aspirin or other NSAIDs is necessary to prevent recurrent ulcer development and prevent complications during the healing phase.
Additionally, patients need to be encouraged to report appropriate symptoms and signs to the health care provider. Early recognition of signs and symptoms can help ensure early initiation of treatment. Proper use of antibiotics and acid suppressors can aid rapid healing of an ulcer. Therefore, patients need to be educated on therapy options and rationales for using these options.
In addition to the abovementioned interventions, related care plan may include: endoscopy to monitor possible re-bleeding , prescription of misoprostol to prevent ulcer ; and other options outlined in nursing care plans .
Gulanick, M., & Myers, J. L. (2014). Nursing Care Plans: Nursing Diagnosis and Intervention 8th edition. Philadelphia: Elsevier Mosby.
Langman, M. J., J. Weil, L., Wainwright, P., Lawson, D. H., M.D. Rawlins, M. D., Logan, R. F., Colin-Jones, D. G. (1994). Risks of bleeding peptic ulcer associated with individual non-steroidal anti-inflammatory drugs. The Lancet 343 (8905), 1075–1078.
Maetzel, A., Ferraz, M. B., & Bombardier, C. (1998). The cost-effectiveness of misoprostol in preventing serious gastrointestinal events associated with the use of nonsteroidal antiinflammatory drugs. Arthritis & Rheumatism Volume 41(1) , 16–25.
Spiegel, B. M., Ofman, J. J., Woods, K., & Vakil, N. B. (2003). Minimizing Recurrent Peptic Ulcer Hemorrhage After Endoscopic Hemostasis: The Cost-Effectiveness of Competing Strategies. The American Journal of Gastroenterology 98, 86-97.
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