The patient who has a history of alcohol abuse, diabetes, and heart failure was brought to the healthcare facility complaining of abdominal pain and vomiting bright red blood. He was subsequently diagnosed with gastric ulcers. Several factors could have contributed to this person's severe bleeding. First, from the medical history of the patient, it was ascertained that he was using warfarin and Glucophage. Warfarin is a blood-thinning agent that is associated with severe peptic ulcers. According to Pourakari et al. (2017), the risk of stomach bleeding is exacerbated by the use of antiplatelet drugs such as warfarin and aspirin. The use of warfarin is justified by the patient’s heart condition since it aid in reducing the formation of blood clots. Secondly, too much use of metformin (Glucophage) can result in lactic acidosis (“Metformin (Oral Route) Precautions - Mayo Clinic,” 2020). For patients with gastric ulcers, gastric acidosis can heighten bleeding, as seen in the patient who was using Glucophage to manage diabetes. According to Strate et al. (2016), alcohol is known to potentiate the effects of antiplatelet drugs such as warfarin, and it is a modifiable risk factor to gastrointestinal bleeding. Thus, the use of warfarin and Glucophage and alcohol abuse are the risk factors for the patient's condition.
Various nursing diagnoses are associated with gastric ulcers. The patient has acute pain, which could be arising from probable or actual tissue damage and may be related to abdominal distention and muscle spasm. The goal of the related intervention is to relieve pain through the use of pharmacological and non-pharmacological medicines. Second, the patient could be experiencing anxiety associated with his acute illnesses such as heart failure and diabetes. The intervention for anxiety is to encourage relaxation methods to reduce anxiety. Last, insufficient knowledge of the condition could be the other nursing intervention. The intervention will assess the patient's knowledge and probable misconceptions regarding gastric ulcers and its treatment. The outcome for this is to assist the client in understanding the significance of complying with medical routine and commitment to self-care management ( Martin, 2019 ). The patient will be placed under a proton pump inhibitor such as omeprazole (PPI) for 7 to 10 days ( Fashner & Gitu, 2015 ). PPI will help reduce acid secretion by inhibiting the cells that produce the acid.
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References
Fashner, J., & Gitu, A. C. (2015). Diagnosis and treatment of peptic ulcer disease and H. pylori infection. American family physician , 91 (4), 236-242.
Martin, P. (2019). 5 Peptic Ulcer Disease Nursing Care Plans - Nurseslabs . Nurseslabs. Retrieved 19 February 2020, from https://nurseslabs.com/peptic-ulcer-disease-nursing-care-plans/.
Metformin (Oral Route) Precautions - Mayo Clinic . Mayoclinic.org. (2020). Retrieved 19 February 2020, from www.mayoclinic.org/drugs-supplements/metformin-oral-route/precautions/drg-20067074 .
Pourafkari, L., Ghaffari, S., Zamani, N., Masnadi-Shirazi, K., Khaki, N., & Tajlil, A. et al. (2017). Upper gastrointestinal bleeding in the setting of excessive warfarin anticoagulation: Risk factors and clinical outcome. Cor Et Vasa , 59 (2), e128-e133. https://doi.org/http://dx.doi.org/10.1016/j.crvasa.2016.03.006
Strate, L., Singh, P., Boylan, M., Piawah, S., Cao, Y., & Chan, A. (2016). A Prospective Study of Alcohol Consumption and Smoking and the Risk of Major Gastrointestinal Bleeding in Men. PLOS ONE , 11 (11), e0165278. https://doi.org/https://doi.org/10.1371/journal.pone.0165278
