At the end of this session, you will be able to :

State the definition of PGU. List the etiology of PGU. Identify the pathophysiology of

PGU. State the sign & symptom of PGU.

LEARNING OBJECTIVES cont.

Identify the complication of PGU. Understand regarding treatment of

PGU. Identify the nursing intervention &

appreciate the nursing care for PGU patient.

PATIENT’S PROFILE

MR. A

MALE

79 YEARS OLD

FARMER

PATIENT’S PROFILE WHEEL CHAIR

CALM

MEDICAL HISTORY – BPH since August 2013

ALLERGICS - UNKNOWN

D.O.A 24/9/13 @ 1220 Hrs

CURRENT MEDICATION

QUERY MEDICATION FROM GH FOR BPH

Mr A was admitted to 5XX-1 by wheel chair with

complaint of abdomen pain & distended with LOA for

few months, unable to pass motion X 3/7 and nauseated & vomited coffee ground 4

times since last night.

Seen by MO at A&E :- IV drip dextrose saline

- Blood taken

Doctor = Dr DA

Diagnosis Perforated Peptic Ulcer Disease

Seen by Dr DA at A&E :- IV drip 3 pint 1 pint Normal saline 1 pint Dextrose saline 1 pint D5%

- Pre OT screening- CEA , Ca 19.9

Seen by Dr DA at A&E :

- For OGDS & colonoscopy CM

- Fleet 45ml at 0600hrs CM- Normal diet- Breakfast CM (only fluid)

VITAL SIGN TEMPERATURE : 37.2˚C BLOOD PRESSURE : 110/70mmHg PULSE : 112 bpm RESPIRATION : 20 bpm PAIN SCORE : 3 Weight : 49 kg

ACTIVITY DAILY LIVING Loss of appetite, nauseated and vomiting

Forgetful & weakness

Smoking

Ambulate using cane & need assistance in ADL

On pampers

Nocturia but now less only 3-4 times per night

PHYSICAL EXAMINATION

WHAT CAUSES IT? Helicobacteria pylori Aspirin Ibuprofen NSAIDs Stress Aging Alcohol & smoking

• Peritonitis• Gastrointestinal bleeding• Gastric outlet obstruction• Cancer• Death

COMPLICATION

• Haemoglobin- 8.4 (13.0 – 18.0 g/dL)

• Glucose- 5.5 (3.9 – 6.1 mmol/L)

• HIV 1/11 antibodies- Non reactive

• HBs antigen- Non reactive

PRE OT SCREENING

• Alpha-feto protein

- 3 ug/L (<11)

• Serum CA 19.9

- 4 U/ml (<32)

• CEA

- 0.9 (<5.1)

• PSA

- 0.5 ug/L (<6.6)

TUMOR MARKER

DRUGSIN WARD

DATEORDERED

DATE OFF

IV Controloc 40mg OD 24/9/13 27/9/13

IV Maxalon 10mg TDS 24/9/13 27/9/13

Tab Sangobion 1 OD 24/9/13 27/9/13

Tab Flagyl 400mg TDS 25/9/13 27/9/13

• Atropic chronic gastritis with tiny perforation

OGDS

• Query CA terminal ileum – small polyp 5cm

Colonoscopy

Potential fall related to weakness.

NURSING DIAGNOSIS

Alteration in nutritional status less than body requirement related to nausea, vomiting and loss of appetite.

NURSING DIAGNOSIS

Potential infection related to intravenous cannulation.

NURSING DIAGNOSIS