Case Study Pud

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 OF FAMILY

RELATIONSHIP

AGE

SEX

EDUCATIONAL ATTAINMENT

T.R.C.

Wife

Female

College graduate

D.D.C.

Son

53 years old 30 years old

Male

College graduate

J.D.C.

Son

27 years old

Male

College graduate

K.D.C.

Daughter

25 years old

Female

College graduate

C.D.C.

Daughter

20 years old

Female

College student

M.D.C.

Son

15 years old

Male

3rd year high 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 TASK

Infancy

Trust

Birth to one year

vs. Mistrust

PATIENT’S BEHAVIOR & DEVELOPMENTAL EXPLANATION

“Ewan ko kung anong ginawa ko sa

mga

taon

na

eto,

basta

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

experience warmth.

provide

as

satisfying

nourishments

Through

continuity

and 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

1-3 years old

vs. Shame/Doubt.

“Gusto ko lang yatang maglaro sa mga taon na to at napakalikot ko raw 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 [15]

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 [19]

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 [21]

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 [22]

•

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, bloodstreaked, 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. [23]

•

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 [26]

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 everchanging 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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