TABLE OF CONTENT

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Content
Acknowledgment Introduction of diagnosis 2.1-Etiology 2.2-Pathophysiology 2.3-Types 2.4-Clinical manifestation 2.5-Complication Patient profile Social history Family history Previous medical and surgical illness Presence history-Assessment Daily report 8.1-Condition of patient 8.2-Complaint from patient 8.3-Nursing care 8.4-Vital signs 8.5-Preview by doctor 8.6-Order by doctor 8.7-Medication and diet Investigation Management Nursing care plan On discharge Health education Summary Conclusion Reference

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Acknowledgment
First and foremost I would like to thankfully to Allah SWT for giving me opportunity to complete my case study on gastritis. Then I would like to thanks to my beloved clinical instructor (CI) Madam Siti Zahara Bt.Mahmood for giving me a lot of supporting and encouragement to finish this case study. Apart from that, I also would like to thanked to all my friends especially my partner group for their effort giving me some useful tips in order to make this case study complete. Furthermore, I also would like to give my great thankful to staff nurse and doctor at An-Nisa Medical Centre, Kota Bharu, Kelantan who give their opinion to me. So that, I can finish my case study competed. Last but not least, I again want to say thankfully to the entire person who had involved directly and indirectly in helped me to complete my case study sharp on time. Thank you for you all.

Introduction of diagnosis Definition: -Gastritis is inflammation and irritation of the inner lining of the Stomach. -Gastritis can be brief and sudden illness (acute gastritis). . perhaps as part of another medical illness. a longerlasting condition (chronic gastritis) or a special condition.

Medications -Aspirin (more than 300 drug products contain some form of aspirin) -Non steroidal anti inflammatory drugs (NSAID.Reason that could cause the irritation/Etiology 1. . Rarely infections with certain viruses 5. Helicobacter Pylori 4. Having tubes or foreign objects placed in the stomach (such as a nasogastric tube. Acid related 2. such as ibuprofen or Naproxen) -Steroids (Prednisolone is one example) 3.

impaired enzyme function. Damage from irritants result in increased intracellular PH. Secretes scanty amount of gastric juice. vascular stasis and tissue death. Gastritis. Superficial ulceration may occur and can lead to hemorrhage. undergoes superficial erosion. ischemia. .Pathophysiology Gastric mucus membranes become edematous and hyperemic (congested with fluid and blood). containing very little acid but much mucus. disrupted cellular structures.

lining becomes thin and atrophy.  Start with inflammation leading to atrophy. inflammation and superficial erosion. -Mucosa rapidly regenerates> heals in a few days. Chronic gastritis  Helicobacter Pylori is a type of bacteria that infects in the stomach. . 2.  Progressive and irreversible changes in the gastric mucosa. caffeine or food.  decreased mucus  Gastric mucosa disrupts and destroyed.Types 1.  Common in elderly. Acute gastritis  an example of acute gastritis is stomach upset that may follow the use of alcohol. chronic alcohol drinkers and cigarette smokers.  Goes deeper.  Pathophysiology. . aspirin. infection with these bacteria may lead to chronic gastritis.disruption of mucosal barrier by a local irritant -Hcl and pepsin come in contact with gastric tissue> irritation.

Anorexia. vomiting and bleeding with hematemesis. Acute gastritis Asymptomatic to mild heartburns to severe distress. 2. Chronic gastritis pain and discomfort region of stomach epigastric pain after meals Vomiting possibly of blood (hematemesis) Heartburn after eating Loss of appetite and sour taste in the mouth Hiccups Indigestion (dyspepsia) Dark stools .Clinical manifestation 1.

Complication .

Kota Bharu. 15200. Date of Birth: 14 April 1971 Age: 39 years Sex: Male Race: Malay Religion: Islam Weight: 72 kg Height: 178cm Phone number: 019-9737573 Date of admission: 8 Jun 2010 Date of discharge: 11Jun 2010 Diagnosed: Chronic Gastritis . Kelantan.Patient Profile Name: Mr. Jalan Sultan Yahya Petra. Z IC: 710414-03-5695 Status: Married Registered number: 891250 Ward: Melor Address: No 19. Lundang.

. However. Kota Bharu. He is working as a Tenaga National Berhad (TNB) officer. such as occurs from smoking increases high risk of heart attack. Both of his children study in Kota Bharu. Mr. His father like smoking and have a chronic cough. Seven years ago. His wife is a teacher at Sekolah Menengah Kebangsaan Kubang Kerian 1. Now.Z was married in 1997 year and has two boys and one girl. Mr. his father was death because disease heart attack. his father also has a chronic gastritis.Z also has disease gastritis. Kelantan.Z lives at Kota Bharu.Family History Mr. Kelantan. A chronic cough.

he become slowly. he spends time to watching television at home with his family. and always feels pain and loss of appetite.Social History Mr. When he knows he had gastritis. Mr. He is also a great smoker and he smoker about 8-15 cigarette per day. On weekend. After that.Z is a Tenaga National Berhad (TNB) officer at Kota Bharu. From day to day. Mr. Besides that. The doctor diagnosed his as gastritis. He must rest more time himself in enough time and limited activities. . One day. he goes to the hospital to get the information and get treatment his disease. he feels pain and discomfort region of stomach especially after take meals. He also feels heartburn and vomiting possibly of blood (hematemesis). his work and activity disturb.Z no active in sport and he did not do any activities outside his house.Z like take fatty food and spicy food such Kentucky Fried Chicken (KFC). He is 39 years old.

Z admitted in ward at Hospital Kubang Kerian. his blood pressure is 130/84. Mr. He follows the treatment in ward and checked by Dr. temperature 37.Previous Medical and Surgical Illness In year 2008. Mr. respiration 22 per minute and spo2 98%. pulse rate 94 beat per minute. His did¶t get any surgery treatment. After his condition stable.Z discharge from ward.Z. Kota Bharu. . His admitted in hospital. Antibiotic (Omeprazole) to treat for kill bacteria and aanti histamine 2 (H2) receptor blocker (Ranitidine) to prevent pepsin or treat acute stress gastritis and to reduce amount or effects of HCL. Kelantan with diagnosed of Acute Gastritis.Maheran. Doctor order antibiotic and antihiatamine for Mr.5 C.

Presence History ± Assessment .

Upper endoscopy for inspection of gastric mucosa.Diagnostic tests 1. Serum vitamin B12 levels are reduced in elderly patients. Gastric analysis -Asses HCL secretions -Less in patient with chronic gastritis 2. 4. Hematocrit and Red blood Cell indices for evidence of anemia. Hemoglobin. 3. .

.Nursing Care Plan 1. Imbalanced nutrition less than body requirement related to anorexia and poor food intake. 2. 5. 3. Anxiety related to the disease and anticipated treatment. Pain related to irritation of gastric mucosal layer. High risk for fluid and electrolyte imbalance related to inadequate intake of food/fluids and abnormal loss of fluid and electrolytes. Knowledge deficit related to disease process and dietary management. 4.

balance. R-IV fluids restore or maintain hydration until adequate oral intake is started. tachypnea and hypotension may indicate fluid volume deficit and as a baseline data. 4. respiration. color. condition and status of oral mucus membrane frequently.Nursing diagnosis 1. Goal Nursing intervention Evaluation 1. Weight daily -monitor daily body weight to see any changes of body weight with nutritional status. pulse rate and electrolyte temperature. . R-skin turgor and mucus membrane assessment indicate hydration status. Nutrition -administer IV fluids as ordered by doctor. R-daily weight is an accurate indicator of fluid volume. 5. R-good skin and mouth care are necessary to maintain skin and mucus membrane integrity. -Patient 2. Observation -fluid and -monitor and record vital signs electrolyte maintains 2hourly till stable then 4hourly blood balance. Assessment -monitor skin turgor. R-tachycardia. fluid and pressure. Hygienic -provide skin and mouth care frequently like brush the teeth with soft brush. High risk for fluid and electrolyte imbalance related to inadequate intake of food/fluids and abnormal loss of fluid and electrolytes. 3.

5. Assessment -pain reduce irritation of gastric mucosal to bear pain -asses nature of pain including layer. Pain related to -patient able 1.2. 3. Activity daily life -restrict activity that may aggravate pain as help in toilet or give bedpan when needed R-to reduce pain at location side 4. . 2. maximum. Position -assist patient to comfortable position such as semi fowlers position and change 2hourly R-to prevent pressure sore and make patient comfortable. Nutrition -advice patient to avoid foods that are too spicy and fatty foods R-to reduce irritation of gastric mucosa. until effects location. -advice patient to drink a lot of water at least 8glass per day R-to neutralize the acid in stomach. intensity pattern use pain of scale level medication R-to know where the pain scale start is at its and how the pain feel to patient. Medication -administer analgesic tablet Paracetamol 500mg order by doctor R-to reduce pain and instruct patient to correct uses of medication to effectiveness of medication actions.

Monitor I/O chart -monitor and record food and fluid intake and any abnormal loss R-careful monitoring can help in developing a dietary plan to meet calorie needs. Dietician -arrange for dietary consultation and refer dietician R-to determine calorie and nutrients needs. weight -monitor weight and lab studies such Sr albumin. 1. 5. 2. Imbalanced nutrition less than body requirement related to anorexia and poor food intake. . hemoglobin and Red Blood Cell indices R-weight and lab values provide data regarding nutritional status and the effectiveness of interventions. -patient maintains balanced nutrition with evidence of appropriate body weight. 4.3. 3. Medication -Administer antiemetic (Maxolon) and other drug as ordered by doctor R-to relieve vomiting and facilitate oral fluid intake. Nutrition -provide nutritional supplements between meals and frequent small meals R-many patient tolerate small better than 3 large meals a day.

4. 5. Knowledge deficit related to disease process and dietary management. . Anxiety related to the disease and anticipated treatment.

Warfarin [Coumadin]). Major action Nursing considerations Clarithromycin(Bioxin) -Exerts bactericidal effects to eradicate H. Flagyl increase blood thinning effects of Warfarin (Coumadin).Pylori bacteria in the gastric mucosa. Lovastatin. . Antibiotics Amoxicillin(Amoxil) -A bactericidal antibiotic that assists with eradicating H.Pylori bacteria in the gastric mucosa.Pylori bacteria in the gastric mucosa when administered with other antibiotics and PDI. Metronidazole(Flagyl) -A synthetic antibactericidal and antiprotozoal agent that assists with eradicating H. -may cause GI upset.Medication Pharmacologic agent 1. -may cause diarrhea -should not be used in patients allergic to Penicillin. -must be used with caution in patient with renal to hepatic impairment. altered taste. -Patient should avoid alcohol. -many drug interactions (eg Cisapride. -Should be administered with meals to decrease GI upset. Tetracycline -Exerts bacteriostatic effects to eradicate H. Colchicine. warm patient to use sunscreen. -may cause photosensitivity reaction. may cause anorexia and metallic taste.Pylori bacteria in the gastric mucosa. headache. -may cause GI upset.

-short term relief for GERD. 3. and gynecomastia. dizziness. -use for treatment of ulcers and GERD.-milk or daily products may reduce effectiveness. -may cause confusion. -least expensive of H2receptor antagonists. nausea and vomiting. diarrhea.Pylori Bismuth Subsalicylate bacteria in the gastric (Pepto-Bismol) mucosa and assists with healing of mucosal ulcers. -best choice for critically ill patient. -given concurrently with antibiotics to eradicate H.Pylori infection. 2. -should be taken on empty stomach. Antidiarrheal -suppresses H. -short term use may cause diarrhea dizziness. . Histamine2 (H2) receptor antagonists. agitation or coma I the elderly or those with renal or hepatic insufficiency. Nizatidine(Axid) -decrease amount of Hcl produced by stomach by blocking action of histamine receptors. -may cause headache. because it is known to have the least risk of drug-drug interactions does not either liver metabolism. -prolonged half life in patient with renal insufficiency. Cimetidine(Tagamet) -decrease amount of Hcl produced by stomach by blocking action of histamine receptors. GI Famotidine(Pepaid) -decrease amount of Hcl produced by stomach by blocking action of histamine receptors.

Pylori infection. constipation. headache and dizziness.decreases gastric acid secretion by slowing the hydrogenpotassium adenosine triphosphatase pump on the surface of the parietal cells. 4. vomiting.Prolonged half life in patient with renal and hepatic insufficiency.A delayed release capsule that is to be swallowed whole and taken before meals. Ranitidine(Zantac) -decrease amount of Hcl produced by stomach by blocking action of histamine receptors . -a delayed release capsule that is to be swallowed whole and taken before meals. Lansoprazole(Prevacid) . -used mainly for treatment of duodenal ulcer disease and H. Proton Pump Inhibitors Esomeprazol(Nexium) -decreases gastric acid secretion by slowing the hydrogenpotassium adenosine triphosphatase pump on the surface of the parietal cells of the stomach.may cause headache. .decreases gastric acid secretion by slowing the hydrogenpotassium adenosine triphosphatase pump on the surface of the parietal cells. -cause fever side effects than Cimetidine. dizziness. Omeprazole(Prilosec) . .A delayed release capsule that is to be swallowed whole and taken before meals. abdominal pain.upset as well as urticaria. constipation. nausea. . nausea and vomiting or abdominal discomfort. -may cause diarrhea. .

decreases gastric acid secretion by slowing the hydrogenpotassium adenosine triphosphatase pump on the surface of the parietal cells. headache abdominal pain and abnormal liver function tests. Prostaglandin E1 analog Misoprostal(Cytotec) -synthetic prostaglandin. hyperglycemia. -administer with food. binding to the surface of the ulcer and prevents digestion by pepsin.Pantoprazole(Protonix) . -may cause diarrhea and cramping. -drug interaction with Digoxin. -creates a viscous substance in the presence of gastric acid that forms a protective barrier. iron and Warfarin(Coumadin).decreases gastric acid secretion by slowing the hydrogenpotassium adenosine triphosphatase pump on the surface of the parietal cells. 5. protects the gastric mucosa from agents that cause ulcers. -a delayed released tablet to be swallowed whole. -a delayed release capsule that is to be swallowed whole and taken before meals. Rabeprazole(AcipHex) . -may cause constipation or nausea. -other medications should be taken 2hours before or after this medication. -use to prevent ulceration in patient using NSAIDS. also increases mucus production and bicarbonate levels. Sucralfate(Carafate) -used mainly for the treatment of duodenal ulcers. -may cause abdominal pain. . -should be taken without food but with water. -may cause diarrhea. diarrhea. nausea and headache.

.Health Education     Maintaining optical nutrition Dietary modifications Usage of prescribed medication Avoiding known gastric irritants like aspirin. alcohol and cigarette smoking.

Summary .

especially epigastric pain after meals and vomiting possibly of blood (hematemesis). .Z was discharge from ward Melor. Then. Istudy how to method for the treatment gastritis. staff nurse and clinical instructor (CI) madam Siti Zahara Bt. most patients with gastritis if symptoms including pain or discomfort region of stomach. I¶m very happy because looking Mr. Lastly.Mahmood because they assist in my case study. I can do conclusion. I also say thank you to patient because give cooperation with me.Conclusion As a conclusion. with have skill and knowledge. I¶m sure can become nurse leather and have responsibility to our patient needs. I say thank you to doctor. From the case study.

(3rd ed).References  Le Mone and Burke (2000) Medical Surgical Nursing critical thinking in client (2nd ed). .  Pearson¶s Professional (1997). Tabblner¶s Nursing Care: Theory and Practice. Churchill Livingstone.

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