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Care Conference Perforated Gastric Ulcer

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Care Conference Perforated Gastric Ulcer

  1. 1. At the end of this session, you will be able to :  State the definition of PGU.  List the etiology of PGU.  Identify the pathophysiology of PGU.  State the sign & symptom of PGU.
  2. 2. LEARNING OBJECTIVES cont.  Identify the complication of PGU.  Understand regarding treatment of PGU.  Identify the nursing intervention & appreciate the nursing care for PGU patient.
  3. 3. PATIENT’S PROFILE  MR. A  MALE  79 YEARS OLD  FARMER
  4. 4. PATIENT’S PROFILE  WHEEL CHAIR  CALM  MEDICAL HISTORY – BPH since August 2013  ALLERGICS - UNKNOWN  D.O.A 24/9/13 @ 1220 Hrs
  5. 5. CURRENT MEDICATION  QUERY MEDICATION FROM GH FOR BPH
  6. 6. Mr A was admitted to 5XX-1 by wheel chair with complaint of abdomen pain & distended with LOA for few months, unable to pass motion X 3/7 and nauseated & vomited coffee ground 4 times since last night.
  7. 7. Seen by MO at A&E : - IV drip dextrose saline - Blood taken
  8. 8. Doctor = Dr DA Diagnosis Perforated Peptic Ulcer Disease
  9. 9. Seen by Dr DA at A&E : - IV drip 3 pint  1 pint Normal saline  1 pint Dextrose saline  1 pint D5% - Pre OT screening
  10. 10. Seen by Dr DA at A&E : - For OGDS & colonoscopy CM - Fleet 45ml at 0600hrs CM - Normal diet - Breakfast CM (only fluid)
  11. 11. VITAL SIGN       TEMPERATURE BLOOD PRESSURE PULSE RESPIRATION PAIN SCORE Weight : : : : : 37.2˚C 110/70mmHg 112 bpm 20 bpm 3 : 49 kg
  12. 12. ACTIVITY DAILY LIVING  Loss of appetite, nauseated and vomiting  Forgetful & weakness  Smoking  Ambulate using cane & need assistance in ADL  On pampers  Nocturia but now less only 3-4 times per night
  13. 13. PHYSICAL EXAMINATION
  14. 14. WHAT CAUSES Helicobacteria pyloriIT?  Aspirin  Ibuprofen  NSAIDs  Stress  Aging  Alcohol & smoking 
  15. 15. COMPLICATION • Peritonitis • Gastrointestinal bleeding • Gastric outlet obstruction • Cancer • Death
  16. 16. PRE OT SCREENING • Haemoglobin - 8.4 (13.0 – 18.0 g/dL) • Glucose - 5.5 (3.9 – 6.1 mmol/L) • HIV 1/11 antibodies - Non reactive • HBs antigen - Non reactive
  17. 17. TUMOR MARKER • Alpha-feto protein - 3 ug/L (<11) • Serum CA 19.9 - 4 U/ml (<32) • CEA - 0.9 (<5.1) • PSA - 0.5 ug/L (<6.6)
  18. 18. DRUGS IN WARD DATE ORDERED DATE OFF IV Controloc 40mg OD 24/9/13 27/9/13 IV Maxalon 10mg TDS 24/9/13 27/9/13 Tab Sangobion 1 OD 24/9/13 27/9/13 Tab Flagyl 400mg TDS 25/9/13 27/9/13
  19. 19. OGDS • Atropic chronic gastritis with tiny perforation
  20. 20. Colonoscopy • Query CA terminal ileum – small polyp 5cm
  21. 21. NURSING DIAGNOSIS  Potential fall related to weakness.
  22. 22. NURSING DIAGNOSIS  Alteration in nutritional status less than body requirement related to nausea, vomiting and loss of appetite.
  23. 23. NURSING DIAGNOSIS  Potential infection related to intravenous cannulation.

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