CACCAM, CHRISTINE AMOR P.

RLE DUTY
THURSDAY/SATURDAY
7:00 AM-3:00 PM

PEPTIC ULCER

STATISTICS and EPIDEMIOLOGY:

 Peptic ulcer disease may occur in both genders and in all ages.
 Peptic ulcer disease occurs with the greatest frequency in people between 40 and 60 years of
age.
 It is relatively uncommon in women of childbearing age, but it has been observed in children
and even in infants.
 After menopause, the incidence of peptic ulcers in women is almost equal to that in men.
 A peptic ulcer is a round or oval sore where the lining of the stomach or duodenum has been
eaten away by stomach acid and digestive juices.
 Excavation in the mucosal wall and underlying tissues of the esophagus, stomach, pylorus, or
the duodenum.
 Peptic ulcers can result from Helicobacter pylori infection or from drugs that weaken the
lining of the stomach or duodenum.
 Discomfort caused by ulcers comes and goes and tends to occur after meals because stomach
acid is produced in response to eating.

PREDISPOSING FACTOR:
 Stress- Risk factor for peptic ulcer
 Cigarette smoking- Interference with the action of histamine-2 antagonist
 Alcohol- stimulates gastric, and hydrochloric acid production that can irritate the mucosal
lining.
 acceleration of gastric emptying of liquids,
 promotion of duodenogastric reflux,
 inhibition of pancreatic bicarbonate secretion,
 reduction of mucosal prostaglandin production.
 Caffeine- same as Alcohol
 Gastritis- Hyper secretion of acids
 Infection- Campylobacter & Helicobacter Pylori- can get when eating raw meat
 Irregular, hurried meals- leads to acid production
 Fatty, spicy, & highly acidic foods- it can irritate the mucosal lining
 Genetics
 Helicobacter pylori- Research has documented that peptic ulcers result from infection with
the gram-negative bacteria H. pylori, which may be acquired through ingestion of food and
water. H. pylori damages the mucous coating that protects the stomach and duodenum.
 Salicylates and NSAIDs- Encourages ulcer formation by inhibiting the secretion of
prostaglandins.
 Various illnesses- Pancreatitis, hepatic disease, Crohn’s disease, gastritis, and Zollinger-
Ellison syndrome are also known causes.
 Excess HCl- Excessive secretion of HCl in the stomach may contribute to the formation of
peptic ulcers.
 Irritants- Ingestion of milk and caffeinated beverages and alcohol also increase HCl
secretion. These contribute by accelerating gastric emptying time and promoting mucosal
breakdown.
 Blood type- Gastric ulcers tend to strike people with type A blood while duodenal ulcers tend
to afflict people with type O blood.

PATHOPHYSIOLOGY:
 Excessive Secretion of HCL Acid- in relation to the protective effects of mucus secretion and
acid neutralization.

MR. RICHARD M. GANANCIAL

CLINICAL INSTRUCTOR
RLE DUTY
CACCAM, CHRISTINE AMOR P.
RLE DUTY
THURSDAY/SATURDAY
7:00 AM-3:00 PM
 Erosion- The erosion is caused by the increased concentration or activity of acid-pepsin or
by decreased resistance of the mucosa.
 Damage- A damaged mucosa cannot secrete enough mucus to act as a barrier against HCL.
 Acid Secretion- Patients with duodenal ulcers secrete more acid than normal, while patients
with gastric ulcer tend to secrete normal or decreased levels of acid.
 Decreased Resistance- Damage to the gastroduodenal mucosa results in decreased
resistance to bacteria and thus infection from the H. pylori bacteria may occur.

CLINICAL MANIFESTATION:
 Gastric- Left Midline Gastric Area (burning, aching and gnawing sensations)
 Pain occurring in the epigastric area radiating to the back
 Pains occurs approximately ½ - 2 hours after eating
 Pain or discomfort continuous in the daytime
 Pain is relieved after ingesting antacids
 Weight loss
 Reflex vomiting- relieved pain
 Hematemesis- vomiting with blood (bright red/coffee ground in color)

 Duodenal- Right Midline Gastric Area (chime will flow to the duodenum)
 Pain in the epigastric region that occurs 2-3 hours after meals
 Intermittent pain- occur frequently at night
 Pain increase by fatty foods, but relieved by other foods
 Weight gain- because eating can relieved the pain cessation.
 Melena- black tarry stool

 Esophageal Ulcer- Esophageal ulcer occurs as a result pf the backward flow of HCl from the
stomach into the esophagus.

NURSING ASSESSMENT:
 Assessment for description of pain.
 Assessment of relief measures to relieve the pain.
 Assessment of the characteristics of the vomitus.
 Assessment of the patient’s usual food intake and food habits.

Complications:
Possible complications may include:

 Hemorrhage- Hemorrhage, the most common complication, occurs in 10% to 20% of

patients with peptic ulcers in the form of hematemesis or melena.
 Perforation and penetration- Perforation is the erosion of the ulcer through the gastric
serosa into the peritoneal cavity without warning, while penetration is the erosion of the
ulcer through the gastric serosa into adjacent structures.
 Pyloric obstruction- Pyloric obstruction occurs when the area distal to the pyloric sphincter
becomes scarred and stenosis from spasm or edema or from scar tissue that forms when an
ulcer alternately heals and breaks down.

DIAGNOSIS FINDINGS:
To establish the diagnosis of peptic ulcer, the following assessment and laboratory studies should be
performed:

 Esophagogastroduodenoscopy- Confirms the presence of an ulcer and allows cytologic

studies and biopsy to rule out H. pylori or cancer.

MR. RICHARD M. GANANCIAL

CLINICAL INSTRUCTOR
RLE DUTY
CACCAM, CHRISTINE AMOR P.
RLE DUTY
THURSDAY/SATURDAY
7:00 AM-3:00 PM
 Physical examination- A physical examination may reveal pain, epigastric tenderness, or
abdominal distention.
 Barium study. A barium study of the upper GI tract may show an ulcer.
 Endoscopy- Endoscopy is the preferred diagnostic procedure because it allows direct
visualization of inflammatory changes, ulcers, and lesions.
 Occult blood- Stools may be tested periodically until they are negative for occult blood.
 Carbon 13 (13C) urea breath test- Reflects activity of H. pylori.

NURSING DIAGNOSIS:
 Pain related to epigastric distress secondary to hypersecretion of acid, mucosal erosion, or
perforation.
 Fiber optic pan-endoscopy (Esophago-Gastroduodenoscopy)
 Serial stool specimen to detect occult blood
 Gastric secretory studies
 Potential for fluid volume deficit secondary to hemorrhage
 Knowledge deficit of physical, dietary, and pharmacology treatment

MEDICAL MANAGEMENT:
1. Specific Pharmacotherapy- After Meal
 Acid-Neutralizing Agent (antacids): neutralize HCL
 E.g. Magnesium & Aluminum Hydroxide (Maalox), Aluminum Hydroxide
(Amphojel),
Magnesium Hydroxide (Milk of Magnesia)
 Histamine Receptor Antagonist: Reduce HCL secretion produced by stomach by blocking
the action of histamine receptors of parietal cells in the stomach.
 Taken with meals- because taken before meals can cause G.I irritation
 E.g. Cimetidine(Tagamet), Ranitidine (Zantac), Famotidine (Pepcid)
 Cytoprotective Drugs: Coats Ulcer (create viscus material)
 Taken 30-60 minutes before meals
 E.g. Sucralfate (Carafate)
 Prostaglandine Analogue- prostaglandin having antisecretory and cytoprotective effects. It
also increases mucous production and bicarbonate level
 E.g. Misoprostol (Cytotec) no to pregnant women it can cause abortion.
 Antisecratory (Proton Pump Inhibitors of Gastric Acid: inhibits the production of gastric
acod by slowing the hydrogen-potassium adenosine triphosphatase (H+, K+, -ATPase) pump
on the surface of the parietal cells of the stomach. Can heal ulcer in 4-8 w2eeks
 E.g. Omeprazole (Losec), Lansoprazole (Prevacid), Esomeprazole (Nexium)
2. Pharmacologic Therapy- Currently, the most commonly used therapy for peptic ulcers is a
combination of antibiotics, proton pump inhibitors, and bismuth salts that suppress or
eradicate the infection.
 Antibiotic Drugs: E.g. Amoxicillin, Clarithromycin, Metronidazole, Tetracycline
3. Stress Reduction and Rest- Reducing environmental stress requires physical and
psychological modifications on the patient’s part as well as the aid and cooperation of family
members and significant others. (Counseling).
4. Smoking Cessation- Studies have shown that smoking decreases the secretion of
bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the
duodenum.
5. Dietary Modification- Avoiding extremes of temperature of food and beverages and
overstimulation from consumption of meat extracts, alcohol, coffee, and other caffeinated
beverages, and diets rich in cream and milk should be implemented.
 Diet as Tolerated
 If pain exist give bland diet.
6. Sedatives/Tranquilizers: for patient w/gastric ulcer.

MR. RICHARD M. GANANCIAL

CLINICAL INSTRUCTOR
RLE DUTY
CACCAM, CHRISTINE AMOR P.
RLE DUTY
THURSDAY/SATURDAY
7:00 AM-3:00 PM
 To provide rest and relaxation
 E.g. Valium, Diazepam

Surgical Management
The introduction of antibiotics to eradicate H. pylori and of H2 receptor antagonists as treatment for
ulcers has greatly reduced the need for surgical interventions.

 Pyloroplasty- involves transecting nerves that stimulate acid secretion and opening the
pylorus. Surgical dilation pf the pyloric sphincter.
 Improves gastric emptying of the acidic chime
 Antrectomy- is the removal of the pyloric portion of the stomach with anastomosis to either
the duodenum or jejunum.
 Billroth I- Gastrodouenostomy (Gastric Ulcer)
 Billroth II- Gastrojejunostomy (Duodenal Ulcer)
 Vagotomy- Resection of the Vagus Nerve (Parasympathetic Nervous System)
 To lower HCL secretion and lower Gastric Motility
 Subtotal Gastrectomy- Removal of 75% of the distal stomach with Billroth I or II repair.

MR. RICHARD M. GANANCIAL

CLINICAL INSTRUCTOR
RLE DUTY
CACCAM, CHRISTINE AMOR P.
RLE DUTY
THURSDAY/SATURDAY
7:00 AM-3:00 PM

NURSING CARE PLAN and GOAL:

The goals for the patient may include:

 Relief of pain.
 Reduced anxiety.
 Maintenance of nutritional requirements.
 Knowledge about the management and prevention of ulcer recurrence.
 Absence of complications.

NURSING INTERVENTIONS:
Nursing interventions for the patient may include:

 Relieving Pain and Improving Nutrition

 Administer prescribed medications.
 Avoid aspirin, which is an anticoagulant, and foods and beverages that contain acid-
enhancing caffeine (colas, tea, coffee, chocolate), along with decaffeinated coffee.
 Encourage patient to eat regularly spaced meals in a relaxed atmosphere; obtain regular
weights and encourage dietary modifications.
 Encourage relaxation techniques.

REDUCING ANXIETY:

 Assess what patient wants to know about the disease, and evaluate level of anxiety;
encourage patient to express fears openly and without criticism.
 Explain diagnostic tests and administering medications on schedule.
 Interact in a relaxing manner, help in identifying stressors, and explain effective coping
techniques and relaxation methods.
 Encourage family to participate in care, and give emotional support.

MONITORING and MANAGING COMPLICATIONS:

If hemorrhage is a concern:
 Assess for faintness or dizziness and nausea, before or with bleeding; test stool for occult or
gross blood; monitor vital signs frequently (tachycardia, hypotension, and tachypnea).
 Insert an indwelling urinary catheter and monitor intake and output; insert and maintain an
IV line for infusing fluid and blood.
 Monitor laboratory values (hemoglobin and hematocrit).
 Insert and maintain a nasogastric tube and monitor drainage; provide lavage as ordered.
 Monitor oxygen saturation and administering oxygen therapy.
 Place the patient in the recumbent position with the legs elevated to prevent hypotension, or
place the patient on the left side to prevent aspiration from vomiting.
 Treat hypovolemic shock as indicated.

If perforation and penetration are concerns:

 Note and report symptoms of penetration (back and epigastric pain not relieved by
medications that were effective in the past).
 Note and report symptoms of perforation (sudden abdominal pain, referred pain to
shoulders, vomiting and collapse, extremely tender and rigid abdomen, hypotension and
tachycardia, or other signs of shock).

MR. RICHARD M. GANANCIAL

CLINICAL INSTRUCTOR
RLE DUTY
CACCAM, CHRISTINE AMOR P.
RLE DUTY
THURSDAY/SATURDAY
7:00 AM-3:00 PM

HOME MANAGEMENT and HOME SELF-CARE:

 Assist the patient in understanding the condition and factors that help or aggravate it.
 Teach patient about prescribed medications, including name, dosage, frequency, and possible
side effects. Also identify medications such as aspirin that patient should avoid.
 Instruct patient about particular foods that will upset the gastric mucosa, such as coffee, tea,
colas, and alcohol, which have acid-producing potential.
 Encourage patient to eat regular meals in a relaxed setting and to avoid overeating.
 Explain that smoking may interfere with ulcer healing; refer patient to programs to assist
with smoking cessation.
 Alert patient to signs and symptoms of complications to be reported. These complications
include hemorrhage (cool skin, confusion, increased heart rate, labored breathing, and blood
in the stool), penetration and perforation (severe abdominal pain, rigid and tender abdomen,
vomiting, elevated temperature, and increased heart rate), and pyloric obstruction (nausea,
vomiting, distended abdomen, and abdominal pain). To identify obstruction, insert and
monitor nasogastric tube; more than 400 mL residual suggests obstruction.

EVALUATION:
Expected patient outcomes include:

 Relief of pain.
 Reduced anxiety.
 Maintained nutritional requirements.
 Knowledge about the management and prevention of ulcer recurrence.
 Absence of complications.

DISCHARGE and HOME-CARE GUIDELINES:

The patient should be taught self-care before discharge.

 Factors that affect- The nurse instructs the patient about factors that relieve and those that
aggravate the condition.
 Medications- The nurse reviews information about medications to be taken at home,
including name, dosage, frequency, and possible side effects, stressing the importance of
continuing to take medications even after signs and symptoms have decreased or subsided.
 Diet- The nurse instructs the patient to avoid certain medications and foods that exacerbate
symptoms as well as substances that have acid-producing potential.
 Lifestyle- It is important to counsel the patient to eat meals at regular times and in a relaxed
setting and to avoid overeating.

MR. RICHARD M. GANANCIAL

CLINICAL INSTRUCTOR
RLE DUTY
CACCAM, CHRISTINE AMOR P.
RLE DUTY
THURSDAY/SATURDAY
7:00 AM-3:00 PM

Nursing Care Plans

The nursing goals of a client with a peptic ulcer disease include reducing or eliminating contributing
factors, promoting comfort measures, promoting optimal nutrition, decreasing anxiety with
increased knowledge of disease, management, and prevention of ulcer recurrence and preventing
complications

Here are five (5) nursing care plans (NCP) and nursing diagnosis for patients with peptic ulcer
disease:

 Acute Pain
 Imbalanced Nutrition: Less Than Body Requirements
 Anxiety
 Deficient Knowledge
 Risk for Deficient Fluid Volume

1. Acute Pain

Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue
damage or described in terms of such damage; sudden or slow onset of any intensity from mild to
severe with anticipated or predictable end and a duration of <6 months.

May be related to
 Abdominal distention
 Abdominal muscle spasm
 Recent nonsteroidal anti-inflammatory drug (NSAID) or acetylsalicylic acid (ASA) use

Possibly evidenced by
 Early satiety
 Nausea and vomiting
 Pain relieved by food or antacid
 Weight loss

Desired Outcomes
 Client will report satisfactory pain control at a level less than 2 to 4 on a scale of 0 to 10.
 Client uses pharmacological and no pharmacological pain relief measures.
 Client will exhibit increased comfort such as baseline levels for HR, BP, and respirations and
relaxed muscle tone for body posture.

Nursing Interventions and Rationale

 Assess the client’s pain, including the location, characteristics, precipitating factors, onset,
duration, frequency, quality, intensity, and severity.
 Clients with gastric ulcer typically demonstrate pain 1 to 2 hours after eating. The client
with duodenal ulcers demonstrate pain 2 to 4 hours after eating or in the middle of the
night. With both gastric and duodenal ulcers, the pain is located in the upper abdomen
and is intermittent. Client may report relief after eating or taking an antacid.

 Encourage the use of no pharmacological pain relief measures:

 Acupressure
 Biofeedback
 Distraction
 Guided imagery

MR. RICHARD M. GANANCIAL

CLINICAL INSTRUCTOR
RLE DUTY
CACCAM, CHRISTINE AMOR P.
RLE DUTY
THURSDAY/SATURDAY
7:00 AM-3:00 PM

 Massage
 Music therapy
 Nonpharmacological relaxation techniques will decrease the production of gastric acid,
which in turn will reduce pain.

 Instruct the client to avoid NSAIDs such as aspirin. These medications may cause irritation of
the gastric mucosa.
 Instruct the client that meals should be eaten and regularly paced intervals in a relaxed
setting. An irregular schedule of meals may interfere with the regular administration of
medications.
 Encourage the importance of smoking cessation. Smoking decreases the secretion of
bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the
duodenum.

 Administer the prescribed drug therapy:

 Antacids
 Antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline
 Histamine receptor antagonists
 Prostaglandin analogues
 Proton pump inhibitor
 Sucralfate

 Antacids buffer gastric acid and prevent the formation of pepsin. This mechanism of action
promotes of healing of the ulcer. Antibiotics treat the Helicobacter pylori infection and
promote healing of the ulcer. As the ulcer heals, the client experiences less pain. H2 receptor
antagonists block the secretion of gastric acid. Prostaglandin analogue reduces acid secretion
and enhance the integrity of the gastric mucosa to resist injury. Proton pump inhibitors block
the production and secretion of gastric acid and thereby reduce gastric pain. Sucralfate forms
a barrier at the base of the ulcer crater to protect the healing ulcer from gastric acid.

2. Imbalanced Nutrition: Less Than Body Requirements

Imbalanced Nutrition: Less Than Body Requirements: Intake of nutrients insufficient to meet
metabolic needs.

May be related to
 Abdominal pain
 Alcohol intake
 Anorexia
 Diarrhea
 Gastrointestinal bleeding
 Nausea, vomiting

Possibly evidenced by
 Inadequate dietary intake
 Malabsorption of irons, minerals, and vitamins
 Weight loss

Desired Outcomes
 Client will verbalize and demonstrate selection of foods or meals that will achieve a cessation
of weight loss.
 Client will weigh within 10% of ideal body weight.

MR. RICHARD M. GANANCIAL

CLINICAL INSTRUCTOR
RLE DUTY
CACCAM, CHRISTINE AMOR P.
RLE DUTY
THURSDAY/SATURDAY
7:00 AM-3:00 PM

Nursing Interventions and Rationale

 Obtain a nutritional history. Clients may often overestimate the amount of food eaten. The
client may not eat sufficient calories or essential nutrients as a way to reduce pain
episodes with peptic ulcer disease. Because of this, clients are at high risk for
malnutrition.
 Assess for body weight changes. Weight loss is an indication of inadequate nutritional
intake. Gastric ulcers are more likely to be associated with vomiting, loss of appetite and
weight loss than duodenal ulcers.
 Assist the client with identifying foods hat cause gastric irritation. Clients need to learn
what foods they can tolerate without gastric pain. Soft, bland, non-acidic foods cause less
gastric irritation. The client is more likely to increase food intake if the foods are not
associated with pain. Foods that may contribute to mucosal irritation include spicy foods,
pepper, and raw fruits and vegetables.
 Monitor laboratory values for serum albumin. This test indicates the degree of
protein depletion (2.5 g/dL indicates severe depletion; 3.8 to 4.5 g/dL is normal).
 Instruct in the importance of abstaining from excessive alcohol. Alcohol causes gastric
irritation and increases gastric pain.
 Encourage the client to limit the intake of caffeinated beverages such as tea and coffee.
Caffeine stimulates the secretion of gastric acid. Coffee, even if decaffeinated, contains a
peptide that stimulates the release of gastrin and increases acid production.
 Teach about the importance of eating a balanced diet with meals at regular intervals.
Specific dietary restrictions are no longer part of the treatment for PUD. During the
symptomatic phase of an ulcer the client may find benefit from eating small meals at more
frequent intervals.

3. Anxiety

Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.

May be related to:

 Fear of the unknown
 Nature of the disease.
 Situational crisis
 Stress

Possibly evidenced by
 Abdominal pain
 Apprehensive
 Expressed concerns about changes in life events
 Fatigue
 Irritability

Desired Outcomes
 Client will demonstrate ways of reducing anxiety level.

Nursing Interventions Rationale

 Assess client’s level of anxiety. Clients with peptic ulcers are anxious, but their anxiety level
is not visible.
 Acknowledge awareness of the client’s anxiety. Acknowledgement of the client’s
feelings validates the feelings and communicates the acceptance of those feelings.
 Encourage to express fears openly Open communication enable the client to develop a
trusting relationship that aids in reducing anxiety and stress.

MR. RICHARD M. GANANCIAL

CLINICAL INSTRUCTOR
RLE DUTY
CACCAM, CHRISTINE AMOR P.
RLE DUTY
THURSDAY/SATURDAY
7:00 AM-3:00 PM

 Use simple language and brief statements when giving instructions to the client. When
experiencing moderate to severe anxiety, clients may be unable to comprehend anything
more than simple, clear, and brief instructions.
 Decrease sensory stimuli by maintaining a quiet environment. Anxiety may escalate to a panic
state with excessive conversation, noise, and equipment around the client.
 Provide emotional support to client. Providing emotional support will give a client calming
and relaxing mood that will lower anxiety, and stress related to the condition.
 Assist the client in developing anxiety-reducing measures such as biofeedback, positive
imagery, and behavior modification. Learning these methods provides the client with a
variety of ways to manage anxiety.

4. Deficient Knowledge

Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.

May be related to
 Lack of recall of previously learned information
 New condition, treatment
 Recurrent episodes of GI bleeding
 Recurrent peptic ulcer disease

Possibly evidenced by
 Incorrect responses to questions about peptic ulcer disease
 Inaccurate follow-through with treatment regimen and lifestyle modifications
 Lack of questions
 Multiple questions

Desired Outcomes
 Client will verbalize understanding of the importance of compliance with medical regimen,
knowledge of peptic ulcer disease, and commitment to self-care management.

Nursing Interventions and Rationale

 Assess the client’s knowledge and misconceptions regarding peptic ulcer disease, lifestyle
behaviors, and the treatment regimen. Clients may have inaccurate information about how
lifestyle behaviors contribute to peptic ulcer disease. The client needs accurate knowledge to
make informed decisions about taking prescribed medications and modifying behaviors that
contribute to peptic ulcer disease or GI bleeding.
 Explain the pathophysiology of disease and how it relates to the functioning of the body. An
understanding of the disease process helps to foster the willingness to follow the
recommended treatment plan and modify behaviors to prevent recurrent episodes or related
complications.
 Instruct the client in what signs and symptoms to report to the health care provider.
Recognizing the signs and symptoms can help ensure the early initiation of treatment.
 Discuss the therapy options and the rationales for using these options. The correct use of
antibiotics and acid suppression medications can promote rapid healing of an ulcer.
 Discuss the lifestyle changes required to prevent further complications or episodes of peptic
ulcer disease. The modifications of lifestyle behaviors such as alcohol use, coffee, and other
caffeinated beverages, and the overuse of aspirin or other nonsteroidal anti-inflammatory
drugs is necessary to prevent recurrent ulcer development and prevent complications during
the healing phase.

MR. RICHARD M. GANANCIAL

CLINICAL INSTRUCTOR
RLE DUTY
CACCAM, CHRISTINE AMOR P.
RLE DUTY
THURSDAY/SATURDAY
7:00 AM-3:00 PM

Risk for Deficient Fluid Volume

May be related to
 Gastrointestinal (GI) bleeding
 Nausea, vomiting

Desired Outcomes
 Client will be normovolemic as evidenced by systolic BP greater than or equal to 90 mm Hg
(or client’s baseline), absence of orthostatic, HR 60 to 100 beats/minute, urine output greater
than 30 ml/hr., and normal skin turgor.

Nursing Interventions and Rationale

 Assess for the signs of hematemesis or melena. The client with a bleeding ulcer may vomit
bright red blood or coffee grounds emesis. Melena occurs when there is bleeding in the upper
GI tract.
 Monitor the client’s fluid intake and urine output. The kidney will reabsorb water into
circulation to support a decrease in blood volume. This compensatory mechanism results in
decreased urine output. A decrease in circulatory blood volume leads to decreased renal
perfusion and decreased urine output
 Monitor the client’s vital signs, and observes BP and HR for signs of orthostatic changes. The
erosion of an ulcer through the gastric or duodenal mucosal layer may cause GI bleeding. The
client may develop anemia. If bleeding is brisk, changes in vital signs and physical symptoms
of hypovolemia may develop rapidly. A decrease in BP and an increase in HR with changes in
position is an early indicator of decreased circulatory volume.
 Instruct the client to immediately report symptoms of nausea, vomiting, dizziness, shortness
of breath, or dark tarry stools. These assessment findings are signs of GI bleeding and should
be reported immediately.
 Monitor hemoglobin and hematocrit levels. Erosion of the gastric mucosa by an ulcer
results in GI bleeding. A decrease in hemoglobin and hematocrit occurs with bleeding.
 Administer IV fluids, volume expanders, and blood products as ordered. Isotonic fluids,
volume expanders, and blood products can restore or expand intravascular volume.

MR. RICHARD M. GANANCIAL

CLINICAL INSTRUCTOR
RLE DUTY