Peptic ulcer is an erosion of gastrointestinal mucosa caused by too much hydrochloric acid and pepsin. Although ulcers can occur in the esophagus, the most common location is the duodenum and stomach (Wardell, 1990).
Chronic ulcers can penetrate the muscular wall. Recovery resulted in the formation of fibrous tissue and eventually permanent scarring. Ulcers can be recovered or recovered several times throughout one's life.
Peptic ulcers are sores on the mucous membranes of the esophagus, stomach and duodenum, which is caused by gastric work.
The main complications related to peptic ulcer disease, in general, are:
- Hemorrhage, evidenced by hematemesis and guaiac positive fesses.
- Perforation, evidenced by the sudden onset of severe pain accompanied by abdominal stiff as a board and symptoms of shock.
- Obstruction. This complication is more common in duodenal ulcer that is located near the pylorus. It is caused by constriction of gastric outlet as a result of edema and scar tissue from recurrent ulcers.
- Increased production of stomach acid.
- Stress.
- Blood type.
- Cigarette smoke.
- Resistance of the lower hull.
- H. pylori infection. H. pylori bacteria can injure the mucous membranes and mucous membranes lose durability. In addition, the body will form antibodies to fight bacterial inflammatory reactions such as side effects but will cause damage to mucous membranes.
- Non-steroidal antiinflamatory drugs (NSAIDs) Drugs NSAIDs will lead to an increase in gastric acid spending, and reducing the protection of the mucous membrane of the stomach acid.
Signs and Symptoms
- Pain is felt after eating.
- Pain midnight.
- Disappear after eating.
- Bleeding, ulcers when active.
- Heartburn sore, commonly occurs 2-3 hours after eating, it gets better when filled with food or an antacid medication was given.
- Patients often wake up at night because of the pain.
- Pain may spread to the waist.
- Nausea.
- Vomiting.
- Discomfort in the pit of the stomach, accompanied by belching, bloating and not resistant to fatty foods.
- Burning feeling in the chest and discomfort in the chest.
- Loss of appetite, weight loss.
- On inspection dirt can be found occult blood.
- Vomiting blood.
Nursing Diagnosis : Risk for Fluid Volume Deficit
related to excessive blood loss secondary to peptic ulcer disease.
Defining characteristics :
- Stool guaiac positive,
- Black stool passage,
- Coffee ground vomiting,
- Drop in blood pressure accompanied by tachycardia, tachypnea, wet moist skin, stating thirst, decreased urine output.
Goal : Demonstrate no signs of acute inflammation.
Outcomes: soft brown stool passage, hemoglobin and hematocrit within normal limits.
Intervention:
- Vital signs every 4 hours, when the stool guaiac positive.
- The color and consistency of stool (fecal guaiac all if bleeding does not appear)
- Coffee ground vomiting.
- Tell your doctor about Coffee ground vomiting, black stool, emesis or stool bright red, a decrease in blood pressure accompanied by tachycardia and tachypnea, cool moist skin, or hemoglobin and hematocrit values below the normal range. Give blood transfusion according to program and monitor adverse reactions.
- Evaluate the effectiveness of the drug. Use infusion pump when giving this medicine with a continuous drip.
- Attach the hose NGT, and connect on intermittent suction according to the program if there is a bright red emesis. Maintain patency irritate the hose with cold normal saline.
- Maintain fasting to order in case of vomiting. Provide appropriate intravenous therapy programs. Use the 18-G needle to start an intravenous infusion when blood transfusion is needed.
- If the patient has weakness and dizziness, place bedpan beside the bed and toileting aids as needed. Instruct the patient to signal for help when getting out of bed.
- Maintain bed rest if active bleeding occurs.
- Prepare patients for surgery or sclerosing to order.
- To evaluate the effectiveness of therapy.
- Emesis coffee color indicates blood mixed with gastric. Black stool (melena) indicates the gastro intestinal bleeding. Emesis or stool red light indicates active bleeding. Excessive blood loss can cause anemia, evidenced by the low hemoglobin and hematocrit and symptoms of shock.
- NGT intubation route to give gastric lavage. Cold solution and vasopressin causes vasoconstriction.
- Hypovolemia cause rapid blood loss. Intravenous fluids help improve intravascular volume until the bleeding can be controlled. Blood transfusion should be administered through a large-diameter needle because of high viscosity.
- Bed rest reduces energy use and activity of the gastrointestinal tract.
- Surgery is required when drug therapy is not effective in controlling severe bleeding after 24 hours.