CHAPTER ONE

INTRODUCTION
 1.1 DEMOGRAPHIC DATA

 Name of Patient: Mr D. K
 Address: Apummiri, ubakala Umuahia local government, abia
state.
 Age: 34 years
 Sex: male
 Marital Status: Married
 Religion: Christianity
 Occupation: Construction worker
 Next of Kin: Mrs F.K
 Relationship: wife
 Address of Next of Kin: Same as Patient
 Local Government Area: Umuahia
 State: Abia State
 Nationality: Nigeria
 Known Allergies: Non
 Medical Diagnosis: Gastric ulcer
 Doctor In charge: Dr I.L.L

Composition of Educational Occupation Income (per

the family background month)
Father undergraduate farmer 50,000
Mother Undergraduate Trader 30,000
1.2 FAMILY DATA

1.3 PREDOMINANT HEALTH PROBLEM IN THE FAMILY

Mr D.K comes from a family with the history of gastric ulcer, where the mother
has a history of gastric ulcer, while the father had a history of hypertension.
1.4 PAST MEDICAL HISTORY
Mr D.K has a medical history of hypertension and had a lifestyle of smoking, no
previous history of ulcers or gastrointestinal issues
1.5 HISTORY OF PAST SURGERIES
No history of past surgeries done

1.6 PRESENT MEDICAL HISTORY

MR D.K presented with a persistent, burning and sharp pain at the epigastric
region, he said it has been occurring for the past 2 weeks, symptoms like
nausea, vomiting and bloating also occurred.
 CHAPTER TWO
APPLICATION OF NURSING PROCESS
2.1 Nursing History
Mr D.K is a construction worker , he complained about a persistent abdominal
pain at the epigastric region which has been occurring for2weeks. He also
identified that he has been going through various symptoms like nausea,
vomiting, bloating and loss of appetite.
Mr D.K came into the health care centre on the 24/09/24 by 12:24pm was
being companied by the wife, Mrs F.K , He was being attended to by the nurses
on duty , physical examination and laboratory investigation was done. Vital
signs assessment was done on the patient by 12:50 pm.
2.2 Physical Examination
Inspection
1. General appearance: Observe the patient's overall appearance, including
their posture, facial expression, and level of comfort.
2. Abdominal contour: Inspect the abdominal contour, looking for any signs of
distension, guarding, or masses.
3. Scars: Note any scars on the abdomen, which may indicate previous
surgeries or injuries.
4. Skin: Observe the skin for any signs of jaundice, pallor, or cyanosis.
5. Mouth and throat: Inspect the mouth and throat for any signs of bleeding,
ulcers, or inflammation.

Palpation
1. Light palpation: Perform light palpation to assess the abdominal wall and
underlying organs.
2. Deep palpation: Perform deep palpation to assess the abdominal organs,
including the liver, spleen, and kidneys.
3. Tenderness: Assess for tenderness in the epigastric region, which may
indicate an ulcer.
4. Guarding: Assess for guarding (muscle tension) in the abdominal wall, which
may indicate peritonitis or an ulcer.
5. Masses: Assess for any masses or abnormalities in the abdominal organs.
6. Rebound tenderness: Assess for rebound tenderness, which may indicate
peritonitis or an ulcer.

Percussion
1. Abdominal percussion: Perform abdominal percussion to assess the size and
position of the abdominal organs.
2. Liver dullness: Assess for liver dullness, which may indicate an enlarged liver.
3. Splenic dullness: Assess for splenic dullness, which may indicate an enlarged
spleen.
4. Tympanic sound: Assess for a tympanic sound, which may indicate gas in the
bowel.

Auscultation
1. Bowel sounds: Auscultate the abdomen to assess bowel sounds, which may
be decreased or absent in cases of ileus or obstruction.
2. Abdominal bruits: Auscultate for abdominal bruits, which may indicate
vascular disease or aneurysms.
3. Friction rub: Auscultate for a friction rub, which may indicate peritonitis or
an ulcer.
4. Heart sounds: Auscultate the heart to assess for any abnormalities, such as
tachycardia or murmurs.

2.3 Assessment of the patient with Gordon typology of eleven functional

patterns
Health Perception-Health Management Pattern
- Perception of health: Patient reports abdominal pain and discomfort, affecting
daily activities.
- Health management: Patient has been taking antacids and avoiding spicy
foods, but has not sought medical attention until now.

Nutritional-Metabolic Pattern
- Dietary habits: Patient reports frequent consumption of spicy and fatty foods,
which may exacerbate ulcer symptoms.
- Nutritional status: Patient's weight and body mass index (BMI) are within
normal limits.

Elimination Pattern
- Bowel habits: Patient reports occasional diarrhea and abdominal cramping.
- Urinary habits: Patient reports normal urinary frequency and output.

Activity-Exercise Pattern
- Activity level: Patient reports reduced activity level due to abdominal pain and
discomfort.
- Exercise habits: Patient does not engage in regular exercise.

Sleep-Rest Pattern
- Sleep habits: Patient reports difficulty sleeping due to abdominal pain and
discomfort.
- Rest habits: Patient reports feeling tired and fatigued during the day.

Cognitive-Perceptual Pattern
- Thought processes: Patient reports feeling anxious and worried about their
symptoms.
- Perception: Patient reports perceiving their symptoms as severe and
debilitating.

Self-Perception-Self-Concept Pattern
- Self-esteem: Patient reports feeling frustrated and helpless due to their
symptoms.
- Body image: Patient reports feeling self-conscious about their abdominal pain
and discomfort.

Role-Relationship Pattern
- Roles: Patient reports difficulty fulfilling work and family responsibilities due
to their symptoms.
- Relationships: Patient reports feeling supported by family and friends.

Sexuality-Reproductive Pattern
- Sexual function: Patient reports no changes in sexual function.
- Reproductive function: Patient reports no changes in reproductive function.

Coping-Stress Tolerance Pattern

- Coping mechanisms: Patient reports using avoidance and denial to cope with
their symptoms.
- Stress tolerance: Patient reports feeling overwhelmed and stressed due to
their symptoms.

Value-Belief Pattern
- Values: Patient reports valuing health and well-being.
- Beliefs: Patient reports believing that their symptoms are related to stress and
diet.
2.4 Medical Investigations
Anthropometric Measurements
- Height: 165 cm (5’9")
- Weight: 60 kg (132 lbs)
- Body Mass Index (BMI): 22.04 kg/m² (normal weight)
Vital Signs
- Temperature: 37.2°C (98.9°F)
- Pulse: 88 beats per minute (bpm) (normal sinus rhythm)
- Blood Pressure: 120/80 mmHg (systolic/diastolic)
- Respiratory Rate: 18 breaths per minute
2.4.2 Laboratory/ Diagnostic results

Complete Blood Count (CBC)

- Haemoglobin (Hb): 12.5 g/dL (normal range: 13.5-17.5 g/dL)
- White Blood Cell Count (WBC): 10,000 cells/μL (normal range: 4,500-11,000
cells/μL)
- Platelet Count: 250,000 cells/μL (normal range: 150,000-450,000 cells/μL)

Blood Chemistry
- Urea: 25 mg/dL (normal range: 10-20 mg/dL)
- Creatinine: 1.0 mg/dL (normal range: 0.6-1.2 mg/dL)
- Electrolytes: Within normal limits
- Liver Function Tests (LFTs): Within normal limits

Gastrointestinal Investigations
- Upper GI Endoscopy: Revealed a 1.5 cm duodenal ulcer
- Biopsy: Revealed chronic inflammation and ulceration
- Helicobacter pylori (H. pylori) test: Positive

Imaging Studies
- Abdominal X-ray: Revealed no signs of obstruction or perforation
- Abdominal Ultrasound: Revealed no signs of liver or pancreatic disease

Other Investigations
- Stool test: Revealed no signs of gastrointestinal bleeding
- Urine test: Revealed no signs of kidney disease

2.4.3 Medical Diagnosis

- Chronic Gastritis: The biopsy findings of chronic inflammation and ulceration
support the diagnosis of chronic gastritis.
 CHAPTER THREE

Nursing care plan for Mr D.K

Date Nursing Objective Nursing action Rationale Evaluatio
diagnosis s n
24/09/2 Impaired The 1. Encourage the patient 1. Provide the The
4 Nutrition patient to eat small, frequent patient with patient
related to will meals to help manage nutritional was able
decreased maintain symptoms. counseling to to
appetite, adequate 2. Provide a bland diet ensure maintain
nausea, and nutrition that is low in fat and adequate adequate
vomiting and spices. nutritional nutrition
secondary hydration 3. Encourage the patient intake. and
to ulcer . to drink plenty of fluids to 2. Encourage hydration
symptoms. help prevent dehydration. the patient to in 2days.
4. Administer nutritional eat small,
supplements as frequent
prescribed. meals to
manage
nausea and
vomiting.
3.Administer
anti-emetic
medications
as prescribed
to manage
nausea and
vomiting.
4.Administer
vitamin and
mineral
supplements
as prescribed
to prevent
malnutrition.
24/09/2 Acute Pain Short- 1. Encourage the 1. Relaxation the
4 related to term patient to take slow, techniques patient
ulceration goal: The deep breaths to Teach the reported
and patient help relax. patient a
inflammatio will 2. Encourage the relaxation decrease
n of the report a patient to avoid techniques, of pain
gastric decrease lying flat, which can such as deep intensity
mucosa. in pain exacerbate pain. breathing, to 2 on
intensity 3. Administer antacids progressive the pain
to 3 or as prescribed muscle scale in
less on 4. Administer pain relaxation, or 12 hours
the pain medication as guided time.
scale prescribed, such as imagery, to
within 24 acetaminophen or help manage
hours. ibuprofen. pain and
Long- anxiety.
term 2. Positioning:
goal: The Encourage the
patient patient to
will be assume a
able to comfortable
manage position, such
pain as sitting up or
effectively lying on their.
, as 3. Administer
evidence antacids as
d by prescribed to
reports of neutralize
minimal stomach acid
or no and reduce
pain. pain.
4. Pain
medication
Administer
pain
medication as
prescribed,
such as
acetaminophe
n or ibuprofen
 to RE

CHAPTER FOUR
PHARMACOLOGICAL REVIEW OF DRUGS

Omeprazole (Losec)
- Drug Group: Proton pump inhibitor
- Mechanism of Action: Inhibits the H+/K+ ATPase enzyme system at the
secretory surface of gastric parietal cells, reducing gastric acid secretion
- Dosage: 20-40 mg orally once daily
- Side Effects: Headache, diarrhea, nausea, vomiting, abdominal pain
- Contraindication: Hypersensitivity to omeprazole or any component of the
formulation
- Indications: Treatment of gastric ulcers, duodenal ulcers, gastroesophageal
reflux disease (GERD), and Zollinger-Ellison syndrome
- Nursing Responsibilities:
- Monitor patient for signs of bleeding or perforation
- Assess patient for signs of hypomagnesemia (e.g., muscle weakness,
fatigue)
- Educate patient on proper administration of medication (e.g., take on an
empty stomach, 1 hour before meals)

Ranitidine (Zantac)
- Drug Group: H2-receptor antagonist
- Mechanism of Action: Competitively inhibits histamine at the H2-receptors of
gastric parietal cells, reducing gastric acid secretion
- Dosage: 150-300 mg orally twice daily
- Side Effects: Headache, diarrhea, nausea, vomiting, abdominal pain
- Contraindication: Hypersensitivity to ranitidine or any component of the
formulation
- Indications: Treatment of gastric ulcers, duodenal ulcers, gastroesophageal
reflux disease (GERD), and Zollinger-Ellison syndrome
- Nursing Responsibilities:
- Monitor patient for signs of bleeding or perforation
- Assess patient for signs of mental confusion or hallucinations (especially in
elderly patients)
- Educate patient on proper administration of medication (e.g., take with
meals or at bedtime)

Aluminum Hydroxide (Amphojel)

- Drug Group: Antacid
- Mechanism of Action: Neutralizes gastric acid by increasing the pH of the
stomach
- Dosage: 500-1000 mg orally 1-3 hours after meals and at bedtime
- Side Effects: Constipation, diarrhea, nausea, vomiting, abdominal cramps
- Contraindication: Hypersensitivity to aluminum hydroxide or any component
of the formulation
- Indications: Treatment of heartburn, indigestion, and upset stomach
- Nursing Responsibilities:
- Monitor patient for signs of constipation or diarrhea
- Assess patient for signs of aluminum toxicity (e.g., confusion, muscle
weakness)
- Educate patient on proper administration of medication (e.g., take after
meals and at bedtime)

Sucralfate (Carafate)
- Drug Group: Sucralfate
- Mechanism of Action: Forms a protective barrier over the ulcer site,
protecting it from acid and pepsin
- Dosage: 1 gram orally 4 times daily, 1 hour before meals and at bedtime
- Side Effects: Constipation, diarrhea, nausea, vomiting, abdominal cramps
- Contraindication: Hypersensitivity to sucralfate or any component of the
formulation
- Indications: Treatment of duodenal ulcers, gastric ulcers, and
gastroesophageal reflux disease (GERD)
- Nursing Responsibilities:
- Monitor patient for signs of constipation or diarrhea
- Assess patient for signs of sucral fate toxicity (e.g., aluminum toxicity)
- Educate patient on proper administration of medication (e.g., take on an
empty stomach, 1 hour before meals)

Antibiotics
Clarithromycin (Biaxin)
- Drug Group: Macrolide antibiotic
- Mechanism of Action: Inhibits protein synthesis in bacteria, leading to
bacterial death
- Dosage: 500 mg orally twice daily for 7-14 days
- Side Effects: Nausea, vomiting, diarrhea, abdominal pain, headache
- Contraindication: Hypersensitivity to clarithromycin or any component of the
formulation
- Indications: Treatment of H. pylori infection, which is a common cause of
gastric ulcers
- Nursing Responsibilities:
- Monitor patient for signs of allergic reaction (e.g., rash, itching)
 - Assess patient for signs of antibiotic-associated diarrhea
- Educate patient on proper administration of medication (e.g., take with
meals, complete full course of treatment)
TREATMENT PLAN FOR Mr D.K
Day 1:

1. Medications:
- Proton pump inhibitor (PPI): Omeprazole 20mg orally twice daily
- Antibiotics: Clarithromycin 500mg orally twice daily and Amoxicillin 1000mg
orally twice daily (for H. pylori infection)
- Antacid: Aluminum hydroxide 500mg orally 1-3 hours after meals and at
bedtime
2. Diet:
- NPO (nothing by mouth) for 24 hours to rest the stomach
- IV fluids to maintain hydration
3. Activity:
- Bed rest for 24 hours to reduce stress and promote healing
4. Monitoring:
- Vital signs: temperature, pulse, blood pressure, respiratory rate
- Abdominal pain: assess pain level using a pain scale (0-10)
- Bowel movements: monitor for diarrhea or constipation

Day 2 (Day of Discharge):

1. Medications:
- Continue PPI: Omeprazole 20mg orally twice daily
 - Continue antibiotics: Clarithromycin 500mg orally twice daily and
Amoxicillin 1000mg orally twice daily (for H. pylori infection)
- Antacid: Aluminum hydroxide 500mg orally 1-3 hours after meals and at
bedtime
2. Diet:
- Progress to a bland diet (e.g., crackers, toast, plain rice, bananas,
applesauce)
- Avoid spicy, fatty, or acidic foods
3. Activity:
- Gradually increase activity level as tolerated
- Avoid heavy lifting, bending, or straining
4. Monitoring:
- Vital signs: temperature, pulse, blood pressure, respiratory rate
- Abdominal pain: assess pain level using a pain scale (0-10)
- Bowel movements: monitor for diarrhea or constipation
5. Discharge Instructions:
- Continue medications as prescribed
- Follow a bland diet and avoid spicy, fatty, or acidic foods
- Avoid heavy lifting, bending, or straining
- Report any worsening of symptoms or concerns to your doctor

ADVICE ON DISCHARGE

Medication Instructions
1. Continue taking your medications as prescribed by your doctor.
2. Take your proton pump inhibitors (PPIs) or H2-receptor antagonists at the
same time every day, as directed.
3. Complete the full course of antibiotics if prescribed for H. pylori infection.
4. Do not stop taking your medications without consulting your doctor.

Dietary Instructions
1. Eat small, frequent meals to avoid putting too much pressure on your
stomach.
2. Avoid spicy, fatty, or acidic foods that can irritate your stomach.
3. Choose bland foods such as crackers, toast, plain rice, bananas, and
applesauce.
4. Avoid caffeine and alcohol, which can irritate your stomach and worsen
symptoms.

Lifestyle Instructions
1. Manage stress through relaxation techniques such as deep breathing,
meditation, or yoga.
2. Get plenty of rest and avoid fatigue.
3. Avoid smoking and secondhand smoke, which can worsen symptoms and
slow healing.
4. Avoid heavy lifting, bending, or straining, which can put pressure on your
stomach.

Follow-up Instructions
1. Schedule a follow-up appointment with your doctor in 1-2 weeks to monitor
your progress.
2. Report any worsening of symptoms, such as increased pain, bleeding, or
vomiting.
3. Inform your doctor of any medication side effects or concerns.

Warning Signs
1. Seek immediate medical attention if you experience:
- Severe abdominal pain
- Vomiting blood or coffee ground-like material
- Black, tarry stools
- Difficulty breathing
- Chest pain or tightness
 CHAPTER FIVE
LITERATURE REVIEW

Definition and Prevalence

Gastric ulcers are open sores that develop on the inside lining of the stomach.
According to a study published in the Journal of Clinical Gastroenterology,
gastric ulcers affect approximately 4.6 million people worldwide, with a
prevalence of 0.1-1.4% in the general population .

Pathophysiology of Gastric Ulcers

Gastric ulcers occur when there is an imbalance between the aggressive factors
(acid and pepsin) and the defensive factors (mucus-bicarbonate barrier,
epithelial cell tight junctions, prostaglandins, and blood flow). The
pathophysiology of gastric ulcers involves:

1. Increased acid production: increased acid production by the parietal cells in

the stomach, which can be stimulated by factors such as stress, caffeine, and
nicotine.
2. Decreased mucus-bicarbonate barrier: decreased production of mucus and
bicarbonate ions, which can be caused by factors such as nonsteroidal anti-
inflammatory drugs (NSAIDs), stress, and H. pylori infection.
3. Disruption of epithelial cell tight junctions: disruption of the tight junctions
between epithelial cells, which can be caused by factors such as NSAIDs, stress,
and H. pylori infection.
4. Decreased prostaglandin production: decreased production of
prostaglandins, which can be caused by factors such as NSAIDs and stress.
5. Decreased blood flow: decreased blood flow to the gastric mucosa, which
can be caused by factors such as stress, smoking, and atherosclerosis.
Etiology
The most common causes of gastric ulcers are:
1. Helicobacter pylori (H. pylori) infection: H. pylori is a type of bacteria that
can infect the stomach lining, leading to inflammation and ulceration. A study
published in the New England Journal of Medicine found that H. pylori
infection is present in approximately 70% of patients with gastric ulcers (2).
2. Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as aspirin and
ibuprofen, can cause gastric ulcers by inhibiting the production of
prostaglandins, which protect the stomach lining. A study published in the
Journal of the American Medical Association found that NSAID use is
associated with a 2- to 5-fold increased risk of gastric ulcers (3).
3. Stress: Stress can cause an increase in stomach acid production, leading to
gastric ulcers. A study published in the Journal of Clinical Gastroenterology
found that stress is a significant risk factor for gastric ulcers (4).

Symptoms and Diagnosis

The symptoms of gastric ulcers can vary, but common symptoms include:
- Abdominal pain or discomfort
- Nausea and vomiting
- Loss of appetite
- Weight loss

Gastric ulcers can be diagnosed using a variety of tests, including:

- Endoscopy: a procedure in which a flexible tube with a camera is inserted
through the mouth to visualize the stomach lining.
- Barium swallow: a procedure in which a liquid containing barium is swallowed
to provide a clear X-ray image of the stomach lining.
- Blood tests: to check for anaemia, inflammation, and H. pylori infection.

Treatment
The treatment of gastric ulcers depends on the underlying cause and the
severity of symptoms. Common treatments include:
- Antibiotics: to treat H. pylori infection.
- Proton pump inhibitors (PPIs): to reduce stomach acid production.
- H2-receptor antagonists: to reduce stomach acid production.
- Antacids: to neutralize stomach acid.
- Surgery: in severe cases, surgery may be necessary to repair the ulcer or
remove the affected portion of the stomach.

Complications
Gastric ulcers can lead to several complications, including:
- Bleeding: gastric ulcers can bleed, leading to anaemia and potentially life-
threatening complications.
- Perforation: gastric ulcers can perforate, leading to peritonitis and potentially
life-threatening complications.
- Obstruction: gastric ulcers can cause narrowing of the stomach outlet, leading
to obstruction and potentially life-threatening complications.

Conclusion
Gastric ulcers are a common and potentially serious condition. Understanding
the etiology, symptoms, diagnosis, treatment, and complications of gastric
ulcers is essential for providing effective care. Healthcare providers should be
aware of the risk factors for gastric ulcers and take steps to prevent them, such
as promoting H. pylori screening and treatment, and encouraging patients to
avoid NSAIDs and manage stress.