Nursing Case Study: Gastric Ulcer

Running head: NURSING CASE STUDY
Name of the student:
Name of the University:
Author’s note

NURSING CASE STUDY
1
Question 1:
The case study represents the gastric ulcer of a 46 years old man, has been admitted to
the hospital for hematemesis and melena. The patient had a medical history of gastric ulcer and
had received Hp eradication therapy two years before his current presentation. He had anemia
and elevated blood urea nitrogen along with ESR40. Gastric ulcer is a life-threatening disease
characterized as an ulcerated lesion in the mucosa of the stomach (Burkitt et al., 2016). PUD
observed in patients while gastric mucosal defenses of the patient become impaired and no
longer able to protect the epithelium from the effects of acid and pepsin. When a break in the
mucosal barrier occurs, hydrochloric acid injures the epithelium. He was denied of using
NSAIDs or aspirin, smoking or alcohol. The common risk factors of the gastric ulcer include
smoking, acidic drink, medication or presence of infection. NSAIDs or aspirin are anti-non-
steroidal anti-inflammatory drugs which can cause ulcer as these anti-non inflammatory drugs
reduced the level of prostaglandin in patients (Www.nps.org.au, 2019). Prostaglandin plays a
crucial role in protecting from acute mucosal damage which is an event in the gastric ulcer
(Www.nps.org.au, 2019). It inhibits acid secretion, facilitates mucus production and bicarbonate
secretion, alters mucosal blood flow and provides protection. The patient might take these drugs
before which further facilitated infection (Abdul Rahim et al., 2016). To prevent the infection he
now denied of taking these drugs and he had been taking H2 blocker Famotidine which reduced
acidity in the stomach.
Considering the current status of the patient, the patient had Nausea and vomiting ++,
Hematemesis. Hematemesis indicates that the bleeding is the result of hemorrhage from the
upper gastrointestinal tract, usually from the stomach (Www.nps.org.au 2019, Hanson &

NURSING CASE STUDY
2
Rudloff, 2018). The hemorrhage can be observed because of the infection present in the body as
bacteria such as H. Pylori is able to weaken the protective mucous coating of the stomach which
further resulted in secretion of acid that gets through the sensitive lining (Hooi et al., 2017). He
had elevated blood urea nitrogen which indicates extensive bleeding into the gastrointestinal
tract. While the normal level of BUN is 6 to 20mg/dl, the patient had 27.9 mg/dL, highlighting
the kidney is failed to digest intake food properly (Tomizawa et al., 2015). On the other hand,
melena is also most commonly observed in gastrointestinal hemorrhage where more blood in
stomach turn stool into black as observed for the patient ( melena ++). Mitchell and Katelaris
(2016) highlighted that melena in upper gastrointestinal hemorrhage is caused by the effect of
gastric acid and pepsin in the blood which is secreted because gastric mucosal defenses failed to
provide protection. Consequent, he might lose electrolytes from the body due to vomiting or
blood loss. Hence, he was administrated with IVT 8/24 Hartman’s Solution. Many researchers
highlighted that most common complication of the hemorrhage is tissue hypoxia which is
observed in the case study where the patient had an oxygen saturation of 94%
(Www.healthdirect.gov.au, 2019). The normal range of oxygen saturation is 95 to 100 % and
94% indicate tissues are deprived of adequate amount of oxygen (Satoh et al., 2015). Moreover,
the patient had anemia which can also induce tissue hypoxia as in anemic patient
oxygen, oxygen delivery reduction is observed but oxygen extraction is amplified which resulted
in lower tissue oxygen saturation to 94% (Lanas et al., 2018). Moreover, due to hemorrhage the
blood pressure is also low inpatient (BP100/60) whereas, in case of healthy individuals, the
normal blood pressure should be 120/ 80 that further reduced the oxygen saturation. Due to
hemorrhage caused by H.pylori, the patient was experiencing severe pain (9/10.) whereas
reduced pain sensation defined as 1/10 in pain assessment scale (Lanas & Chan, 2017). In the

NURSING CASE STUDY
3
case of the patient, Erythrocyte Sedimentation Rate is 40 which is occurred with inflammation
because of infection and also with anemia. While the normal range of ECR is 0 and 20 mm/hr,
40 indicated the presence of the infection and anemia and require immediate clinical attention
(Satoh et al., 2015).
Question 3:
The two nursing diagnosis during research would be:
 Pain assessment to gain an understanding of the pain due to ulcer
 ECR rate of the patient to gain an understanding of the presence of infection inpatient
For facilitating faster recovery of the patient, short term and long term goal would be specified
for the patient.
The short term smart goal would be:
 Effective pain management along with stable vital signs within the next 48 hours.
The long term goal SMART goal for the patient would be:
 Modification of diet and lifestyle within three months
 Monitoring complications of ulcer for such as hemorrhage, ECR rate within three
months
 Reduction of psychological distress within in 1month
The five nursing interventions for the planned short term and long term recovery goal of the
patient are the following:
1. Management of pain: