Nursing 213

N213: Health Differences Across the Lifespan 3 Study Guide Nursing interventions for peptic ulcer disease: • Give medications to control stomach acid per MDorder: o Antacids and H2 blockers : Give one to three hours prior to eating for gastric acid to neutralize; give one hour apart from any other medications, as it reduces absorption o Bismuth: Prevents over secretion of acids o Carafate (sucralfate): Give one hour prior to eating and at bedtime to protect healing ulcers o Antibiotics: Clarithromycin, amoxicillin, tetracycline, or metronidazole (Flagyl) to treat H. Pylori infection • Provide a bland diet and avoid spicy and greasy foods; avoid milk and cream since they stimulate more acid production; after the patient returns home, they can return to a normal diet but avoid foods that irritate the stomach • Assess pain on a scale of 1-10 and avoid aspirin or ibuprofen for treating pain • Discourage alcohol, smoking, and caffeine intake • Encourage increased fluids, especially water, which neutralizes gastric acids • Prepare patient for surgery if necessary: billroth I or II or vagotomy/vagotomy with pyloroplasty • Talk to the patient about stress and anxiety relief methods; recommend therapy or support groups • Teach patient and family about peptic ulcer treatment, diet, and lifestyle modifications Expected outcomes for peptic ulcer disease: • Patient remains free of complications: GI bleeds, perforation, and obstruction • Demonstrates increased coping of stress and anxiety • Verbalizes increased comfort and pain relief • Maintains nutritional, fluid, and electrolyte balance • Verbalizes understanding of the treatment plan, medications, and lifestyle modifications Crohn’s Disease This is also known as inflammatory bowel disease and is caused by inflammation in the terminal ileum. The cause is not known, but it may be an autoimmune disease. Other causes may be allergies, infection, and obstruction of the lymph nodes. The inflammation comes on in an unpredictable manner and begins to spread progressively though all of the layers of the intestinal wall, regional lymph nodes, and the mesentery layer. In between the affected areas, the bowel still appears normal. The lymph nodes become obstructed with edema, the mucosa becomes irritated, and fissures and abscesses then develop. Fibrosis begins to occur with disease progression and the bowel wall thickens making the lumen narrower. Crohn’s disease can be found in any part of the bowel but most often affects the jejunum, the colon, and the terminal ileum.

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