Peptic Ulcer Disease Therapy. Peptic Ulcer Disease Collaborative Care Medical regimen consists of...

download Peptic Ulcer Disease Therapy. Peptic Ulcer Disease Collaborative Care Medical regimen consists of Medical regimen consists of ï´ Adequate rest ï´ Dietary

of 46

  • date post

    23-Dec-2015
  • Category

    Documents

  • view

    218
  • download

    0

Embed Size (px)

Transcript of Peptic Ulcer Disease Therapy. Peptic Ulcer Disease Collaborative Care Medical regimen consists of...

  • Slide 1
  • Peptic Ulcer Disease Therapy
  • Slide 2
  • Peptic Ulcer Disease Collaborative Care Medical regimen consists of Medical regimen consists of Adequate rest Dietary modification Drug therapy Elimination of smoking Long-term follow-up care
  • Slide 3
  • Peptic Ulcer Disease Collaborative Care Aim of treatment program Aim of treatment program degree of gastric acidity Enhance mucosal defense mechanisms Minimize harmful effects on mucosa
  • Slide 4
  • Peptic Ulcer Disease Collaborative Care Generally treated in ambulatory care clinics Generally treated in ambulatory care clinics Requires many weeks of therapy Pain disappears after 3 to 6 days
  • Slide 5
  • Peptic Ulcer Disease Collaborative Care Healing may take 3 to 9 weeks Healing may take 3 to 9 weeks Should be assessed by means of x-rays or endoscopic examination Moderation in daily activity is essential Moderation in daily activity is essential NSAIDs that are COX-2 inhibitors are used NSAIDs that are COX-2 inhibitors are used
  • Slide 6
  • Peptic Ulcer Disease Drug Therapy Includes use of Includes use of Antacids H 2 R blockers PPIs Antibiotics Anticholinergics Cytoproctective therapy
  • Slide 7
  • Peptic Ulcer Disease Drug Therapy Recurrence of peptic ulcer is frequent Recurrence of peptic ulcer is frequent Interruption or discontinuation of therapy can have detrimental results No drugs, unless prescribed by health care provider, should be taken No drugs, unless prescribed by health care provider, should be taken Ulcerogenic effect
  • Slide 8
  • Peptic Ulcer Disease Drug Therapy Histamine- 2 receptor blocks (H 2 R blockers) Histamine- 2 receptor blocks (H 2 R blockers) Used to manage peptic ulcer disease Block action of histamine on H 2 receptors HCl acid secretion conversion of pepsinogen to pepsin ulcer healing
  • Slide 9
  • Peptic Ulcer Disease Drug Therapy Proton pump inhibitors (PPI) Proton pump inhibitors (PPI) Block ATPase enzyme that is important for secretion of HCl acid Antibiotic therapy Antibiotic therapy Eradicate H. pylori infection No single agents have been effective in eliminating H. pylori
  • Slide 10
  • Peptic Ulcer Disease Drug Therapy Antacids Antacids Used as adjunct therapy for peptic ulcer disease gastric pH by neutralizing acid Anticholinergic drugs Anticholinergic drugs Occasionally ordered for treatment cholinergic stimulation of HCl acid
  • Slide 11
  • Peptic Ulcer Disease Drug Therapy Cytoprotective drug therapy Cytoprotective drug therapy Used for short-term treatment of ulcers Tricyclic antidepressants Tricyclic antidepressants Serotonin reuptake inhibitors Serotonin reuptake inhibitors
  • Slide 12
  • Peptic Ulcer Disease Nutritional Therapy Dietary modifications may be necessary so that foods and beverages irritating to patient can be avoided or eliminated Dietary modifications may be necessary so that foods and beverages irritating to patient can be avoided or eliminated Nonirritating or bland diet consisting of 6 small meals a day during symptomatic phase Nonirritating or bland diet consisting of 6 small meals a day during symptomatic phase
  • Slide 13
  • Peptic Ulcer Disease Nutritional Therapy Include a sample diet with a list of foods that usually cause distress Include a sample diet with a list of foods that usually cause distress Hot, spicy foods and pepper, alcohol, carbonated beverages, tea, coffee, broth Foods high in roughage may irritate an inflamed mucosa Foods high in roughage may irritate an inflamed mucosa
  • Slide 14
  • Peptic Ulcer Disease Nutritional Therapy Protein considered best neutralizing food Protein considered best neutralizing food Stimulates gastric secretions Carbohydrates and fats are least stimulating to HCl acid secretion Carbohydrates and fats are least stimulating to HCl acid secretion Do not neutralize well
  • Slide 15
  • Peptic Ulcer Disease Nutritional Therapy Milk can neutralize gastric acidity and contains prostaglandins and growth factors Milk can neutralize gastric acidity and contains prostaglandins and growth factors Protects GI mucosa from injury
  • Slide 16
  • Peptic Ulcer Disease Therapy Related to Complications Acute exacerbation Acute exacerbation Treated with same regimen used for conservative therapy Situation is more serious because of possible complications of perforation, hemorrhage, gastric outlet obstruction Accompanied by bleeding, pain and discomfort, nausea, vomiting
  • Slide 17
  • Peptic Ulcer Disease Therapy Related to Complications Acute exacerbation (cont.) Acute exacerbation (cont.) Recurrent vomiting, gastric outlet obstruction NG tube placed in stomach with intermittent suction for about 24 to 48 hours Fluids and electrolytes are replaced by IV infusion until patient is able to tolerate oral feedings without distress
  • Slide 18
  • Peptic Ulcer Disease Therapy Related to Complications Acute exacerbation (cont.) Acute exacerbation (cont.) Management is similar to that for upper GI bleeding Blood or blood products may be administered Careful monitoring of vital signs, intake and output, laboratory studies, signs of impending shock
  • Slide 19
  • Peptic Ulcer Disease Therapy Related to Complications Acute exacerbation (cont.) Acute exacerbation (cont.) Endoscopic evaluation reveals degree of inflammation or bleeding and ulcer location 5-year follow-up program is recommended
  • Slide 20
  • Peptic Ulcer Disease Therapy Related to Complications Perforation Perforation Immediate focus to stop spillage of gastric or duodenal contents into peritoneal cavity and restore blood volume NG tube is placed into stomach Placement of tube as near to perforation site as possible facilitates decompression
  • Slide 21
  • Peptic Ulcer Disease Therapy Related to Complications Perforation (cont.) Perforation (cont.) Circulating blood volume must be replaced with lactated Ringers and albumin solutions Blood replacement in form of packed RBCs may be necessary Central venous pressure line, indwelling urinary cater should be inserted and monitored hourly
  • Slide 22
  • Peptic Ulcer Disease Therapy Related to Complications Gastric outlet obstruction Gastric outlet obstruction Decompress stomach Correct any existing fluid and electrolyte imbalances Improve patients general state of health NG tube inserted in stomach, attached to continuous suction to remove excess fluids and undigested food particles
  • Slide 23
  • Peptic Ulcer Disease Therapy Related to Complications Gastric outlet obstruction (cont.) Gastric outlet obstruction (cont.) Continuous decompression allows Stomach to regain its normal muscle tone Ulcer can begin to heal Inflammation and edema subside When aspirate falls below 200 ml, within normal range, oral intake of clear liquids can begin
  • Slide 24
  • Peptic Ulcer Disease Therapy Related to Complications Gastric outlet obstruction (cont.) Gastric outlet obstruction (cont.) Watch patient carefully for signs of distress or vomiting IV fluids and electrolytes are administered according to degree of dehydration, vomiting, electrolyte imbalance
  • Slide 25
  • Peptic Ulcer Disease Nursing Management Overall Goals Overall Goals Comply with prescribed therapeutic regimen Experience a reduction or absence of discomfort related to peptic ulcer disease
  • Slide 26
  • Peptic Ulcer Disease Nursing Management Overall Goals (cont.) Overall Goals (cont.) Exhibits no signs of GI complications Have complete healing Lifestyle changes to prevent recurrence
  • Slide 27
  • Peptic Ulcer Disease Nursing Implementation Health Promotion Health Promotion Identify patients at risk Early detection and morbidity Encourage patients to take ulcerogenic drugs with food or milk Teach patients to report symptoms related to gastric irritation to health care provider
  • Slide 28
  • Peptic Ulcer Disease Nursing Implementation Acute Intervention Acute Intervention Patient generally complains of pain, nausea, vomiting, and some bleeding May be maintained on NPO status for a few days, have NG tube inserted, fluids replaced intravenously Physical and emotional rest are conducive to ulcer healing
  • Slide 29
  • Peptic Ulcer Disease Nursing Implementation Hemorrhage Hemorrhage Changes in vital signs, in amount and redness of aspirate signal massive upper GI bleeding amount of blood in gastric contents pain because blood helps neutralize acidic gastric contents Keep blood clots from obstructing NG tube
  • Slide 30
  • Peptic Ulcer Disease Nursing Implementation Perforation Perforation Sudden, severe abdominal pain unrelated in intensity and location to pain that brought patient to hospital
  • Slide 31
  • Peptic Ulcer Disease Nursing Implementation Perforation (cont.) Perforation (cont.) Indicated by a rigid, boardlike abdomen Severe generalized abdominal and shoulder pain Shallow, grunting respirations
  • Slide 32
  • Peptic Ulcer Disease Nursing Implementation Perforation (cont.) Perforation (cont.) Ensure any known allergies are reported on chart Antibiotic therapy is usually started Surgical closure m