INFLAMMATORY

BOWEL DISEASE
(IBD)
CROHN'S DISEASE
Presentation by:
DUMILE, AYESSA CAMELLE A.
ENAD, FRANCES ELLEAN I.
 TABLE OF
CONTENTS
MEDICAL AND
SIGNS AND DIAGNOSTIC
INTRODUCTION PHARMACOLOGIC
SYMPTOMS LABORATORIES INTERVENTIONS

NURSING NURSING
DIAGNOSIS INTERVENTIONS
INTRODUCTION
CROHN'S DISEASE

an idiophatic, chronic, transmural inflammatory

process of the bowel that can affect any part of the
gastro intestinal tract from the mouth to the anus.

most cases involved the small bowel, particularly the

terminal ileum.
Classification
ILEOCOLIC CROHN'S DISEASE: affects
both the ileum snd the large intestine
(50%).
CROHN'S ILEITIS: affects the ileum only
(30%).
CROHN'S COLITIS: affects the large
intestine. accounts for the the remaining
twenty percent of cases.
Classification
STRICTURING: disease causes
narrowing of the bowel which lead to
bowel obstruction or changes in the
caliber of the feces.
Classification
PENETRATING:disease creates abnormal
passage ways between the bowel and
other structures such as the skin.
Classification
INFLAMMATORY:disease causes
inflammation without causing strictures
of fistulae.
 MOST COMMON
SITES IN CROHN'S
DISEASE

TERMINAL ILEUM ILEOCECAL VALVE CECUM

 SIGNS AND
SYMPTOMS
STOMATITIS INFLAMMATION IN
EYES

MOUTH ULCER DYSPHAGIA

 SIGNS AND
SYMPTOMS
ABDOMINAL
DIARRHEA
PAIN

FLATULENCE BLOATING
 SIGNS AND
SYMPTOMS
WEIGHT LOSS RELATED
RETARDATION OF TO DECREASE FOOD
GROWTH INTAKE

EXTENSIVE SMALL
INTESTINE HAVE
MALABSORPTION OF
CHO/ LIPIDS.
 SIGNS AND
SYMPTOMS
PAINFUL SWELLING DIFFULTY OF
OF LOWER LEGS BREATHING

AUTOIMMUNE
HEMOLYTIC ANEMIA
 DIAGNOSTIC
LABORATORIES
COLONOSCOPY
UPPER OR CAPSULE ENDOSCOPY
ABDOMINAL CT SCAN
BLOOD TESTS
STOOL TESTS
 MEDICAL AND
PHARMACOLOGIC
INTERVENTIONS
A. PHARMACOLOGIC INTERVENTIONS
ANTI- INFLAMMATORY DRUGS
-Mesalamine
-Sulfasalazine
-5-ASA agents, such as ASACOL, DIPENTUM, OR
PENTASE
CORTICOSTERONE OR STEROIDS
 MEDICAL AND
PHARMACOLOGIC
INTERVENTIONS
IMMUNE SYSTEM SUPPRESSORS
-6- MERCAPTOPURINE/ AZATHIOPRINE
INFLIXIMAB ( RENICADE)
ANTIBIOTICS
ANTI-DIARRHEALS
-DIPHENOXYLATE, LOPERAMIDE, CODELINE
FLUID REPLACEMENT
-FLUIDS & ELECTROLYTES
 MEDICAL AND
PHARMACOLOGIC
INTERVENTIONS
B. DIET & NUTRIYION
HIGH PROTEIN, HIGH CALORIE DIET GIVEN BY ORAL/
PARENTERAL CARE.
PLASMA & BLOOD TRANSFUSION
LOW FAT DIET OR MILK FREE DIET
LOW RESIDUE OR HIGH FIBER DIET
SUPPLEMENTATION OF IRON, FOLIC ACID, CALCIUM,
VITAMIN D, ELECTROLYTES
TOTAL PARENTERAL NUTRITION
 MEDICAL AND
PHARMACOLOGIC
INTERVENTIONS
SURGICAL MANAGEMENT
-Surgery to remove a damaged portion of GI tract to close fistulas or
remove scar tissue.
surgical procedures include resection of the affected area with
anastomosis, colectomy with ileorectal anastomosis, depending on
the area of bowel involved.
 NURSING
DIAGNOSIS

DIARRHEA RELATED TO INFLMMATORY BOWEL DISEASE

IMPAIRED NUTRION LESS THAN BODY REQUIREMENTS RELATED TO
ANOREXIA & MALABSORPTION
FLUID VOLUME DEFICIT RELATED TO ANOREXIA, NAUSE, DIARRHEA
ACUTE PAIN RELATED TO INCREASED PERISTASIS & CRAMPING
IMPAIRED SKIN INTEGRITY RELATED TO FREQUENT LOOSE STOOLS
INEFFECTIVE COPING RELATED TO REPEATED EPISODES OF DIARRHEA
 NURSING
INTERVENTIONS
A. TEACHING & EDUCATION
STRESS MANAGEMENT TECHNIQUES
MEDICATION THERAPIES
DIET MANAGEMENT & EXERCISE
DIAGNOSTIC TESTING AND PROCEDURES
B. SUPPORT
UNDERSTANDING THE DISEASE
BODY IMAGE
C. COLLABORATE
1. DIETITIAN 2. GASTROENTEROLOGIST& SUREGEON 3. SMOKING CESSATION PROGRAM
Thank You
 INFLAMMATORY BOWEL DISEASE
(ULCERATIVE COLITIS)

ESPINA, ANGELINE
F O R M E N T E R A , C H A R M E N D.
ULCERATIVE COLITIS
• Is a medical condition that involves the inflammation and ulcer formation in the lining of the
colon (large intestine) and rectum.
• A type of inflammatory bowel disease (IBD) that can have progressive symptoms over time and
could be both debilitating and life-threatening if left uncontrolled.
• There is no cure for ulcerative colitis yet, the treatment is aimed at the reduction of signs and
symptoms of this condition, and the prevention of complications.
TYPES OF ULCERATIVE COLITIS
1. PANCOLITIS – affecting the entire colon and includes severe bloody diarrhea and significant
weight loss
2. LEFT-SIDED COLITIS – inflammation extending from the rectum to the sigmoid and
descending colon; includes pain on the left abdominal area
3. PROCTOSIGMOIDITIS – inflammation involving the sigmoid colon and rectum
4. ULCERATIVE PROCTITIS – inflammation that is on the anus and not extending to the rest of
the colon; includes rectal bleeding as the main symptom
 SIGNS AND SYMPTOMS
1. Diarrhea that could have blood or pus
2. Abdominal pain and cramping
3. Rectal bleeding and/or rectal pain
4. Tenesmus- increased urgency to defecate but inability to move bowels; accompanied by cramping
rectal pain
5. Inability to defecate despite urgency
6. Weight loss
7. Fatigue
8. Fever
CAUSES
• The exact cause of ulcerative colitis remains unknown. Previously, diet and stress were
suspected. However, researchers now know that these factors may aggravate but don't cause
ulcerative colitis.
• One possible cause is an immune system malfunction. When your immune system tries to fight
off an invading virus or bacterium, an irregular immune response causes the immune system to
attack the cells in the digestive tract, too.
• Heredity also seems to play a role in that ulcerative colitis is more common in people who have
family members with the disease. However, most people with ulcerative colitis don't have this
family history.
RISK FACTORS
Ulcerative colitis affects about the same number of women and men. Risk factors may include:
Age. Ulcerative colitis usually begins before the age of 30, but it can occur at any age. Some
people may not develop the disease until after age 60.
Race or ethnicity. Although white people have the highest risk of the disease, it can occur in any
race. If you're of Ashkenazi Jewish descent, your risk is even higher.
Family history. You're at higher risk if you have a close relative, such as a parent, sibling or child,
with the disease.
COMPLICATIONS
Possible complications of ulcerative colitis include:
• Severe bleeding
• Severe dehydration
• A rapidly swelling colon, also called a toxic megacolon
• A hole in the colon, also called a perforated colon
• Increased risk of blood clots in veins and arteries
• Inflammation of the skin, joints and eyes
• An increased risk of colon cancer
• Bone loss, also called osteoporosis
DIAGNOSTIC LABORATORIES

Blood test- It may Stool studies- stool Endoscopy- examine

suggest to check for sample can help rule out inside the colon and
Anemia other disorder such as rectum with a lighted
- To check for signs of infection caused by tube inserted.
infection inflammation bacteria, viruses ad
parasites
 DIAGNOSTIC LABORATORIES

X-ray- for severe Chromoendoscopy- a CT Scan- scan of the

symptoms, may use x-ray technique used during abdomen or pelvis .
of your abdominal area colonoscopy to look for It is also reveal how
polyps or precancerous much the colon is
inflamed
DIAGNOSTIC LABORATORIES

Computerized tomography (CT) Colonoscopy- This exam allows Flexible sigmoidoscopy- uses a
enterography and magnetic your provider to view your entire slender, flexible, lighted tube to
resonance (MR) enterography- colon using a thin, flexible, lighted examine the rectum and sigmoid
These types of noninvasive tests tube with a camera on the end. colon — the lower end of your
may be recommended to exclude colon. If your colon is severely
any inflammation in the small inflamed, this test may be
intestine. preferred instead of a full
colonoscopy
MEDICAL AND PHARMACOLOGICAL INTERVENTIONS
Ulcerative colitis treatment usually involves either medication therapy or surgery.
Anti-inflammatory medications:

• 5-aminosalicylates
• Corticosteroids
Immune system suppressors:

• Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan)

• Cyclosporine (Gengraf, Neoral, Sandimmune)
• "Small molecule" medications
Biologics:
•Infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi)
•Vedolizumab (Entyvio)
• Ustekinumab (Stelara)
Other medications:
• Anti-diarrheal medications
• Pain relievers
• Antispasmodics
• Iron supplements
Surgery:
• Proctocolectomy
• Ileoanal anastomosis
Cancer surveillance
Diet:
• Limit dairy products.
•Eat small meals
•Drink plenty of liquids
•Talk to a dietitian
Stress:
• Exercise
• Biofeedback
• Regular relaxation and breathing exercises
 POSSIBLE NURSING DIAGNOSIS AND NURSING
INTERVENTIONS
NURSING DIAGNOSIS NURSING INTERVENTIONS
Nursing Diagnosis: • Commence a stool chart. Use a standardized stool
• Acute pain assessment tool such as Bristol stool chart.
• Ineffective Coping • Administer medications for ulcerative colitis as
• Deficient Knowledge prescribed
• Risk for Deficient Fluid Volume • Encourage to increase oral fluid intake as tolerated,
• Anxiety ideally at least 2L per day. Avoid cold drinks. Check if
the patient is in any fluid restriction before doing so.
• Diarrhea related to inflammation of bowel as • Help the patient to select appropriate dietary choices
evidenced by loose, watery stools, abdominal to reduce the intake of milk products, caffeinated
cramping and pain, increased urgency to defecate, drinks, alcohol and avoid high fiber, high fat foods.
tenesmus and increased bowel sounds • Start the patient on a nothing by mouth status and
gradually progress to clear liquids, followed by bland
diet and the low residue diet. The patient can then
have a low fat/residue, low fiber diet on a long-term
basis, as a recommended by the dietitian
 NURSING DIAGNOSIS NURSING INTERVENTIONS
• Imbalanced Nutrition : Less than Body • Explore the patient’s daily nutritional intake and
Requirements related to altered absorption food habits (e.g. mealtime, duration of each
of nutrients secondary to Ulcerative colitis, meal session, snacking, etc.)
as evidenced by diarrhea, abdominal pain • Create a daily weight chart and a flood and fluid
chart. Discuss with the patient the short term
and cramping
and long term nutrition and weight goals related
to ulcerative colitis.
• Help the patient to select appropriate dietary
choices to reduce the intake of milk products,
caffeinated drinks, alcohol and high fiber, high
foods.
• Refer the patient to the dietitian
• Start the patient on a nothing by mouth status,
and gradually progress to clear liquids, followed
by bland diet and the low residue diet. The
patient can then have a low fat, low fiber diet on
a long-term basis.
IRRITABLE BOWEL
SYNDROME

GONZALES, CHARLES
GRINO, NIRIE JOY
 IRRITABLE BOWEL SYNDROME (IBS)

• Is a common, long term condition of the digestive

system.
• A common disorder that affects the stomach and
intestines, also called the gastrointestinal tract. It is
also known as spastic colon or irritable colon.
• Affects all ages, females diagnosed two to three
times often than males.
 TYPES OF IBS

• IBS with constipation (IBS-C): Most of your poop is

hard and lumpy.
• IBS with diarrhea (IBS-D): Most of your poop is loose
and watery.
• IBS with mixed bowel habits (IBS-M): You have both
hard and lumpy bowel movements and loose and watery
movements on the same day.
 Diagnosis of IBS
• Medical History
• Physical Exam
• Poops examine
• Computerized tomography (CT) scan- CT scan produce cross-
sectional X-ray images of internal organ.
• Colonoscopy- in some cases, your doctor may perform this
diagnostic test, in which a small, flexible tube is used to examine
the entire length of the colon.
 Signs/Symtoms of IBS

• Symptoms of IBS vary but are usually present

for a long time. The most common include:
• Abdominal pain, usually in the lower half of
the abdomen.
• Stomach Cramps
• bloating
• Changes in appearance of bowel movement.
• Pain, distension or abdominal discomfort.
• Diarrhea or constipation, or both
• Changes in how often you are having a bowel
movement.
• Excess gas
• Mucus in your poop (may look whitish)
 Causes of IBS
• Abnormal gastrointestinal (GI) tract movements.
• A change in the nervous system communication between the
GI and brain.
• Sensory and motor disorder of the colon.
• Dietary allergies or food sensitivities.
• Neurotransmitter imbalance (decreased serotonin levels).
• Stress.
 Treatment of IBS
• Treatment involves a mix of drug, diet, and psychosocial
intervention.
• Avoid food that trigger symptoms
• Change in what you eat and other lifestyle changes, medicines,
probiotics, and mental health therapies.
• Nonpharmacologic: fiber supplementation, regular exercise, low-
FODMAP diet and behavioral therapy.
• Pharmacologic- polyethylene (IBS-C), alosetron (women, IBS-C &
IBS-M), Rifaximin (IBS-D).
• Probiotics may be an option for you.
• Dietary changes:
• Increase fiber in your diet — eat more fruits, vegetables,
grains and nuts.
• Add supplemental fiber to your diet, such as Metamucil or
Citrucel
• Drink plenty of water.
• Avoid caffeine (from coffee, chocolate, teas and sodas).
• Limit cheese and milk.
 Supporting diagnostic features in IBS

• Symptoms > 6 months

• Frequents consultation for non-GI problem.
• Previous medically unexplained symptoms
• Stress worsen symptoms
 Alarm features in IBS

• Age > 50 years, female gender

• Unexplained Weight loss
• Nocturnal symptoms
• Family history of colon cancer
• Anemia
• Rectal bleeding.
 Nursing management
• Reassurance and psychological support
• Dietary advice- patients should avoid dairy products, foods,
beverages, or medications containing fructose or sorbital.
• High fibre diets- high fibre food are needed to relieve
consipations
• Assess the bowel pattern including frequency and
consistency of stool.
• Assess the patients activity level.
• Administer drug as ordered & check for side effects.
 Nursing diagnosis

• Constipation
• Diarrhea related to food intolerance
• Readiness for enhanced self-health management.
• Pain related to abdominal distention.
• Disturbed body image related to bowel incontinence.
THANK YOU!
LIVER CIRRHOSIS

NCM 116 MIDTERM TOPIC

Liver Cirrhosis
Cirrhosis, also known as liver cirrhosis or hepatic cirrhosis, and end-stage
liver disease, is the impaired liver function caused by the formation of scar
tissue known as fibrosis due to damage caused by liver disease.

Damage causes tissue repair and subsequent formation of scar tissue,

which over time can replace normal functioning tissue,leading to the
impaired liver function of cirrhosis

The disease typically develops slowly over months or years

Clinical Manifestation
● Fatigue
● Easily bleeding or bruising
● Loss of appetite
● Nausea
● Swelling in your legs, feet or ankles (edema)
● Weight loss
● Itchy skin
● Yellow discoloration in the skin and eyes (jaundice)
Clinical Manifestation

Fluid accumulation in your abdomen (ascites)

Spider like blood vessels on your skin
Redness in the palms of the hands
For women, absent or loss of periods not related to menopause
For men, loss of sex drive, breast enlargement (gynecomastia) or
testicular atrophy
Confusion, drowsiness and slurred speech (hepatic encephalopathy)
Liver Cirrhosis
● Stage 1 cirrhosis involves some scarring of the liver, but few symptoms.
This stage is considered compensated cirrhosis, where there are no
complications.
● Stage 2 cirrhosis includes worsening portal hypertension and the
development of varices.
● Stage 3 cirrhosis involves the development of swelling in the abdomen
and advanced liver scarring. This stage marks decompensated cirrhosis,
with serious complications and possible liver failure.
● Stage 4 cirrhosis can be life threatening and people have develop end-
Risk Factors
● Drinking too much alcohol. Excessive alcohol consumption is a risk factor for
cirrhosis.
● Being overweight. Being obese increases your risk of conditions that may lead
to cirrhosis, such as nonalcoholic fatty liver disease and nonalcoholic
steatohepatitis.
● Having viral hepatitis. Not everyone with chronic hepatitis will develop
cirrhosis, but it's one of the world's leading causes of liver disease.
Cause
Liver cirrhosis increases at any level of alcohol consumption for women,
which means even a moderate drinker may be at some risk. For men, the
risk of cirrhosis increases when an individual has more than one drink a
day.

Hepatitis C is a viral infection that can lead to inflammation and damage

to the liver. Individuals who are at risk of getting this type of viral
hepatitis include those who:

● use illegal injected drugs

● engage in sex without a condom or other barrier method
● are on kidney dialysis
Cause
● Hepatitis D. Hepatitis D is often seen in people who already have
hepatitis B.
● Autoimmune hepatitis. Autoimmune hepatitis causes inflammation
that can lead to cirrhosis.
● Damage to the bile ducts. These ducts function to drain bile. One
example of a condition is primary biliary cholangitis.
● Disorders that affect the body’s ability to handle iron and copper.
Two examples are hemochromatosis and Wilson’s disease..
● Medication. This includes prescription and over-the-counter drugs
like acetaminophen, some antibiotics, and some antidepressants.
Diagnostic Examination
● Physical exam: Your doctor will examine you, looking for the signs and
symptoms of cirrhosis including: the red, spider-like blood vessels on your
skin; yellowing of your skin or whites of your eyes; bruises on your skin;
redness on your palms; swelling, tenderness or pain in your abdomen; enlarged
firmer-feeling, bumpy texture to the lower edge of your liver (the part of
your liver below the rib cage that can be felt).
Diagnostic Examination
● Blood tests: If your doctor suspects cirrhosis, your blood will be checked
for signs of liver disease. Signs of liver damage include:
○ Lower than normal levels of albumin and blood clotting factors (lower
levels means your liver has lost its ability to make these proteins).
○ Raised levels of liver enzymes (suggests inflammation).
○ Higher level of iron (may indicate hemochromatosis).
○ Presence of autoantibodies (may indicate autoimmune hepatitis or
primary biliary cirrhosis).
○ Raised bilirubin level (suggests liver isn’t working properly to remove
bilirubin from the blood).
○ High white blood cell count (indicates an infection).
○ High creatinine level (a sign of kidney disease that suggests late-
stage cirrhosis).
○ Lower levels of sodium (is an indicator of cirrhosis).
○ Raised level of alpha-fetoprotein (indicates presence of liver cancer).
Diagnostic Examination
● Imaging tests: Imaging test show the size, shape and texture of
the liver. These tests can also determine the amount of scarring,
the amount of fat you have in your liver and fluid in your abdomen.
Imaging tests of your liver that could be ordered include
computerized tomography(CT)scan, abdominal ultrasound and
magnetic resonance imaging (MRI). A special ultrasound, called a
transient elastography, measures the fat content and amount of
stiffness in your liver. Two different types of endoscopies might
be ordered: an endoscopic retrograde cholangiopancreatography
to detect bile duct problems, and/or upper endoscopy to detect
enlarged veins (varices) or bleeding in your esophagus, stomach or
intestines.
Diagnostic Examination
● Biopsy: A sample of liver tissue (biopsy) is removed from your liver
and examined under the microscope. A liver biopsy can confirm a
diagnosis of cirrhosis, determine other causes or extent of liver
damage or enlargement or diagnosis liver cancer.
Nursing Intervention

● Observe stools and emesis for color, consistency, and amount, and test
each one for occult blood.
● Monitor fluid intake and output and serum electrolyte levels to prevent
dehydration and hypokalemia, which may precipitate hepatic
encephalopathy.
● Maintain some periods of rest with legs elevated to mobilize edema and
ascites. Alternate rest periods with ambulation.
● Encourage and assist with gradually increasing periods of exercise.
● Encourage the patient to eat high-calorie, moderate protein meals and
supplementary feedings. Suggest small, frequent feedings.
● Encourage oral hygiene before meals.
● Administer or teach self-administration of medications for nausea,
vomiting, diarrhea or constipation.
Nursing Intervention

● Encourage frequent skin care, bathing with soap, and massage with
emollient lotions.
● Keep the patient’s fingernails short to prevent scratching from pruritus.
● Keep the patient quiet and limit activity if signs of bleeding are evident.
● Encourage the patient to eat foods high vitamin C content.
● Use small gauge needles for injections and maintain pressure over
injection site until bleeding stops.
● Protect from sepsis through good handwashing and prompt recognition
and management of infection.
● Pad side rails and provide careful nursing surveillance to ensure the
patient’s safety.
● Stress the importance of giving up alcohol completely.
● Involve the person closest to the patient, because recovery usually is not
Management
Pharmacologic Intervention

● Provide asymptomatic relief measures such as pain medications and

antiemetics.
● Diuretic therapy, frequently with spironolactone, a potassium-
sparing diuretic that inhibits the action of aldosterone on the
kidneys.
● I.V albumin to maintain osmotic pressure and reduce ascites.
● Administration of lactulose or neomycin through a nasogastric tube
or retention enema to reduce ammonia levels during periods of
hepatic encephalopathy.
Complication
● High blood pressure in the veins that supply the liver (portal
hypertension). Cirrhosis slows the normal flow of blood through the liver,
thus increasing pressure in the vein that brings blood to the liver from
the intestines and spleen.
● Swelling in the legs and abdomen. The increased pressure in the portal
vein can cause fluid to accumulate in the legs (edema) and in the abdomen
(ascites). Edema and ascites also may result from the inability of the liver
to make enough of certain blood proteins, such as albumin.
● Enlargement of the spleen (splenomegaly). Portal hypertension can also
cause changes to and swelling of the spleen, and trapping of white blood
cells and platelets. Decreased white blood cells and platelets in your blood
can be the first sign of cirrhosis.
Complication
● Infections. If you have cirrhosis, your body may have difficulty fighting
infections. Ascites can lead to bacterial peritonitis, a serious infection.
● Malnutrition. Cirrhosis may make it more difficult for your body to process
nutrients, leading to weakness and weight loss.
● Buildup of toxins in the brain (hepatic encephalopathy). A liver damaged by
cirrhosis isn't able to clear toxins from the blood as well as a healthy liver can.
These toxins can then build up in the brain and cause mental confusion and
difficulty concentrating. With time, hepatic encephalopathy can progress to
unresponsiveness or coma.
● Jaundice. Jaundice occurs when the diseased liver doesn't remove enough
bilirubin, a blood waste product, from your blood. Jaundice causes yellowing of
the skin and whites of the eyes and darkening of urine.
● Bone disease. Some people with cirrhosis lose bone strength and are at
greater risk of fractures.
Complication
● Bleeding. Portal hypertension can cause blood to be redirected to smaller
veins. Strained by the extra pressure, these smaller veins can burst,
causing serious bleeding. Portal hypertension may cause enlarged veins
(varices) in the esophagus (esophageal varices) or the stomach (gastric
varices) and lead to life-threatening bleeding. If the liver can't make
enough clotting factors, this also can contribute to continued bleeding.
● Increased risk of liver cancer. A large proportion of people who develop liver
cancer have pre-existing cirrhosis.
● Acute-on-chronic cirrhosis. Some people end up experiencing multiorgan failure.
Researchers now believe this is a distinct complication in some people who have
cirrhosis, but they don't fully understand its causes.
Prevention
● Do not drink alcohol if you have cirrhosis. If you have liver disease, you
should avoid alcohol.
● Eat a healthy diet. Choose a plant-based diet that's full of fruits and
vegetables. Select whole grains and lean sources of protein. Reduce the
amount of fatty and fried foods you eat.
● Maintain a healthy weight. An excess amount of body fat can damage
your liver. Talk to your doctor about a weight-loss plan if you are obese or
overweight.
● Reduce your risk of hepatitis. Sharing needles and having unprotected
sex can increase your risk of hepatitis B and C. Ask your doctor about
hepatitis vaccinations
NASOGASTRIC TUBE INSERTION

NCM 116 RLE

Nasogastric Tube
An NGT is a flexible rubber or plastic tube that is passed through the nose, down
through the esophagus, and into the stomach. The tube is temporarily placed in order
to deliver substances to or remove them from the stomach.

It's most commonly used to deliver liquid nutrition directly to the stomach because a
person is unable to eat enough for their body's needs, though there are other uses.

If you can’t eat or swallow, you may need to have a nasogastric tube inserted. This
process is known as nasogastric (NG) intubation. During NG intubation, your doctor or
nurse will insert a thin plastic tube through your nostril, down your esophagus, and into
your stomach.

Once this tube is in place, they can use it to give you food and medicine. They can also
use it to remove things from your stomach, such as toxic substances or a sample of
your stomach contents.
Equipment
Protective gown, gloves, and face shield
Nasogastric tube for decompression such as a Levin tube (single
lumen)
If small intestine feeding planned, a long, thin, intestinal feeding tube
(nasoenteric tube) for long-term enteral feeding (use with a
stiffening wire or stylet)
Topical anesthetic spray such as benzocaine or lidocaine
Vasoconstrictor spray such as phenylephrine or oxymetazoline
Cup of water and straw
60-mL catheter-tipped syringe
Equipment
Lubricant
Emesis basin
Towel or blue pad
Stethoscope
Tape and benzoin
Suction (wall or mobile device)
Indication

NG intubation is most commonly used for the following reasons:

● feeding
● delivering medication
● removing and evaluating stomach contents
● administering radiographic contrast for imaging studies
● decompressing blockages
Contraindication
1. Severe maxillofacial trauma
2.Nasopharyngeal or esophageal obstruction
3. Esophageal abnormalities, such as recent caustic ingestions, diverticula, or
stricture, because of a high risk of esophageal perforation
Nasogastric Tube
● remove a sample of your stomach contents for analysis
● remove some of your stomach contents to the relieve the pressure on an
intestinal obstruction or blockage
● remove blood from your stomach
Risk Factor
If your NG tube isn’t inserted properly, it can potentially injure the tissue inside your nose,
sinuses, throat, esophagus, or stomach.

This is why placement of the NG tube is checked and confirmed to be in the correct location
before any other action is performed.

NG tube feeding can also potentially cause:

● abdominal cramping
● abdominal swelling
● diarrhea
● nausea
● vomiting
● regurgitation of food or medicine
Risk Factor
Your NG tube can also potentially become blocked, torn, or dislodged. This can lead to
additional complications. Using an NG tube for too long can also cause ulcers or infections
in your sinuses, throat, esophagus, or stomach.
Nasogastric Tube
An NG tube is placed by a doctor or a nurse. Usually, the procedure is done in the
hospital. While there are instances when the doctor may need to put you to sleep
to place the tube, most people are awake during the procedure.
First, your nasal area might be numbed with either lidocaine or an anesthetic
spray. The NG tube is then inserted up through the nostrils, down through the
esophagus, and into the stomach.
Your doctor will usually tell you to swallow while the NG tube is being placed. The
procedure is uncomfortable, but it shouldn't be painful. If you do feel pain, it
could be a sign that the tube isn't placed properly.
Your doctor may check the tube by adding or removing some stomach contents.
They may also order an X-ray to ensure that the tube is in the correct position.
Finally, the outside of the tube will be taped down onto the skin so that it doesn't
become dislodged accidentally.
Procedure
1. Patient sits upright in the sniffing position with the neck slightly flexed.
2. If unable to sit upright, patient lies in the left lateral decubitus position.
3. If patient is ventilated through an endotracheal tube that protects the
airway, the nasogastric tube can be placed with patient upright or, if needed,
supine.
Procedure
1 Review the physician’s order and know the type, size, and purpose of the NG
tube. It is widely acceptable to use a size 16 or 18 French for adults while sizes
suitable for children vary from a very small size 5 French for children to size 12
French for older children.

2 Check the client’s identification band. Just like in administering medications, it is

very important to be sure that the procedure is being carried out on the right client.

3 Gather equipment, set up tube-feeding equipment or suction equipment mentioned

above. This is to make sure that the equipment is functioning properly before using it
on the client.

4 Briefly explain the procedure to the client and assess his capability to
participate. It is not advisable to explain the procedure too far in advance because the
client’s anxiety about the procedure may interfere with its success. It is important
that the client relax, swallow, and cooperate during the procedure.
Procedure
5 Observe proper handwashing and don non-sterile gloves. Clean, not
sterile, technique is necessary because the gastrointestinal (GI) tract is not
sterile.

6 Position client upright or in full Fowler’s position if possible. Place a

clean towel over the client’s chest. Full Fowler’s position assists the client to
swallow, for optimal neck-stomach alignment and promotes peristalsis. A towel
is used as a covering to protect bed linens and the client’s gown.

7 Measure tubing from bridge of nose to earlobe, then to the point

halfway between the end of the sternum and the navel. Mark this spot
with a small piece of temporary tape or note the distance. Each client will
have a slightly different terminal insertion point. Measurements must be
made for each individual’s anatomy.
Procedure
8 Wipe the client’s face and nose with a wet towel. Wipe down the exterior of
the nose with an alcohol swab. The NG tube will stay more secure if taped on a
clean, non oily nose. If the nose has been cleaned with an alcohol swab, the tape
will stay more secure and the tube will not move in the throat—causing gagging or
discomfort later.

9 Cover the client’s eyes with a cloth. This protects the client’s eyes from any
alcohol fumes from the alcohol swab.

10 Examine nostrils for deformity or obstruction by closing one nostril and

then the other and asking the client to breathe through the nose for each
attempt. If the client has difficulty breathing out of one nostril, try to insert
the NG tube in that one. The client may breathe more comfortably if the “good”
nostril remains patent.The blocked nasal passage may not be totally occluded and
thus you may still be able to pass an NG tube. It may be necessary to use the
more patent nostril for insertion.
Procedure
11 Lubricate 4 to 8 inches of the tub with a water-soluble lubricant. The NG intubation
is very uncomfortable for many patients, so a squirt of Xylocaine jelly in the nostril, and a
spray of Xylocaine to the back of the throat will help alleviate the discomfort.
12 Flex the client’s head forward, tilt the tip of the nose upward and pass the tube
gently into the nose to as far as the back of the throat. Guide the tube straight back.
Flexing the head aids in the anatomic insertion of the tube.The tube is less likely to pass into
the trachea.
13 Once the tube reaches the nasopharynx, allow the client lower his head slightly. Ask
the assistant to hold the glass of water. Ready the emesis basin and tissues. The positioning
helps the passage of the NG to follow anatomic landmarks. Swallowing water, if allowed, helps
the passage of the NG tube.

14 Instruct the client to swallow as the tube advances. Advance the tube until the
correct marked position on the tube is reached. Encourage the client to breathe through his
mouth. Swallowing of small sips of water may enhance passage of tube into the stomach
rather than the trachea.
Procedure
15 If changes occur in patient’s respiratory status, if tube coils in mouth, if the patient
begins to cough or turns cyanotic, withdraw the tube immediately. The tube may be in the
trachea.

16 If obstruction is felt, pull out the tube and try the other nostril. The client’s nostril may
deflect the NG into an inappropriate position. Let the client rest a moment and retry on the other
side.

17 Advance the tube as far as the marked insertion point. Place a temporary piece of tape
across the nose and tube. In this way, you can check for placement before securing the tube. The
tube may move out of position if not secured before checking for placement.

18 Check the back of the client’s throat to make sure that the tube is not curled in the back
of the throat. On instance, the NG will curl up in the back of the throat instead of passing down to
the stomach. Visual inspection is needed in this situation. Withdraw the entire tube and start again
if such thing occurred.
Procedure
19 Check tube placement with these methods. Check the tube for correct
placement by at least two and preferably three of the following methods:

A. Aspirate stomach contents. Stomach aspirate will appear cloudy,

green, tan, off-white, bloody, or brown. It is not always visually possible to
distinguish between stomach and respiratory aspirates. Special note: The
small diameters of some NG tubes make aspiration problematic. The tubes
themselves collapse when suction is applied via the syringe. Thus, contents
cannot be aspirated.

B. Check pH of aspirate. Measuring the pH of stomach aspirate is

considered more accurate than visual inspection. Stomach aspirate
generally has a pH range of 0 to 4, commonly less than 4. The aspirate of
respiratory contents is generally more alkaline, with a pH of 7 or more.
Procedure
C. Inject 30 mL of air into the stomach and listen with the stethoscope for the
“whoosh” of air into the stomach. The small diameter of some NG tubes may make
it difficult to hear air entering the stomach.

D. Confirm by x-ray placement. X-ray visualization is the only method that is

considered positive.

20 Secure the tube with tape or commercially prepared tube holder once stomach
placement has been confirmed. It is very important to ensure that the NG tube is in
its correct place within the stomach because, if by accident the NG is within the
trachea, serious complications in relation to the lungs would appear. Securing the tube
in place will prevent peristaltic movement from advancing the tube or from the tube
unintentionally being pulled out.
Aftercare
1. Flush small tubes, such as intestinal feeding tubes, with 20 to 30 mL of tap
water at least 2 to 3 times a day.
2. In patients receiving tube feedings, elevate the head of the bed to at least 30°
to help prevent aspiration.
Tips and Tricks of Nasogastric Tube Insertion
● When inserting the nasogastric tube, it may be helpful to place your other
hand behind the patient’s head to keep him or her from pulling back.
● Asking the patient to take sips of water when passing the nasogastric
tube through the pharynx into the esophagus and through the esophagus
into the stomach can greatly improve the chance of success and reduce
gagging. This technique allows the patient to swallow the tube.
● Sometimes having the patient tuck their chin toward their chest (chin
tuck) while sipping water can help facilitate tube passage from the
oropharynx into the stomach.
Complication
Nasopharyngeal trauma with or without hemorrhage- during insertion
Sinusitis and sore throat
Pulmonary aspiration
Traumatic esophageal or gastric hemorrhage or perforation
Intracranial or mediastinal penetration (very rare)
PREPARED BY:
SALIGUMBA, MARISH
SALVAÑA, KEIN KAREN
INTRODUCTION
 Nasogastric Tube
A tube that is inserted through the nose, down
the throat and esophagus, and into the stomach.
It can be used to give drugs, liquids, and liquid
food, or used to remove substances from the
stomach.
SHORT TUBES - Passed
through the nose into the MEDIUM TUBES - tubes are
stomach: range in size from 14 passed through the nose to
to 18 Fr, single lumen made of duodenum and the jejunum.
plastic or rubber with holes
near the tip.
LONG TUBES - passed through the
nose. through the esophagus and
stomach into the intestines. Used for
decompresion of the intestines.
Some conditions that may require NGT
feeding:
• Difficulty swallowing (dysphagia)
• Head and Neck cancers
• Altered mental status/ unconsciousness.
• Malnutrition
• Endotracheal Intubation
 Who needs an NGT?
• Surgical Patients
• Ventilated Patients
• Neuromuscular Impairment
• Patients who are unable to maintain oral
intake to meet metabolic/ nutritional
demands.
• To feed the patient with fluids when oral intake is not
possible.
• To prevent stress on operated site by
decompressing.
• To instill ice cold solution to control gastric bleeding.
• To relieve vomiting and distention.
• To collect gastric juice for diagnostic purposes.
• To collect gastric juice for diagnostic purposes.
Indications of NGT Insertion

• To feed the patient with fluids when oral intake is

not possible.
• To prevent stress on operated site by
decompressing.
• To instill ice cold solution to control gastric
bleeding.
• To relieve vomiting and distention.
• To collect gastric juice for diagnostic purpose
Complications of NGT Insertion

• Gagging or vomiting
• Tissue trauma along the nasal, oropharyngeal or
upper gastrointestinal tract
• Esophageal perforation (rare)
• Incorrect placement leading to respiratory tree
intubation may cause aspiration.
Risk for aspiration related to tube feeding
as evidence by patient having peg tube
with feedings and speech evaluation is
silent aspiration.
• The nurse will check the patients peg tube residual
and document residual amounts every shift.
• Provide oral and skin care. Give mouth rinses and
apply lubricant to the patient's lips and nostril. using
the water soluble lubricant, lubricate the catheter
until where it touches the nostrils because cliets
nose may become irritated and dry.
Thank you for
listening!
NGT Feeding Gavage
Sanchez, John Lloyd
Suwaib, Maisa
INTRODUCTION
• A nasogastric tube is a long, skinny tube that goes through the nose, down
the throat, and into the stomach.

• NG tubes are held in place by pieces of tape on the cheek

• Gavage feeding is an artificial method of giving fluids and nutrients. This is a

process of feeding with the tube (Nasogastric tube) inserted through the
nose, pharynx, and esophagus and into the stomach.

• Gavage feeding is a way to provide breastmilk or formula directly to your

baby’s stomach. A tube placed through your baby’s nose (called Nasogastric
or NG tube) carries breast milk/formula to the stomach.
PURPOSES & INDICATION
• To feed the children who are unable to take feed orally.

• Feed the children who are undergoing oral surgery like - cleft lip or cleft
palate, fracture of jaw, and in condition of difficulty swallowing.

• when patient is unconsciuos or semiconscious

• when the condition is not supportive to take large amount of food orally e.g -
severe burns, malnutrition, prematurity, acute and chronic infections.

• conditions when the patient is unable to retain the food e.g anorexia nervosa
and vomiting.
CONTRAINDICATION
• Loss of airway protective reflexes, such as in a patient with depressed state
of consciousness.

COMPLICATIONS
• nasal airway obstruction
• aspiration pneumonia
• ulceration or stomach perforation
• irritation of the mucous membrane
• incompetence of esophageal-cardiac sphincter
• epistaxis
Differences between Types of Feeding

• usually with syringe and by

gravity
Intermittent • need caution to prevent air
from entering stomach
• also called Gavage

• with pump machine and order

rate and time
Continuos Infusion • air sensor
• also called bolus
ADVANTAGES OF NASOGASTRIC FEEDING

• All types of nutrients including distasteful foods and medications

can be given in adequate amount.

• Without any danger, feeding can be continued for weeks.

• According to need, stomach can be aspirated at any time.

• Large amount of fluids can be given with safety.

PRINCIPALS INVOLVED IN GASTRIC GAVAGE
• Tube feeding is a process og giving liquid nutrients or medications through a tube into the
stomach when the oral intake is inadequate or impossible

• A thorough knowledge of the anatomy and physiology of the digestive tract and respiratory
tract. Ensures safe induction of the tube (avoid misplacement of the tube).

• Micro-organisms enter the body through food and drink

• Introduction of the tube into the mouth or nostrils is a frightening situation and the client will
resist every attempt. Mental and physical preparation of the client facilities introduction of the
tube.

• Systematic ways of working adds to the comfort and safety of the client and help in the
economy of material, time and energy.
POLICY
• 6 fr feeding tube is used for infants <1000 grams.

• 6 fr or # 8 fr feeding tube are used for infants >1000 grams.

• Never force the feeding under pressure.

• If possible, the infant should be held in semi-up-right position during the

feeding; if not possible, position infant on right side or prone as this will
facilitate gastric emptying.

• If respiratory rate >70, check with physician about withholding feeding.

ARTICLES NEEDED
• Mackintosh with towel
• Kidney tray for receiving the waste
• “Cotton tipped” applicators to clean the nostrils
• Ryle’s tube in a bowel
• Lubricant (water soluble jelly/glycerin) to prevent friction
• Gauze pieces to clean the secretions
• Scissors and adhesive plaster or tape
• Measuring cup or glass/ounces glass.
• sterile syringe, about 10-20 ml
• paper bag - to collect the wastes.
• glass of feed in a bowel of warm water to give the feed at
the body temperature
• tongue blade
• suction apparatus - to clear the airway, whenever need.
• bowel with water - to test the location of tube.
• clamp - to clamp the tube to prevent leakage of gastric
contents.
EQUIPMENT
• suction machine and catheter
• stethoscope
• feeding fluid (formula) as prescribed
• clear calibrated reservoir for feeding fluid or
• catheter tip syringe 20 ml
• cup of water
• PH paper
PROCEDURE

• Do the hand washing properly

• Wear the hand gloves

• Identify the patient

• Explain the procedure in the patient (mother, father, relatives)

• Maintain privacy

• Make the patient in comfortable position.

• Make the patient sit on chair or place him in fowlers position.

PROCEDURE (continuation)
• Arrange the meckintosh and face towel across the chest and put under the chin to protect the
garments and bed linens.

• Keep the kidney tray ready for receiving the vomit, if occur

• Remove the dentures and place in a bowl of clean water.

• Clean the nostrils with cotton applicators, if secretions are deposited.

• Arrange all articles near the bed side or on the bed side looker

• Check the patency of the tube

PROCEDURE (continuation)

• Measure the length of the tube by measuring it from the tip of the nose to ear lobe and from
ear lobe to the tip of the xiphoid process of the sternum

• Lubricate the tube with glycerine - or jelly by the piece of gauze. It is start from tip to the 6 to
8 inches long.

• Now insert the tube with the right hand into the left nostril slowly
PROCEDURE (continuation)
• Pass the tube slowly backwards and downwards. When the tube reaches at pharynx, give
patient sips of water and swallow, while swallow insert the tube about 3-4 inches each time.
When it reaches completely till the mark stop to insert.

• Now confirm the placement of tube by aspirating the gastric contents with the syringe. Other
method is to place the tube end in a bowl of water and check the bubbles. If bubbles are
present it indicates position in trachea.

• Examine the mouth of patient with tongue blade and light source.

• After this secure the tube with the adhesive tape at the nasal bridge.

• After some time give some water to expel the air, Give the feed with feeding syringe or
funnel. Give feed slowly; do not push the feeding solution with plunger.
PROCEDURE (continuation)
• When the feeding is completed, pour a little amount of water and clamp the tube firmly to
prevent leakage of fluids

• When any obstructions occurs while feeding, remove the funnel and take a syringe with
sterile water. Push the water slowly, and draw it back from gastric contents. When fluids
starts to enter, connect the feeding funnel with tube.

• Provide oral hygiene every 4 to 6 hours to prevent infections

• Dispose the waste materials and clean the articles properly and replace them.

• Do the hand washing.

• Recording and reporting.

AFTER CARE OF THE CLIENT AND ARTICLES

• Offer a mouth wash. Clean the face and hands and dry them

• Remove the mackintosh and towel

• Make the client comfortable in bed

• In case of unconscious or seriously ill clients, apply suction if

secretions are collected in the mouth.
AFTER CARE OF THE CLIENT AND ARTICLES (continuation)

• Take all articles to the utility room, Discard the waste and clean the articles
with the soap and water. Dry them. Replace them into their proper places

• Wash hands

• Record the time, date, amount of feed, the nature of the feed, the reaction of
the client if any, in the nurses record as well as in the intake and output chart

• Remove the tube when the tube feeding is to be stopped

THANK YOU
NGT FEEDING/GAVAGE

NCM 116 RLE

Equipment
● Gloves
● Clamp (optional)
● Feeding solution
● Large catheter tip syringe (30 mL or larger)
● Feeding bag with tubing
● Water
● Measuring cup
● Other optional equipment (disposable pad, pH indicator strips, water-
soluble lubricant, paper towels)
Procedure
The following are the step in administering tube feeding via nasogastric tube.

1 Prepare formula. Follow the substeps below:

1.1. Check expiration date. Outdated formula may be contaminated or

have reduced nutritional value.

1.2. Shake can thoroughly. Feeding solution may settle and mixing is
necessary just before administration.

1.3. For powdered formula, mix according to the instructions on the

package. Prepare just enough for the next 24 hours and refrigerate
unused formula. Allow formula to reach room temperature before
using. Formula loses its nutritional value and can be contaminated if kept
for more than 24 hours. Cold formulas can cause abdominal discomfort.
Procedure
2 Explain the procedure to the client. Providing the right information may
result to client’s cooperation and understanding.

3 Always check the position of the client. Make sure that the position of
the client with a tube feeding remain with the head of bed elevated at
least 30 to 40 degrees. Never feed the client with supine position. Semi-
Fowler’s or full-Fowler’s position prevents aspiration pneumonia and possible
death due to pulmonary complications.

4 Check placement of feeding tube by:

A. Aspirating stomach contents. This indicates that the tube is in its proper
place in the stomach. The amount of residual reflects gastric emptying time
and indicates if feeding should proceed. This contents are returned to the
stomach because they contain valuable electrolytes and digestive enzymes.
Procedure
1. Connect syringe to end of feeding tube.
2. Pull back on plunger carefully.
3. Determine amount of residual fluid (clamp tube if it is necessary to
remove the syringe).
4. Return residual to stomach via tube and continue with feeding if
amount does not exceed agency protocol or physician’s orders.

B. Injecting 10 to 20 mL of air into tube (3–5 mL for children). A

whooshing or gurgling sound usually indicates that the tube is in the
stomach.This method may not be a reliable indicator with small-bore feeding
tubes.

1. Connect syringe filled with air to tube.

2. Inject air while listening with stethoscope over left upper quadrant.
C. Measuring the pH of aspirated gastric secretions. Gastric contents are
Procedure
acidic, and a pH indicator strip should reflect a range of 1 to 4. Pleural fluid
and intestinal fluid are slightly basic in nature.

D. Taking an x-ray or ultrasound. This may be needed to determine tube

placement. X-ray visualization is the only method that is considered positive.

6 If using a syringe:

6.1 Clamp the gastric tube. Connect the tip of the large syringe, with
the plunger or bulb removed, into the gastric tube. Gently pour feeding
into the syringe. Raise the syringe 12 to 18 inches above the stomach.
Open the clamp. Gravity promotes movement of feeding into the stomach.

6.2 Allow feeding solution to flow slowly into the stomach. Raise and
lower the syringe to control the rate of flow. Add additional formula to
the syringe as it empties until feeding is complete. Controlling
administration and flow rate of feeding solution prevents air from entering
the stomach and nausea and abdominal cramping from developing.
Procedure
7 Stop feeding when completed. Instill prescribed amount of water.
Keep the client’s head elevated for 20 to 30 minutes. Elevated
position prevents the client from aspiration of feeding solution into the
lungs.

8 Regularly assess the skin around the injection site of surgically

placed tubes. Cleanse skin with mild soap and water and dry
thoroughly. Check site for redness, swelling, pain, or additional signs
of inflammation. Careful assessment and care can prevent spread
infection and skin breakdown.

9 Always observe proper hygiene by providing mouth care such as

brushing teeth, offering mouthwash, and keeping the lips moist.
These activities promote oral hygiene and improve comfort.
Click to edit Master title style

Peptic Ulcer
Disease
By: Francis Aj Belotindos & Michael Bruno

1
Click to edit Master title style
 Peptic ulcer disease occurs when open
sores, or ulcers, form in the stomach
or first part of the small intestine.
 Many cases of peptic ulcer disease
develop because a bacterial infection eats
away the protective lining of the digestive
system. People who frequently take pain
relievers are more likely to develop ulcers.

Ulcer – open sore

Peptic - cause of the problem is due to acid

2
2
 Types ofedit
Click to Peptic Ulcer
Master title style
• The two most common types of peptic ulcer are called
“gastric ulcers” and “duodenal ulcers”. These names refer
to the location where the ulcer is found.

Gastric Ulcer
• Gastric ulcers are located in the stomach

Duodenal Ulcer
• Duodenal ulcers are found at the beginning of the small
intestine (also called the small bowel) known as the
duodenum. A person may have both gastric and duodenal
ulcers at the same time.

3 3
ClickFactors
Risk to edit Master title style
One in 10 people develops an ulcer.

Risk factors that make ulcers more likely include:

Frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs),
a group of common pain relievers that includes ibuprofen
(Advil® or Motrin®).
A family history of ulcers.
Illness such as liver, kidney or lung disease.
Regularly drinking alcohol.
Smoking.

4 4
Click
Causesto edit Master title style
People used to think that stress or certain foods could cause ulcers. But researchers haven’t found
any evidence to support those theories. Instead, studies have revealed two main causes of ulcers:
• Helicobacter pylori (H. pylori) bacteria.
• Pain-relieving NSAID medications.

H. pylori bacteria

• H. pylori commonly infects the stomach. About 50% of the world’s population has an H. pylori
infection, often without any symptoms. Researchers believe people can transmit H. pylori from
person to person, especially during childhood.

• The H. pylori bacteria stick to the layer of mucus in the digestive tract and cause inflammation
(irritation), which can cause this protective lining to break down. This breakdown is a problem
because your stomach contains strong acid intended to digest food. Without the mucus layer to
protect it, the acid can eat into stomach tissue. 5 5
•Click toforedit
However, Master
most people title style
the presence of H. pylori doesn’t have a negative impact. Only 10% to
15% of people with H. pylori end up developing ulcers

Pain relievers
• Another major cause of peptic ulcer disease is the use of NSAIDs, a group of medications used to
relieve pain. NSAIDS can wear away at the mucus layer in the digestive tract.

These medications have the potential to cause peptic ulcers to form:

Aspirin (even those with a special coating).
Naproxen (Aleve®, Anaprox®, Naprosyn® and others).
Ibuprofen (Motrin®, Advil®, Midol® and others).
Prescription NSAIDs (Celebrex®, Cambia® and others).
Acetaminophen (Tylenol®) is not an NSAID and won’t cause damage to your stomach. People
who can’t take NSAIDs are often directed to take acetaminophen.
6 6
Click to edit Master title style
• Not everyone who takes NSAIDs will develop ulcers. NSAID use coupled with an H. pylori
infection is potentially the most dangerous.
• People who have H. pylori and who frequently use NSAIDs are more likely to have damage to
the mucus layer, and their damage can be more severe.

Developing an ulcer from NSAID use also increases if you:

Take high doses of NSAIDs.
Are 70 years or older.
Are female.
Use corticosteroids (drugs your doctor might prescribe for asthma, arthritis or lupus) at the same
time as taking NSAIDs.
Use NSAIDS continuously for a long time.
Have a history of ulcer disease.
7 7
Click to
Signs andedit
Symptoms
Master title style
Some people with ulcers don’t experience any symptoms. But signs of an ulcer can include:
Gnawing or burning pain in your middle or upper stomach between meals or at night.
Pain that temporarily disappears if you eat something or take an antacid.
Bloating.
Heartburn.
Nausea or vomiting.

In severe cases, symptoms can include:

Dark or black stool (due to bleeding).
Vomiting.
Weight loss.
Severe pain in your mid- to upper abdomen. 8 8
Click to edit
Diagnosis andMaster
Tests title style

How are ulcers diagnosed?

• Your healthcare provider may be able to make the diagnosis just by talking with you about your
symptoms. If you develop an ulcer and you’re not taking NSAIDs, the cause is likely an H. pylori
infection.

To confirm the diagnosis, you’ll need one of these tests:

Endoscopy
• If you have severe symptoms, your provider may recommend an upper endoscopy to determine
if you have an ulcer. In this procedure, the doctor inserts an endoscope (a small, lighted tube
with a tiny camera) through your throat and into your stomach to look for abnormalities.

9 9
Click to edit Master title style
H. Pylori tests
• Tests for H. pylori are now widely used and your provider will tailor treatment to reduce your
symptoms and kill the bacteria. A breath test is the easiest way to discover H. pylori. Your
provider can also look for it with a blood or stool test, or by taking a sample during an upper
endoscopy.

Imaging tests
• Less frequently, imaging tests such as X-rays and CT scans are used to detect ulcers. You have
to drink a specific liquid that coats the digestive tract and makes ulcers more visible to the
imaging machines.

1010
Click to Diagnosis
Nursing edit Master
and
title
Intervention
style
Acute Pain
May be related to: Desired Outcomes:
• Abdominal distention • Client will report satisfactory pain
• Abdominal muscle spasm control at a level less than 2 to 4
on a scale of 0 to 10.
• Recent nonsteroidal anti-inflammatory drug
(NSAID) or acetylsalicylic acid (ASA) use • Client uses pharmacological and
nonpharmacological pain relief
measures.
Possibly evidenced by:
• Client will exhibit increased
• Early satiety comfort such as baseline levels
• Nausea and vomiting for HR, BP, and respirations and
relaxed muscle tone for body
• Pain relieved by food or antacid posture.
• Weight loss
1111
 Nursing Intervention Rationale
Click to edit Master title style
 Assess the client’s pain, including the location, • Clients with gastric ulcer typically demonstrate
characteristics, precipitating factors, onset, pain 1 to 2 hours after eating. The client with
duration, frequency, quality, intensity, and severity. duodenal ulcers demonstrate pain 2 to 4 hours
after eating or in the middle of the night. With both
gastric and duodenal ulcers, the pain is located in
the upper abdomen and is intermittent. Client may
report relief after eating or taking an antacid.

 Encourage the use of nonpharmacological pain • Nonpharmacological relaxation techniques will

relief measures: decrease the production of gastric acid, which in
turn will reduce pain.
• Acupressure
• Biofeedback
• Distraction
• Guided imagery
• Massage
• Music therapy

1212
Click to edit
Deficient Master
Knowledge title style
May be related to:
• Lack of recall of previously learned information
• New condition, treatment
• Recurrent episodes of GI bleeding
• Recurrent peptic ulcer disease
Desired Outcomes:
• Client will verbalize understanding of
Possibly evidenced by: the importance of compliance with
• Incorrect responses to questions about peptic medical regimen, knowledge of peptic
ulcer disease ulcer disease, and commitment to
self-care management.
• Inaccurate follow-through with treatment
regimen and lifestyle modifications
• Lack of questions
• Multiple questions
1313
Click to edit Master
Nursing title style
Intervention Rationale
 Assess the client’s knowledge and misconceptions • Clients may have inaccurate information about
regarding peptic ulcer disease, lifestyle behaviors, how lifestyle behaviors contribute to peptic ulcer
and the treatment regimen. disease. The client needs accurate knowledge to
make informed decisions about taking prescribed
medications and modifying behaviors that
contribute to peptic ulcer disease or GI bleeding.

 Explain the pathophysiology of disease and how it • An understanding of the disease process helps to
relates to the functioning of the body. foster the willingness to follow the recommended
treatment plan and modify behaviors to prevent
recurrent episodes or related complications.

 Discuss the therapy options and the rationales for • The correct use of antibiotics and acid
using these options. suppression medications can promote rapid
healing of an ulcer.

1414
Click to edit Master
Management and Treatment
title style

Will ulcers heal on their own?

• Though ulcers can sometimes heal on their own, you shouldn't ignore the warning signs. Without
the right treatment, ulcers can lead to serious health problems, including:
Bleeding.
Perforation (a hole through the wall of the stomach).
Gastric outlet obstruction (from swelling or scarring) that blocks the passageway from the
stomach to the small intestine.

What ulcer treatments are available?

• If your ulcer is bleeding, your doctor may treat it during an endoscopy procedure by injecting
medications into it. Your doctor could also use a clamp or cauterization (burning tissue) to seal
it off and stop the bleeding.
1515
Click to edit Master title style
For most people, doctors treat ulcers with medications, including:

Proton pump inhibitors (PPI)

• These drugs reduce acid, which allows the ulcer to heal. PPIs include Prilosec®, Prevacid®,
Aciphex®, Protonix® and Nexium®.
Histamine receptor blockers (H2 blockers)
• These drugs also reduce acid production and include Tagamet®, Pepcid®, Zantac® and Axid®.
Antibiotics
• These medications kill bacteria. Doctors use them to treat H. pylori.
Protective medications
• Like a liquid bandage, these medications cover the ulcer in a protective layer to prevent further
damage from digestive acids and enzymes. Doctors commonly recommend Carafate® or Pepto-
Bismol®.
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Prevention

How can I prevent ulcers?

You may be able to prevent ulcers from forming if you:

Talk to your doctor about alternatives to NSAID medications (like acetaminophen) to relieve pain.
Discuss protective measures with your doctor, if you can’t stop taking an NSAID.
Opt for the lowest effective dose of NSAID and take it with a meal.
Quit smoking.
Drink alcohol in moderation.

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Prognosis

Are ulcers curable?

• For most people, treatment that targets the underlying cause (usually H. pylori bacterial infection
or NSAID use) is effective at eliminating peptic ulcer disease. Ulcers can reoccur, though,
especially if H. pylori isn’t fully cleared from your system or you continue to smoke or use
NSAIDs.

How long does it take an ulcer to heal?

• It generally takes several weeks of treatment for an ulcer to heal.

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Thank You
for Listening!
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