A 37 year odlwoman with a 6 year history of peptic ulcer disease comes to the emergency room with acute abdominal pain described as intense burning for the last 3 hours. The patients admits to medicating herself with OTC products, including antacids 4 times a day and crimetidine (Tagamet, once a day)
1) What other information should the nurse elicit from the patient?
2) What should the nurse receive for her drug therapy and what teaching should the nurse incorporate into the plan of care?
pls....give me the right answer...its quite a hard for me to answer this question... Lets see ...
1) a.)she needs to ask if there has been a change of diet recently?
b) has she noticed any blood in her stool or emesis??
c.) what color is her stool??Is it tarry black?(tarry black stools could be a sign she has old blood in her stool)
d.) If she is throwing up has she noticed if there has been any coffee grounds looking stuff in her vomit?(This is also a sign of old blood)
e.)what part of the stomach is she burning in?
f) any other type of pain?Anywhere else?
g.)Do the otc medications work?If so for how long after taking them?
h) Whats her vital signs?(drops in bp and rise in pulse can be signs of internal bleeding)( a temp could mean infection)
i) has she ever had it come on this bad before? If so what helped? What tests were done at that time?results?
j) Do any certain foods make it worse??
okay on to the next question...
2.)a.) First of all some tests need to be ran before any medication therapy is began.....
Tests should/could include: a stool sample to check for occult blood, upper gi with a barium swallow, possibily a endoscopy of the upper digestive system should be set up..Blood work to rule out other causes(cbc,chem panel)
b)if every thing comes back ok as far as ruling out other illnesses such as gallbladder,heart problems, or appendix you could give the patient what I have always known to be called a GI Cocktail...Which is basically a mixture given in the situations at er's that is comprised of mylanta or maalox with vicious lidocaine and one other liquid stomach medication that my mind just went blank on..Most ER doctors will know this and that is who should be Rx'ing any meds in an er setting...
c) Now days its common for someone with a history of peptic ulcer disease to be given one of the several medications that have been shown to actually begin to heal the ulcer..Such as Protonix or Preveciad...
d) Now for pt teaching....
*The nurse needs to stress the importance of taking all medication as presribed..
* Report any worsening of symptoms
* Report any new symptoms..
*Watch bowel movements for black tarry stools and if vomiting watch for coffee ground type vomit..
* Avoid spicy foods and foods high in protien as those can aggrevate stomach symptoms..
*If possible use a board or brick to raise head of bed at home by 30 degrees to promote gravitational digestion..
* Eat several small meals thru-out the day instead of 3 large meals..
* Oh and make sure to stress to the patient that she not exceed the daily maximum listed on any bottle of tums or rolaids due to the fact they contain calcium and she could end up with hypercalcemia and that can affect her heart..
Thats all I can think of right off the top of my head...If I think of more I will try to come back and let you know... Oh one thing she needs to know is that often Heart problems in women can often mimmic stomach problems so if there is any doubt about her symptoms or if something just doesnt seem right that she needs to return to the ER asap....
Hope this helped.....
(please excuse any misspellings in this post,The spell check thing wouldnt work for me tonight) As the nurse, you would ask the following:
Besides Tagamet, does she take NSAIDs?
Any dark or black stools? (could be bleeding)
Is she vomiting blood, with a "coffee-ground" appearance?
Does she have another illness, such as liver, kidney or lung disease? Does she drink alcohol regularly?
Plan of Care would be as follows:
(Physician will prob order an upper endoscopy)
Your role as the nurse would be:
1. Control hemorrhage.
2. Achieve/maintain hemodynamic stability.
3. Promote stress reduction.
4. Provide information about disease process/prognosis, treatment needs, and potential complications.
Discharge goals would be as follows:
1. Hemorrhage curtailed
2. Hemodynamically stable
3. Anxiety/fear reduced to manageable level.
4. Disease process/prognosis, therapeutic regimen, and potential complications understood
5. Plan in place to meet needs after discharge.
Drug Therapy would be as follows:
Combination drug therapy to treat a peptic ulcer caused by Helicobacter pylori (H. pylori) infection involves taking two antibiotics, a proton pump inhibitor, and sometimes a bismuth-containing medication. |
