a. A gastrointestinal ulcer is a break in the continuity of the mucous lining.
Ulcers may occur in any part of the GI tract that comes in contact with the gastric juices. Ulcers commonly occur in the lower esophagus, the stomach, and the duodenum.
b. In addition to mucosal deterioration by hydrochloric acid and pepsin secretion, other factors may be implicated in the development of ulcers.
(1) Emotional stress.
(2) Prolonged physical stress associated with trauma, surgery, burns, and so forth.
(3) Hereditary factors.
(4) Certain drugs and medications. For example: alcohol, caffeine, aspirin, corticosteroids, and chemotherapeutic agents.
c. The primary symptom of ulcers is pain. It is described as a burning, cramping, aching, or gnawing pain in the stomach area between the xiphoid process and the umbilicus. The severity of the pain is generally an indication of the extent of the ulceration. Likewise, ulcer pain is normally localized, the patient being able to indicate the area of the pain by pointing one finger. Radiating pain indicates a severe or perforated (ruptured) ulcer.
d. Nursing implications are usually twofold. The focus of treatment and nursing care for the patient with ulcers is twofold. The first objective is to promote gastric rest. The second objective is prevention of further ulceration. Both of these objectives may be accomplished by utilizing the following measures:
(1) Encourage physical and emotional rest by using relaxation techniques and prescribed medications (such as sedatives and tranquilizers) to reduce anxiety, restlessness, and insomnia.
(2) Practice prophylaxis (prevention) by use of antacids and avoidance of irritants such as aspirin, alcohol, caffeine, and spicy foods.
(3) Dietary management aids in control of pain and prevention of ulcers. Meals should be frequent, regular, and small to moderate in size. Foods not well tolerated should be eliminated. Daily intake should be of sufficient caloric and nutritive value to maintain health.
(4) When ulceration is in the acute stage, diet should be modified to consist of bland, low-fiber, non-gas-producing foods. Foods that are mechanically, chemically, and thermally nonirritating to the stomach.
e. Observe for signs and symptoms such as nausea, vomiting, blood in emesis or stool, abdominal rigidity, or abdominal pain. These symptoms may indicate the presence of bleeding, rupture, or obstruction at the ulcer site.