An ulcer develops when there is erosion of a portion of the mucosal layer of either
the stomach or duodenum. The ulcer may occur within the stomach (gastric
ulcer), or the duodenum (duodenal ulcer). A break in the protective mucosal lin-
ing allows the acid within the stomach to make contact with the epithelial tissues.
Gastric ulcers favor the lesser curvature of the stomach. Duodenal ulcers tend to
be deeper, penetrating through the mucosa to the muscular layer. Helicobacter
pylori infection has been associated with duodenal ulcers. Stress ulcers are asso-
ciated with another acute medical condition or traumatic injury. As the body
attempts to heal from the other physical condition (for example, major surgery),
small areas of ischemia develop within the stomach or duodenum. The ischemic
areas then ulcerate.
PROGNOSIS
The ulcerated areas may develop bleeding or may perforate. Depending on the
location of the ulceration, a vessel may become exposed to the effects of the stom-
ach acids. Damage to these vessels may result in significant bleeding. Perforation
of the ulcer can occur as the ulcer continues to erode more deeply into the tissue.
Perforation permits the contents of the stomach or duodenum to enter the peri-
toneum, leading to peritonitis, paralytic ileus, septicemia, and shock. This patient
will need emergency surgery due to a life-threatening condition.
SIGNS AND SYMPTOMS
• Sudden, sharp pain
• Tender, rigid, board-like abdomen
• Knee-chest position reduces pain
• Hypovolemic shock
• Weight changes
• Loss with gastric ulcer
• Gain with duodenal ulcer
TREATMENT
• Administer antacids
• Administer histamine-2 blockers:
• famotidine, ranitidine, nizatidine
• Administer proton pump inhibitors:
• omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole
• Administer mucosal barrier fortifiers:
• sucralfate
• Administer prostaglandin analogue:
• misoprostol
• Adjust diet.
• Treat H. pylori infection if present with combination therapy:
• Proton pump inhibitor plus clarithromycin plus amoxicillin or
• Proton pump inhibitor plus metronidazole plus clarithromycin or
• Bismuth subsalicylate plus metronidazole plus tetracycline.
NURSING DIAGNOSES
• Acute pain
• Risk for imbalanced nutrition: less than what body requires
• Risk for imbalanced nutrition: more than what body requires
NURSING INTERVENTION
• Monitor vital signs.
• Monitor intake and output.
• Assess abdomen for bowel sounds, tenderness, rigidity, rebound pain, guarding.
• Monitor stool for change in color, consistency, blood.
• Teach patient about home care:
• Diet modification to avoid acidic foods, caffeine, peppermint, alcohol.
• Eat more frequent, small meals.
• Avoid nonsteroidal anti-inflammatory medication.
• Stop smoking.
