A nurse is assessing a client who has peptic ulcer disease. Which of the following findings should the nurse identify as the priority?
A.
Diarrhea
B.
Dyspepsia
C.
Epigastric discomfort
D.
Hematemesis
The correct answer and Explanation is :
The correct answer is D. Hematemesis.
Explanation:
Peptic ulcer disease (PUD) involves the development of ulcers in the lining of the stomach, duodenum, or esophagus. The most common symptoms include dyspepsia (indigestion), epigastric discomfort, and potentially diarrhea due to gastric dysfunction. However, among the listed options, hematemesis—vomiting of blood—indicates a more severe and potentially life-threatening complication and is the priority finding.
Hematemesis as a Priority:
Hematemesis usually occurs due to bleeding from an ulcer, which can erode blood vessels in the gastrointestinal (GI) tract. This condition suggests either an upper GI bleed or a perforated ulcer, both of which are medical emergencies. A client presenting with hematemesis could be at risk of hypovolemic shock, which occurs when there’s a significant loss of blood volume. This could result in decreased tissue perfusion, organ failure, and even death if not treated promptly. Immediate intervention includes stabilization with IV fluids, blood transfusions if necessary, and endoscopic or surgical treatment to control the source of bleeding.
Comparison of Findings:
- Diarrhea: While it can occur in PUD patients, diarrhea is not as urgent unless accompanied by dehydration or electrolyte imbalances. It does not signify immediate bleeding or shock.
- Dyspepsia (Indigestion): This is a common symptom in PUD but is not life-threatening. It’s usually managed with dietary modifications and medications like proton pump inhibitors.
- Epigastric discomfort: This refers to pain in the upper abdomen and is common in PUD due to the irritation caused by acid on the ulcer. However, it does not indicate active bleeding or severe complications.
In summary, hematemesis is the most critical symptom, requiring immediate medical intervention to prevent further complications like hemorrhagic shock.