§ Inflammation of the gastric or stomach mucosa
§ Gastritis may be:
ú Acute
lasting several hours to a few days
ú Chronic
resulting from repeated exposure to irritating agents or recurring episodes of acute gastritis
Causes of Gastritis
Acute Gastritis
o Dietary indiscretion
o Overuse of aspirin and NSAID
o Excessive alcohol intake
o Bile reflux
o Radiation therapy
o Ingestion of strong acid or alkali
Acute Gastritis
o Dietary indiscretion
o Overuse of aspirin and NSAID
o Excessive alcohol intake
o Bile reflux
o Radiation therapy
o Ingestion of strong acid or alkali
Chronic Gastritis
o Benign or malignant ulcers of the stomach
o Helicobacter pylori
o Autoimmune diseases (Pernicious Anemia)
o Use of medications, especially NSAID
o Alcohol
o Smoking
o Reflux of intestinal contents into the stomach.
o Benign or malignant ulcers of the stomach
o Helicobacter pylori
o Autoimmune diseases (Pernicious Anemia)
o Use of medications, especially NSAID
o Alcohol
o Smoking
o Reflux of intestinal contents into the stomach.
Signs and Symptoms
Acute Gastritis
Ø Abdominal discomfort
Ø Headache
Ø Lassitude
Ø Anorexia
Ø Nausea and vomiting
Ø Abdominal discomfort
Ø Headache
Ø Lassitude
Ø Anorexia
Ø Nausea and vomiting
Chronic Gastritis
Ø Anorexia
Ø Heartburn after eating
Ø Belching
Ø Sour taste in the mouth
Ø Nausea and vomiting
Ø Mild epigastric discomfort
Ø Intolerance to spicy or fatty foods
Ø Slight pain that is relieved by eating
Ø Anorexia
Ø Heartburn after eating
Ø Belching
Ø Sour taste in the mouth
Ø Nausea and vomiting
Ø Mild epigastric discomfort
Ø Intolerance to spicy or fatty foods
Ø Slight pain that is relieved by eating
Assessment and Diagnostic Findings
§ Gastritis is sometimes associated with:
ú Achlorhydria (absence of HCl)
ú Hypochlorhydria (low levels HCl)
ú Hyperchlorhydria (high levels of HCl)
ú Achlorhydria (absence of HCl)
ú Hypochlorhydria (low levels HCl)
ú Hyperchlorhydria (high levels of HCl)
Diagnosis can be determined by:
ú Endoscopy
ú Upper GI radiographic studies
ú Histologic examination of a tissue specimen obtained by biopsy
ú Determine the presence of H. Pylori by serologic testing for antibodies against the H. pylori antigen
ú H. Pylori test (Urea-Breath test)
ú Endoscopy
ú Upper GI radiographic studies
ú Histologic examination of a tissue specimen obtained by biopsy
ú Determine the presence of H. Pylori by serologic testing for antibodies against the H. pylori antigen
ú H. Pylori test (Urea-Breath test)
Medical Management
§ Antibiotic
ú Amoxicillin
ú Action
a bactericidal antibiotic that assist with eradicating H. Pylori bacteria in the gastric mucosa.
ú Side effects
vaginal itching or discharges
headache
swollen tongue
oral thrush (white patches inside the mouth or throat)
nausea, vomiting, stomach pain
ú Nursing Consideration
May cause diarrhea
Should no be used in patient allergic to penicillin
ú Amoxicillin
ú Action
a bactericidal antibiotic that assist with eradicating H. Pylori bacteria in the gastric mucosa.
ú Side effects
vaginal itching or discharges
headache
swollen tongue
oral thrush (white patches inside the mouth or throat)
nausea, vomiting, stomach pain
ú Nursing Consideration
May cause diarrhea
Should no be used in patient allergic to penicillin
§ Antidiarrheal
ú Bismuth subsalicylate
ú Action
Suppress H. Pylori bacteria in the gastric mucosa and assist with healing of mucosal ulcer
ú Side effect
Stools may appear gray-black in color
ú Nursing consideration
Given concurrently with antibiotic to eradicate H. pylori infection
Should be taken on empty stomach
ú Bismuth subsalicylate
ú Action
Suppress H. Pylori bacteria in the gastric mucosa and assist with healing of mucosal ulcer
ú Side effect
Stools may appear gray-black in color
ú Nursing consideration
Given concurrently with antibiotic to eradicate H. pylori infection
Should be taken on empty stomach
§ Histamine2 Receptor Antagonist
ú Cimetidine
ú Action
Decreases amount of HCl produced by stomach by blocking the action of histamine on histamine receptors of parietal cells in stomach
ú Side effect
Long term use may cause diarrhea
Dizziness
Gynecomastia
ú Nursing Consideration
May cause confusion
Agitation
Coma in the elderly for those with renal or hepatic insufficiency
ú Cimetidine
ú Action
Decreases amount of HCl produced by stomach by blocking the action of histamine on histamine receptors of parietal cells in stomach
ú Side effect
Long term use may cause diarrhea
Dizziness
Gynecomastia
ú Nursing Consideration
May cause confusion
Agitation
Coma in the elderly for those with renal or hepatic insufficiency
§ Proton pump inhibitor
ú Omeprazole
ú Action
Decreases gastric acid secretion by allowing hydrogen potassium adenosine triphospate pump on the surface of the parietal cells in the stomach
ú Side effects
Headache
Diarrhea or constipation
Flatulence
Nausea and vomiting
Dry mouth
ú Nursing consideration
Taken before meal
ú Omeprazole
ú Action
Decreases gastric acid secretion by allowing hydrogen potassium adenosine triphospate pump on the surface of the parietal cells in the stomach
ú Side effects
Headache
Diarrhea or constipation
Flatulence
Nausea and vomiting
Dry mouth
ú Nursing consideration
Taken before meal
§ Prostaglandin E1 Analog
ú Sucralfate
ú Action
Create a viscous substance in the presence of gastric acid that form a protective barrier, binding to the surface of the ulcer, and prevents digestion by pepsin
ú Side effects
Constipation
Flatulence
Headache
Hypophosphatemia
Dry mouth
ú Nursing consideration
Should be taken without food but with water
Other medication should be taken hours before or after his medication
May cause constipation and nausea
ú Sucralfate
ú Action
Create a viscous substance in the presence of gastric acid that form a protective barrier, binding to the surface of the ulcer, and prevents digestion by pepsin
ú Side effects
Constipation
Flatulence
Headache
Hypophosphatemia
Dry mouth
ú Nursing consideration
Should be taken without food but with water
Other medication should be taken hours before or after his medication
May cause constipation and nausea
Nursing Management
I. Assessment
• History taking
• Signs and symptoms
allergies
• Medication taken
• Past medical history
• Last oral intake
• Events leading to illness
• Signs to note during physical examination
• Abdominal tenderness
• Dehydration
• Evidence of any systemic disorder that might be responsible for the symptoms of gastritis
• History taking
• Signs and symptoms
allergies
• Medication taken
• Past medical history
• Last oral intake
• Events leading to illness
• Signs to note during physical examination
• Abdominal tenderness
• Dehydration
• Evidence of any systemic disorder that might be responsible for the symptoms of gastritis
II. Nursing Diagnosis
• Anxiety related to treatment
• Imbalanced nutrition, less than body requirements, related to inadequate intake of nutrients
• Risk for imbalanced fluid volume related to insufficient fluid intake and excessive fluid loss subsequent to vomiting
• Deficient knowledge about dietary management and disease process
• Acute pain related to irritated stomach
• Anxiety related to treatment
• Imbalanced nutrition, less than body requirements, related to inadequate intake of nutrients
• Risk for imbalanced fluid volume related to insufficient fluid intake and excessive fluid loss subsequent to vomiting
• Deficient knowledge about dietary management and disease process
• Acute pain related to irritated stomach
III. Planning and Goals
§ The major goals for the patient include:
§ Reduce anxiety
§ Avoidance of irritating food
§ Adequate intake of nutrients
§ Maintenance of fluid balnce
§ Increase awareness of dietary management
§ Relief of pain
§ The major goals for the patient include:
§ Reduce anxiety
§ Avoidance of irritating food
§ Adequate intake of nutrients
§ Maintenance of fluid balnce
§ Increase awareness of dietary management
§ Relief of pain
IV. Nursing Interventions
• Reducing anxiety
• Important to explain all procedures and treatment base on the patients level understanding
• Promoting optimal nutrition
• Help the patient manage the symptoms including nausea, vomiting heartburn and fatigue
• The patient should take no foods or fluids by mouth until the acute symptoms subside allowing the gastric mucosa to heal
• If IV therapy is necessary, the nurse monitors intake and output along with serum electrolyte values
• If IV therapy is necessary, the monitors intake and output along with serum electrolyte values
• Offer ice chips until symptoms subside followed by clear
• As food is introduced, the nurse evaluates and reports and symptoms that suggest a repeated episode of gastritis
• Discourage intake of alcohol and caffeinated beverages to because its is as CNS stimulant that increases gastric activity and pepsin secretion
• Discourage cigarette smoking because nicotine reduces the secretion of pancreatic bicarbonate, which inhibits the neutralization of gastric acid in the duodenum.
• Promoting fluid balance
• Detect early signs of DHN (minimal urine output of 30 ml/hr or minimal intake of 1.5 L/day
• If NPO, IVF are prescribed
• Assess electrolyte values q24H (Na, K, Cl)
• Alert indicators of hemorrhagic gastritis (hematemesis, tachycardia and hypotension) if this occurs notify physician immediately.
• Relieving
• Instruct the patient to avoid foods and beverages that may be irritating to the gastric mucosa
• Instruct the patient about the correct use of medication to relieve chronic gastritis
• Promoting home and community based
• Self care teaching
• Stress management
• Diet
• Medication
• Continuing care
• Ongoing assessment on patient symptoms
• Lifelong Vit. B12 injection
• Emphasized the importance of follow up appointments
• Reducing anxiety
• Important to explain all procedures and treatment base on the patients level understanding
• Promoting optimal nutrition
• Help the patient manage the symptoms including nausea, vomiting heartburn and fatigue
• The patient should take no foods or fluids by mouth until the acute symptoms subside allowing the gastric mucosa to heal
• If IV therapy is necessary, the nurse monitors intake and output along with serum electrolyte values
• If IV therapy is necessary, the monitors intake and output along with serum electrolyte values
• Offer ice chips until symptoms subside followed by clear
• As food is introduced, the nurse evaluates and reports and symptoms that suggest a repeated episode of gastritis
• Discourage intake of alcohol and caffeinated beverages to because its is as CNS stimulant that increases gastric activity and pepsin secretion
• Discourage cigarette smoking because nicotine reduces the secretion of pancreatic bicarbonate, which inhibits the neutralization of gastric acid in the duodenum.
• Promoting fluid balance
• Detect early signs of DHN (minimal urine output of 30 ml/hr or minimal intake of 1.5 L/day
• If NPO, IVF are prescribed
• Assess electrolyte values q24H (Na, K, Cl)
• Alert indicators of hemorrhagic gastritis (hematemesis, tachycardia and hypotension) if this occurs notify physician immediately.
• Relieving
• Instruct the patient to avoid foods and beverages that may be irritating to the gastric mucosa
• Instruct the patient about the correct use of medication to relieve chronic gastritis
• Promoting home and community based
• Self care teaching
• Stress management
• Diet
• Medication
• Continuing care
• Ongoing assessment on patient symptoms
• Lifelong Vit. B12 injection
• Emphasized the importance of follow up appointments
V. Evaluation
• Exhibit low level of anxiety
• Avoid eating irritating food or drinking caffeine beverages or alcohol
• Maintain fluid balance
ü Oral fluid intake of at least 1.5 L a day
ü Drink 6-8 glasses of water daily
ü Has a urinary output of approximately 1L daily
ü Display adequate skin turgor
• Adhere to medical regimen
ü Select non-irritating foods and beverages
ü Take medication as prescribed
• Maintain appropriate weight
• Report less pain
• Exhibit low level of anxiety
• Avoid eating irritating food or drinking caffeine beverages or alcohol
• Maintain fluid balance
ü Oral fluid intake of at least 1.5 L a day
ü Drink 6-8 glasses of water daily
ü Has a urinary output of approximately 1L daily
ü Display adequate skin turgor
• Adhere to medical regimen
ü Select non-irritating foods and beverages
ü Take medication as prescribed
• Maintain appropriate weight
• Report less pain
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