Question

Chief complaint: epigastric pain Acute myocardial infarction; Hypertensive cardiovascular disease; ruled out PUD; diabetic nephropathy

FAMILY AND PERSONAL HEALTH HISTORY:, 64-year-old, male, has a critical health problem. He said that he was an alcohol drinker during his adolescence and late adulthood and confessed that he only drinks 2-6 glasses or more on occasional basis; however, he has no history of cigarette smoking. At first, he experienced hypertension when he was still 55 years old., because of overwork and emotional stress, he has experienced severe chest pain and that same year he was diagnosed of having Diabetes Nephropathy and Chronic Renal Insufficiency. hospital has been transfused with 5 bags of Packed Red Blood Cell and there were no reports of allergic reaction. At that time, he was advised by the doctor to have his monthly check-up for his health problems.

CHIEF COMPLAINT AND HISTORY OF PRESENT ILLNESS:experienced chest pain with complaints of acute epigastric pain, growing in character and on and off. The patient was anorexic and hypertensive (180/ 60 mm Hg). With the help of his family he went to the hospital for check-up, they thought that it was just an ulcer, but the doctor had a diagnosis of Acute myocardial infarction; Hypertensive cardiovascular disease; ruled out PUD; diabetic nephropathy. Due to the severity of pain he was prompted for admitted

create a pathophysiology and ncp

Answer 1

Pathophysiology of pepetic ulcer.

The epithelial cells of the stomach and dudenum,secrete mucous in response to irritation of the epithelial loning and as a result of cholinergic stimulation.The superficial portion of the gastric and dudeodnal mucosa exist in the form of a gellayer, which is impeermeable to acid and pepsin.Other gastrci and duodenal cells secrete bicarbonate, which aids in buffering acid.

When H plyori colonises the gastric mucosa, inflammation ususally occurs which further leads to high levels of gastrin and pepsinoggen and reduced levels of somatostatin. The combination of increased gastric secretion and reduced bicarbonate secretion lowers the pH level and results in gastric metaplasis..This stage incduces the H pylori bacteria to cause dueodnitis and enhances to acid injury therby predisposing to duodenal ulcer.

Nursing care plan

Nursing diagnosis; Acute pain related to severe epigastric pain frequently as evidenced by patient facial expression.

Nursing outcomes; client will report satisfactory pain control.

Nursing Intervention	Rationale
Asseess the clients level of pain	they will usually show the symtpoms immedate;y 1 to 2hours after having food.Assessing the level of pain will help us to plan the care ffectively.
encourage the use of non-pharmacological measures.	this will help in the reduction of acid secretion.
instruct the client to avoid NSAIDS	It can cause irrittaioon of the gastric mucosa.
encourage the client to eat at regular intervals.	irregular schedule can interfere with the medications.
Administer drug therapy	it promotes the healing of ulcer.

2.Imbalanced nutrition less than body requirements related to abdominal pain as evidenced by inadequate dietary intake.

Nursing outcomes; client will verbalise and demonstarte selection of foods that will achieve a cessation of weight loss.

Nursing intervention	Rationale
Obtain nutrition history	To obtain a nutritional history of the patient
assess for body changes	to plan for the further care
asssit the client with identifying foods that cause irritation	t educate the cleint regarding the food that they should avoid.
instruct the patient to abstain from alochol	Intake of alochol can increase the gastric pain
teach the importance of having a balanced diet	it will help them to have a regain their health

3.anxiety related to fear of unknown as evidenced by patients facial expressionand verbalisation.

outcome; client will demonstrate ways of reducing the anxiety level.

interevention	rationale
assess the clients level of anxiety level	it will help to plan for futher care
aknowldege the awareness of the anxiety level	communicate and help them to reduce the level of anxiety through proper communication.
encourage to express the fears openly	it will help them to reduce their anxiety level by building a trustworthy relationship
use simple language and brief expalnation	this will help them to understand properly and reduce their anxiety level.
provide emotional support to the client	this wll help to accept the disease condition and help to reduce the anxiety