ANSWER
Peptic Ulcer Disease Pathophysiology (PUD)
When the stomach or duodenum’s protective mucosal lining deteriorates, ulceration results, which is known as peptic ulcer disease (PUD). There is an imbalance between defensive mechanisms (mucosal barrier, bicarbonate, and prostaglandins) and aggressive forces (gastric acid and pepsin). The most frequent causes are chronic use of nonsteroidal anti-inflammatory medicines (NSAIDs), which weaken the mucosal barrier, and Helicobacter pylori (H. pylori) infection. Urease, which is produced by H. pylori, neutralizes stomach acid and permits bacterial colonization by converting urea into ammonia. NSAIDs further harm the lining by inhibiting prostaglandins, which lowers mucosal blood flow and bicarbonate output. Ulcers develop when mucosal damage surpasses the body’s ability to heal itself. (Sung and others, 2020).
Implications for Culture, Finance, and the Environment
Implications for Culture
PUD may be impacted by cultural customs including traditional medicine and eating habits. High intakes of alcohol or spicy meals may make symptoms worse in some cultures. Furthermore, the shame attached to getting medical assistance may cause treatment to be delayed, which may increase difficulties.
Financial Consequences
PUD treatment can be costly, particularly for people without insurance. This includes the price of follow-up care, drugs (such antibiotics and proton pump inhibitors), and diagnostic tests (like endoscopies). Financial limitations raise the risk of complications like bleeding or perforation by causing treatment to be delayed or medication adherence to be poor (Leontiadis et al., 2019).
Effects on the Environment
Living circumstances and exposure to tainted food or water might raise the chance of contracting H. pylori. By raising the production of stomach acid, stressful situations or work-related stress can potentially make symptoms worse.
Nursing Interventions of Priority Following Discharge
Medication Adherence Education: Make sure the client is aware of the significance of taking the antibiotics prescribed for H. pylori and following the instructions for proton pump inhibitor (PPI) medication.
Lifestyle Changes: Teach the client to abstain from irritants such as alcohol, coffee, NSAIDs, and smoking.
Dietary Advice: Suggest a well-rounded diet, steering clear of items high in acidity and spice that could exacerbate symptoms.
Symptom Tracking: Tell the client to keep an eye out for any warning indications of complications, like severe abdominal pain or black, tarry stools, which could indicate bleeding.
Stress Management: Provide strategies for reducing stress because it might worsen symptoms by causing the stomach to secrete more acid.
Labs and Diagnostic Testing to Track H. pylori Testing: Make careful to undertake follow-up testing with endoscopy, stool antigen testing, or urea breath testing to verify eradication.
Check for anemia, which could be a sign of gastrointestinal bleeding, using the complete blood count (CBC).
Fecal Occult Blood Test (FOBT): Check for concealed blood in feces to find bleeding that is still occurring.
Liver Function Tests: Determine whether liver disease is a contributing issue, as this could change the course of treatment.
Critical Indicators: Positive occult blood tests, deteriorating hemoglobin, and ongoing symptoms all call for prompt medical attention.
(Sung and others, 2020)
Multidisciplinary Group Members
The primary care provider (PCP) is in charge of monitoring follow-up care and modifying treatment plans as needed.
Endoscopy and other diagnostic procedures are carried out by gastroenterologists, who also handle problems.
A dietitian offers nutritional advice based on the client’s health and cultural preferences.
A pharmacist makes ensuring that medications are managed appropriately, taking into account adverse effects and drug interactions.
A mental health counselor deals with the psychological factors that exacerbate PUD.
Justification: By addressing the medical, dietary, psychological, and behavioral variables that contribute to PUD, a multidisciplinary approach guarantees holistic care. Cooperation lowers problems and improves treatment adherence.
Citations
Molloy-Bland, M., Moayyedi, P., Leontiadis, G. I., & Howden, C. W. (2019). Comorbidity’s impact on mortality in peptic ulcer bleeding patients: a systematic review and meta-analysis. Gastroenterology in America, 114(8), 1296–1308.
El-Serag, H. B., Kuipers, E. J., and Sung, J. J. Y. (2020). Systematic review: Peptic ulcer disease prevalence and incidence worldwide. 51(7), 749–758; Alimentary Pharmacology & Therapeutics. 10.1111/apt.15681 https://doi.org/10.1111
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:
- 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? Provide a rationale and support with a scholarly source.