4 Peptic Ulcer Disease Nursing Care Plans

Peptic ulcer patients come in with epigastric burning and a story that points to gastric or duodenal disease. Your priorities are pain relief, nutrition and fluid balance, watching for GI bleeding, and teaching the lifestyle changes that keep them from coming back.

What is Peptic Ulcer?

A peptic ulcer is ulceration in the mucosal wall of the lower esophagus, stomach, pylorus, or duodenum, named duodenal, gastric, or esophageal by location. The most common symptom of both gastric and duodenal ulcers is epigastric pain, a burning sensation that comes shortly after meals with gastric ulcers and 2 to 3 hours afterward with duodenal ulcers.

Predisposing factors include infection with the gram-negative bacteria Helicobacter pylori (acquired through food and water), excessive HCl secretion, chronic NSAID use that weakens the mucosal layer, the stress of illness and surgery, alcohol, and heavy cigarette smoking.

Nursing Care Plans and Management

Nursing Assessment

Assess for these subjective and objective findings:

• Early satiety
• Nausea and vomiting
• Pain relieved by food or antacid
• Weight loss

Nursing Diagnosis

Form the nursing diagnosis from your assessment and clinical judgment. The label matters less than matching the plan to what the patient in front of you actually needs.

Nursing Goals

• The client will report satisfactory pain control, less than 2 to 4 on a scale of 0 to 10.
• The client will use pharmacologic and nonpharmacologic pain relief.
• The client will show increased comfort: baseline HR, BP, and respirations, and relaxed muscle tone and posture.
• The client will be normovolemic: systolic BP at or above 90 mm Hg (or baseline), no orthostasis, HR 60 to 100 beats/minute, urine output above 30 mL/hr, and normal skin turgor.

Nursing Interventions and Actions

1. Pain Relief and Comfort

Assess pain location, characteristics, precipitating factors, onset, duration, frequency, quality, intensity, and severity. Gastric ulcers typically hurt 1 to 2 hours after eating; duodenal ulcers hurt 2 to 4 hours after eating or in the middle of the night. Both produce intermittent upper abdominal pain, often relieved by eating or an antacid.

Encourage nonpharmacologic relief: acupressure, biofeedback, distraction, guided imagery, massage, and music therapy. Relaxation decreases gastric acid production and reduces pain.

Instruct the client to avoid NSAIDs such as aspirin. They irritate the gastric mucosa.

Have the client eat at regularly paced intervals in a relaxed setting. An irregular schedule interferes with regular medication timing.

Encourage smoking cessation. Smoking decreases bicarbonate secretion from the pancreas into the duodenum, increasing duodenal acidity.

Administer the prescribed drug therapy:

• Antacids. Buffer gastric acid and prevent peptin formation, promoting ulcer healing.
• Antibiotics: amoxicillin, clarithromycin, metronidazole, tetracycline. Treat Helicobacter pylori and promote healing, which reduces pain.
• Histamine receptor antagonists. H2 antagonists block gastric acid secretion. Prostaglandin analogues reduce acid and strengthen the mucosa against injury.
• Proton pump inhibitor. Blocks production and secretion of gastric acid, reducing pain.
• Sucralfate. Forms a barrier at the ulcer base to protect the healing crater from gastric acid.

2. Nutritional and Fluid Balance

Obtain a nutritional history. Clients often overestimate intake and may undereat to avoid pain, putting them at high risk for malnutrition.

Assess for weight changes. Weight loss signals inadequate intake. Gastric ulcers more often cause vomiting, appetite loss, and weight loss than duodenal ulcers.

Monitor serum albumin. Indicates protein depletion (2.5 g/dL is severe; 3.8 to 4.5 g/dL is normal).

Help the client identify foods that cause gastric irritation. Soft, bland, non-acidic foods irritate less. Spicy foods, pepper, and raw fruits and vegetables can irritate the mucosa.

Instruct the client to avoid excessive alcohol. Alcohol irritates the stomach and increases pain.

Limit caffeinated beverages such as tea and coffee. Caffeine stimulates gastric acid. Coffee, even decaffeinated, contains a peptide that triggers gastrin and increases acid.

Teach a balanced diet with meals at regular intervals. Specific dietary restrictions are no longer standard for PUD. During the symptomatic phase, small frequent meals may help.

Assess for hematemesis or melena. A bleeding ulcer may produce bright red blood or coffee-grounds emesis. Melena indicates upper GI bleeding.

Monitor fluid intake and urine output. With falling blood volume the kidney reabsorbs water and urine output drops, reflecting decreased renal perfusion.

Monitor vital signs and watch BP and HR for orthostatic changes. Erosion through the mucosa causes GI bleeding and anemia. Brisk bleeding changes vitals fast. A drop in BP and a rise in HR with position change is an early sign of decreased volume.

Monitor hemoglobin and hematocrit. Both fall with GI bleeding.

Instruct the client to immediately report nausea, vomiting, dizziness, shortness of breath, or dark tarry stools. These signal GI bleeding.

Administer IV fluids, volume expanders, and blood products as ordered. Isotonic fluids, volume expanders, and blood products restore intravascular volume.

3. Reducing Anxiety

Assess the client's anxiety level. Peptic ulcer patients are often anxious without showing it.

Acknowledge the client's anxiety. Validates and accepts the feelings.

Encourage open expression of fears. Builds trust and reduces anxiety and stress.

Use simple language and brief statements. Moderate to severe anxiety limits comprehension to clear, brief instructions.

Decrease sensory stimuli; keep the environment quiet. Excess conversation, noise, and equipment can escalate anxiety toward panic.

Provide emotional support. Calms the client and lowers anxiety related to the condition.

Help the client develop anxiety-reducing measures: biofeedback, positive imagery, and behavior modification. Gives the client several ways to manage anxiety.

4. Patient Education and Health Teaching

Assess knowledge and misconceptions about peptic ulcer disease, lifestyle, and the treatment regimen. Accurate knowledge lets the client make informed decisions about medications and behavior change.

Explain the pathophysiology and how it affects the body. Understanding the disease fosters willingness to follow the plan and prevent recurrence.

Teach which signs and symptoms to report to the provider. Early recognition speeds treatment.

Discuss therapy options and their rationales. Correct use of antibiotics and acid suppression promotes rapid healing.

Discuss lifestyle changes to prevent complications and recurrence. Modifying alcohol, coffee and other caffeine, and overuse of aspirin or other NSAIDs prevents recurrent ulcers and complications during healing.