CAMU, KIM D
BSN 3
ASSIGNMENT
A 55-year-old man is transferred to your unit from the intensive care unit following a head injury.
During your admission assessment, he complains of a burning sensation in his midepigastric area. On
examination, you note a distended abdomen with tenderness in the epigastric area.
A. What questions would you ask the patient?
- Lifestyle such as diet, smoking, drinking. - Bile works to break down fats we eat so the body
can absorb them. Ingesting a high fats diet, the gallbladder contracts significantly in response,
and combined with blocked ducts, this pressure can cause pain. Smoking also increases the
rate of bile salt reflux and the concentration of gastric bile salts, resulting in increased
duodenogastric reflux and a higher risk of gastric ulcer in smokers. Smoking and nicotine not
only create ulcers, but they also make ulcers induced by H. influenzae worse. And Heavy
alcohol consumption can increase the risk of pancreatitis
- What medication is he taking? - Aspirin damages the mucosa of the gastrointestinal tract in a
different way than NSAIDs do.
- Family history of ulcer disease? - Peptic ulcers are an infection with the
bacteriumHelicobacter pylori (H. pylori) and can be passed on from mother to child
B. What diagnostic tests would you anticipate and how would you prepare your patient for these?
- Barium- An upper GI series is ingesting a white chalky substance known as barium and then
having a series of x-rays taken to examine the stomach lining. When barium is present in the
x-rays, doctors can notice the ulcers.- Preparation for the patient:The first thing that I would
do is to explain the procedure to the patient. After That, I will ask him for informed consent.
If the patient has already signed the consent, I will discuss with him that he will be under
NPO for about 8 hrs before the swallowing test. I will ask him if he has an allergy to certain
drugs such as latex, tape, or anesthetic medicines, and also all the medicines that he is taking
including OTC drugs, supplements, etc. Then after these, wecan now proceed to the test
- Stool Sample - Stool specimens are analyzed for occult blood, gastric secretory tests are
performed, and biopsy and histology with culture are used to detect H. H. pylori can also be
detected by serologic testing, stool antigen assays, or a breath test.Preparation for the patient
- Blood Test - For H.pylori, you'll have to take an exam. A bacteria that can be found in the
stomach. Anemia will be checked with another test. When you don't have enough red blood
cells, you can develop anemia. You may need to take dietary supplements if you have low
levels of specific vitamins.- Preparation for the client:Before the client undergoes a blood test,
I will instruct him to avoid drinking or eating anything for 8-12 hrs, and may drink water.
Also, I will tell him that he should eat less fatty and fried foods, and avoid alcohol 1-2 days
prior to the test. He will need to avoid any physical activity and stress until the procedure is
done.
- Breath Test- You may be subjected to a test in which your breath is taken and examined for
stomach bacteria.- Preparation for the test:I will instruct the patient before the test to only eat
plain white bread or rice,plain white potatoes, broiled plain chicken or fish, water, or
unflavored tea.Also I will tell him to avoid eating or drinking anything, including water, in
the8 to 12 hours prior to his test. Smoking, chewing gum, mouthwash, are also restricted prior
to the test.
C. Describe your plan of nursing care for this patient
ASSESSME DIAGNOSI PLANNING INTERVEN RATIONAL INTERVEN
NT S TION E TION
Subjective: Acute pain After 24 1. Assess the ● Clients After hours
complains of related to hours of client's with gastric of nursing
burning inflammatio nursing pain,includin ulcers intervention,
sensation in n of gastric intervention, g the typically Patient was
his liningAEB Patient will location,char demonstrate be able to
midepigastri burning be able to acteristics,pr pain 1 to 2 report pain is
c area. sensation in report pain is ecipitating hours after relieved or
midepigastri relieved or factors, eating. The lessened
c area lessened onset,duratio client with
Objective: n,frequency, duodenal
distended quality,intens ulcers
abdomen ity, and demonstrates
with severity. pain 2 to 4
tenderness in hours after
the epigastric 2.Encourage eating or in
area The use of the middle of
nonpharmac the night.
ological pain Withboth
relief gastricand
measures: duodenalulce
Acupressure rs, the pain is
Biofeedback located in
Distraction the upper
Guided abdomen
Imagery andis
Massage intermittent.
Music patient may
Therapy report relief
after eating
3. Instruct or taking an
the client to antacid.
avoidNSAID
s such as NonPharmac
aspirin ological
relaxation
4. Instruct techniques
the client will decrease
that meals the
should be production
eaten of gastric
regularly acid,which
spaced in turn will
intervals in a reduce pain
relaxed
setting. These
medications
5.Administer may cause
The irritation of
prescribed the gastric
drug therapy: mucosa
Antacids
Antibiotics An irregular
Histamine schedule of
Receptor meals may
Antagonists interfere
Prostaglandi with the
n analogueS regular
administratio
n of
medications
These
Medications
Can treat the
infection,pro
mote healing
of the ulcer,
and reduce
gastric pain
