GOVT COLLEGE OF NURSING ,MBS HOSITAL

KOTA

LESSON PLAN
ON

Peptic ulcer

Submitted to;
MR.GAJRAJ MEENA
HOD MEDICAL SURGICAL NURSING
MBS HOSPITAL KOTA submitted by
Mr.chhailu singh
Msc (Nur.) previous
 NAME OF THE STUDENT : R. SARASWATHI

COURSE : MSC NURSING I YEAR

SPECIALITY : MEDICAL –SURGICAL NURSING

TOPIC : PEPTIC ULCER

DATE : 22.08.019

NAME OF THE EVALUATOR : MR.GAJRAJ MEENA

AVAIDS : CHART, OHP, BLACK BORAD

TIME : 1 HOUR

PLACE : GOVT.COLLEGE OF NURSING KOTA

Central objectives:
At the end of the class the student will be able to gain more knowledge about peptic ulcer and develops skills on
management of patient with peptic ulcer.

Specific objectives:

- Define peptic ulcer?

- List out the causes?
- Enumerate the path physiology?
- Highlight the signs and symptoms
- Determine the diagnostic evaluation
- Explain the management of peptic ulcer
- Describe the complication?
Specific TIME CONTENT Teachers Learners AV evaluation
objectives activity activity AIDS
2 Introduction:
mints

A 30 years old man came to the hospital with the

complaints of vomiting, severe abdomen pain, burning
pain, nausea. What could be the cause? Due to problem
in the GI tract. What are the problems arises in GI
tract. Gastritis, cancer, esophagi is, ulcer. What is
peptic ulcer? Let us discuss peptic ulcer.

Student will be 2mints

able to define
Definition: explaining
peptic ulcer It I defined a an excavation (hollowed –out area) that Listening OHP Define peptic
and ulcer?
form in the mucosal all of the stomach, in the pylorus, writing th
 in the duodenum, or in the esophagus e points
Risk factors:
-emotional factors[stress, anxiety]
Inflammation[serious illness]
-heredity
-endocrine disorder
-sex
-other factors: poor dietary habits
-smoking, alcohol intake
-chronic pain
-DM
Location or areas of peptic ulcer:
It occurs in 3 places/ areas
1.gastric ulcer
2.duodenum
-esophagus
Etiology:
Student will be 5mints Listenin
able to list out H. pylori: it is responsible for most ulcers. this Explaining g and
the causes writing
organism weakness the protective coating of the
the points
stomach and duodenum and allows the damaging
List out the
digestive juice to irritate the sensitive lining below
OHP causes?
NSAIDS:ongoing use of this class of medication i the
 second mot common cause of ulcers
[apirin,ibuprofen,diclofenac, indomethacin,salcilate] are
acidic and they block prostaglandin substances in the
stomach blood flow and protect the area from injury.
Zollinger Ellison syndrome[ZES]
People with this uncommon condition have duodenum
that produce gatrin, a hormone that stimulate gastric
acid production , diarrhea may precede ulcer formation
Other causes:
Ulcer that can result in direct damage to the wall of the
stomach or duodenum such as heavy use of alcohol,
radiation therapy, burns, physical injury.
Path physiology:
Due to any etiological factors
↓

Student will be Increased HCL secretion, pepsin secretion Listening

able to explain 5mints ↓ and
the path writing
physiology Erosion of gastric mucosa the points
Decreased resistance of the gastric mucosa Explaining

↓ Explain the
Damaged mucosa can not secrets the mucus to act as a CHART path
physiology?
barrier against
 ↓
Ulceration[inflammation]

Clinical manifestation:
-dull gnawing pain or a burning sensation in the mid
epigastrium or in the back
-pain is relieved by eating listening

-other symptoms:
-Pyrosis,

5mints -poor appetite,

Student will be - nausea, vomiting, Explaining
able to highlight
the signs and -dyspepsia What are the
symptoms -,constipation or diarrhea, signs of
OHP peptic ulcer?
- GI bleeding evidenced by Melina
-Weight loss
-belching
Diagnostic evaluation:
History collection: a thorough history about dietary
pattern, lifestyle factors, family history of ulcer disease,
history of prolonged use of NSAIDS. Types of pain,
where it occur? When it is relieves.
Student will be 5mints explaining Writing
able to Physical examination: notes
determine the Thorough examination includes abdomen distention,
diagnostic
burning pain, history of nausea , vomiting
evaluation
Upper GI endoscopy: this allows direct visualization
of these organs for an ulcer or other problems and
How will you
sampling of tissue from the walls of the test for h- diagnose the
peptic ulcer?
pylori.
OHP
Gastric analysis: to rule out the H- pylori as well as
HCL pepsin, gastrin level.
-stool test: stool occult blood to rule out bleeding
Blood test: CBC, sr.electrolytes-to rule out anemia,
electrolytes imbalances.
Comparison of duodenal ulcer and gastric ulcer:
Duodenal ulcer Gastric ulcer
Listening
-Age 30-60years -age 50 and over and
9mints -male: female ratio=2-3:1 -male: female ratio=1:1 Explaining writing
student will be the What is the
able to compare -80 of peptic ulcer are -15% gastric ulcers points deference
the duodenal duodenal -normal /hypo secretion between
ulcer and gastric duodenal and
ulcer -increased hcl of stomach of stomach acid OHP gastric
-may have weight gain - weight loss may occur ulcers?

-pain occurs 2-3 hours -pain is occurs ½ hour to

after meals 1 hour after meals.
-vomiting uncommon Relieved by vomiting
 -hemorrhage is less -vomiting is common
chance -hemorrhage is more
-malignancy rarely present
occurs. Occasional.
H- pylori, alcohol, H- Pylori. Gastritis,
smoking, stress, cirrhosis alcohol smoking
NSAIDS stress

Management:
it includes
- Medical management
5mints Listening
Student will be - Surgical management and
able to explain - Pharmacological management writing
the management the points
- Nursing management
Medical management
Explaining
1.stress reduction:
Identify the situations that are stressful or exhausting
-advice the patient to take rest regularly during the day. Explain
briefly about
Biofeedback, hypnosis, behavior modification , management?
massage or acupuncture may be helpful
2.dietary modification:
-advice the patient to avoid excessive spicy foods
-advice the patient to take regular meals that is 3 times /
day
-advice the patient to drink more water and tender
coconut water.
-advice the patient to avoid citrus fruits
-advice the patient to avoid alcoholic beverages
-advice the patient to take small and frequent meals
-advice the patient to avoid extreme hot/ cold food
-avoid milk and cream
Pharmacological management:
drugs actions
Histamine h2 receptor -potent histamine h2
antagonist-ranitidine receptors antagonist

Antacids: aluminum- -neutralizes the gastric

containing antacids acids

-magnesium containing
antacids[milk of magnesia] -neutralizes the gastric
acids and provides pain
Anti cholinergic[atropine, relief
diclomine]
 - decreases vagul
Antiemetic[omeprozole] stimulation of parietal
Proton pump inhibitors cells, decreases
motility and volume of
gastric secretions
Others: sucralfate -suppress h+, k+ at
passé enzyme system
of gastric acid
production
-reacts with acid to
-antibiotics form paste that adheres
to GI mucosa and
allows ulcer heal
-amoxylin, metrogyl

Surgical management:
1. Antrectomy:removal of the antrum of the
stomach to eliminate the gastric phase of
digestion
2. Pyloro plasty:
3. Enlargement of the pyloric sphincter with
acceleration of gastric emptying
 4. Gastrectectomy: removal of parts/ total stomach
5. Esophagus jejunostomy
Vagotomy:it is an surgery performed to decrease the
vegus nerve stimulation opening of the vagus nerve
through open surgical or laparoscopy
billrothI: gastroduodenoscopy:
Removal of the lower portion of the antrum of the
stomach as well as a small portion of the duodenum and
pylorus. Remaining segment is anastemosed to the
duodenum
billrothII gastrojejunostomy:
Removal of lower portion of the stomach with
anatemosis of jejunum.
Complication:
Student will be 1 .hemorrhage: it occurs due to erosion of gastric listening
able to find out
the mucosa. Symptoms are melena, hematoma explaining
complication 2. perforation:
5mints
Peptic ulcer may progressively erode the sub mucosal
muscular and serous layers penetrated some of the
stomach or duodenal content escapes into the perineal
cavity and causes a generalized peritonitis by chemical
irritation & infection
Pyloric obstructions:
It is due to inflammation, edema and spasm when the
ulcer is in the acute stage or by scar tissue which is
formed as the ulcer heals.4. marginal ulcers: where the
gastric acid contact post operative site
-alkaline reflux gastritis:
After gastric surgery the duodenal content is refluxed
into stomach
List out the
-Acute gastric dilation complication?
-Nutritional problems
-dumping syndrome
-gastro jejunocolic fistula.
Nursing management:
--Acute pain related to irritated stomach mucosa as
evidenced by restlessness, anxious.
--Imbalanced nutritional status less then body
requirements related to less intake of food , vomiting as
evidenced by vomiting, weight loss
--Fluid volume deficit related to subsequent vomiting
as evidenced by dehydration
--Anxiety related to disease prognosis; follow up as
evidenced by depression, fear.
--Impaired sleeping pattern related to pain as evidenced
by disturbed sleep
--Deficient knowledge related to treatment; follow up as
evidenced by lake of awareness.

1. Acute pain related to irritated stomach mucosa as

evidenced by restlessness, anxious.
Intervention:
- provide comfortable bed, position.
---give psychological support
--Provide divertional therapy
-Advice the patient to avoid citrus fruits
-provide calm and quit environment
-administer analgesic as per doctors
2.Imbalanced nutritional status less then body
requirements related to less intake of food , vomiting as
evidenced by vomiting, weight loss
Intervention:
dislikes
-provide high calorie diet
-give low fat diet
-provide carbohydrate rich diet
- maintain I/O chart
-recheck the weight daily
Provide parental nutritional therapy
-advice the patient to avoid alcohol intake
3. Fluid volume deficit related to subsequent vomiting
as evidenced by dehydration
Intervention:
provide more fluid diet
-advice the patient to drink more water
-maintain i/o chart
Provide more IV fluid
provide liquid diet
-provide antiemetic as per doctors
4. --Anxiety related to disease prognosis; follow up as
evidenced by depression, fear.
Intervention
Explain about disease condition, treatment, follow up
-give psychological support
- maintain good IPR
-provide relaxation therapy
-clear the doubt
Explain about similar situation
-give anti anxiety drugs as per doctor
--Deficient knowledge related to treatment; follow up as
evidenced by lake of awareness.
Intervention:
-explain about disease condition, treatment, follow up
-clear the doubt
- give health education about hygiene, nutrition
-provide information booklet
Advice the patient about life style modification

Summary:
Peptic ulcer is occur due to high / increased secretion of
gastrin / pepsin It I commonly occur in stomach,
duodenum, and esophagus. Peptic ulcer is caused by
H.pylori, increased HCL secretion. It is treated with
dietary modification; drug therapy .if it is not reduced
with medical management surgical management is
required.
Conclusion:
This class is useful to the students for gaining
knowledge about peptic ulcer and develops skills for
management of patient with peptic ulcer.
Assignment:
Write details about surgical management of peptic
ulcer?
Evaluation: 10 marks
Short notes:2+5=10
1. Define peptic ulcer? Listout the causes?
2. Write in detail about complication?

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and related pathology, Joan A royle, mikes Walsh.
ELBS .4: 499- 510.
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Joan luckmann, Sounders Company. 389-920.
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