You are caring for 39-year-old Kali Kim-Collins who arrived for follow-up care at her primary physician's office after being discharged from the emergency department with peptic ulcer disease. Mrs. Collins went to the emergency department after experiencing severe gastric pain for three days. She reported the pain was relieved after eating.
Based on this information, your prior knowledge of this client (refer to medical card from the Collins-Kim family tree interactive), and your knowledge of the pathophysiology of peptic ulcer disease, respond to the following prompts:
- Thoroughly explain the pathophysiology of peptic ulcer disease. Use a scholarly or authoritative source to support your answer.
- Examine each of the following three factors related to this disease process. Support all three with a scholarly source.
- cultural
- financial
- environmental implications
- Identify 3-5 priority nursing interventions for the client after discharge home.
- Describe labs and diagnostic testing you would anticipate monitoring for the client upon follow-up with her PCP. What are critical indicators? Support with a scholarly source.
- What members of the interdisciplinary team need to be included for holistic patient-centered care?
Full Answer Section
Cultural implications of peptic ulcer disease
Peptic ulcer disease is a common condition that affects people of all cultures. However, there are some cultural factors that can increase the risk of developing PUD. For example, people who eat a diet high in spicy foods or who drink a lot of coffee or alcohol are at increased risk of developing PUD.
Financial implications of peptic ulcer disease
Peptic ulcer disease can be a costly condition to treat. The cost of medications, doctor's visits, and other medical expenses can add up. Additionally, people with PUD may be unable to work due to their symptoms, which can lead to financial hardship.
Environmental implications of peptic ulcer disease
The environment can play a role in the development of peptic ulcer disease. For example, people who live in areas with high levels of air pollution are at increased risk of developing PUD. Additionally, people who work in certain jobs, such as those who are exposed to chemicals or solvents, are also at increased risk.
Priority nursing interventions for the client after discharge home
The following are some priority nursing interventions for the client after discharge home:
- Educate the client about the causes and prevention of PUD. This includes teaching the client about the importance of avoiding NSAIDs, smoking, and excess alcohol consumption.
- Teach the client about the signs and symptoms of PUD. This will help the client to identify early signs of a recurrence so that they can seek medical attention promptly.
- Provide the client with information about medications and therapies. This includes teaching the client about the proper way to take their medications and any potential side effects.
- Encourage the client to follow a healthy diet. This includes eating a balanced diet that is low in spicy foods and caffeine.
- Encourage the client to manage stress. This includes teaching the client relaxation techniques and coping mechanisms.
Labs and diagnostic testing to monitor for the client upon follow-up with her PCP
The following are some labs and diagnostic testing that the client's PCP may monitor:
- Complete blood count (CBC): A CBC can be used to check for anemia, which can be a sign of blood loss from an ulcer.
- Basic metabolic panel (BMP): A BMP can be used to check for electrolyte imbalances, which can occur from dehydration or vomiting.
- Stool guaiac test: A stool guaiac test is a test to check for blood in the stool. This test can be used to diagnose PUD or to monitor for bleeding from a recurrence.
- Upper endoscopy: An upper endoscopy is a procedure that uses a thin, flexible tube with a camera on the end to examine the stomach and duodenum. This procedure can be used to diagnose PUD and to identify any complications, such as bleeding or scarring.
Critical indicators
The following are some critical indicators that the client's PCP will monitor:
- Severe abdominal pain: Severe abdominal pain is a sign of a recurrence of PUD or a complication, such as bleeding or perforation.
- Vomiting of blood or coffee-ground material: Vomiting of blood or coffee-ground material is a sign of bleeding from an ulcer.
- Black, tarry stools: Black, tarry stools are a sign of bleeding from an ulcer.
- Dizziness or lightheadedness: Dizziness or lightheadedness can be a sign of dehydration or anemia, which can occur from blood loss from an ulcer.
- Rapid heart rate: A rapid heart rate can be a sign of shock, which can occur from severe blood loss.
Members of the interdisciplinary team to include for holistic patient-centered care
The following are some members of the interdisciplinary team that need to be included for holistic patient-centered care:
Sample Answer
Pathophysiology of peptic ulcer disease
Peptic ulcer disease (PUD) is a condition that occurs when the lining of the stomach or duodenum (the first part of the small intestine) is damaged by acids or pepsin. Pepsin is a digestive enzyme that breaks down protein.
PUD can be caused by a number of factors, including:
- Helicobacter pylori (H. pylori) infection: H. pylori is a bacteria that can live in the stomach lining. It can cause inflammation and damage the stomach lining, leading to ulcers.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs are over-the-counter and prescription medications that are used to reduce pain and inflammation. However, they can also irritate the stomach lining and cause ulcers.
- Smoking: Smoking increases the production of acid in the stomach and reduces the production of mucus, which protects the stomach lining from acid.
- Excess alcohol consumption: Alcohol can irritate the stomach lining and increase the production of acid.
- Stress: Stress can increase the production of acid in the stomach.