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 da...
SOAP Note


Subjective , cont



Endoscopy shows multiple gastric ulcer



Manager of stressful job




His father di...
SOAP Note
Objective :
 Hgb 11.0 mg/dL
 Hct 33
 Abd : Mild tenderness , no masses
 Rect : Non-tender ; melenic stool fo...
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...


DRP ,,, cont

Safety (adverse drug
reaction )

Undesirable effect

A.S 55 year-old African-American male who
takes OTC ...
Therapeutic goal
Short term goal :
 Prevent complication (perforation , penetration
, obstruction , malignancy
 promote ...
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 subsalicylat...
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 ...
Monitoring


Efficacy



Symptomatic improvement.



Safety



The appearance of adverse events like :
muscle cramps, ...
Monitoring
Testing for H.pylori
 Patients taking the test should stop taking
PPIs for at least 2 weeks (they interfere wi...
Follow up
•
•







Assess the adherence.
Assess the signs and symptoms of progression of
ulcer

Follow up session sho...
Patient education :









Take omeprazole 1 hour before meals .
Avoid spicy food and xanthin containing
beverage ...
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 )
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 )

  1. 1. Nsaid Induced Duodenal ulcer #1 Done By : Aya kamel Ali
  2. 2. 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
  3. 3. 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
  4. 4. 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 . 
  5. 5. Risk factors :      Nsaid use (ibuprofen) Age Smoking Family history Stress
  6. 6. 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
  7. 7.  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 .
  8. 8. Therapeutic goal Short term goal :  Prevent complication (perforation , penetration , obstruction , malignancy  promote ulcer healing Stop the ulcer bleeding  Symptomatic relive .
  9. 9. Long term goals :   Preventing recurrence and avoiding potential complications. Reduce financial cost of treatment .
  10. 10. Blatchford score According to blatchford score Patient has high risk of bleeding 
  11. 11. Pharmacological intervention :  Stop using ibuprofen to prevent further complication  Stop using bismuth subsalicylate to minimize the risk of bleeding .
  12. 12. Cont …    Add omeprazole 2o mg Bid Brand name : Gasec by mepha company Price 27 SR
  13. 13. Alternatives   Ranitidine double dose 300 mg q.i.d Endoscopy treatment
  14. 14. 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
  15. 15. Monitoring  Efficacy  Symptomatic improvement.  Safety  The appearance of adverse events like : muscle cramps, muscle weakness or limp feeling; seizures 
  16. 16. 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 
  17. 17. 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.
  18. 18. 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.

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