B. Diagram of Pathophysiology

Ulcer induced by NSAIDs

Topical irritation of the gastric epithelial cells and

reduced protective prostaglandin synthesis

Pharmacologic properties

Increased concentration or activity of acid-pepsin

Altered mucosal gel layer

Tissue cannot withstand the digestive action of gastric acid HCL and

Pepsin

Normal antireflux barrier is impaired

Predisposing Factors:

- Genetics- Helicobacter pylori- Hypersecretory Condition

Precipitating Factors:

- Smoking

- Drinking Alcohol

- Taking NSAIDs

Signs and Symptoms:

- Loss of appetite

- Abdominal pain

- Pain after eating

- vomiting

- Weakness due to vomiting, loss of appetite and pain

- Heartburn or Bleeding perforation from the ulcer

- Gastric outlet obstruction

Helicobacter bacteria occur

Decrease Resistant to bacteria

Act as a barrier to HCLDamage mucosa cannot secrete enough mucous

Erosion to the mucosaDecrease resistance of

the Mucosa

Normal flora of mucosal layer which coats the lining of the human stomach and

doudenum

inflammation

Host immune system reponse

Damage mucosal defense system

Diminished blood flow

Good Prognosis

If not treatedIf treated

Nursing Management

- Advice to avoid spicy and acidic food and dairy products and caffeinated drinks; alcohol and smoking cigarettes.

- Advice to take small frequent meals

- Any bleeding from the rectum, blood in stools sudden acute

abdominal pain restlessness, falling of temperature should be reported at once to the physician or the patient should be brought at once to the hospital.

- Take vital signs and teach patient family member how to take and record same.

- Provide light clothing or linens.

- Modify the environment through cooling by turning on the air

conditioner or fan.

- Instruct to increase oral fluid intake

- Regulate IV fluid.

- Administer medications as ordered.

- Teach members of the family how to report all symptoms to the attending physician especially when patient is being cared for at home.

- Teach, guide and supervise members of the family on nursing

techniques which will contribute to the patient’s recovery.

- Interpret to family the nature of disease and need for practicing preventive and control measures.

Medical Management

- IV fluids and electrolytes- Bed rest- Avoid NSAIDs- Histamine-2 (H2) receptor antagonist

Surgical Movement- Vagotomy – may be performed to reduce

gastric acid secretion

The bacteria that does not re- infect the host is shed

into the stool

The bacteria that remained present in the system of the host pauses and continuous to multiply

which makes the host as “carrier” for a long time.

Bad Prognosis

Death

- internal bleeding in

the digestive system

- splitting (perforation)

of a section of the

digestive system or

bowel, which

spreads the infection

to nearby tissue

- High possibility of

getting Gastric

cancer