PUD Flashcards
Characteristics of Gastrointestinal bleed
- Sudden, severe, and w/o vomiting
- May not have pain (common w/ NSAID use)
- Acute Hemorrhage (more on another card)
- Circulatory shock may develop
Characteristics of Acute hemorrhage from GI bleed
- Sudden weakness
- Dizziness
- Cold moist skin
- Passage of lost tarry stools
- Coffee ground emesis
Characteristics of Penetration
- Ulcer crater penetrates to adjacent organs
- Referred pain to sites other than abdomen, Intense and persistent
- Gradual increase in pain severity and frequency
Characteristics of Perforation
- Release GI contents into peritoneum
- Peritonitis causes sudden, intense epigastric pain
- Abdomen is tender to palpation, abd muscles are rigid,
- Hypoactive bowel sounds
- Abd distention and third spacing
Characteristics of Obstruction
-Interference with free passage of gastric contents
-Feeling full, epigastric fullness
-Heaviness post meals
-Gastric reflex
-Weight loss
-Abd pain
-Pain is worse at the end of the day
Severe obstruction: vomiting undigested food
What is the common cause of PUD?
H. pylori
What ulcer causes pain almost right after a meal (30-60min or 1-2hrs)?
Epigastric
Pain PQRST for Duodenal Ulcer
P: Burning or cramp like pain in midepigastric or back
Q: Hurts so bad they wake up in the middle of the night
R: Relieved by ingestion of food or antacids
T:2-5 hrs after meal
-Melena & well nourished
Conservative care for PUD
- Rest
- Bowel rest teaching
- No smoking or alcohol
- Stress management
- No NSAIDs or ASA 4-6 wks unless administered with PPI, H2 Receptor blocker, or misoprostol
Dietary Teaching
- Avoid spicy foods, caffeine, alcohol
- Six small meals
- Increase fluid intake
- Discourage smoking
What are the 3 major complications from PUD?
- Hemorrhage
- Perforation (Most lethal - watch for shock)
- Gastric outlet obstruction (emergent)
How do you treat a gastric outlet obstruction?
- Decompress the stomach with NGT
- PPI or H2 receptor
- Pain management
- Fluid & electrolyte replacement
- Surgery or balloon dilation
Acute management for perforation
- Notify HCP
- Frequent VS
- No oral or NG intake
- IV fluids
- Pain management
- Antibiotics
- Prepare for surgery if needed
Acute management for gastric outlet obstruction
- NGT to suction, irrigate
- Monitor I/O
- Reposition patient bc NGT can get stuck to wall
- IV fluids & electrolyte replacement
- Gastric residual; if less than 200mL after clamped for 8-12 hrs begin oral intake; progress to solid
