{
  "name": "Peptic Ulcer Disease",
  "slug": "peptic-ulcer-disease",
  "url": "https://nursingplex.com/care-plans/peptic-ulcer-disease",
  "category": "Gastrointestinal",
  "summary": "Mucosal ulceration; pain relief, H. pylori therapy and bleeding surveillance.",
  "nursing_diagnoses": [
    "Acute pain",
    "Risk for bleeding",
    "Deficient knowledge"
  ],
  "overview": [
    "Peptic ulcer disease is an erosion through the mucosa of the stomach or duodenum, extending into the muscularis. It develops when aggressive factors — acid, pepsin, Helicobacter pylori infection, NSAIDs — overwhelm the mucosal defenses of mucus, bicarbonate and healthy blood flow. Most ulcers today are explained by H. pylori or NSAID use rather than by stress or spicy food.",
    "Duodenal ulcers are the more common type. Their pain typically appears two to three hours after eating and at night, and is relieved by food or antacids because eating buffers acid. Gastric ulcers are more often seen in older adults, hurt sooner after eating, and may be worsened by food; weight loss is more typical, and malignancy must be excluded.",
    "The reason ulcers matter clinically is their complications: hemorrhage, perforation and gastric outlet obstruction. Nursing assessment is therefore oriented as much to detecting bleeding and sudden rigid abdominal pain as it is to symptom relief."
  ],
  "key_facts": [
    {
      "label": "Main causes",
      "text": "Helicobacter pylori infection and NSAID or aspirin use; smoking, alcohol and corticosteroids contribute."
    },
    {
      "label": "Duodenal pattern",
      "text": "Burning epigastric pain 2–3 hours after meals and at night, relieved by eating."
    },
    {
      "label": "Gastric pattern",
      "text": "Pain 30–60 minutes after meals, often worsened by eating, with weight loss."
    },
    {
      "label": "Perforation sign",
      "text": "Sudden severe upper abdominal pain with a board-like rigid abdomen and rebound tenderness — a surgical emergency."
    },
    {
      "label": "Bleeding signs",
      "text": "Coffee-ground emesis, melena, hypotension and tachycardia."
    }
  ],
  "nursing_priorities": [
    "Relieve pain and promote mucosal healing.",
    "Detect gastrointestinal bleeding early and treat hypovolemia.",
    "Recognize perforation and obstruction as emergencies.",
    "Eradicate H. pylori and remove ulcerogenic drugs.",
    "Restore nutritional intake and stable weight.",
    "Teach lifestyle change and full medication adherence to prevent recurrence."
  ],
  "assessment": {
    "subjective": [
      "Burning, gnawing or aching epigastric pain with a characteristic time relationship to meals",
      "Nighttime pain that wakes the patient",
      "Bloating, early satiety, belching, heartburn, nausea",
      "Reports of relief with food or antacid, or of worsening after eating",
      "Anorexia and unintentional weight loss",
      "Reported use of NSAIDs, aspirin, steroids, alcohol or tobacco"
    ],
    "objective": [
      "Epigastric tenderness on palpation",
      "Vomiting, possibly with coffee-ground material",
      "Black tarry stools or a positive occult blood test",
      "Tachycardia, hypotension, pallor and dizziness in significant bleeding",
      "Falling hemoglobin and hematocrit",
      "Rigid, board-like abdomen with absent bowel sounds in perforation",
      "Persistent vomiting of undigested food and visible distention in outlet obstruction"
    ],
    "related_factors": [
      "Helicobacter pylori colonization damaging the mucosal barrier",
      "NSAID and aspirin inhibition of protective prostaglandins",
      "Hypersecretion of acid and pepsin",
      "Smoking, which delays healing and increases recurrence",
      "Alcohol and corticosteroid use",
      "Severe physiologic stress causing stress-related mucosal disease in critical illness"
    ]
  },
  "goals": [
    "The client will report epigastric pain reduced to an acceptable level and identify factors that trigger it.",
    "The client will remain free of bleeding, with stable vital signs and hemoglobin and no melena or hematemesis.",
    "The client will maintain or regain weight with adequate oral intake.",
    "The client will complete the full eradication regimen and name the drugs and their purpose.",
    "The client will identify and eliminate personal ulcerogenic factors such as NSAIDs, smoking and alcohol."
  ],
  "interventions": [
    {
      "title": "1. Pain assessment and relief",
      "points": [
        "Ask specifically about the timing of pain in relation to meals; the pattern helps distinguish gastric from duodenal ulcer and guides teaching.",
        "Give acid-suppressing therapy on schedule rather than as needed; consistent suppression is what allows healing.",
        "Administer antacids at the ordered interval — usually one and three hours after meals and at bedtime — and separate them from other drugs by at least one to two hours to avoid absorption interference.",
        "Give sucralfate on an empty stomach, one hour before meals, so it can bind to the ulcer base.",
        "Encourage small, frequent meals and discourage lying down for two to three hours after eating.",
        "Discourage smoking, alcohol, caffeine and any food the patient personally identifies as a trigger; a rigid bland diet is no longer recommended."
      ]
    },
    {
      "title": "2. Monitoring for and managing hemorrhage",
      "points": [
        "Check vital signs frequently, watching for tachycardia and orthostatic changes that appear before frank hypotension.",
        "Inspect all emesis and stool; coffee-ground emesis indicates bleeding altered by acid, while bright red blood suggests brisk hemorrhage.",
        "Monitor hemoglobin, hematocrit, coagulation values and type-and-crossmatch status.",
        "For active bleeding, keep the patient NPO, maintain large-bore IV access, give volume and blood products as ordered, and prepare for endoscopic hemostasis.",
        "Position a bleeding, vomiting patient on their side with the head elevated to protect the airway."
      ]
    },
    {
      "title": "3. Recognizing perforation and obstruction",
      "points": [
        "Treat sudden severe pain radiating to the shoulder with a rigid abdomen as perforation: stop oral intake, notify the provider immediately and prepare for surgery.",
        "Assess for absent bowel sounds, rebound tenderness, shallow rapid breathing and rapidly rising heart rate.",
        "For suspected outlet obstruction — vomiting of undigested food, fullness, distention — anticipate nasogastric decompression and correction of hypokalemic, hypochloremic alkalosis.",
        "Measure and document nasogastric output, and maintain suction and irrigation per order."
      ]
    },
    {
      "title": "4. Medication and eradication therapy",
      "points": [
        "Explain that H. pylori treatment uses a combination of two antibiotics with a proton pump inhibitor, and that the entire course must be finished even after the pain stops.",
        "Give proton pump inhibitors before the first meal of the day for maximum effect.",
        "Review all home medications for NSAIDs, aspirin and steroids, and arrange substitutes such as acetaminophen when appropriate.",
        "Warn about common side effects: metallic taste and strict alcohol avoidance with metronidazole, black stools with bismuth (not to be confused with melena), and diarrhea with antibiotics.",
        "Reinforce that stopping therapy early is the most common reason for treatment failure and recurrence."
      ]
    },
    {
      "title": "5. Nutrition and weight",
      "points": [
        "Weigh regularly and track intake; unexplained continued weight loss with a gastric ulcer requires evaluation for malignancy.",
        "Provide small frequent meals eaten slowly in a relaxed setting.",
        "Discourage bedtime snacks, which stimulate a nocturnal acid surge.",
        "Consult dietitian support for patients with restricted intake or after gastric surgery.",
        "After gastric resection, teach the dumping syndrome pattern: small dry meals, fluids between rather than with meals, low simple sugars, and lying down after eating."
      ]
    },
    {
      "title": "6. Reducing stress and recurrence risk",
      "points": [
        "Explore work, sleep and coping patterns; stress does not create ulcers on its own but reliably worsens symptoms and adherence.",
        "Teach relaxation, regular meals and adequate sleep as part of the treatment plan.",
        "Provide smoking cessation resources — smoking is the strongest modifiable predictor of recurrence.",
        "Schedule follow-up endoscopy or breath testing as ordered to confirm healing and eradication."
      ]
    }
  ],
  "patient_teaching": [
    "Finish every dose of the antibiotic and acid-suppression regimen, even after symptoms disappear.",
    "Avoid NSAIDs and aspirin; use the approved alternative analgesic instead.",
    "Stop smoking and limit or avoid alcohol and caffeine.",
    "Eat small, regular meals and avoid the specific foods that cause your symptoms; there is no single universal ulcer diet.",
    "Do not eat within two to three hours of bedtime.",
    "Report black or tarry stools, vomiting blood or coffee-ground material, dizziness, or sudden severe abdominal pain immediately.",
    "Take antacids at the prescribed times and separate them from other medications.",
    "Keep follow-up appointments to confirm the ulcer has healed and the infection is gone."
  ]
}