Peptic Ulcer

Patient: Mr. John Smith, a 55-year-old male Chief Complaint: Epigastric pain History of Present Illness: Mr. Smith presents to the emergency department with epigastric pain that has been getting worse over the past 2 weeks. He also reports heartburn, nausea, and vomiting. He has a history of peptic ulcer disease, which he has been taking medication for for the past 10 years. Past Medical History: Peptic ulcer disease, hypertension, hyperlipidemia Social History: Mr. Smith is a retired construction worker. He smokes 1 pack of cigarettes per day and drinks alcohol occasionally. He is married and has two adult children. Physical Examination:

• Vital signs: BP 140/90 mmHg, HR 100 bpm, RR 20 bpm, SpO2 98% on room air
• General: Well-developed, well-nourished male in no acute distress
• HEENT: Pupils equal, round, and reactive to light; Sclerae anicteric
• Neck: No jugular venous distension
• Lungs: Clear to auscultation
• Heart: Regular rate and rhythm, no murmurs, rubs, or gallops
• Abdomen: Soft, non-tender, non-distended; positive bowel sounds
• Extremities: No edema

Laboratory Studies:

• Complete blood count: Within normal limits
• Blood chemistry: Sodium 135 mEq/L, potassium 4.0 mEq/L, chloride 100 mEq/L, bicarbonate 24 mEq/L, glucose 120 mg/dL, creatinine 1.0 mg/dL, BUN 15 mg/dL
• Creatinine clearance: 60 mL/min
• Urinalysis: Negative for protein, glucose, and blood
• Upper endoscopy: Visible ulcer in the duodenum

Diagnosis: Duodenal ulcer Treatment Plan:

• Medications:
  • Proton pump inhibitor
  • Antibiotic (if H. pylori infection is present)
• Lifestyle modifications:
  • Smoking cessation
  • Weight loss
  • Increased physical activity
• Education:
  • Patient education about peptic ulcer disease and its complications
  • Importance of taking medications as prescribed
  • Lifestyle modifications to reduce risk of further complications

Nursing Interventions:

• Monitor vital signs and fluid status
• Administer medications as prescribed
• Provide patient education about peptic ulcer disease
• Encourage lifestyle modifications to reduce risk of further complications

Discussion Questions:

1. What are the risk factors for peptic ulcer disease?
2. What are the laboratory and diagnostic findings that are consistent with peptic ulcer disease?
3. What are the medications that are commonly used to treat peptic ulcer disease?
4. What are the lifestyle modifications that can help to reduce the risk of complications from peptic ulcer disease?
5. What are the nursing interventions that are important for the care of a patient with peptic ulcer disease?

Conclusion: Mr. Smith is a 55-year-old male with a history of peptic ulcer disease who presents with epigastric pain. His physical examination and laboratory studies are consistent with duodenal ulcer. He has been started on medications and has been given education about peptic ulcer disease. He will be monitored closely for further complications. Additional Information:

• Peptic ulcer disease is a condition in which an ulcer forms in the lining of the stomach or duodenum.
• The most common cause of peptic ulcer disease is infection with the bacterium Helicobacter pylori.
• Other risk factors for peptic ulcer disease include smoking, excessive alcohol consumption, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs).
• Treatment for peptic ulcer disease typically involves medications to reduce stomach acid and antibiotics to treat H. pylori infection.
• Lifestyle modifications, such as smoking cessation and weight loss, can also help to prevent peptic ulcer disease and its complications.

Sample Solution

History of Present Illness: Mr. Smith presents to the emergency department with epigastric pain that has been getting worse over the past 2 weeks.