Formal case Presentation (care plan for  patient has duodenal ulcer caused by Nsaid usage )
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Formal case Presentation (care plan for patient has duodenal ulcer caused by Nsaid usage )

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Formal case Presentation (care plan for  patient has duodenal ulcer caused by Nsaid usage ) Formal case Presentation (care plan for patient has duodenal ulcer caused by Nsaid usage ) Presentation Transcript

  • Nsaid Induced Duodenal ulcer #1 Done By : Aya kamel Ali
  • SOAP Note Subjective : He complains of epigasteric abdominal pain , vague abdominal discomfort and dizziness He noticed darkening of stool one week ago the pain come between 1-3 am and relived by food He describes it of being moderately to severe
  • SOAP Note  Subjective , cont  Endoscopy shows multiple gastric ulcer  Manager of stressful job   His father died at age of 59 of shock due to severe GI bleeding 2ry to untreated PUD
  • SOAP Note Objective :  Hgb 11.0 mg/dL  Hct 33  Abd : Mild tenderness , no masses  Rect : Non-tender ; melenic stool found in rectal valut ; stool heme +ve  Endoscopy shows multiple gastric ulcer . 
  • Risk factors :      Nsaid use (ibuprofen) Age Smoking Family history Stress
  • Assessment  DRP Indication (Needs additional drug therapy ) Untreated condition A.S 55 year-old African-American male who suffers from epigastric abdominal pain 1 year ago which not relieved by using OTC antacid (Maalox & Bismuth subsalicylate ) needs additional drug therapy
  •  DRP ,,, cont Safety (adverse drug reaction ) Undesirable effect A.S 55 year-old African-American male who takes OTC bisthmus subsalicylate for epigasteric abdominal pain , but his condition become worse and develops bleeding as a side effect which increase risk of recuurance . he needs to stop using it .
  • Therapeutic goal Short term goal :  Prevent complication (perforation , penetration , obstruction , malignancy  promote ulcer healing Stop the ulcer bleeding  Symptomatic relive .
  • Long term goals :   Preventing recurrence and avoiding potential complications. Reduce financial cost of treatment .
  • Blatchford score According to blatchford score Patient has high risk of bleeding 
  • Pharmacological intervention :  Stop using ibuprofen to prevent further complication  Stop using bismuth subsalicylate to minimize the risk of bleeding .
  • Cont …    Add omeprazole 2o mg Bid Brand name : Gasec by mepha company Price 27 SR
  • Alternatives   Ranitidine double dose 300 mg q.i.d Endoscopy treatment
  • Non pharmacological intervention      Omega -3 fatty acids has anti-inflamatory effect help to protect the stomach from ulcers Acupuncture treatments . Endoscopy treatment . Injection therapy . Yoga practice to manage stress
  • Monitoring  Efficacy  Symptomatic improvement.  Safety  The appearance of adverse events like : muscle cramps, muscle weakness or limp feeling; seizures 
  • Monitoring Testing for H.pylori  Patients taking the test should stop taking PPIs for at least 2 weeks (they interfere with the test) and starve for 4 hours before.  Fecal Occult Blood Test CBC & Hemoglobin 
  • Follow up • •    Assess the adherence. Assess the signs and symptoms of progression of ulcer Follow up session should be scheduled 2-4 weeks after initiating the therapy. repeat endoscopy to confirm healing at 6 to 8 weeks. If ulcer healed decrease omeprazole dose gradually to maintenance dose to prevent recurrence.
  • Patient education :       Take omeprazole 1 hour before meals . Avoid spicy food and xanthin containing beverage and , drinks containing caffeine. Avoid heavy meals before bed time Smoking increases the amount of acid produced by the stomach . need smoking cessation plan . Encourage small frequent low caloric meals Avoid ulcerating drug e.g. NSAIDs ,Corticosteroid.