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
H. pylori is a type of bacteria that can live in the stomach acid. It is thought to cause PUD by irritating the lining of the stomach and duodenum and making it more susceptible to damage from acid and pepsin. Pepsin is a digestive enzyme that helps to break down food.
NSAIDs can also irritate the lining of the stomach and duodenum and make it more susceptible to damage from acid and pepsin. NSAIDs can also reduce the production of mucus, which helps to protect the lining of the stomach and duodenum from acid.
Other factors that can contribute to PUD include:
- Smoking
- Excessive alcohol consumption
- Zollinger-Ellison syndrome, a rare condition that causes the body to produce too much stomach acid
- Crohn's disease, an inflammatory bowel disease that can affect the stomach and duodenum
- Stress
Cultural implications of PUD
Cultural factors can influence the development and management of PUD. For example, in some cultures, there is a high prevalence of H. pylori infection. This is thought to be due to factors such as poor sanitation and overcrowding.
Cultural factors can also influence the symptoms that people with PUD experience. For example, people from some cultures may be more likely to experience abdominal pain, while people from other cultures may be more likely to experience nausea and vomiting.
Cultural factors can also influence the treatments that people with PUD choose to use. For example, some people may prefer to use traditional herbal remedies, while others may prefer to use conventional Western medicine.
Financial implications of PUD
PUD can have a significant financial impact on individuals and families. The cost of treatment can be high, especially for people who require surgery. People with PUD may also have to miss work due to their illness, which can lead to lost income.
In addition to the direct costs of treatment, PUD can also have indirect financial costs. For example, people with PUD may have to buy special foods or take dietary supplements. They may also have to travel long distances to see a specialist.
Environmental implications of PUD
Environmental factors can also play a role in the development of PUD. For example, people who live in areas with poor sanitation and overcrowding are more likely to be infected with H. pylori.
Environmental factors can also influence the severity of PUD. For example, people who live in areas with high levels of air pollution are more likely to experience severe PUD symptoms.
Priority nursing interventions for the client after discharge home
The following are 3-5 priority nursing interventions for the client after discharge home:
- Educate the client about PUD and its management. This includes teaching the client about the risk factors for PUD, the signs and symptoms of PUD, and the treatment options for PUD.
- Help the client to develop a treatment plan. This may involve working with the client to develop a dietary plan, a medication plan, and a lifestyle plan.
- Monitor the client's symptoms. This is important to ensure that the client's treatment plan is effective and that the client is not experiencing any serious complications.
- Provide support and counseling to the client. PUD can be a stressful condition, so it is important to provide the client with support and counseling to help them cope with their illness.
Labs and diagnostic testing to monitor for the client upon follow-up with her PCP
The following labs and diagnostic testing may be monitored for the client upon follow-up with her PCP:
- Complete blood count (CBC): This test can be used to check for anemia, which can be a complication of PUD.
- Basic metabolic panel (BMP): This test can be used to check for kidney function and electrolyte imbalances, which can be complications of PUD.
- Gastric panel: This test can be used to check for H. pylori infection and other stomach disorders.
- Upper endoscopy: This test can be used to visualize the lining of the stomach and duodenum and to look for ulcers.
Critical indicators
The following are critical indicators that the client's PUD is not improving or that the client is experiencing complications:
- Persistent abdominal pain
- Nausea and vomiting
- Black stools
- Tarry stools
- Bloody stools
- Weight loss