P K DAS COLLEGE OF NURSING

LESSON PLAN
ON
PEPTIC ULCER
Submitted To Submitted By
PROF.DR ARYALAKSHMI RAVEENA.R. NAIR
HOD. Child Health Nursing First Year MSc NURSING
P.K.Das CON Nursing Education

Submitted On: / /
BACKGROUND OF INFORMATION

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Name of the Student Teacher RAVEENA R NAIR
Topic PEPTIC ULCER
Subject NURSING EDUCATION
Duration 1 HOUR
Date & Time 13/01/2025 @1.30 -2.30PM
Methods of Teaching LECTURE CUM DISCUSSION
AV-Aids PPT, Pamphlets, Chart, Handouts

General Objectives
At the end of the lecture students will gain knowledge about Peptic Ulcer and develop a positive attitude towards it and will be able to apply this
knowledge in clinical setting.

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Specific Objectives
At the end of the lecture the students will be able to :-
 Define Peptic Ulcer
 List down the Causes of Peptic Ulcer
 Memorize the Types of Peptic Ulcer
 Explain the Pathophysiology of Peptic Ulcer
 Relate the Clinical Manifestations of Peptic Ulcer
 Tell the Diagnostic Evaluations of Peptic Ulcer
 Practice Medical & Surgical Management of Peptic Ulcer


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Sr. Specific AV- Teaching Learning Evaluation
No Time Objectives Content Aid Methods Activity
s
1. 1Mnt. At the end of INTRODUCTION: PPT Lecture Listen What is Peptic
the lecture the A peptic ulcer is a sore on the lining of the stomach, small intestine or cum Ulcer?
student’s will oesophagus. A peptic ulcer in the stomach is called gastric ulcer. discussion.
be able to: Ulcers occur when stomach acid damages the lining of the digestive
tract. Common causes include the bacteria H pylori. Upper abdominal
pain is a common symptom. Treatment usually includes m
medication to decrease stomach acid production. If is caused by
bacteria antibiotics may be required.

2. 2min. Define the DEFINITION PPT Lecture Listen Define

Peptic Ulcer cum Carefully Peptic Ulcer?
 Pepic ulcer disease refers to painful sore or ulcer in the lining discussion
of the stomach or first part of the small intestine, called the
duodenum. Peptic ulcer disease (PUD), also known as a
peptic ulcer or stomach ulcer, is a break in the lining of the
stomach or in the first part of the small intestine.
OR
 A peptic ulcer is a sore on the lining of stomach or
duodenum.
3. 4min. List down the
CAUSES:
causes and H Ask Learners What are the
risk factors of Question answer the causes and risk
1.Helicobacter pylori bacteria:
Peptic Ulcer A questions factors of
Peptic Ulcer?
 Helicobacter pylori is a bacterium that can damage the
N
mucosal lining of the stomach and duodenum. This infection
is one of the most common causes of peptic ulcers.
D
 The bacterium weakens the protective mucus layer, allowing

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 stomach acid to irritate and erode the underlying tissue, which O
results in the formation of ulcers. Student
U Teacher
2.Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Appreciate
 Taking aspirin, ibuprofen, as well as certain over-the-counter T the students.
and prescription pain Medication called non-steroid anti-
inflammatory drugs (NSAIDs), can irritate or inflame the S
lining of stomach and small intestine.
 NSAIDs inhibit the production of
prostaglandins, which are substances that help maintain the mucosal
barrier in the stomach. Without enough prostaglandins, the stomach
lining becomes more vulnerable to damage by gastric acid.

3. Excessive Alcohol Consumption

 Chronic alcohol use can irritate and erode the stomach lining,
increasing the risk of ulcers.
 Alcohol also stimulates the stomach to produce more acid,
which can worsen the damage to the gastric mucosa.

4. Smoking

 Smoking increases the risk of peptic ulcer formation and

slows the healing of existing ulcers.
 Nicotine increases acid production in the stomach and
decreases blood flow to the mucosal lining, impairing its
ability to heal.

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 5. Stress

 Physical stress from conditions such as burns, head trauma, or

severe illness can increase the risk of developing stress ulcers,
which are a type of peptic ulcer.
 Although emotional stress has not been conclusively linked to
peptic ulcers, it can exacerbate symptoms or slow healing.

4. 4min. Memorize the M Explain the Take notes Enlist the types
types of peptic TYPES OF PEPTIC ULCER: Types of of peptic
ulcer. O peptic ulcer ulcers?
1. Gastric Ulcers (Stomach Ulcers)
D
 Location: These ulcers occur on the inner lining of the
stomach. E
 Cause: Gastric ulcers are most commonly associated with
Helicobacter pylori (H. pylori) infection or the use of L
nonsteroidal anti-inflammatory drugs (NSAIDs).
 Symptoms: The pain often occurs shortly after eating, due to
the presence of acid in the stomach. This pain may worsen
with food intake, causing some patients to eat less, leading to
weight loss.
 Risk Factors: Smoking, excessive alcohol use, and chronic
use of NSAIDs or corticosteroids.

2. Duodenal Ulcers (Duodenal Ulcers)

 Location: These ulcers occur in the duodenum, the first part

of the small intestine just after the stomach.
 Cause: Duodenal ulcers are most commonly caused by H. .

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 pylori infection and excessive gastric acid production. They
are less commonly linked to NSAID use than gastric ulcers.
 Symptoms: The pain often occurs 2 to 3 hours after eating
(when the stomach is empty) and may be relieved by food or
antacids. The pain can also be described as burning or
gnawing in nature.
 Risk Factors: Similar to gastric ulcers, including H. pylori
infection, NSAIDs, smoking, and alcohol use.

3. Oesophageal Ulcers

 Location: These ulcers form in the oesophagus, usually due

to gastroesophageal reflux disease (GERD), where stomach
acid irritates the oesophagus over time.
 Cause: Chronic acid reflux or regurgitation of stomach acid
into the esophagus can cause mucosal injury, leading to ulcer
formation. Other causes may include infections or the use of
irritating medications.

 Symptoms: Symptoms include heartburn, difficulty

swallowing (dysphagia), chest pain, and regurgitation of food
or acid.
 Risk Factors: GERD, hiatal hernia, smoking, obesity, and
alcohol use.

4. Stress Ulcers

 Location: Stress ulcers can form in any part of the

gastrointestinal tract but are most commonly found in the
stomach or duodenum.
 Cause: These ulcers develop due to physical stress, such as
severe illness, trauma, burns, or surgery. They are often seen

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 in critically ill patients, particularly those who are
mechanically ventilated or have sustained head trauma.
 Symptoms: Symptoms may not be as evident early on, but
patients may experience gastrointestinal bleeding, black stools
(melena), or vomiting blood (hematemesis).

PATHOPHYSIOLOGY
5. 2min. Explain the Due to etiological factors (H. Pylori) Lecture Listen Explain about
pathophysiolo cum carefully Pathophysiolo
gy of Peptic C discussion gy
Ulcer Of Peptic
H Ulcer?

A
Breakdown of mucosal barrier
R
Excessive secretion of HCL and directly enter in to mucosa.
T
Injury to tissue and cell

Cellular destruction.
6. 3min. Relate the Lecture Focus What are the
clinical cum Attention clinical
manifestations CLINICAL MANIFESTATIONS discussion manifestations
of peptic ulcer ?
GASTRIC ULCER: it includes
 Hyposecretion of HCL

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  The most common symptom of stomach ulcer is burning P
sensation
 Gnawing Pain A
 Sharp Pain in left of mid epigastric region.
M
DUODENAL ULCER: it includes
 Hypersecretion of HCL. P
 Burning Pain in mid epigastric region.
 Pain is relieved by after food ingestion. H
 Heartburn.
L
ESOPHAGEAL ULCER: it includes
 Dysphagia E
 Pyrosis
 Chest pain T
 Nausea / Vomiting
 Hematemesis S
 Pain in centre of chest
 Anorexia

STRESS ULCERS: it includes

 Pain in upper stomach
 Bloating
 Shortness of breath
 Anaemia
 Nausea &Vomiting
7. 4min. Tell the Lecture Logical Explain about
Diagnostic DIAGNOSTIC EVALUATION cum thinking diagnostic
Evaluation discussion evaluations of
1. MEDICAL HISTORY: To help diagnose a peptic ask about peptic ulcer?
the previous medical history especially nonsteroidal a
nti-inflammatory drugs (NSAIDs), such as

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 D
 Aspirin
 Ibuprofen I

2. PHYSICAL EXAMINATION: A physical exam may help G

to diagnose a peptic ulcer. During a physical
examination, check for: I
 Checks for bloating in Abdomen
 Listens to sounds in abdomen using a stethoscope T
 Check for tenderness or pain in abdomen
A
3. LABORATORY TESTS: It includes
L
a. Helicobacter pylori Testing:
B
 Urea Breath Test: This non-invasive test detects the
presence of H. pylori by measuring the amount of labeled O
carbon dioxide in the breath after ingestion of a urea solution.
 Serologic Tests: Blood tests can detect antibodies to H. A
pylori, though they are less commonly used for diagnosis and
more often used for epidemiologic studies. R
 Stool Antigen Test: This test detects H. pylori antigens in
stool samples. D
 Endoscopic Biopsy: A biopsy taken during an endoscopy can
be tested for the presence of H. pylori.

b. Complete Blood Count (CBC): A CBC may be performed to

check for anemia, which could indicate chronic blood loss
from the ulcer.
c. Liver Function Tests and Renal Function Tests: These may
be conducted to rule out other potential causes of
gastrointestinal symptoms.

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 4. Barium Swallow (Upper GI Series):

 Purpose: An X-ray examination of the upper gastrointestinal

tract using a barium contrast medium. This can help identify
ulcers, strictures, or other abnormalities.

5.Gastric pH Testing:

 In some cases, especially if Zollinger-Ellison syndrome (a

rare condition causing excessive gastric acid secretion) is
suspected, pH testing can measure the acidity of the stomach.
 Gastric pH can be done via an oesophageal pH probe or a test
to measure the gastric acid secretion over 24 hours.
8. 8min. Practice the B Lecture Listen Explain the
Management MEDICAL MANAGEMENT cum carefully & management of
of peptic ulcer O discussion take notes peptic ulcer?
1.Pharmacological Management
O
The most commonly used therapy for peptic ulcer is combination of
antibiotics, proton pump inhibitors which supress or eradicate K
H.pylori. The therapy will be including triple therapy with 2
antibiotics + 1 proton pump inhibitor or Quadruple therapy with 2 L
antibiotics + 1 proton pump inhibitor + bismuth salt.
E
H2 blocker and proton pump inhibitors that reduce gastric acid
secretion are used to treat ulcer not associated with H.pylori infection. T
The patient is advised to adhere to complete the medication regimen
to ensure complete healing of ulcer. The patient is advised to avoid
[NSAIDS] patient with stress ulcer eg. patient with head injury or
extensive burns.

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2.Surgical Management
 Vagotomy: It is a surgical operation in which one or more
branches of the vagus nerve are cut, typically to reduce the
rate of gastric secretion.
 Pyloroplasty: It is surgery performed to widen the opening at
the lower part of the stomch, also known as the pylorus.
 Distal Gastrectomy: This surgery removes, the lower part of
the stomach
 Billroh I- gastroduodenostomy: Removal of the lower portion
of the antrum of the stomach [which contain the cell that
secret gastric] as well as small portion of the duodenum and
pylorus. The remaining segment is anastomosed to the
duodenum.
 Billroth II gastrojejunostomy: Removal of lower portion of
the stomach with the anastomosis to the jejunum.

3.Nursing Diagnosis
Based on the assessment data, the patient’s nursing diagnoses may PPT
include the following:

Acute pain related to the effect of gastric acid secretion on

damaged tissue.
Anxiety related to an acute illness.
Imbalanced nutrition related to changes in the diet.
Deficient knowledge about prevention of symptoms and
management of the condition.

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Nursing Care Planning & Goals

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.

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  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.
Home Management and Teaching 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.

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 Summarization
9. 1min. Summarize Verbal Done

SUMMARIZATION
Today, on this session we have discussed about peptic ulcer. We have
discussed about:

 Definition of Peptic Ulcer Diseases

 Types of Peptic ulcer Disease
 Causes of Peptic Ulcer Disease
 Sign and Symptoms of Peptic Ulcer Disease
 Diagnostic Studies of Peptic Ulcer Disease
10. 1min. Recapitalizatio  Management of Peptic Ulcer Diseases Recapitalizatio
n  Complication of Peptic Ulcer Diseases Verbal n
RECAPTUALIZATION
Enlist the Causes of peptic ulcer diseases?
Enumerate the sign and symptoms of peptic ulcer diseases?
11. 1min. Explain the complications of peptic ulcer diseases?

ASSIGNMENT
Write a assignment on complications of peptic ulcer and submit on
15/01/2025
REFERENCES
1. Suddharth’s and Brunner’s, “A Text Book of Medical Surgical
Nursing”, 13th edition, page no. 632-639 published by Wolters
Kluwer.
2. Lippincott Mannual of “A Text Book of Medical Surgical
Nursing”,10th edition, published by Wolters Kluwer.
3. Lewis’s, “A Text Book Of Medical Surgical Nursing”, 4 th
edition,page no. 922-930 published by Elsevier.
4. Peptic Ulcer Disease - American College of Gastroenterology

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 5. Prevalence and risk factors of asymptomatic peptic ulcer disease in
Taiwan - PMC

REFERENCES
6. Suddharth’s and Brunner’s, “A Text Book of Medical Surgical Nursing”, 13th edition, page no. 632-639 published by Wolters Kluwer.
7. Lippincott Mannual of “A Text Book of Medical Surgical Nursing”,10th edition, published by Wolters Kluwer.
8. Lewis’s, “A Text Book Of Medical Surgical Nursing”, 4th edition,page no. 922-930 published by Elsevier.
9. Peptic Ulcer Disease - American College of Gastroenterology
10. Prevalence and risk factors of asymptomatic peptic ulcer disease in Taiwan - PMC

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REFERENCES
1. Suddharth’s and Brunner’s, “A Text Book of Medical Surgical Nursing”, 13th edition, page no. 632-639 published by Wolters Kluwer.
2. Lippincott Mannual of “A Text Book of Medical Surgical Nursing”,10th edition, published by Wolters Kluwer.
3. Lewis’s, “A Text Book Of Medical Surgical Nursing”, 4th edition,page no. 922-930 published by Elsevier.
4. Peptic Ulcer Disease - American College of Gastroenterology
5. Prevalence and risk factors of asymptomatic peptic ulcer disease in Taiwan - PMC

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