Uiii

FD, a 48-year-old patient, complains of a gnawing, aching pain in the abdominal
area that usually occurs several hours after eating. He says that over-the-counter
antacids help somewhat but that the pain has recently intensified. Diagnostic
tests indicate that the patient has a duodenal ulcer.
1. Differentiate between peptic ulcer, gastric ulcer, and duodenal ulcer. Explain
your answer.
Peptic ulcer disease occurs when open sores, or ulcers, form in the stomach or first
part of the small intestine. Many cases of peptic ulcer disease develop because a
bacterial infection eats away the protective lining of the digestive system.The
condition known as peptic ulcer disease causes sores or ulcers to appear on the lining
of the stomach or the first section of the small intestine (the duodenum). The stomach
lining is often shielded from the effects of its digestive fluids by a thick coating of
mucus. However, a number of factors can weaken this barrier, allowing stomach acid
to harm the tissue. While duodenal ulcers, which affect the upper part of the small
intestine, are ten times more prevalent than gastric and esophageal ulcers. Due to a
deficiency in buffers to neutralize gastric acid in the stomach, a faulty digestive
system, or excessive acid discharge from the stomach into the duodenum, a duodenal
ulcer is created or a weak pyloric sphincter, or because the stomach is very active.
Large arteries are more likely to degrade into duodenal ulcers, leading to more serious
bleeding. Finally, a gastric ulcer is commonly caused by a breakdown of the gastric
mucosal barrier (GMB). Depending on where they are and how much acid they
secrete, there are five different types of gastric ulcers. Aching, gnawing discomfort is
a hallmark of peptic ulcers. A duodenal ulcer causes discomfort 2 to 3 hours after
eating, whereas a gastric ulcer causes pain 30 minutes to 1.5 hours after eating.
2. What are the predisposing factors related to peptic ulcers?
 Mechanical disturbances:Increased secretion of pepsin and acid; insufficient

GMB mucous secretion; reduced GMB resistance; increased stomach motility;
ineffective (defective) cardiac or pyloric sphincter
 Genetic influences: the stomach's parietal cells have increased;
mucosal lining's vulnerability to acid penetration and toxicity
Histamine and acetylcholine; excessive hydrochloric acid brought on by outside
stimuli
 Environmental influences: Foods and liquids containing caffeine; fatty, fried, and
highly spiced foods; alcohol; nicotine, especially from cigarette smoking;
stressful
situations; pregnancy; massive trauma; major surgery
 Helicobacter pylori: The gram-negative microorganism H. pylori, which can
cause gastritis, gastric ulcers, and duodenal ulcers, infects the gastric mucosa. If
left untreated, peptic ulcers could come back up to once a year. H. Some patients
may develop atrophic gastritis as a result of pylori. H can be found using specific
breath testing and serology. pylori.
 Drugs: NSAIDs, including aspirin and aspirin compounds, ibuprofen, and
indomethacin; corticosteroids; potassium salts; antineoplastic drugs
3. What additional information do you need from FD?

4. What nonpharmacologic measures can you suggest to alleviate symptoms
related to peptic ulcer?
Instruct the patient to abstain from alcohol and smoke to reduce stomach secretions.
In addition, the patient should refrain from eating anything that is extremely hot,
spicy, or oily foods.
5. Why does the health care provider suggest that the patient take ranitidine
with meals? Why should Mylanta and ranitidine not be taken at the same time?
It is because it blocks the histamine 2 receptor, rinatidine reduces

a factor to be taken into account when using this medication is the production of
stomach acid to consume it with food. Typically, gastrin promotes the release of
histamine following a meal an enzyme produced by enterochromaffin-like cells binds
to histamine H2 receptors on
stomach parietal cells and causes the release of gastric acid. By preventing histamine
H2RAs act as a histamine receptor, causing parietal cells to secrete acid decrease the
histamine-induced stimulation of both basal and stimulated stomach acid output.
6. In what ways are ranitidine and cimetidine (Tagamet) the same, and how do
they differ?
Cimetidine and Ranitidine fall under the same medication classification as Histamine
2.Anti-receptor substances. Both actively prevent histamine from acting on the H2
reducing the release of stomach acid through parietal cells' receptor sites. Ranitidinem
is thought to be more effective than cimetidine since its oral form has a longer action
time of 13 hours, compared to cimetidine's oral form, which has a shorter action time
of 4-5 hours. Cimetidine is also regarded as an enzyme inhibitor, therefore with
a greater number of medication interactions compared to ranitidine, which does not
prevent hepatic microsomal enzymes that interact with drugs less.
7. As part of patient teaching, the nurse discusses side effects of ranitidine with
JH. What is the most effective way to present this information? Develop a plan.
After discussing the side effects, discuss also the side effects on the watcher and make
them understand what ranitidine with JH can do to your body. And be approachable.
ENDOCRINE SYSTEM
1. In place of insulin, the patient is taking the oral diabetes medication metformin.
Metformin alone is sufficient to control blood sugar levels in diabetes mellitus. The
same chemicals that aid in the development of the fetus during pregnancy may create
insulin resistance in the mother, increasing blood glucose levels to reaches risky
levels and causes gestational diabetes. According to research, metformin by alone
may be able to reduce blood glucose levels and the likelihood of newborn
hypoglycemia in the vast majority of pregnant women who develop diabetes. After
giving birth, if there are no signs or causes for concern regarding gestational age,
metformin may be a helpful supplementary medication for women with diabetes to
help them achieve their glycemic goals.
2. Metformin is frequently suggested as the first drug for type 2 diabetes patients
individuals have mildly to moderately uncontrolled blood sugar levels and diabetes. It
is an add-on to diet for people with the stated condition to lower their blood sugar
levels. It works to improve insulin sensitivity, which increases peripheral glucose
uptake and usage, while reducing hepatic glucose synthesis and intestinal glucose
absorption. in light of the medicine is contraindicated in people older than 80 due to
the danger of lactic acidosis, unless creatinine clearance reveals normal renal
function. Caution is advised be taken into account while delivering metformin to
patients who are elderly, infirm, or undernourished, as well as those who have adrenal
or pituitary insufficiency because of increased Hypoglycemia risk.
3. Self-checking blood sugar levels over time can aid in lowering HbA1c levels. You
have too much blood sugar if your HbA1c level is high are more likely to experience
problems from diabetes. It enables patient NC and her healthcare professionals to
choose the best therapy approach (such as diet, exercise, or insulin) to regulate blood
sugar levels and lower the risk of complications from diabetes. The quantity of daily
tests necessary to fully. According to the doctor's advice, each patient's blood glucose
levels should be monitored. In addition, healthcare professionals can help patients
overcome obstacles to receiving optimal diabetes care and reap long-term benefits by
teaching them how to self-monitor their blood glucose levels.

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FD, a 48-year-old patient, complains of a gnawing, aching pain in the abdominal

2. What are the predisposing factors related to peptic ulcers?

 Mechanical disturbances:Increased secretion of pepsin and acid; insufficient

3. What additional information do you need from FD?

It is because it blocks the histamine 2 receptor, rinatidine reduces

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