A Client Care Study Of Patient With Perforated Duodenal Ulcer (Peptic Ulcer)

Medical and Health Science Project and Seminar Material

A Client Care Study Of Patient With Perforated Duodenal Ulcer (Peptic Ulcer)


Abstract


Data was analysed using Miles and Huberman content analysis. Four major themes being participants‘ knowledge regarding diabetic peptic ulcer, challenges of managing perforated peptic ulcer, coping strategies in managing perforated peptic ulcer, and support systems in managing perforated peptic ulcer emerged from the study. In conclusion, education on foot care practices must be intensified by healthcare professionals to enable patients self- manage the ulcer. Provision of emotional, social and psychological support to patients managing perforated peptic ulcer must be made a priority to help them cope with the effects of the perforated peptic ulcer.


Chapter One


Introduction

Background to the Study

Peptic ulcer disease (PUD) results from an imbalance of acid secretion and mucosal defenses that resist acid digestion. Moreover, studies have confirmed the strong association between gastric antral infection with H pylori and peptic ulceration. More than 90% of patients with peptic ulcer disease are infected with H pylori, and eradication of this infection not only heals most uncomplicated ulcers but also significantly decreases the likelihood of recurrent ulceration 1, 2.

Magnitude of the problem

The disease continues to have a substantial impact on our society’s health care system. It occurs slightly more frequent in men. Although 70% of ulcer patients are between the ages of 25 and 64, the peak prevalence of complicated ulcer disease requiring hospitalization is in the age group 65 to 74 years3, 4.

Although morbidity from PUD is decreasing in the west, the incidence of perforated ulcer remains relatively constant. Perforated ulcers are decreasing in incidence in younger age patients and are increasingly being observed in the elderly and in women. Perforation is typically a significant clinical event marked by abdominal pain, rigidity, the absence of bowel sounds and a sense of impending doom. Most duodenal ulcers perforate anteriorly, while gastric ulcers generally perforate along the anterior wall of the lesser curvature of the stomach. Elective surgery leads to 5 – 10% of mortality while in emergency situation it goes to 20 – 30% and may be as high as 30% to 50% particularly in elderly 1-3

Current situation on the matter in World literature

Following developments in the medical treatment of PUD in the last two decades, surgical intervention is currently confined to the treatment of complicated disease, namely, ulcer hemorrhage, perforation, penetration and obstruction. Simple closure or omental patch repair is the mainstay of treatment of perforated peptic ulcer (PPU), definitive surgery being rarely practiced, and dependence now being on medical therapy to complete the healing process and prevent recurrence of the disease.


Statement of the Problem

In Nigeria, studies on the experiences of individuals living with perforated peptic ulcer seem to be limited. A few studies on perforated peptic ulcerin Nigeria centered on the cost of treatment and knowledge and practice of foot care among people diagnosed with the disease. It has been realized that, research is needed to investigate the experiences of individuals with perforated peptic ulcer at Korle–Bu Teaching Hospital. Reading through the available literature it was noted that patients living with perforated peptic ulcer sometimes have inadequate knowledge about the disease, fear of recurrence of the ulcers, pain, immobility and financial constraints (Gilpin and Lagan, 2008; Price, 2004). In addition it has also been observed through clinical practices that patients with duodenal are at risk of slow and non-healing ulcers and once an ulcer is diagnosed, the possibility of amputation becomes unavoidable.

Given the enormous challenges of perforated peptic ulcerand the number of people who report yearly to the University of Jos Teaching Hospital for treatment, it can be deduced that many people go through challenges while managing the disease. There is therefore the need for this study to be conducted purposely to assess the experiences of diabetic patients managing perforated peptic ulcerat the University of Jos Teaching Hospital.


Purpose of the Study

The purpose of this study was to assess individuals‘ experiences of living with perforated peptic ulcer at the University of Jos Teaching Hospital.


Specific Objectives

The objectives of the study were to:

  1. Assess patients‘ knowledge regarding PPUs.
  2. Identify challenges of diabetic patients managing perforated peptic ulcer.
  3. Assess coping strategies of individuals managing perforated peptic ulcer.
  4. Describe the support systems available for diabetic patients living with perforated peptic ulcer.

Research Questions

  1. What is a person diagnosed with type 1 or 2 duodenal understanding of a peptic ulcer?
  2. What are the challenges of diabetic patients with perforated peptic ulcer?
  3. What are the coping strategies of patients with perforated peptic ulcer?
  4. What support systems are available for diabetic patients with perforated peptic ulcer?

Significance of the Study

The results from this study will serve as a tool for educating healthcare professionals about the living experiences of individuals with perforated peptic ulcer. The findings will also unearth other areas for future research work relating to nursing practice, education and policy formulation in the management of perforated peptic ulcer. It will also be used in making recommendations for improving support for individuals with PPUs at the University of Jos Teaching Hospital.


Scope of the Study

This study will investigate the knowledge and experience of individuals living with perforated peptic ulcer. Particularly, reference is made to patients living with perforated peptic ulcer at the University of Jos Teaching Hospital.


Operational Definitions

Perforated peptic ulcer (PPUs):

These are ulcers that occur on the feet of individuals who have type 1 and type 2 duodenal mellitus.

Healthcare Professionals / Health Care Staff / Health Care Workers:

Medical doctors, nurses and other paramedics in charge of patients‘ care in healthcare settings.

Experiences:

Personal happenings undergone, lived or come face to face with.

Individuals / Patients / Participants:

Persons on treatment for PPUs.


Chapter Five


Conclusions and Recommendation

Conclusion of the Study

Interacting with diabetics with perforated peptic ulcer has been an interesting learning experience for the researcher. The researcher was interested in gaining in-depth knowledge of the experiences of diabetic patients living with perforated peptic ulcer. The findings of this research revealed patients‘ lack of knowledge regarding foot care practices though their knowledge about other aspects of the disease was adequate. It was realized that, participants faced enormous challenges from expensive cost of treating perforated peptic ulcer to lack of information on foot care practices. It was obvious participants adopted strategies to cope with the challenges along with the numerous supports that were made available to them by family members, friends, church and health care professionals. The findings of this study must be given the needed attention to help make the treatment of duodenal free to help people receive adequate treatment in order to reduce the incidence of peptic ulcer occurrence among diabetic patients. It is suggested that more strategic, practical and easily comprehensible duodenal and peptic ulcer educational programmes, be provided by healthcare professionals to help reduce and prevent the rate and incidence of peptic ulcer occurrences among diabetics. These programmes may be beneficial to diabetics personally by leading to the compliance of individual diabetics to their treatments. Healthcare professionals must be seen at the forefront providing emotional and psychological support to diabetics with perforated peptic ulcer since the study has identified them to be a major resource group that influence patients‘ ability to cope with the disease. The need for further research especially on foot care practices and among diabetics with perforated peptic ulcer is proposed so that effective guidelines are developed at the University of Jos Teaching Hospital to enhance the quality of patients care in perforated peptic ulcer.


Recommendations

The following recommendations are made based on the findings of the study.

Psychological Counseling:

There is the need to set up a unit to counsel diabetics with perforated peptic ulcer to provide them with support to enable them cope with the stress associated with managing the disease.

Foot Care Education:

Intensive foot care education must be provided to diabetic patients as soon as they are diagnosed to equip them with knowledge to self- manage disease.

Self -care Practices:

Diabetic patients must be encouraged to actively undertake appropriate foot care practices through interactive teaching and demonstrations to prevent peptic ulcerations.

Infrastructural Development:

There is the need to provide permanent offices that can cater for the increasing numbers of patients with perforated peptic ulcer who need to interact with healthcare professionals on a one-on- one basis.

Human Resource Development:

Managing perforated peptic ulcer needs the attention of professionals with specialized training including surgeons, physicians, dialectologists, podiatrists, dieticians and counsellors. It is evident from the University of Jos Teaching Hospital that most of these specialists are not available. It is recommended that the Hospital and the Ministry of Health through its development partners collaborate to train some of these specialists to help provide the needed care for patients who seek perforated peptic ulcer care at the hospital. Also, the hospital must liaises with the Ministry of Local Government and other Non-Governmental Organizations (NGOs) with interest in health to provide vehicles and other logistics to enable Community Health Nurses (CHNs) and Public Health Nurses (PHNs) undertake intensive public education on duodenal and its complications including perforated peptic ulcer for families, individuals, churches and organizations. There is the need for public/community health nurses to intensify home visits during which individuals with at risk feet can be identified and referred for specialist care.

Protocol:

A simplified documented protocol for guiding health teaching and education on duodenal and perforated peptic ulcer in the form of booklets and leaflets can be developed and given to patients at the duodenal clinic to provide information on foot care practices.

Public Education:

Since some people get to know about their duodenal status after the ulcers have developed, there is the need for continuous public health education by the public health unit of the Nigeria Health Service on duodenal and its related complications through the mass media to enable people identify and report the disease on time when they develop it.

Duodenal /Perforated peptic ulcer Support Groups:

There is the need for a diabetic foot support group to be formed aside the Nigeria Duodenal Association in the hospital with the support of doctors and nurses where those with perforated peptic ulcer can come together and talk about issues affecting their welfare. These individuals can be encouraged in order to cope with the challenges they face in managing the duodenal and perforated peptic ulcer.


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