I.

INTRODUCTION

A case study is defined as an intensive analysis of an individual unit stressing

developmental factors in relation to environment. (Merriam Webster’s Dictionary)

Case study refers to the collection and presentation of detailed information about

a particular participant or small group, frequently including the accounts of subjects

themselves. A form of qualitative descriptive research, the case study looks intensely at

an individual or small participant pool, drawing conclusions only about that participant or

group only in that specific context.

(http.//writing.colostate.edu/guides/research/casestudy/pop2a.cfm)

A peptic ulcer, also known as ulcus pepticum, PUD or peptic ulcer disease, is an

ulcer (defined as mucosal erosions equal to or greater than 0.5 cm) of an area of the

gastrointestinal tract that is usually acidic and thus extremely painful. As much as 80% of

ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the

acidic environment of the stomach, however only 20% of those cases go to a doctor.

(http://en.wikipedia.org/wiki/Peptic_ulcer)

Peptic ulcers are open sores that develop on the inside lining of your stomach,

upper small intestine or esophagus. The most common symptom of a peptic ulcer is

abdominal pain. It wasn't too long ago that lifestyle factors, such as a love of spicy foods

or a stressful job, were thought to be at the root of most peptic ulcers. Doctors now know

that a bacterial infection or some medications — not stress or diet — cause most peptic

ulcers. Peptic ulcers are common, affecting as many as 10 percent of Americans at

some point in their lives. The good news is that successful treatment of peptic ulcers is

possible. Burning pain is the most common peptic ulcer symptom. The pain is caused by

the ulcer and is aggravated by stomach acid coming in contact with the ulcerated area.

(http://www.mayoclinic.com/health/peptic-ulcer/DS00242)

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 A peptic ulcer may arise at various locations, they can either be at the stomach

(gastric ulcer), some occurs in the duodenum (duodenal ulcer), at the esophagus

(esophageal ulcer) and at the Meckel's Diverticulum (Meckel's Diverticulum Ulcer). In

connection with this, five types of peptic ulcers are known as: Type I – ulcer along the

lesser curve of stomach, Type II – two ulcers present – one gastric,one duodenal, Type

III – Pre-pyloric ulcer, Type IV – proximal gastroesophageal ulcer and Type V –

anywhere along gastric body induced by NSAID's

Peptic ulcer accounts for about 50% of all cases of upper gastrointestinal

bleeding. Acute mortality may be as high as 14%. Infection with Helicobacter plyori (Hp)

and the use of non-steroidal anti-inflammatory drugs (NSAIDs) are the predominant risk

factors. While the prevalence of Hp in ulcer bleeding is still debated, there is strong

evidence that eradication of bacteria reduce the risk of re-bleeding significantly.

It is estimated that 2% of the adult population in the United States has active

peptic ulcers, and that about 10% will develop ulcers at some point in their lives. There

are about 500,000 new cases of peptic ulcer in the United States every year, with as

many as 4 million recurrences. The male/female ratio for ulcers of the digestive tract is

3:1.

(http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?

requestURI=/healthatoz/Atoz/ency/ulcers_digestive.jsp)

The most common forms of peptic ulcer are duodenal and gastric. About 80% of

all ulcers in the digestive tract are duodenal ulcers. This type of ulcer may strike people

in any age group but is most common in males between the ages of 20 and 45. Gastric

ulcers account for about 16% of peptic ulcers. They are most common in males between

the ages of 55 and 70.

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 According to the records of Tarlac Provincial Hospital, there were 27 cases of

Peptic Ulcer from the month of August to December 2008, for the year 2009 – there

were nine new cases identified.

Importance of the Case Study

Our group has chosen a case which may be mostly common and familiar but still

demands a broad understanding to be able to come up with a successful outcome.

In constructing this case study, we encountered different kinds of diseases which can

help in developing our knowledge and skills in formulating and rendering the most

appropriate care and service for our patient.

As we go further with our case findings and assessments, we will be able to

successfully determine and formulate appropriate nursing interventions to contribute in

the cure of the disease. Also, the group wishes to enhance their knowledge regarding

the disease process and therefore gain new learnings about peptic ulcer disease type III

and be able to apply that knowledge as we go along our profession.

OBJECTIVES

General Objectives

The main objective of the group for conducting this case study is primarily

focused on enhancing our knowledge and understanding of the nursing process and to

become familiar with the etiology, risk factors, prevalence, outlook and nursing

management of the disease process. It will also be of great help to increase the group’s

level of competitiveness by learning new clinical skills needed in the management of a

client with peptic ulcer type III.

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Specific Objectives

1. To understand the client’s health condition by means of thorough assessment which

includes:

 Personal Data

 Family History of Health and Illness

 History of Past Illness

 History of Present Illness

2. To establish a baseline data regarding the patient’s situation through accomplishment

of the different areas of assessment such as:

 13 Areas of Assessment

 Physical Assessment

 Diagnostics and Laboratory Procedures

 Anatomy and Physiology

 Pathophysiology

3. To come up with the health management appropriate to formulate the nursing care

plans.

4. To contribute for the continuity of patient’s health by monitoring the following:

 Nursing Procedures

 Vital Signs

 Diagnostics and Laboratory Procedures

 Medications

 Diet

 Activity and Exercise

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5. To formulate the appropriate discharge planning summary by taking in consideration

the patient’s:

 General Condition upon discharge

 Medications

 Treatment

 Exercise

 Health Teachings

 Diet

6. To come up with the suitable conclusion and evaluation

7. To clarify misconceptions and help the patient achieve self-autonomy to continue

planning for future self-care.