The nurse is caring for a patient with the diagnosis of sepsis.The patient is on a ventilator in the critical care unit,and is receiving a proton pump inhibitor (PPI)to reduce the risk for a stress ulcer.In this scenario,a stress ulcer is likely to be secondary to
A) infection with Helicobacter pylori bacteria.
B) decreased acetylcholine production.
C) a decreased number of parietal cells.
D) ischemia associated with sepsis.

Question

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A stress ulcer is an acute form of peptic ulcer that often accompanies severe illness,systemic trauma,or neurological injury.Ischemia is the prior etiology associated with stress ulcer formation.Ischemic ulcers develop within hours of an event such as hemorrhage,multisystem trauma,severe burns,heart failure,or sepsis.The shock,anoxia,and sympathetic responses decrease mucosal blood flow,leading to ischemia.The secretion of acid is important in the pathogenesis of ulcer disease.Acetylcholine (a neurotransmitter),gastrin (a hormone),and secretin (a hormone)stimulate the chief cells,which stimulate acid secretion.Parietal cell mass in people with peptic ulcer disease is 1.5 to 2 times greater than in persons without disease.Infection with Helicobacter pylori bacteria is a major cause of duodenal ulcers.

The Nurse Is Caring for a Patient with the Diagnosis