Editing Medical-Surgical Nursing (section)

=== Gastroesophageal Reflux and Peptic Ulcer Disease ===

Reflux produces heartburn, regurgitation, and sometimes a chronic cough or hoarseness. Teach the patient to avoid large meals, to remain upright for two to three hours after eating, to elevate the head of the bed, to lose weight if indicated, and to limit caffeine, alcohol, chocolate, peppermint, fatty foods, and tobacco.

Peptic ulcer disease is most often caused by ''Helicobacter pylori'' infection or by nonsteroidal anti-inflammatory drug use. Gastric ulcer pain typically worsens with eating, whereas duodenal ulcer pain typically improves with eating and returns two to three hours later or at night. Treatment includes proton pump inhibitors and, for ''H. pylori'', combination antibiotic therapy.

Nursing application: sudden severe diffuse abdominal pain with a rigid board-like abdomen, absent bowel sounds, rebound tenderness, and tachycardia indicates perforation. Keep the patient nothing by mouth, notify the provider immediately, and prepare for surgery. Coffee-ground emesis or melena indicates upper gastrointestinal bleeding.