Nursing Diagnosis for Peptic Ulcer: Complete Guide, Interventions, and Patient Care
A peptic ulcer is an open sore that develops on the inner lining of the stomach (gastric ulcer) or the upper part of the small intestine, specifically the duodenum (duodenal ulcer). This condition occurs when the protective mucosal layer becomes damaged, allowing stomach acid and digestive enzymes to erode the tissue beneath. Peptic ulcer disease (PUD) is a common gastrointestinal disorder that affects millions of people worldwide and can significantly impair quality of life if not properly managed.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the most common causes of peptic ulcers are infection with Helicobacter pylori (H. pylori) bacteria and prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, aspirin, and naproxen. Contrary to common myths, stress and spicy foods do not directly cause ulcers but may aggravate symptoms.
What Is a Peptic Ulcer?
A peptic ulcer forms when the mucosal barrier that protects the stomach and duodenum from hydrochloric acid breaks down. Once the mucosa is compromised, the acid begins to erode the tissue, causing inflammation, pain, and sometimes bleeding. If not treated, peptic ulcers can lead to severe complications, including perforation, gastric outlet obstruction, and internal bleeding.
Types of Peptic Ulcers
- Gastric Ulcer: Occurs in the stomach lining.
- Duodenal Ulcer: Occurs in the duodenum; these are more common than gastric ulcers.
- Esophageal Ulcer: Occurs in the lower esophagus, often due to chronic acid reflux.
Common Causes of Peptic Ulcers
The balance between digestive acids and the protective mucosal lining determines whether an ulcer develops. When this balance is disturbed, ulcer formation becomes more likely. Major causes include:
- Helicobacter pylori infection: Responsible for more than 70% of peptic ulcer cases worldwide. This bacterium weakens the mucous coating, making it easier for acid to damage the stomach lining.
- Long-term NSAID use: NSAIDs inhibit prostaglandins that protect the gastric mucosa, increasing the risk of ulcers.
- Alcohol and smoking: These do not directly cause ulcers but delay healing and worsen symptoms.
- Genetics: A family history of PUD may increase susceptibility.
- Physiological stress: Severe illness, trauma, or major surgery can cause stress ulcers.
Symptoms of Peptic Ulcer
The hallmark symptom of a peptic ulcer is a burning or gnawing pain in the stomach. This pain typically:
- Comes and goes over days or weeks
- Occurs when the stomach is empty, such as at night or early morning
- Improves temporarily after eating food
- Returns when the stomach empties again
Other Symptoms Include:
- Nausea and vomiting
- Bloating and belching
- Dark, tarry stools (sign of bleeding)
- Weight loss
- Loss of appetite
If severe symptoms such as vomiting blood or sudden sharp abdominal pain occur, immediate medical attention is required as these may indicate perforation or hemorrhage.
Complications of Untreated Peptic Ulcer
- Internal bleeding leading to anemia
- Perforation (a hole in the stomach or duodenal wall)
- Gastric outlet obstruction from swelling or scarring
- Infection spreading into the abdominal cavity (peritonitis)
Treatment of Peptic Ulcer
The primary goals of treatment are to relieve symptoms, promote healing, prevent recurrence, and address the underlying cause. A combination of medications and lifestyle modifications is often required.
Common Medications
- Proton Pump Inhibitors (PPIs): Reduce stomach acid production (e.g., omeprazole, lansoprazole).
- Antibiotics: Used to eradicate H. pylori infection (e.g., clarithromycin, amoxicillin).
- Antacids: Provide quick relief by neutralizing stomach acids.
- H2 blockers: Decrease acid production (e.g., ranitidine).
In rare cases where medication does not resolve the ulcer or complications develop, surgical intervention may be necessary.
Nursing Diagnosis for Peptic Ulcer
Nursing care for patients with peptic ulcer focuses on managing pain, improving nutrition, reducing anxiety, and promoting patient knowledge to prevent recurrence. Below are common NANDA-I approved nursing diagnoses:
- Acute Pain related to irritation of the mucosa and muscle spasms.
- Anxiety related to the nature and management of long-term illness.
- Imbalanced Nutrition: Less than Body Requirements related to pain associated with food intake.
- Knowledge Deficit related to inadequate information about prevention, symptoms, and treatment.
1. Acute Pain: Nursing Interventions
- Assess pain characteristics and precipitating factors.
- Administer prescribed medications such as PPIs.
- Encourage small, frequent meals.
- Avoid foods that trigger acid production such as coffee, citrus, and spicy foods.
2. Anxiety
- Provide accurate information about the disease and treatment plan.
- Encourage relaxation techniques such as deep breathing.
3. Imbalanced Nutrition
- Monitor nutritional intake and body weight.
- Consult a dietitian for individualized meal plans.
- Encourage consumption of non-irritating foods.
4. Knowledge Deficit
- Educate patients on avoiding NSAIDs unless prescribed.
- Explain the importance of completing antibiotics to eradicate H. pylori.
- Teach early recognition of warning signs such as bloody stools.
Lifestyle Modifications for Prevention
- Avoid NSAIDs unless medically necessary
- Stop smoking and limit alcohol consumption
- Maintain a balanced diet
- Manage psychological stress
Conclusion
Peptic ulcer disease remains a significant global health concern. Early recognition of symptoms, proper diagnosis, and prompt management are crucial to preventing complications. Nurses play a pivotal role in patient care by assessing symptoms, providing education, addressing nutritional needs, and implementing interventions to reduce pain and anxiety.
With effective treatment and appropriate lifestyle modifications, most ulcers heal completely and do not recur. Nursing diagnosis helps guide patient care, ensuring holistic, evidence-based interventions that support patient recovery and long-term well-being.
Sources
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
- World Gastroenterology Organisation (WGO) Guidelines
- NANDA International Nursing Diagnoses
