When a client has peptic ulcer disease, the nurse would expect a priority intervention to be:
A. Assisting in inserting a Miller-Abbott tube.
B. Assisting in inserting an arterial pressure line.
C. Inserting a nasogastric tube.
D. Inserting an I.V.
Correct Answer: C. Inserting a nasogastric tube.
An NG tube insertion is the most appropriate intervention because it will determine the presence of active GI bleeding. Monitor the client’s fluid intake and urine output. Assess for the signs of hematemesis or melena. The client with a bleeding ulcer may vomit bright red blood or coffee grounds emesis. Melena occurs when there is bleeding in the upper GI tract.
Option A: A Miller-Abbott tube is a weighted, mercury-filled balloon tube used to resolve bowel obstructions. The modifications of lifestyle behaviors such as alcohol use, coffee, and other caffeinated beverages, and the overuse of aspirin or other nonsteroidal anti-inflammatory drugs is necessary to prevent recurrent ulcer development and prevent complications during the healing phase.
Option B: There is no evidence of shock or fluid overload in the client; therefore, an arterial line is not appropriate at this time. Monitor the client’s vital signs, and observe BP and HR for signs of orthostatic changes.
Option D: An IV is optional. Administer IV fluids, volume expanders, and blood products as ordered. Isotonic fluids, volume expanders, and blood products can restore or expand intravascular volume.
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