Peptic ulcer and reflux: teaching, medicines and the warning signs of perforation
- Safe practice
Nursing care in ulcer and reflux: medicines at the right time, no NSAIDs, no tobacco or alcohol, and quick action on bleeding or perforation.
What it is
A peptic ulcer is a sore in the lining of the stomach or duodenum; reflux is stomach content flowing back into the oesophagus. Most of the nursing work is teaching: how and when to take the medicines, which habits make things worse, and which signs turn an outpatient problem into an emergency. The two big ulcer complications are bleeding and perforation; reflux has its own warning signs. Causes and treatment choices are on the condition pages.
What it requires
- A pain history: where, when (night, empty stomach, after meals), nausea, vomiting, early fullness, weight loss.
- A full medicine list, including over-the-counter NSAIDs and aspirin.
- Clear teaching on medicine timing, food habits, tobacco and alcohol.
- Knowing the signs of bleeding, perforation and the reflux warning signs.
How it is applied (and why)
- Assess pain, its link to meals and the abdomen each shift — a baseline lets you notice a sudden change.
- Do a focused cardiac assessment for any chest pain — heart pain can feel like heartburn.
- Review medicines for NSAIDs and aspirin and report them to the prescriber — they remove the lining's protection.
- Give anti-ulcer medicines at the right time: antacids apart from other drugs; sucralfate on an empty stomach — timing changes the effect.
- Teach the patient to complete the H. pylori treatment exactly as prescribed — stopping early can leave the infection.
- Teach reflux measures: head of bed raised, no lying down soon after meals, weight loss if needed, avoid trigger foods.
- Support quitting tobacco and avoiding alcohol — both slow healing and raise the risk.
- Watch for slow blood loss: tiredness, dizziness, anaemia on blood tests — an ulcer can bleed without pain.
- Teach the emergency signs and where to go — bleeding and perforation need care within minutes to hours.
In nursing practice
- Long-term acid-suppressing medicines can lower magnesium, zinc and vitamin B12; the team follows these when indicated.
- Reflux warning signs needing review: trouble or pain swallowing, food that sticks, weight loss, bleeding, frequent vomiting, early fullness.
- Some medicines can worsen reflux (certain blood pressure medicines, sedatives, tricyclic antidepressants): the patient does not stop them without the prescriber.
- For pain, paracetamol (acetaminophen) is usually suggested instead of NSAIDs, with the prescriber's agreement.
- Scarring from an ulcer can make the stomach empty more slowly.
Common mistakes
- Treating chest pain as reflux without a cardiac assessment.
- Giving an antacid at the same time as other oral medicines.
- Missing over-the-counter NSAIDs in the medicine history.
- Letting the patient stop the H. pylori treatment when the pain improves.
Test yourself
Think of the answer, then tap the question to see it.
What signs suggest a perforated ulcer?
Sudden, sharp abdominal pain with a rigid, tender abdomen. It is a medical emergency.
Why must the nurse ask about over-the-counter pain medicines?
Aspirin and other NSAIDs block the lining's protection and are a main cause of ulcers; they also worsen reflux.
When is sucralfate given?
On an empty stomach: one hour before or two hours after meals, as the label says.
What can a patient with night reflux do?
Raise the head of the bed, finish dinner two to three hours before lying down, avoid trigger foods, tobacco and alcohol, and lose weight if overweight.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Peptic ulcer (MedlinePlus, U.S. National Library of Medicine, 2026); Gastroesophageal reflux disease (MedlinePlus, U.S. National Library of Medicine, 2026); Nursing Pharmacology, 7.3 Anti-Ulcer Medications (Open RN (Chippewa Valley Technical College), LibreTexts, 2020).
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Representative model, for educational purposes only.