PEPTIC ULCER DISEASE CASE STUDY

A patient in the ED has been experiencing upper abdominal pain after meals for the past 2 months. She also notices that when she takes a nap or sleeps at night, she has pain. Eating seems to decrease the pain. She has been taking OTC antacids with some relief. The nurse understands that which assessment factor places the patient at risk for peptic ulcer disease? ​

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• GERD 4 years ago​

• Weight loss of 35 pounds

• Use of NSAIDs to control arthritis pain​

  D. Use of prednisone (Deltasone) for inflammation​

• Use of prednisone (Deltasone) for inflammation​

Which diagnostic results support the diagnosis of peptic ulcer disease (PUD)? (Select all that apply.)

• Low hemoglobin (Hgb)​

• Low white blood cell (WBC) level​

• Low white blood cell (WBC) level​

• Low white blood cell (WBC) level​

• Low potassium of 3.4 mEq/L​

Answer explanation

A,C,D

An EGD confirms that the patient has PUD. Three hours later, the patient is admitted to the medical unit for workup and further testing. On admission the patient reports midline epigastric tenderness and indigestion (dyspepsia). The patient is prescribed triple therapy.​

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Which drugs will the nurse expect to be prescribed for the patient at this time?​

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  Proton pump inhibitor (PPI) and two antibiotics

• Antibiotic and two PPIs

• Histamine antagonist, antacid, and PPI

• Antacid, PPI, and prostaglandin analogue

Answer explanation

A

Which patient statement would cause the nurse to suspect that she may have Zollinger-Ellison syndrome (ZES)? 

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  “I can’t lie flat for awhile after I’ve eaten.

• “I feel much better after taking Zantac (ranitidine).”

• “Occasionally I have pain in my left lower quadrant.”

• “The stomach pain hurts, but the foul-smelling diarrhea is worse.”

Answer explanation

D

Symptoms of ZES are similar to those of peptic ulcer disease. Diarrhea occurs in almost half of patients, which may be associated with large amounts of hydrochloric acid secreted into the proximal duodenum. The other statements are not associated with ZES

As the patient prepares for discharge, the nurse provides education about behaviors that reduce symptoms and aggravate peptic ulcers.​

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Which teaching does the nurse provide? (Select all that apply.)​

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  Sit upright 30 to 60 minutes after meals.​

• Spices should be added to food to enhance flavor.​

• Extreme vomiting should be reported to your physician.​

• H. pylori can be a concern in patients with peptic ulcers.​

• The goal of initial intervention is to control symptoms and prevent further complications.​

Answer explanation

A,C,D.E