# A nurse is caring for a 52-year-old female client who presents to the emergency department with epigastric pain, nausea, and a history of taking NSAIDs for chronic back pain. Endoscopy confirms a gastric ulcer with no signs of active bleeding. Which nursing intervention should be the priority?

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> subject: Adult Health

## 문제

A nurse is caring for a 52-year-old female client who presents to the emergency department with epigastric pain, nausea, and a history of taking NSAIDs for chronic back pain. Endoscopy confirms a gastric ulcer with no signs of active bleeding. Which nursing intervention should be the priority?

## 보기

1. Monitor for signs and symptoms of gastrointestinal bleeding **✔ 정답**
2. Administer prescribed antacids every 2 hours
3. Encourage the client to eat small, frequent meals
4. Provide stress reduction techniques and relaxation therapy

**정답: 1**

## 해설

Monitoring for GI bleeding is the priority as it is the most serious complication requiring immediate intervention to prevent hemorrhagic shock. Other options are supportive but less urgent.

## 심화 해설

Understanding the Priority: Safety and the Nursing Process

For a client with a confirmed gastric ulcer, the immediate priority is always safety, specifically preventing life-threatening complications. While the endoscopy report indicates no active bleeding at this moment, the underlying pathophysiology of a gastric ulcer—an erosion in the mucosal lining of the stomach—creates a high-risk state for future hemorrhage. The mucosa is compromised, and the ulcer base can erode deeper into submucosal blood vessels at any time. This is especially critical given the client's history of NSAID use, which impairs the stomach's natural defenses by inhibiting cyclooxygenase-1 (COX-1), leading to reduced prostaglandin synthesis, decreased mucus and bicarbonate secretion, and impaired mucosal blood flow. The ulcer is not just a static lesion; it is a dynamic injury with the potential to progress to a life-threatening bleed. Therefore, vigilant monitoring for the earliest signs of deterioration is the most crucial nursing action.

Analyzing the Correct Answer: Option 1

Monitoring for signs and symptoms of gastrointestinal bleeding is the priority intervention. This directly addresses the most significant risk identified in the client's assessment: hemorrhage from a known gastric ulcer. A key study on patients with gastrointestinal bleeding found that structured nursing interventions significantly impacted recurrence rates, underscoring the critical role of nursing surveillance in this population [1]. The nurse must be the first to detect subtle changes indicating that the non-bleeding ulcer has transitioned to an active bleed. This includes assessing for:

- Hematemesis (bright red or coffee-ground emesis)

- Melena (black, tarry stools)

- A sudden drop in blood pressure with a compensatory rise in heart rate (orthostatic hypotension)

- A decrease in hemoglobin and hematocrit levels

- Complaints of new or worsening epigastric pain, lightheadedness, or syncope

Early detection of these signs allows for rapid intervention, such as fluid resuscitation, blood transfusion, or emergent endoscopic hemostasis, which can be lifesaving.

Analyzing the Incorrect Answers

Option 2: Administer prescribed antacids every 2 hours.

While antacid administration is a standard part of peptic ulcer disease management to neutralize gastric acid and promote mucosal healing, it is not the priority nursing intervention. The action of administering a medication is a dependent nursing function that follows the provider's prescription. The priority is the independent nursing function of assessment and monitoring for a life-threatening complication. The comprehensive management of peptic ulcer disease, particularly in high-risk patients, involves a balance of pharmacotherapy and vigilant monitoring, with monitoring taking precedence to ensure the treatment plan is safe and effective . The nurse must first ensure the client is stable before implementing a scheduled medication regimen.

Option 3: Encourage the client to eat small, frequent meals.

This is a comfort and health-promotion intervention. While small, frequent meals can help buffer gastric acid and may reduce pain for some patients, this advice is secondary to ensuring physiological safety. The immediate threat is not related to nutritional intake but to the potential for the ulcer to erode into a blood vessel. Furthermore, the presence of risk factors like NSAID use is a more critical concern in the acute phase than meal patterning, as highlighted by research identifying NSAIDs as a primary driver of peptic ulcer disease prevalence .

Option 4: Provide stress reduction techniques and relaxation therapy.

Stress reduction is a supportive, long-term intervention that may help with symptom management and overall well-being. However, it does not address the acute, immediate risk of a life-threatening hemorrhage. The case report on a perforated ulcer mimicking other complications serves as a stark reminder that these lesions can rapidly progress from a stable state to a surgical emergency . The nurse's priority must be on the physiological threat that can cause rapid clinical deterioration, not on psychosocial interventions that have a delayed effect. Using the ABC (Airway, Breathing, Circulation) framework, monitoring for bleeding directly relates to maintaining circulatory volume and hemodynamic stability.References (research sources)

- [1]Impact of nursing interventions based on a multidisciplinary team (MDT) model on recurrence rate and treatment compliance in patients with gastrointestinal bleeding.Research articleWang K, Sun P. (2026) · DOI: 10.1097/md.0000000000049067

## 임상 시나리오

Gastric Ulcer: Nursing Surveillance for BleedingPrioritizing Safety in a High-Risk Lesion
A confirmed gastric ulcer is a dynamic injury with a high risk of hemorrhage, even without active bleeding. The priority is vigilant monitoring for deterioration.

Assess for signs of GI bleeding: melena, hematemesis, hypotension, tachycardia, and a drop in hemoglobin. NSAIDs increase risk by inhibiting COX-1, reducing mucosal protection.

CautionDo not wait for overt bleeding. Subtle changes in vital signs or a gradual hemoglobin decrease can be the earliest indicators of a life-threatening hemorrhage.

## 핵심 개념

- **Gastric Ulcer** — An erosion in the mucosal lining of the stomach, often caused by NSAIDs or H. pylori, posing a risk for bleeding, perforation, or obstruction.
- **COX-1 Inhibition** — The mechanism by which NSAIDs reduce prostaglandin synthesis, leading to decreased gastric mucus, bicarbonate, and mucosal blood flow, impairing the stomach's protective barrier.
- **Hemorrhage** — A life-threatening complication of peptic ulcer disease where the ulcer erodes into a blood vessel, requiring immediate recognition and intervention.
- **Nursing Priority** — Based on the nursing process and safety principles, the most critical intervention is assessment and monitoring for the highest-risk complication.

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