Peptic Ulcer

Disease
PUD
Nursingcasestudy.blogspot.com

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I. INTRODUCTION

Peptic ulcer disease (PUD) is a common disorder that affects millions of

individuals in the United States each year. PUD has a major impact on our health

care system by accounting for roughly 10% of medical costs for digestive

diseases. In the last two decades, major advances have been made in the

understanding of the pathophysiology of PUD, particularly regarding the role of

Helicobacter pylori infection and nonsteroidal anti-inflammatory drugs (NSAIDs).

This has led to important changes in diagnostic and treatment strategies, with the

potential for improving the clinical outcome and for decreasing health care costs.

Peptic ulcers are defects in the gastric or duodenal mucosa that extend

through the muscularis mucosa. H pylori infection and NSAID use are the most

common etiologic factors. Other less common causes are hypersecretory states,

such as Zollinger-Ellison syndrome, G-cell hyperplasia, mastocytosis, and

basophilic leukemias.

Under normal conditions, a physiologic balance exists between peptic acid

secretion and gastroduodenal mucosal defense. Mucosal injury and, thus, peptic

ulcer occur when the balance between the aggressive factors and the defensive

mechanisms is disrupted. Aggressive factors, such as NSAIDs, H pylori, alcohol,

bile salts, acid, and pepsin, can alter the mucosal defense by allowing back

diffusion of hydrogen ions and subsequent epithelial cell injury. The defensive

mechanisms include tight intercellular junctions, mucus, mucosal blood flow,

cellular restitution, and epithelial renewal.

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II. GENERAL DATA

Name : D.D.C.

Bed Number : A-608

Hospital Number : 090022514602

Sex : Male

Age : 54 years old

Date of Birth : September 01, 1954

Birthplace : Botolan, Zambales

Address : Pasar Isabel Leyte

Citizenship : Filipino

Religion : Christian

Status : Married

Height : 168 cm

Occupation : none

Weight : 80 kg

Occupation : Supervisor

Date of admission : February 23, 2009 02:07 pm

Name of Spouse : T. R. C.

Physician : Dr. Rody Kiok Go

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III.HISTORY OF PRESENT ILLNESS

Patient has been having on and off epigastric pain for about a year which

was not associated with food intake. Patient took esomeprazole (Nexium) as

needed for pain which afforded relief.

One and a half month prior to admission, patient had recurrence of

epigastric pain, 6-7/10 in severity, relieved by esomeprazole. He experienced

loss of appetite, diarrhea and a feeling of fullness in upper abdomen after eating.

He then sought consult with a private medical doctor and was advised

gastroscopy.

IV.PAST HEALTH HISTORY

On his early childhood, he had chickenpox and measles. When he had a

fever, her mother wiped her whole body to relieve the heat. He sometimes had

headache and diarrhea but he will just take a medicine for it. At the age of ten, he

had felt pain at his epigastric area and his parents brought him to the hospital for

a checkup. He had a diagnosis of an acute gastritis. He remembers that, he felt

so tired at that time. He received a complete immunization. He does not have

any allergies to foods or drugs. In the year 1979, he was hospitalized due to

malaria at Luna Medical Center. At the age of 40, he was diagnosed as

hypertensive.

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V. GORDON’S HEALTH PATTERN

Health Perception- Health Management Pattern

The patient usually described his health as good but at this time,

perceived his health in a fair condition. He realized that health is so important

and it’s not easy to be hospitalized especially the expenses.

Nutritional Metabolic Pattern

The patient usually eats rice, egg and other processed foods during

breakfast; rice, meat and some vegetables for lunch; and, for suppertime, he eats

rice and fish. His usual fluid intake is water then sometimes, soft drinks as well,

every morning, before going at work he drinks coffee. He has no problem with his

appetite and ability to eat before he got sick. He prefers to eat fatty foods though

it is not good to him. He takes food supplements or vitamins. He loves to eat

spicy foods.

Elimination Pattern

The patient does not have any problem with his urination and defecation.

He defecates every other day usually in the afternoon. His stools vary depending

upon the food he has eaten.

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Activity - Exercise Pattern

The patient is a supervisor. He spends his leisure time watching television

shows, listening to the radio, and playing basketball with his friends. Walking

from his house to his workplace would serve as his exercise.

Sleep – Rest Pattern

The patient’s usual sleeping time is between 10 pm to 11 pm. His rising

time is 5 am. He usually gains 6-7 hours of sleep excluding naptime. He takes an

afternoon nap, from 1 pm to 2 pm to feel relax.

Cognitive Perceptual Pattern

The patient was conscious, responsive and coherent. He can see clearly

with an aid of an eyeglass. He can hear clearly and his other senses are

functioning well. He knows how to read and write. He was well oriented of the

time and place.

Self - Perception Pattern

The patient was concerned about his condition. His present health goals

are simply to be cooperative and being obedient to what his doctor advised him

to do concerning his health condition. Being ill does not made him feel different

about himself.

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Role- Relationship Pattern

The patient lives with his family. He can easily express himself and can

understand others as well through writing, gestures and verbal. He usually asks

help to his wife whenever he has problem and sometimes to his friends too. He is

the one who disciplines his children. In terms of making decisions, he and his

wife will have to decide for it. He has a good relationship and bonding with his

family.

Sexuality- Sexual Functioning

The patient is sexually active. He does not anticipate a change in his

sexual relations despite of his condition. He sometimes use condom whenever

he and his wife had coitus.

Coping- Stress Management Pattern

The patient analyzes first the situation before making decisions. He

always makes decisions together with his wife. If he were stress, he would just

find ways to make himself enjoy like watching television shows and bonding with

her children and a way to relax through sleeping.

Value - Belief System

The patient’s source of strength is his family and God. For him, God is

very important to his life. He prays every day, visits churches and hears masses

together with his family.

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VI.FAMILY, PERSONAL, SOCIAL AND ENVIRONMENTAL HISTORY

A. MEMBERS OF IMMEDIATE FAMILY

MEMBERS RELATIONSHIP AGE SEX EDUCATIONAL

OF FAMILY ATTAINMENT
T.R.C. Wife 53 years Female College graduate
old
D.D.C. Son 30 years Male College graduate
old

J.D.C. Son 27 years Male College graduate

old
K.D.C. Daughter 25 years Female College graduate
old
C.D.C. Daughter 20 years Female College student
old

M.D.C. Son 15 years Male 3rd year high

old school

B. PERSONAL AND SOCIAL HISTORY

Patient is a smoker and alcoholic. He describes himself as simple and

approachable. He might look silent but he said he is talkative. During his high

school years, he loves to be with his friends and go out for gimmicks. He may

look strict but deep inside he is friendly, kind and easy to get along with other

people. He works hard especially when he became a father and a husband to his

wife. He spends his free time in watching television shows, listening to radio and

be playing basketball with his friends. He eats three times a day excluding

snacks but sometime his eating time is late because he does not want to leave

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what he is working. He usually sleeps at between 10 pm to 11 pm. His rising time

is 5 am. Whenever he had problem, he will ask for help to his wife and friends.

He does not do any exercise. He is religious and attends masses every Sunday.

C. ENVIRONMENTAL HISTORY

Patient and her family own a house at Pasar Isabel, Leyte. They live in

that silent and peaceful place for almost five years. He said that they are fine and

comfortable with their house and its place. Whenever they want to have fun, they

will just go to the leisure center near their house. In addition, there is church and

a swimming pool near the place. The space of their house is just enough for

them. They have their own comfort room, water and electrical supply. Their

neighbors are good and so approachable. They maintain cleanliness of their

environment by having proper disposal of waste and drainage system.

D. HEREDO – FAMILIAL HISTORY

Patient states in his father’s side, there is no genetic factor or illness

inherited. In contrary, hypertension is in the bloodline of his mother’s side.

VII. PHYSICAL ASSESSMENT

A case of D.D.C., 54 years old, male, married, Christian, Filipino from

Pasar Isabel, Leyte was admitted due to on and off epigastric pain at Chong Hua

Hospital. Patient was seen lying awake on bed, conscious, coherent, not in

respiratory distress and appropriately responds to questions when asked.

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Vital Signs taken during the first contact with the patient:

Blood Pressure : 140/100 mmHg

Heart Rate : 66 beats per minute

Respiratory Rate : 15 cycles per minute

Temperature : 36.2 0C

Skin: brown in color; has lesions on lower extremities; warm and dry; skin turgor

springs back to its previous state in 2-3 seconds

Hair: straight; black in color; not extremely oily; evenly distributed; negative for

lice

Scalp: shiny; smooth; no dandruff; white in color; negative for lesions

Head: normocephalic; with smooth contour; without masses; symmetrical;

proportion to body

Face: symmetrical facial features; round in shape; has no pimples; no masses;

lesions noted on both cheek

Eyes: eyelids appear symmetrical with no drooping; eyelashes are black in color

and well curved; lacrimal apparatus has no discharges upon palpation and

no pain felt; pupils are equally round and reactive to light and

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 accommodation with a size of 3mm; has pink palpebral conjunctiva; with

anecteric sclerae

Ears: symmetrical and at level of eyes outer cantus; brown in color; smooth; can

hear normally; no inflammation or lesion noted

Nose: symmetrical to the midline of the face; no lesions or swelling noted; no

discharges; airways are patent and free from obstructions; sinuses are

negative for congestion and no pain felt upon palpation; nasal mucosa is

free from inflammation or any indication of an infection or infestation of

certain microorganisms

Mouth: teeth are incomplete, with upper and lower dentures, slightly yellow in

color with no indication of any tooth decay or other tooth related problems;

gums are pinkish with no bleeding; tongue is red in color, symmetrical to

the midline of the mouth, moves freely; lips are dark in color, close

symmetrically and negative for lesions

Neck: patient was able to hold the neck erect at midline with symmetrical

muscles; free from any aberration or injury; no inflammation noted on the

thyroid glands; lymph nodes are not inflamed; no masses of any type were

noted in the general area of the neck; no bounding of jugular vein.

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Chest: no lesions noted; equal chest expansion and registers a clear breath

sound; no cough of any condition was present; absence of adventitious

sounds upon auscultation; respiratory rate is 18 cycles per minute from the

normal range of 12-20 cycles per minute.

Heart: with normal heart sounds; has a regular rhythm with 66 beats per minute

from the normal rate of 60-100 beats per minute; no visible pulsations

Breasts: flat; have smooth contour; no redness; no dimpling; lymph nodes are not

bulged; with symmetrical nipples; no swellings noted; has no discharges

noted

Abdomen: flabby, with normoactive bowel sounds, soft, with 3 bowel sound per

minute upon auscultation; no masses were noted on the general area;

warm to touch;

Upper Extremities: equally grip; low strength; warm to touch; good skin turgor;

both hands have five fingers; nails are short slightly pinkish

Lower Extremities: equal strength; negative for edema formation; lesions are

noted; nails are clean and short; warm to touch; good skin turgor

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VIII.DEVELOPMENTAL DATA

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 STAGE DEVELOPMENTAL PATIENT’S BEHAVIOR &
TASK DEVELOPMENTAL EXPLANATION

Infancy Trust “Ewan ko kung anong ginawa ko

Birth to one year vs. sa mga taon na eto, basta

Mistrust natatandaan kong sinabi ng aking ina

na ayaw ko raw magpaiwan kaya

naman lage na lang niya akong

karga.”

Infants trust in familiar and natural

person who are responsible in its

needs and provide satisfying

experience as nourishments and

warmth. Through continuity of

experience with adults, infants learn

to rely on them and trust them. When

infants’ needs which are not granted

immediately, they may develop

mistrust to the parents.

Toddlers Autonomy “Gusto ko lang yatang maglaro sa

1-3 years old vs. mga taon na to at napakalikot ko raw

Shame/Doubt. peru madali lang din sabihan.”

A child learns what is expected of

it, what its obligation and privileges

are and what limitations are place

upon it. A sense of self – control

provides a child with lasting feelings

[14]of good will and pride. The child

begins to judge it and others and to

IX. A.ANATOMY AND PHYSIOLOGY OF THE SYSTEM INVOLVED

Salivary Glands

Three pairs of salivary glands communicate with the oral cavity. Each is a

complex gland with numerous acini lined by secretory epithelium. The acini

secrete their contents into specialized ducts. Each gland is divided into smaller

segments called lobes.

The parotid glands are large, irregular shaped glands located under the

skin on the side of the face. They secrete 25% of saliva. The parotids produce a

watery secretion which is also rich in proteins. Immunoglobins are secreted help

to fight microorganisms and a-amylase proteins start to break down complex

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carbohydrates.

The submandibular glands secrete 70% of the saliva in the mouth. They

are found in the floor of the mouth, in a groove along the inner surface of the

mandible. These glands produce a more viscid (thick) secretion, rich in mucin

and with a smaller amount of protein. Mucin is a glycoprotein that acts as a

lubricant.

The sublinguals are the smallest salivary glands, covered by a thin layer

of tissue at the floor of the mouth. They produce approximately 5% of the saliva

and their secretions are very sticky due to the large concentration of mucin. The

main functions are to provide buffers and lubrication.

Pharynx

The pharynx or throat is a tubular structure that extends from the base of

the skull to the esophagus and is situated immediately in front of the cervical

vertebrae. It serves as a passageway for the respiratory and digestive tracts and

changes shape to allow formation of various vowel sound.

Tongue

It is the principal organ of the sense of taste that also assist in the

mastication and deglutition of food.

Esophagus

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 The esophagus is a muscular tube of approximately 25cm in length and

2cm in diameter. It extends from the pharynx to the stomach after passing

through an opening in the diaphragm. The esophagus functions primarily as a

transport medium between compartments.

Stomach

The stomach is a J shaped expanded bag, located just left of the midline

between the esophagus and small intestine. It is divided into four main regions

and has two borders called the greater and lesser curvatures. The first section is

the cardia which surrounds the cardial orifice where the esophagus enters the

stomach. The fundus is the superior, dilated portion of the stomach that has

contact with the left dome of the diaphragm. The body is the largest section

between the fundus and the curved portion of the J.

This is where most gastric glands are located and where most mixing of

the food occurs. Finally the pylorus is the curved base of the stomach. Gastric

contents are expelled into the proximal duodenum via the pyloric sphincter. The

inner surface of the stomach is contracted into numerous longitudinal folds called

rugae. These allow the stomach to stretch and expand when food enters. The

stomach can hold up to 1.5 litres of material. The functions of the stomach

include:

• The short-term storage of ingested food.

• Mechanical breakdown of food by churning and mixing motions.

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 • Chemical digestion of proteins by acids and enzymes.

• Stomach acid kills bugs and germs.

• Some absorption of substances such as alcohol.

Most of these functions are achieved by the secretion of stomach juices by

gastric glands in the body and fundus. Some cells are responsible for secreting

acid and others secrete enzymes to break down proteins.

Small Intestine

The small intestine is the longest part of the digestive tract, extending for

about 7m from the pylorus of the stomach to the ileocecal junction. It is divided

into the duodenum, jejunum, and ileum. It functions in digestion and is the major

organ of absorption of prepared food.

Large Intestine

The large intestine is horse-shoe shaped and extends around the small

intestine like a frame. It consists of the appendix, cecum, ascending, transverse,

descending and sigmoid colon, and the rectum. It has a length of approximately

1.5m and a width of 7.5cm. The cecum is the expanded pouch that receives

material from the ileum and starts to compress food products into fecal material.

Food then travels along the colon. The wall of the colon is made up of several

pouches (haustra) that are held under tension by three thick bands of muscle

(taenia coli).

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 The rectum is the final 15cm of the large intestine. It expands to hold fecal

matter before it passes through the anorectal canal to the anus. Thick bands of

muscle, known as sphincters, control the passage of feces. The mucosa of the

large intestine lacks villi seen in the small intestine. The mucosal surface is flat

with several deep intestinal glands. Numerous goblet cells line the glands that

secrete mucous to lubricate fecal matter as it solidifies. The functions of the large

intestine can be summarized as:

• The accumulation of unabsorbed material to form feces.

• Some digestion by bacteria. The bacteria are responsible for the formation

of intestinal gas.

• Reabsorption of water, salts, sugar and vitamins.

Liver

The liver is a large, reddish-brown organ situated in the right upper

quadrant of the abdomen. It is surrounded by a strong capsule and divided into

four lobes namely the right, left, caudate and quadrate lobes. The liver has

several important functions. It acts as a mechanical filter by filtering blood that

travels from the intestinal system. It detoxifies several metabolites including the

breakdown of bilirubin and estrogen. In addition, the liver has synthetic functions,

producing albumin and blood clotting factors. However, its main roles in digestion

are in the production of bile and metabolism of nutrients. All nutrients absorbed

by the intestines pass through the liver and are processed before traveling to the

rest of the body. The bile produced by cells of the liver, enters the intestines at

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the duodenum. Here, bile salts break down lipids into smaller particles so there is

a greater surface area for digestive enzymes to act.

Gall Bladder

The gallbladder is a hollow, pear shaped organ that sits in a depression on

the posterior surface of the liver's right lobe. The main functions of the gall

bladder are storage and concentration of bile.

Pancreas

The pancreas is a lobular, pinkish-grey organ that lies behind the stomach.

Its head communicates with the duodenum and its tail extends to the spleen. The

organ is approximately 15cm in length with a long, slender body connecting the

head and tail segments. It is made up of numerous acini (small glands) that

secrete contents into ducts which eventually lead to the duodenum. It secretes

fluid rich in carbohydrates and inactive enzymes. It has both exocrine and

endocrine functions.

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B. CONCEPTUAL FRAMEWORK OF THE PATHOPHYSIOLOGY OF ACID

PEPTIC DISEASE

C. DISCUSSION ON THE PATHOPHYSIOLOGY OF ACID PEPTIC DISEASE

The stomach's lining has a protective layer of cells that produce mucus.

The mucus prevents the stomach from being injured by stomach acids and

digestive juices. When this protective layer is damaged, it cannot secrete enough

mucus to act as a barrier against HCl, thus an ulcer may occur. Peptic ulcers

occur mainly in the gastroduodenal mucosa because this tissue cannot withstand

the digestive action of gastric acid (HCl) and pepsin. Normally, when the mucosa

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is damaged, the defensive forces will respond.

Stomach ulcers may develop from: the presence of bacteria called

Helicobacter pylori (H. pylori), the most common cause of stomach ulcers;

decreased resistance of the lining of the stomach to stomach acid and increased

production of stomach acid.

Stomach ulcers are more likely to occur in people who: regularly take

nonsteroidal anti-inflammatory drugs (NSAIDS), such as aspirin, ibuprofen, and

naproxen; smoke cigarettes and intake of excessive alcohol. In addition,

substances that increase the production of stomach acids, such as caffeine, may

increase the risk of ulcers and are known to worsen the pain.

Usually, the ulceration is preceded by shock; this leads to decreased

gastric mucosal blood flow and to reflux of duodenal contents into the stomach.

In addition, large quantities of pepsin are released. The combination of ischemia,

acid, and pepsin creates an ideal climate for ulceration.

D. SYMPTOMATOLOGY

• Signs and symptoms:

• A gnawing or burning ache or pain in the upper abdomen that may

become either worse or better after eating.

• Loss of appetite.

• Bloating: A feeling of fullness in upper abdomen after eating

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 • Loss of appetite Belching: Belching either does not relieve the pain or

relieves it only briefly.

• Nausea and vomiting: The vomit may be clear, green or yellow, blood-

streaked, or completely bloody, depending on the severity of the stomach

inflammation.

• Constipation or diarrhea

• Signs and symptoms manifested by the patient:

• Loss of appetite

• Diarrhea

• Dull, gnawing pain or burning sensation in the midepigastrium area

• Bloating

X. MEDICAL MANAGEMENT

A.TREATMENT AND PROCEDURES

• Monitoring vital signs

• Closely monitored to detect changes in the patient’s

condition.

• Administering medications

• Medications to be given are as prescribed by the

physician in-charge of the patient.

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• Intravenous therapy

• This is done to sustain fluids and electrolytes in the body.

• Upper Gastrointestinal Endoscopy

• This allows direct visualization of inflammatory changes,

ulcers and lesions of the upper gastrointestinal tract that

is why this is the preferred diagnostic procedure. Through

this procedure, a biopsy of the gastric mucosa and of any

suspicious lesions can be obtained. Endoscopy may

reveal lesions that, because of their size or location, are

not evident on x-ray studies.

B. MEDICATIONS

• Amoxicillin 500 mg per cap 2 caps PO BID

• Clarithromycin 500 mg per tab 1 tab PO OD

• Lifezar 50 mg PO OD

• Omepron 40 mg IVTT every 12 hours

• Prevacid FDT 30 mg per tab 1 tab PO BID ac

• Zinnat 500mg 1 tab PO BID

• Mucosta 100 mg 1 tab PO TID ac

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C. DIAGNOSTIC PROCEDURES

• Upper GI endoscopy

02-24-09

Pre-endoscopic diagnosis: Roll out Peptic Ulcer Disease

Post-endoscopic diagnosis: Antral gastritis

• Tissue report

02-24-09

Specimen: stomach for biopsy

Brief history: recurrent abdominal pain with edematous folds at fundus

Clinical impression: chronic gastritis

Diagnosis

Stomach: chronic gastritis with erosions

Gross description

Stomach: received are four tiny tan tissues aggregately measuring

4x4x2mm. (ALL)

Microscopic description:

Stomach: section shows fragments of antral and body type gastric

mucosa. There is moderate chronic inflammation seen associated

with formation of several lymphoid patches. Occasional eosinophils

are also seen. Some fragments show epithelial erosions and

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 congestion. No cryptitis is observed. Few H. pylori like organisms

are observed. No evidence of malignancy seen.

D.DIET

The physician advised the patient to take full, low sodium, low fat, low

purine diet. It is to prevent continually high blood pressure. And so it would not

exacerbate condition.

XI. NURSING MANAGEMENT

A. ACTUAL CARE GIVEN

As the patient was admitted to Chong Hua Hospital, care was given in

order for the patient to be relieved from the present condition. Nursing care was

given which includes the following: assessment of patient’s health status, taking

of Vital Signs for the baseline data of the patient, intake and output of the patient

was monitored, measured and recorded on the patient’s chart, checking patient’s

intravenous fluid and regulated at prescribed rate. Giving medications were done

as ordered by the physician. I encouraged patient to have adequate rest and

sleep.

B. PROBLEMS ENCOUNTERED DURING THE IMPLEMENTATION OF

NURSING CARE

There were no major tribulations encountered in the implementation of

quality nursing care. The patient was very obliging as well as cooperative and

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was very aware of his health needs and status. I was able to perform the needed

skills with no problems at all.

C. RESTORATIVE MEASURES USED

Restorative measures were done and performed for it is very important for

the patient to recover from the discomforts and aggravating factors from his

condition. The patient was encouraged to ambulate as he can to promote good

and stable blood circulation throughout the system. He was advice to take

adequate rest period. I encouraged patient to verbalize any personal discomforts

felt. Moreover, I discussed the importance of therapeutic regimen compliance.

D. EVALUATION

The evaluation of care depends on the effort exerted both by the nurse

and in the patient himself. Verbalization of discomforts is one of the important

components in order to know if the nursing care given was effective or not. As

the patient was discharged from the health care facility, the patient was under

normal condition and reports absence of any discomfort. Vital signs were stable.

E. PATIENT TEACHING

Health teachings were directed toward resulting the patient’s individual

needs for knowledge of self-care and health maintenance activities. I, as a

student nurse, shared necessary health teachings to my patient. I discussed to

him the importance of having adequate rest, avoiding stress and having lifestyle

modification like cessation of drinking alcoholic beverages. I stressed out to him

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the benefits he could get out from quitting smoking and the reasons why he

needs to do it. I encouraged him not to forget the medications prescribed by the

physician. I also taught him on what kind of food that he needs to be avoided,

which includes the salty, spicy and acidic food, because these can stimulate acid

secretion.

XII. A. CONCLUSION

Patient with acid peptic disease needs to be attended to. He should be

assessed of what he feels especially if there is pain. As we all know pain is very

uncomfortable and hassle to anyone experiencing it. Encouraging patient to

verbalize his feelings is very important. He should be given necessary health

teachings in order for him to avoid those factors that may worsen his condition.

After caring for my patient, I realized that nurses are very much important.

Unlike other medical personnel, nurses are able to get close to patient which is

important for patient to feel that there is someone who is willing to help them at

times they are sick. Patients usually keep what they feel inside. Having a nurse,

help patients to verbalize their feelings about the situation they are in right now.

This is like hitting two birds in one stone, not only will the patient feel relieved but

also this will give the nurse an idea what he/she must can do to provide care to

the patient.

B. RECOMMENDATION

As future nurses, we should acquire the three important aspects of being a

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good nurse: knowledge, skills, and attitude. These will help us to become

effective and efficient nurses who know how to deal with patients of different

disease conditions in different situations. A lack of even one of these will be very

difficult to a nurse, and it is expected that he/she will not be able to provide the

care needed by the patient. I also recommend, especially to student nurses, to

voice out their concerns and ask if they are curious and/or unsure about doing

procedures for them not to commit mistakes. Besides, there is nothing wrong in

asking. Not asking will only endanger your patient and yourself.

XIII. IMPLICATION OF THE STUDY TO:

A. NURSING EDUCATION

Our hunger for knowledge is insatiable. We continue to learn as we

continue to live. So why not learn to be of help to everyone. The implication of

this case study to nursing education is to broaden, upgrade, and maximize the

knowledge and skills of the nurses (especially the student nurses) in terms of

caring patients with acid peptic disease. Nursing is a never-ending educational

challenge to nurses and to the other health care team members. Changes and

evolution of care concerning this kind of disease was brought about by the rapid

change of technology nowadays. We all know that a good background about

something is like a good investment to our chosen profession. I believe that

knowing about acid peptic disease will help us know what we should do and what

attitude we should make in dealing with clients having this kind of disease, since

giving optimal care is one of our goals as nurses. We are dealing with lives, so

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every action we make is very vital to our patient; therefore making mistakes can

put our patient in grave danger. So to avoid making mistakes, it is good to have

some foundation, some knowledge. We play an important part in patients’ lives.

So, we need to remember to be careful because we cannot always undo the

things that we already did; same as “We cannot bring back the dead to life.”

Moreover, when reading this case study, this will help you not only become

efficient but to be effective as well in rendering care to patients especially to

those patients with acid peptic disease.

B. NURSING PRACTICE

The implication of this study in regards with nursing practice is the

utilization of nursing concepts, which includes nursing care plan, nursing process

etc. This is important in nursing practice because in this stage where nursing

interventions are implemented and done in order to promote wellness in the

patient and also to broaden the concept of the student nurse in rendering care. In

this way, the student nurse will be able to prioritize his or her focus of care and

apply the principles in the clinical setting, which he or she learns. Nursing is

planning. It is essential because it aids the student in critical thinking skills.

Prioritizing care, which learned, developed and evolved in this phase. The ever-

changing role of the nurses in terms of giving care plays an important role in

caring for the sick. Its role is to broaden the knowledge of the people in terms of

the importance prevention and compliance to therapeutic regimen to restore the

good health to patients. As a conclusion, the student nurses can emphasize their

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skills in terms of giving care. The important is to serve and give care even in the

evolution of trends and technology of new care settings and the changes and

acceptance of roles of the nurses in the nursing field of care.

C. NURSING RESEARCH

Every day, illnesses and disease conditions continue to evolve to the next

level. And same can be said to interventions and medications to treat these

conditions. In order to come up with these said interventions and medications,

the facts of the previous disease conditions are used as basis. And so I consider

this case study as an important part of this research. I believe that this case

study will help researchers discover something that will not only treat a disease

but more importantly on how to prevent acquiring diseases. This case study is

important for us to know more about acid peptic disease and how to deal with it.

Therefore, we must be open minded to whether old or new trends about things

because this trends will always help us. Who knows, we might be able to

discover something new that will be of great help in the future just by giving time

to read articles and books.

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