LESSON PLAN ON PEPTIC ULCER

Prepared by:
Mr. Justin K. Joy
Assistant Professor
Faculty of Nursing & Paramedical
GENERAL INFORMATION
Subject: Medical-Surgical Nursing
Topic: Peptic Ulcer
Class: BSc/GNM Nursing
Duration: 60 minutes
Method of Teaching: Lecture cum Discussion
AV Aids: LED board, PowerPoint, Models, Charts, Handouts
Date:
Time:
Venue: Classroom
 GENERAL OBJECTIVE
At the end of the class, the students will gain in-depth
knowledge of Peptic Ulcer, including its causes, symptoms,
diagnostic methods, treatment, and nursing management,
and apply this understanding in clinical practice.
 SPECIFIC OBJECTIVES
• Define peptic Ulcer
• Explain the types and causes of peptic Ulcer
• Describe the risk factors and pathophysiology.
• Identify clinical manifestations of peptic Ulcer
• Discuss diagnostic evaluations and investigations.
• Explain medical, surgical, and nursing management.
• Describe complications and prevention.
 TEACHING PLAN
S.No Tim Specific Content Teaching Learning A.V. Aids /
e Objective Activity Activity Evaluation
1. 2 Introduc Introduction: Peptic Lecture Listen PPT / What is a
min e the ulcer is an erosion of the carefully peptic ulcer?
topic GI mucosa due to
digestive action of HCl
and pepsin.
2. 3 Define Definition: Open sores Lecture with Note down Whiteboard /
min peptic on the inner lining of example definition Define peptic
ulcer the stomach or ulcer
duodenum.
Peptic ulcer is a
localized erosion or sore
in the mucosal lining of
the stomach,
duodenum, or
esophagus caused by the
corrosive action of gastric
acid and pepsin. It results
from an imbalance
between aggressive
factors (like H. pylori
infection, NSAIDs) and
the protective
mechanisms of the
gastrointestinal mucosa.
3. 5 Explain Types: Discussion Participate Chart / Name
min types using chart two types of
and Types of Peptic Ulcer: peptic ulcer
etiology 1. Gastric Ulcer
o Occurs on the

inner lining of
the stomach.
o Common in

older adults
(50+ years).
o Often

associated with
normal or
reduced gastric
acid secretion.
2. Duodenal Ulcer
o Develops in the

first part of the

small intestine
(duodenum).
 o More common
in younger
individuals
(30–50 years).
o Typically

associated with
increased acid
secretion.
3. Esophageal Ulcer
o Found in the

lower part of
the esophagus.
o Usually caused

by acid reflux
or
gastroesophage
al reflux
disease
(GERD).
4. Stress Ulcer
 o Occurs in
critically ill
patients (e.g.,
severe trauma,
burns, or major
surgery).
o Results from

decreased
blood flow to
the stomach
lining.
5. Refractory Ulcer
o Ulcers that do

not heal after 8

to 12 weeks of
standard
treatment.
o Often due to

persistent H.
pylori
infection, drug
resistance, or
underlying
malignancy.
 Etiology:
1. Helicobacter pylori
(H. pylori)
infection
o Most common

cause.
o Damages the

mucosal lining,
increasing
vulnerability to
acid.
2. Non-Steroidal
Anti-Inflammatory
Drugs (NSAIDs)
o e.g., aspirin,

ibuprofen,
naproxen.
o Inhibit

prostaglandin
 synthesis,
reducing
mucosal
protection.
3. Excess Gastric
Acid Secretion
o Seen in

conditions like
Zollinger-
Ellison
Syndrome.
o Leads to

mucosal
erosion.
4. Smoking
o Reduces

bicarbonate
production and
delays ulcer
healing.
5. Alcohol
Consumption
o Irritates and

erodes the
mucosal lining.
6. Caffeine Intake
o Stimulates acid

secretion and
gastric motility.
7. Stress
(Physiological)
o Critical illness

or surgery can
reduce mucosal
blood flow and
cause stress
ulcers.
8. Genetic Factors
o Family history

of ulcers may
 increase risk.
9. Dietary Factors
(less common)
o Spicy foods,

irregular meals,
or skipping
meals may
aggravate
symptoms but
are not direct
causes.
10. Other Diseases
 Conditions like
COPD, chronic renal
failure, or cirrhosis
may increase ulcer
risk.

4. 5 Describe H. pylori, NSAIDs, alcohol, Lecture Listen and Slides / Mention

min risk caffeine, smoking, stress. recall any two risk
factors factors
1. H. pylori Infection
o Most significant
risk factor for
duodenal and
gastric ulcers.
2. Prolonged Use of
NSAIDs
o Regular intake of
drugs like aspirin,
ibuprofen, or
naproxen
weakens the
gastric mucosa.
3. Smoking
o Impairs mucosal
blood flow,
delays healing,
and increases
ulcer recurrence.
o
4. Alcohol Consumption
 o Directly irritates
and erodes the
gastric mucosa,
enhancing acid
effects.
5. Excess Gastric Acid
Secretion
o Seen in stress,
certain tumors
(Zollinger-Ellison
syndrome), or
lifestyle factors.
6. Stress (Severe
Physical Stress)
o Especially in
critically ill or
post-operative
patients leading
to stress ulcers.

7. Family History
 o Genetic
predisposition
may increase
susceptibility.
8. Caffeine and
Carbonated
Beverages
o Stimulate acid
secretion and
may worsen
symptoms.
9. Age (Above 50 Years)
o Increased
vulnerability due
to reduced
mucosal defenses
and
polypharmacy.
 10.Chronic Illnesses

 Conditions such as
liver cirrhosis, COPD,
and chronic kidney
disease.

11.Irregular Eating
Habits and Skipping
Meals

 May increase acid

exposure to
unprotected mucosa.
5. 7 Explain Acid production or Use of Observe and Flowchart /
min pathoph decreased mucosal diagram question Explain the
ysiology defense leads to ulcer. mechanism

Triggering Factors (H.

pylori / NSAIDs / Stress)
↓
Mucosal Barrier Damage
↓
↑ Acid & Pepsin Activity
— ↓ Mucosal Protection
↓
Mucosal Inflammation &
Erosion
↓
Ulcer Formation
↓
Complications (Bleeding,
Perforation, Obstruction)
6. 6 List Burning pain, bloating, Lecture Ask doubts Poster / List 3
min signs & nausea, vomiting, symptoms
sympto melena, hematemesis.
ms
1. Epigastric Pain
 Burning, gnawing,
or aching pain in
the upper abdomen
 May be relieved by
eating (duodenal
ulcer) or worsened
after meals (gastric
ulcer)
2. Bloating and Fullness
 Feeling of heaviness
or distension,
especially after
meals
3. Nausea and Vomiting
 Occurs due to
irritation of the
stomach lining
 Sometimes vomiting
may provide
temporary relief
from pain
4. Loss of Appetite
 Due to persistent
discomfort or fear of
eating triggering
pain
5. Weight Loss
 Often associated
with gastric ulcers
 due to decreased
intake
6. Hematemesis
(Vomiting of blood)
 Indicates bleeding
from the stomach or
esophageal ulcer
7. Melena (Black, tarry
stools)
 Sign of upper GI
bleeding; digested
blood in stool
8. Belching and Acid
Reflux
 Regurgitation of
sour fluid or food
 from the stomach
9. Heartburn (Pyrosis)
 Burning sensation
behind the
breastbone
10. Fatigue or
Weakness
 Often due to chronic
blood loss and
resulting anemia.

7. 7 Diagnost Endoscopy, Urea breath Group Note and Models / What is

min ic tests test, H. pylori tests, explanation discuss the gold
CBC standard test?
1. Epigastric Pain
  Burning, gnawing,
or aching pain in
the upper abdomen
 May be relieved by
eating (duodenal
ulcer) or worsened
after meals (gastric
ulcer)
2. Bloating and Fullness
 Feeling of heaviness
or distension,
especially after
meals
3. Nausea and Vomiting
 Occurs due to
irritation of the
stomach lining
  Sometimes vomiting
may provide
temporary relief
from pain
4. Loss of Appetite
 Due to persistent
discomfort or fear of
eating triggering
pain

5. Weight Loss
 Often associated
with gastric ulcers
due to decreased
 intake
6. Hematemesis
(Vomiting of blood)
 Indicates bleeding
from the stomach or
esophageal ulcer
7. Melena (Black, tarry
stools)
 Sign of upper GI
bleeding; digested
blood in stool

8. Belching and Acid

Reflux
 Regurgitation of
 sour fluid or food
from the stomach
9. Heartburn (Pyrosis)
 Burning sensation
behind the
breastbone
10. Fatigue or
Weakness
 Often due to chronic
blood loss and
resulting anemia

8 10 Medical Lecture cum List drugs Drug chart /

min and interaction Name two drugs
surgical 🩺 Medical Management
manage 1. Antacids
ment o Neutralize
gastric acid
(e.g.,
aluminium
hydroxide,
magnesium
hydroxide)
2. Proton Pump
Inhibitors (PPIs)
o Reduce acid

production
(e.g.,
omeprazole,
pantoprazole)
3. H2 Receptor
Blockers
o Inhibit acid

secretion (e.g.,
ranitidine,
famotidine)
4. Antibiotics
o Eradicate H.

pylori infection
(e.g.,
amoxicillin,
clarithromycin,
metronidazole)
5. Cytoprotective
Agents
o Protect mucosal

lining (e.g.,
sucralfate,
misoprostol)
6. Dietary
Modifications
o Avoid spicy,

oily, acidic
foods
o Eat small,

frequent meals
 o Avoid caffeine,
alcohol, and
smoking
7. Lifestyle Changes
o Manage stress

o Avoid NSAIDs

o Regular follow-

up

🏥 Surgical Management
1. Vagotomy
o Cutting the

vagus nerve to
reduce acid
 secretion
2. Antrectomy
o Removal of the

antral portion
of the stomach
3. Pyloroplasty
o Surgical

widening of the
pyloric canal
4. Subtotal
Gastrectomy
o Partial removal

of the stomach
5. Oversewing of
Bleeding Ulcer
o Emergency

surgery to
control active
bleeding
6. Graham Patch
 Repair
o Closure of

perforated ulcer
using a piece of
omentum

9. 10 Nursing Pain relief, monitor Scenario- Apply clinical Handout / What

min manage bleeding, fluid balance, based thinking diet is
ment education discussion recommended?
👩‍⚕️Nursing
Management of Peptic
Ulcer
Here is a comprehensive
list of nursing
interventions:
1. Pain Management
 Assess
characteristics,
severity, and
location of pain
 Administer
prescribed
analgesics and
antacids
 Encourage
relaxation
techniques to reduce
discomfort

2. Monitor for
Complications
 Observe for signs of
 GI bleeding (e.g.,
hematemesis,
melena)
 Monitor vital signs
(tachycardia,
hypotension, pallor)
 Check hemoglobin
and hematocrit
levels if bleeding
suspected

3. Medication
Administration and
Compliance
 Administer
prescribed PPIs,
antibiotics,
antacids on
 schedule
 Educate patient on
the importance of
completing the full
course of antibiotics
for H. pylori

4. Nutrition and Fluid

Balance
 Encourage small,
frequent meals and
avoid irritating
foods
 Maintain adequate
hydration
 Monitor input and
output if patient is
 vomiting or bleeding

5. Lifestyle and Health

Education
 Advise to avoid
NSAIDs, alcohol,
smoking, and
caffeine
 Educate about stress
management
techniques
 Encourage regular
medical follow-ups

6. Prevent Recurrence
 Educate patient on
recognizing early
 signs of ulcer
recurrence
 Emphasize
adherence to dietary
and lifestyle changes
 Discuss importance
of avoiding self-
medication with
painkillers

7. Preoperative and
Postoperative Care (if
surgical intervention is
required)
 Prepare patient for
surgery if indicated
(e.g., NPO, consent,
labs)
  Monitor wound site
and vital signs
postoperatively
 Encourage early
ambulation and deep
breathing exercises

10. 3 Complic Hemorrhage, Case study Ask questions Flashcards /

min ations perforation, gastric Name one
outlet obstruction complication
⚠️Complications of
Peptic Ulcer
Here is a concise list of
common and serious
complications associated
with peptic ulcer disease:
1. Gastrointestinal
Bleeding
o Most common

complication
o May present as

hematemesis
(vomiting
blood) or
melena (black
tarry stools)
o Can lead to

anemia or
hypovolemic
shock
2. Perforation
o Ulcer erodes

through the full

thickness of the
stomach or
duodenal wall
 o Causes sudden,
severe
abdominal pain
and peritonitis
(a surgical
emergency)

3. Penetration
o Ulcer extends

into adjacent
organs such as
the pancreas or
liver
o Causes referred

pain and
persistent
symptoms
4. Gastric Outlet
Obstruction
 o Caused by
inflammation,
edema, or
scarring near
the pylorus
o Leads to
vomiting,
bloating, and
early satiety

5. Peritonitis
o Occurs if

perforation
leaks gastric
contents into
the peritoneal
cavity
o Requires

immediate
 surgical
intervention
6. Recurrent Ulcers
o Ulcers may

reappear if H.
pylori is not
fully eradicated
or lifestyle
factors persist
o

7. Malignant
Transformation
(Rare)
o Long-standing

gastric ulcers
may develop
into gastric
cancer

11. 2 Preventi Avoid NSAIDs, quit Lecture Listen Chart / How to

min on smoking, limit alcohol, prevent
manage stress recurrence?
 Eradicate H. pylori
Infection
 Complete prescribed
antibiotic regimen
 Confirm eradication
if symptoms persist
 Avoid NSAIDs and
Aspirin (if possible)
 Use with caution
and under medical
supervision
 Take with food or
use protective agents
like PPIs if
necessary
 Limit Alcohol
Consumption
 Alcohol irritates the
gastric lining and
increases acid
secretion
 Quit Smoking
 Smoking impairs
mucosal healing and
increases acid
production
 Manage Stress
 Practice relaxation
techniques (yoga,
meditation,
counseling)
  Maintain work–life
balance
 Follow a Healthy
Diet
 Avoid spicy, fried,
and acidic foods
 Eat small, frequent
meals
 Avoid caffeine and
carbonated drinks
 Avoid Self-
medication
 Do not take
painkillers, steroids,
or antibiotics
without prescription
 Regular Health
 Check-ups
 Especially for
individuals with a
history of ulcers or
GI symptoms
 Use Gastroprotective
Agents (if at risk)
 Especially in
patients taking
NSAIDs long-term
(e.g., sucralfate,
PPIs)

12. 3 Summar Peptic ulcer is Brief review Reflect & ask Slides /
min y & manageable with queries Summarize
recapitul prompt treatment. peptic ulcer
ation
Peptic ulcer is a break or
erosion in the mucosal
lining of the stomach,
duodenum, or esophagus,
primarily caused by H.
pylori infection and
NSAID use. It manifests
as epigastric pain,
bloating, nausea, and may
lead to serious
complications like
bleeding, perforation,
or gastric outlet
obstruction. Diagnosis is
confirmed via endoscopy
and H. pylori testing.
Management includes
pharmacological
therapy (PPIs,
antibiotics, antacids),
 lifestyle modifications,
and occasionally surgical
intervention. Preventive
measures such as
avoiding NSAIDs,
smoking cessation, stress
management, and healthy
eating are essential for
long-term control and
recurrence prevention.

CONCLUSION
Appendicitis is a common gastrointestinal disorder that
can significantly affect quality of life. With early
recognition, appropriate pharmacological and surgical
management, and effective nursing care, complications
can be prevented. As future nurses, it is essential to
provide holistic care and educate patients on lifestyle
modifications to prevent recurrence.