This document provides information on peptic ulcer disease, including its prevalence, risk factors, types, clinical manifestations, diagnosis, medical and surgical management, complications, nursing care, and follow up. Some key points:
- Peptic ulcers affect 4-10 per 1000 people in India and are more common in males aged 30-60. Risk factors include H. pylori infection, smoking, alcohol, NSAIDs.
- Types include acute, chronic, gastric, and duodenal ulcers. Chronic ulcers erode through the stomach/duodenal wall.
- Symptoms include abdominal pain relieved by food. Tests include endoscopy, biopsy to detect H. pylori.
- Treatment
Acid reflux occurs when the sphincter muscle at the lower end of your esophagus relaxes at the wrong time, allowing stomach acid to back up into your esophagus.
Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine. They're usually formed as a result of inflammation caused by the bacteria H. pylori, as well as from erosion from stomach acids. Peptic ulcers are a fairly common health problem.
Intestinal obstruction is a significant or mechanical blockage of intestine that occurs when food or stool can not move through the intestine.
These obstruction may be complete or partial.
A chronic, progressive disease characterized by widespread fibrosis(scarring) and nodule formation.
The development of cirrhosis is an insidious, prolonged course, usually after decades of chronic liver disease.
Acid reflux occurs when the sphincter muscle at the lower end of your esophagus relaxes at the wrong time, allowing stomach acid to back up into your esophagus.
Peptic ulcers are sores that develop in the lining of the stomach, lower esophagus, or small intestine. They're usually formed as a result of inflammation caused by the bacteria H. pylori, as well as from erosion from stomach acids. Peptic ulcers are a fairly common health problem.
Intestinal obstruction is a significant or mechanical blockage of intestine that occurs when food or stool can not move through the intestine.
These obstruction may be complete or partial.
A chronic, progressive disease characterized by widespread fibrosis(scarring) and nodule formation.
The development of cirrhosis is an insidious, prolonged course, usually after decades of chronic liver disease.
Gallstones are hardened deposits of bile that can form in your gallbladder. Bile is a digestive fluid produced in your liver and stored in your gallbladder. When you eat, your gallbladder contracts and empties bile into your small intestine (duodenum)
Image result for ulcerative colitis
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.
Ulcerative colitis (UC) is an inflammatory bowel disease. It causes irritation, inflammation, and ulcers in the lining of your large intestine (also called your colon). There's no cure, and people usually have symptoms off and on for life
Image result for gastritis
Gastritis is a general term for a group of conditions with one thing in common: inflammation of the lining of the stomach. The inflammation of gastritis is most often the result of infection with the same bacterium that causes most stomach ulcers.
Benign prostatic hyperplasia is an enlargement of the prostate gland resulting from an increase in the number of epithelial cells and stromal tissue and developing upward into the bladder and obstructing the outflow of urine.
Introduction, anatomy of GI tract, definition, cause & risk factors, pathophysiology, types, clinical manifestations, diagnostic tests, medical management, surgical management and nursing management, complications of Regional Enteritis/Crohn's Disease.
Gallstones are hardened deposits of bile that can form in your gallbladder. Bile is a digestive fluid produced in your liver and stored in your gallbladder. When you eat, your gallbladder contracts and empties bile into your small intestine (duodenum)
Image result for ulcerative colitis
Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.
Ulcerative colitis (UC) is an inflammatory bowel disease. It causes irritation, inflammation, and ulcers in the lining of your large intestine (also called your colon). There's no cure, and people usually have symptoms off and on for life
Image result for gastritis
Gastritis is a general term for a group of conditions with one thing in common: inflammation of the lining of the stomach. The inflammation of gastritis is most often the result of infection with the same bacterium that causes most stomach ulcers.
Benign prostatic hyperplasia is an enlargement of the prostate gland resulting from an increase in the number of epithelial cells and stromal tissue and developing upward into the bladder and obstructing the outflow of urine.
Introduction, anatomy of GI tract, definition, cause & risk factors, pathophysiology, types, clinical manifestations, diagnostic tests, medical management, surgical management and nursing management, complications of Regional Enteritis/Crohn's Disease.
This presentation is about peptic ulcer disease , including:Pathomorphology,etiology,symptoms,complications,diagnosis and pharmacotherapy,asurgical intervention and prevention...
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
5. RISK FACTORS
H. pylori,
Alcohol,
Smoking,
Cirrhosis,
Stress
Usually 50 and over
Male higher risk
Normal ,hyper secretion of stomach acid (HCl) (zollinger
Ellison syndrome)
Gastritis,
Use of NSAIDs
7. Acute
Is associated with superficial erosion and minimal
inflammation it is of short duration and resolves quickly
when the cause is identified and removed
8. Chronic
Chronic ulcer is one of long duration eroding through
the muscular wall with the formation of fibrous tissue it
may be present continuously for many months or
intermittently throughout the person’s life time
10. Comparison of gastric and deodenal ulcer
Gastric ulcers Duodenal ulcers
Lesion Superficial smooth margins ,not oval or
cone shaped
Penetrating
Associated with deformity of
duodenum from recurrent
healing
Location of
lesion
Predominantly antrum also in body and
funds
First 1-2 cm of duodenum
Gastric
secretion
Normal or decreased increased
Incidence
Greater in women
Peak age 50-60 yrs
Common in lower socio economic status
,increased with smoking use of drug use
and alcohol use seen in pyloric sphincter
and bile reflex
Greater women
Post menopausal women
higher risk
Associated with pyloric stress
Increased with smoking
alcohol and drug use associated
with other disease
COPD ,zollinger Ellison
syndrome chronic renal failure
Clinical
manifestation
Burning or gacious pressure in high left
epigastriam and back and upper abdomen
,pain 1-2 hrs after meal ,if penetrating
ulcer aggravation of discomfort with food
occasional nausea and vomiting
Burning,cramping pressure like
pain back pain
Recurrence
rate
high high
11. ETIOLOGY
stress and anxiety
gram-negative bacteria H. pylori
Stress
Excessesive secretion of HCL
Familial tendency
Blood group o
Use of NSAID
Alcohol
Excessive smoking
Hyperacidity
Gastrin secreting malignant tumors
Esophageal ulcers
GERD
12. PATHOPHYSIOLOGY
Peptic ulcer occurs mainly in the gastro duodenal
mucosa because this tissue cannot withstand the
digestive action of gastric acid HCl and pepsin. Vagus
nerve stimulates the parietal cells to secrete gastric acid.
The erosion is caused by the increased concentration or
activity of pepsin, or by decreased resistance of the
mucosa. A damaged mucosa cannot secrete enough
mucus to act as a barrier against HCl. The use of
NSAIDs inhibits the secretion of mucus that protects the
mucosa.
13.
14.
15. CLINICAL MANIFESTATIONS
dull, gnawing pain or a burning
Pain is usually relieved by eating
Tenderness
pyrosis (heartburn),
vomiting, constipation or diarrhea, and bleeding
burping
vomiting
bleeding
tarry stools
16. ASSESSMENT AND DIAGNOSTIC
FINDINGS
Pain,
Epigastric tenderness,
Abdominal distention.
A barium study
Stools study
Gastric secretory studies
H. Pylori infection
Breath test that detects H. Pylori
19. STRESS REDUCTION AND REST
Avoid stressful or exhausting situations
A rushed lifestyle
irregular schedule
Biofeed back
Hipnosis
Behavier modification
Change in job
20. SMOKING CESSATION
smoking decreases the secretion of bicarbonate from the
pancreas into the duodenum resulting in increased
acidity of the duodenum.
21. DIETARY MODIFICATION
avoiding
extremes of temperature
Over stimulation from consumption of meat extracts
alcohol,
coffee (including decaffeinated coffee)
Milk
cream
22. SURGICAL MANAGEMENT
Principles of surgery
Reduce acid secreting ability
Remove malignant or potentially malignant lesions treat
surgical emergency
Treat clients do not respond to medical intervention
23. VAGOTOMY
Vagotomy is performed to eliminate the acid secreting
stimulus to gastric cells
Truncal
Completely cutting each vagus nerve
Selective
The surgeon partially severs the nerves to preserve the
hepatic and celiac branches
Proximal
Only paritel cell mass is denerveted
26. GASTROENTEROSTOMY
Permits regurgitation of alkaline deodenal contents
thereby neutralizing gastric acid in this procedure a
drain is made on the bottom of the stomach and sewn to
an opening made in the jejunum
28. SUBTOTAL GASTERCTOMY
This is a genetic term referring to any surgery that
involves partial removal of the stomach may be
performed by either Billroth 1 or Billroth 2
29. BILLROTH GASTRECTOMY
Operation was devised more by accident than a surgery
design A gastro enterostomy was performed on a
gravely ill patient with a pyloric resection by Christian
Aiberl Theociot Billroth. 1829-1894, Professor of
Surgery, Vienna, Austria. Anton wolfler. 1850-1917,
Professor of Surgery, Prague, The Czech Republic
further refined the surgery The first successful
gastrectomy was performed by Billroth in January 1881,
and Wolfler performed the first gastroenterostomy in the
same year
30. BILROTH 1
The surgeon removes a part of distal portion of the
stomach including the andrum the remainder of the
stomach is anastomosed to duodenum this combined
procedure called gastrodeodenostomy this decreases
dumping syndrome
32. BILROTH II
This involves reanastomosis of the proximal remnant of
the stomach to the proximal jejunum pancreatic
secretions and bile continue to secrete in jejunum even
after surgery surgeons prefer Billroth 2 technique for
treatment of duodenal ulcers because recurrent ulcer
develops less frequent in this procedure
34. COMPLICATIONS
Dumping syndrome
Early dumping
Early dumping include abdominal and vasomotor
symptoms which are found in 5-10%of patients the
small bowel is filled with food from stomach which have
high osmotic load this lead to shift of fluid to
stomach from systemic circulation symptoms are
vertigo, tachycardia syncope sweating pallor palpitation
diarrhea and nausea etc
35. Late dumping
This is reactive hypoglycemia. The carbohydrate load
in the small bowel causes a rise in the plasma glucose
level, which, in turn, causes insulin levels to rise,
causing a secondary hypoglycemia. This can be easily
demonstrated by serial measurements of blood glucose
in a patient following a test meal. Other symptoms
include epigastric fullness distention discomfort
abdominal cramping nausea etc the treatment is
essentially the same as for early dumping
36. TREATMENT
The principal treatment is dietary manipulation, dry
meals are best, and avoiding fluids with a high carbo-
hydrate content
37. Other side effects
Hemorrhage
Marginal ulcers
Alkaline reflex gastritis
Nutritional deficiency ( Vitamin B12 and folic acid
deficiency)
38. FOLLOW-UP CARE
The likelihood of recurrence is reduced if the patient
avoids smoking, coffee (including decaffeinated coffee)
and their caffeinated beverages, alcohol, and ulcerogenic
medications (eg, NSAIDs)
39. NURSING PROCESS:
Assessment
Pain, (type timing, duration)
Use of antacids
Vomitus
Smoking
Use of alcohol
Use of NSAID
Eating habbits ,
Blood in stool
Physical examination
40. NURSING DIAGNOSES
Acute pain related to incresed gastric secretions ,decresed mucosal
protection ,and ingestion of gastric irritants as evidenced by burning
cramp like pain in epigastrium and abdomen
Nausea related to acute exacerbation of disease process as evidenced
by episodes of nausea and vomiting
Ineffective therapeutic regimen management related to lack of
knowledge of long term management of peptic ulcer disease and
consequence of not following treatment plan and unwillingness to
modify lifestyle as evidenced by frequent questions about home care
incorrect response to questions about peptic ulcer disease
42. RELIEVING PAIN
Pain relief can be achieved with prescribed
medications.
The patients hould avoid aspirin, foods and
beverages that contain caffeine, and decaffeinated
coffee,
meals should be eaten at regularly paced intervals
in a relaxed setting.
Some patients benefit from learning relaxation
techniques to help manage stress and pain and to
enhance smoking cessation efforts
43. REDUCING ANXIETY
The nurse assesses the patient’s level of anxiety.
Patients with peptic ulcers are usually anxious, but their anxiety is
not always obvious.
Appropriate information is provided at the patient’s level of
understanding, all questions are answered, and the patient is
encouraged to express fears openly.
Explaining diagnostic tests and administering medications on
schedule also help to reduce anxiety.
The nurse interacts with the patient in a relaxed manner, helps
identify stressors, and explains various coping techniques and
relaxation methods, such as biofeedback, hypnosis, or behavior
modification.
The patient’s family is also encouraged to participate in care and to
provide emotional support.
44. MAINTAINING OPTIMAL
NUTRITIONAL STATUS
assesses the patient for malnutrition and
weight loss.
After recovery from an acute phase of
peptic ulcer disease, the patients are
advised about the importance of
complying with the medication regimen
and dietary restrictions.
45. TEACHING PATIENTS SELF-CARE
Give information about medications to be taken at home, including name,
dosage, frequency, and possible side effects, stressing the importance of
continuing to take medications even after signs and symptoms have
decreased or subsided.
the patient is instructed to avoid certain medications and foods that
exacerbate symptoms as well as substances that have acid producing
potential (eg, alcohol; caffeinated beverages such as coffee, tea, and
colas).
It is important to counsel the patient to eat meals at regular times and in
a relaxed setting, and to avoid overeating
the nurse also informs the patient about the irritant effects of smoking on
the ulcer and provides information about smoking cessation programs.
The nurse reinforces the importance of follow-up care for approximately1
year,
the need to report recurrence of symptoms,
and the need for treating possible problems that occur after surgery,
such as intolerance to dairy products and sweet foods
47. Hemorrhage
1) Monitoring the hemoglobin and hematocrit to assist in evaluating
blood loss
2) Inserting an NG tube to distinguish fresh blood from “coffee
grounds” material, to aid in the removal of clots and acid, to
prevent nausea and vomiting, and to provide a means
monitoring further bleeding
3) Administering a room-temperature lavage of saline solution or
water. This is controversial; some authorities recommend using
ice lavage
4) Inserting an indwelling urinary catheter and monitoring urinary
output
5) Monitoring vital signs and oxygen saturation and administering
oxygen therapy
6) Placing the patient in the recumbent position with the legs
elevated to prevent hypotension; or, to prevent aspiration from
vomiting, placing the patient on the left side
7) Treating hemorrhagic shock
48. Perforation and Penetration
Hypotension and tachycardia, indicating shock
Because chemical peritonitis develops within a few hours after
perforation and is followed by bacterial peritonitis,
the perforationmust be closed as quickly as possible and
assesses the patient for peritonitis or localized infection
(increased temperature, abdominal pain, paralytic ileus,
increased or absent bowel sounds, abdominal distention).
Antibiotic therapy is administered parenteral as prescribed
Immediate surgical repair and haemodynamic stabilisation
49. Pyloric Obstruction
insert an NG tube to decompress the stomach. Confirmation that
obstruction is the cause of the discomfort is accomplished by
assessing the amount of fluid aspirated from the NG tube.
A residual of more than 400 mL strongly suggests obstruction .
Usually an upper GI study or endoscopy is performed to confirm
gastric outlet obstruction.
Decompression of the stomach and management of extracellular fluid
volume and electrolyte balances may improve the patient’s condition
and avert the need for surgical intervention.
A balloon dilatation of the pylorus via endoscopy may be beneficial.
If the obstruction is unrelieved by medical management, surgery (in
the form of a vagotomy andantrectomy or gastrojejunostomy and
vagotomy) may be required.
50. FOLLOW-UP CARE
Recurrence within 1 year may be prevented with the
prophylactic use of H2 receptor antagonists given at a
reduced dose.
all patients require maintenance therapy; it may be
prescribed only for those with two or three recurrences
per year,
The likelihood of recurrence is reduced if the patient
avoids smoking, coffee (including decaffeinated coffee)
and their caffeinated beverages, alcohol, and ulcerogenic
medications (eg, NSAIDs) etc