Peptic Ulcer Disease Pathophysiology (PUD)

ANSWER

Peptic Ulcer Disease Pathophysiology (PUD)
An imbalance between protective factors (mucus and bicarbonate secretion, epithelial cell repair, and adequate blood flow) and aggressive factors (gastric acid, pepsin, Helicobacter pylori infection, and NSAID use) causes the gastrointestinal mucosa to erode in Peptic Ulcer Disease (PUD). NSAID-induced mucosal injury and H. pylori infection are the most frequent causes.

Infection with H. pylori: The bacteria produce urease, which raises local ammonia levels, damages the epithelium, and permits stomach acid to pass through the mucosa, weakening the mucosal barrier. This exacerbates the development of ulcers by causing persistent inflammation (Cheung et al., 2022).
NSAIDs: Reduce the production of prostaglandins by inhibiting the cyclooxygenase (COX) enzymes. Because they increase blood flow and stimulate the release of mucus and bicarbonate, prostaglandins are essential for preserving the stomach lining. The use of NSAIDs undermines these defenses, resulting in ulcers and damage to the mucosa (Zagari et al., 2021).
Implications of PUD on the Environment, Economy, and Culture Cultural Implications:

Eating a lot of hot or acidic meals, for example, can make symptoms worse or slow the healing process.
People from cultures that place a strong emphasis on holistic or traditional cures, for instance, may put off obtaining medical attention.
Financial Consequences:

Treatment for PUD, which includes proton pump inhibitors (PPIs), antacids, and H. pylori eradication regimens, can be expensive, particularly for individuals who lack insurance or have inadequate insurance.
Financial burden and lost income might result from missed workdays brought on by symptom treatment or complications like bleeding ulcers.
Environmental Consequences:

The danger of H. pylori spread by tainted food or water is increased by unsanitary living circumstances or cramped quarters.
Stressful situations might make symptoms worse by causing the creation of more stomach acid.
Priority Interventions in Nursing After Discharge
Teach Medication Compliance:

Make sure PPIs or H2 receptor antagonists are used appropriately to lower the production of stomach acid and antibiotics are used to eradicate H. pylori.
To avoid recurrence, stress the importance of finishing the entire course of antibiotics.
Dietary Adjustments:

Encourage staying away from foods and drinks that upset the stomach, like alcohol, coffee, and spicy foods.
To control symptoms and avoid excessive stomach acid production, promote modest, frequent meals.
Handling Stress:

Reduce the amount of stomach acid secreted by stress by teaching relaxation techniques.
Keep an eye out for any complications:

Tell the client to report any symptoms of acute discomfort that doesn’t go away right away or any indications of gastrointestinal bleeding (such as black stools or blood in the vomit).
Promote Quitting Smoking:

Smoking raises the chance of recurrence and slows the healing of ulcers.
Diagnostic testing and labs
Complete Blood Count (CBC): Checks for anemia brought on by possible gastrointestinal hemorrhage. A large loss of blood is indicated by a low hematocrit or hemoglobin level.
Testing for H. pylori: Use a stool antigen or urea breath test to confirm eradication after treatment.
Tests for liver function (LFTs): Distinguish concurrent hepatic dysfunction, which can make managing PUD more difficult.
When resistant ulcers occur, esophagogastroduodenoscopy (EGD) can be used to assess healing progress and rule out cancer.
Crucial Signs:

Continuous bleeding may be indicated by persistently low hemoglobin.
After therapy, positive H. pylori tests indicate reinfection or treatment failure.
Multidisciplinary Group Members
The primary care physician (PCP) is in charge of drug administration, follow-up treatment, and problem-spotting.
Gastroenterologist: Treats severe or refractory conditions and performs diagnostic tests such as EGD.
Dietitian: Offers tailored dietary advice to encourage recovery and stop symptoms from getting worse.
A pharmacist makes sure that patients are taking their medications as prescribed, informs them of potential side effects, and looks for drug interactions.
A mental health counselor helps patients control their stress in order to keep their PUD symptoms from getting worse.
Justification: By addressing the medical, nutritional, and psychosocial aspects that contribute to PUD, a multidisciplinary approach ensures comprehensive care, supporting optimal healing and lowering the risk of recurrence (Cheung et al., 2022).

Citations
In 2022, Cheung, K. S., Leung, W. K., and Chan, F. K. Helicobacter pylori and NSAIDs play a part in the pathophysiology of peptic ulcer disease. Gastroenterology: Current Opinion, 38(5), 475-482. 1097/MOG.0000000000000853 https://doi.org
Camilleri, M., Zagari, R. M., and Stanghellini, V. (2021). Non-steroidal anti-inflammatory medications and peptic ulcer disease. North American Gastroenterology Clinics, 50(3), 361-379. 10.1016/j.gtc.2021.06.003 https://doi.org

 

 

 

 

QUESTION

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:

1. Thoroughly explain the pathophysiology of peptic ulcer disease. Use a scholarly or authoritative source to support your answer.
2. Examine each of the following three factors related to this disease process. Support all three with a scholarly source.
   1. cultural
   2. financial
   3. environmental implications
3. Identify 3-5 priority nursing interventions for the client after discharge home.
4. 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.
5. What members of the interdisciplinary team need to be included for holistic patient-centered care? Provide a rationale and support with a scholarly source.