Republic of the Philippines

Tarlac State University

College of Science
Department of Nursing
Lucinda Campus, Brgy. Ungot, Tarlac City Philippines 2300
Accredited Level 4 Status by the Accrediting Agency of Chartered Colleges and
Universities in the Philippines (AACUP), Inc.

NCM 112 LABORATORY

Case study:
PEPTIC ULCER DISEASE

Submitted to:
Prof. KINGSLEY CASTRO

Submitted by:
Antipuesto, Misty Joy Dumlao
Barolo, Mikaela Raine Diaz
Domincel, Clarissa
Domingo, Clair Portugal
Grande, John Lester Cabubos
Isao, Cj Angelean Apongol
Javier, Marivic Opao-Opao
Moriones, Trisha Anne
Ramos, Princess
 INTRODUCTION

A peptic ulcer referred to as a gastric, duodenal, or esophageal ulcer, depending on its

location. A person who has a peptic ulcer has peptic ulcer disease. A peptic ulcer is an
excavation that forms in the mucosal wall of the stomach, in the pylorus or the opening between
the stomach and duodenum, or in the esophagus. Erosion of a circumscribed area of mucous
membrane is the cause. This erosion may extend as deeply as the muscle layers or through the
muscle to the peritoneum.

Peptic ulcers are more likely to be in the duodenum than in the stomach. As a rule they
occur alone, but they may occur in multiples. Chronic gastric ulcers tend to occur in the lesser
curvature of the stomach, near the pylorus. Esophageal ulcers occur as a result of the backward
flow of HCl from the stomach into the esophagus ( gastroesophageal reflux disease/ GERD ).

The most common causes of peptic ulcers are infection with the bacterium Helicobacter
pylori (H. pylori) and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stress and spicy foods do not
cause peptic ulcers. However, they can make your symptoms worse. In the past, stress and
anxiety were thought to be causes of ulcers, but research has documented that peptic ulcers result
from infection with the gram-negative bacteria H. pylori, which may be acquired through
ingestion of food and water. Person-to-person transmission of the bacteria also occurs through
close contact and exposure to emesis. It is not known why H. pylori infection does not cause
ulcers in all people, but most likely the predisposition to ulcer formation depends on certain
factors, such as the type of H. pylori and other as yet unknown factors .

SIGNS AND SYMPTOMS

 Burning stomach pain

 Feeling of fullness, bloating or belching

 Intolerance to fatty foods

  Heartburn

 Nausea

 Vomiting or vomiting blood — which may appear red or black

 Dark blood in stools, or stools that are black or tarry

 Trouble breathing

 Feeling faint

 Nausea or vomiting

 Unexplained weight loss

 Appetite changes

STATISTICS
In the United States, peptic ulcer disease affects approximately 4.6 million people
annually, with an estimated 10% of the US population having evidence of a duodenal ulcer at
some time.  H pylori infection accounts for 90% of duodenal ulcers and 70-90% of gastric ulcers. 
The proportion of people with H pylori infection and peptic ulcer disease steadily increases with
age.
According to the latest WHO data published in 2018 Peptic Ulcer Disease Deaths in
Philippines reached 6,283 or 1.03% of total deaths. The age adjusted Death Rate is 9.69 per
100,000 of population ranks Philippines #18 in the world.

REASON FOR CHOOSING THE CASE FOR PRESENTATION

The group was assigned to have Peptic Ulcer Disease as their case study for them to have
a deeper knowledge about this disease. It also helps them understand the disease process of
PUD , and to orient one of the appropriate nursing interventions that could be offered/help to the
patient. Through this, they could identify and address the needs and concerns of their upcoming
future patients by providing them the proper individualized or standardized care.
OBJECTIVES (GENERAL & SPECIFIC)
GENERAL OBJECTIVE:
This case study aim to broaden the knowledge of nursing students about PUD by
gathering relevant information from the patient and it also aims to develop our skills in
formulating nursing diagnosis and nursing care place to render proper interventions to help our
patient and to promote quality care.
SPECIFIC OBJECTIVES:
 To assess patient and obtain personal data properly.
 To formulate a appropriate nursing diagnosis.
 To provide planning that will help in providing the continuity of care, safety and
quality of care.
 To provide appropriate nursing interventions.
 To determine the completeness and usefulness of the care planning system.

II. NURSING PROCESS

A. ASSESSMENT

Patient Profile:
Name: Patient X
Age: 45 years old
Sex: Male
Marital status: Single
Address: Sta. Ignacia Tarlac
Nationality: Filipino
Religion: Catholic
Height: 150 cm
Weight: 70 kg
Date and time of admission: May 10, 2021(10:00 AM )
Chief complaint: Epigastric Abdominal Pain (burning pain), distended abdomen ,vomiting
Admitting diagnosis: Peptic Ulcer Disease
2. Family history
According to the patient he has family history of significant medical problem his mother
died due to gastric cancer and his father died due to prostate cancer.

3. History of Past Illness

Patient X is a 45 years old man from Sta. Ignacia Tarlac . He is a construction worker and
stated that he is fond of eating raw foods and spicy foods, he also smoke and consume 1-2 packs
a day and drink alcohol enormously every after his work and was able to drink 2 bottles of Gin.
Prior to admission , he stated that he experienced epigastric abdominal pain and describes pain as
burning and says that it occurs at night or early in the morning and also found that these
symptoms generally improved after eating food. He also stated that OTC medication like H2
antagonist help him to resolved his symptoms. He also takes pain reliever drugs like mefenamic
acid and alaxan after work.

4. History of Present Illness

May 10 2021 10:00 AM, Patient X was admitted to Tarlac Provincial Hospital with a
chief complaint of abdominal pain (burning pain) ,distended abdomen and vomiting in which he
describes pain as burning and says that it occurs at night or early in the morning. The patient has
found that eating food generally improves these symptoms. In assessing the patient, physical
examination reveals that he loss10kg of his weight from 80kg becomes 70 kg, PE also reveals a
normal head and neck, and cardiopulmonary examinations show no abnormalities. The abdomen
is slightly distended, minimally tender in the epigastrium, and without masses. A rectal
examination reveals Hemoccult stool. Laboratory studies reveal elevated values for the white
blood cell (WBC) count of 12mg/dl, hemoglobin 9mg/dl, hematocrit levels and platelet count
within normal limit, electrolyte levels potassium slightly low, serum amylase level and liver
function tests are normal. Vital signs on the emergency department BP 130/90mmhg, PR 89
bpm, RR 18cpm, Temp 37.2C , O2 sat is 98%. Doctor ordered PNSS 1L x KVO rate,
Omeprazole drip: Omeprazole 80mg + 100ml PNSS per soluset to run for 24hrs, Tranexamic
Acid 500mg IVP q 8hrs, omeprazole 40mg IVP OD in AM.
On the medical ward the pain does not subsides with the pain scale of 7/10, the doctor requested
that Patient X is for abdominal ultrasound and revealed that there is some gastric erosion at the
pyloric antrum and to confirm the erosion the doctors did a endoscopy to visualized the
condition of Patient X stomach at the result was there is a gastric erosion and perforation. The
doctor immediately order that Patient X is scheduled for operation/ surgery Emergency Bilroth
I.