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Name: Patient F
Age: 16 years old
Sex: Male
Nationality: Filipino
Ward: Male Medical Ward
Bed No: G12
II. Diagnosis
Vomiting
Abdominal Pain
Nausea
Indigestion
Headache
III.B Allergies
NIL
The gastrointestinal (GI) tract is a passageway that begins at the lips and ends at the
anus (Figure 1). Its purpose is to transport and digest food. Along the way, the
passageway changes character because different functions are required at different
points.
In the uppermost portion, the teeth begin the process of digestion by grinding food into
small fragments. The esophagus delivers the food to the stomach where strong acid
further breaks up and degrades the swallowed material.
Small amounts of the liquified food called chyme are then delivered in spurts
from the stomach into the duodenum where they are mixed with bile from
the liver (via the bile ducts) and pancreatic juice (via the pancreatic duct).
Bile aids in the breakdown and digestion of fat, while the pancreatic
enzyme amylase fragments starches into smaller molecules. The
pancreas also releases a fluid into the duodenum, which
neutralizes the acidic stomach contents. This neutral
bile/amylase/fragmented food substance passes to the upper small
intestine for the next phase of digestion. It is moved along by
peristalsis, worm-like contractions of the intestine.
By the time the intestinal contents reach the large intestine, most of its nutritional
value has been extracted, leaving a watery waste product. The role of the large
intestine is fluid absorption from the remaining waste and compaction and storage of
what is left. Expulsion of the waste (feces, stool) is generally under voluntary control
and is undertaken when socially convenient.
Chemicals or stimulating foods will cause columnar epithelial cells, whose function is
to produce mucus, reducing production. While it is the function of mucus to protect
gastric mucosa that did not participate undigested. The response of the gastric
mucosa due to decreased vasodilation, mucous secretion varies among gastric
mucosal cells. There gastric mucosal lining cells produce HCl (especially the fundus)
and blood vessels. Vasodilatation gastric mucosa will cause increased production of
HCl. Anorexia can also cause pain. The pain inflicted by HCl contact with the gastric
mucosa. Response due to decreased gastric mucosal mucus secretion may be
eksfeliasi (exfoliation). Gastric mucosal cell exfoliation will lead to erosion of the
mucosal cells. Mucosal cell loss due to erosion lead to bleeding. Bleeding happens to
people with life-threatening, but it can also stop yourself because the process of
regeneration, so that erosion disappear within 24-48 hours after hemorrhage.
Additional Information
Chemicals or stimulating foods will cause columnar epithelial cells, whose function is
to produce mucus, reducing production. While it is the function of mucus to protect
gastric mucosa that did not participate undigested. The response of the gastric
mucosa due to decreased vasodilation, mucous secretion varies among gastric
mucosal cells. There gastric mucosal lining cells produce HCl (especially the fundus)
and blood vessels. Vasodilatation gastric mucosa will cause increased production of
HCl. Anorexia can also cause pain. The pain inflicted by HCl contact with the gastric
mucosa. Response due to decreased gastric mucosal mucus secretion may be
eksfeliasi (exfoliation). Gastric mucosal cell exfoliation will lead to erosion of the
mucosal cells. Mucosal cell loss due to erosion lead to bleeding. Bleeding happens to
people with life-threatening, but it can also stop yourself because the process of
regeneration, so that erosion disappear within 24-48 hours after hemorrhage.
Causes of Gastritis
Gastritis can be caused by irritation due to excessive alcohol use, chronic vomiting,
stress, or the use of certain medications such as aspirin or other anti-inflammatory
drugs. It may also be caused by any of the following:
Helicobacter pylori (H. pylori): A bacteria that lives in the mucous lining of the
stomach; without treatment, the infection can lead to ulcers, and in some people,
stomach cancer.
Pernicious anemia: A form of anemia that occurs when the stomach lacks naturally
occurring substance needed to properly absorb and digest vitamin B12
Bile reflux: A backflow of bile into the stomach from the bile tract (that connects to the
liver and gallbladder)
Diagnostic Procedure
Blood tests. checking your red blood cell count to determine whether you have anemia,
which means that you do not have enough red blood cells. It can also screen for H.
pylori infection and pernicious anemia with blood tests.
Fecal occult blood test (stool test). This test checks for the presence of blood in your
stool, a possible sign of gastritis.
Taking antacids and other drugs (such as proton pump inhibitors or H-2 blockers) to
reduce stomach acid
If the gastritis is caused by pernicious anemia, B12 vitamin shots will be given.
Eliminating irritating foods from your diet such as lactose from dairy or gluten from
wheat
Generic Name:Omeprazole(o-me´pra-zole)
Classifications: gastrointestinal agent; proton pump inhibitor
Pregnancy Category:C
Actions: An antisecretory compound that is a gastric acid pump inhibitor. Suppresses
gastric acid secretion by inhibiting the H+, K+-ATPase enzyme system [the acid
(proton H+) pump] in the parietal cells.
Therapeutic effects : Suppresses gastric acid secretion relieving gastrointestinal
distress and promoting ulcer healing.
Uses: Duodenal and gastric ulcer. Gastroesophageal reflux disease including severe
erosive esophagitis (4 to 8 wk treatment). Long-term treatment of pathologic
hypersecretory conditions such as Zollinger-Ellison syndrome, multiple endocrine
adenomas, and systemic mastocytosis. In combination with clarithromycin to treat
duodenal ulcers associated with Helicobacter pylori.
Contraindications :Long-term use for gastroesophageal reflux disease, duodenal
ulcers; lactation.
Adverse effects
CNS:Headache, dizziness, fatigue. GI:Diarrhea, abdominal pain, nausea, mild
transient increases in liver function tests. Urogenital:Hematuria, proteinuria.
Skin:Rash.
Nursing implications
Assessment & Drug Effects
Lab tests: Monitor urinalysis for hematuria and proteinuria. Periodic liver function
tests with prolonged use.
Nausea
Vomiting
Diarrhea
Hypotension
Thromboembolic, e.g., arterial, venous, embolic;
Neurologic, e.g., visual impairment, convulsions, headache, mental status changes;
myoclonus;
Rash
Contraindications
Tranexamic acid is contraindicated in patients with:
Pregnancy
Tranexamic acid crosses the placenta.
Breast-feeding
Tranexamic acid is distributed into breast milk; concentrations reach approximately
1% of the maternal plasma concentration
Nursing Responsibilities
Before:
During:
Stabilize IV catheter to minimize thrombophlebitis. Monitor site closely.
After:
CONTRA-INDICATIONS:
cardiac disease or hypertension
glaucoma
gastric or duodenal ulcers
NURSING CONSIDERATIONS:
Caution the client that the medication may cause drowsiness, creating difficulties
or hazards or other activities that require alertness.
Tell the client to take the medication with food to decrease GI upset.
Explain to the client that arising quickly form a lying or sitting position may cause
orthostatic hypotension.
When taking these medications, the client needs to have blood cells counts,
renal function, hepatic function, and blood pressure monitored.
Adverse effects of these drugs occur more commonly in elderly clients.
Explain to the client that use of these drugs in warm weather may increase the
likelihood of heatstroke.
Pregnancy Category B
Therapeutic actions
Sucralfate protects GI lining against peptic acid, pepsin and bile salts by binding with
positively-charged proteins in exudates forming a viscous paste-like adhesive
substance thus forming a protective coating.
Indications
Short-term treatment of duodenal ulcers, up to 8 wk
Maintenance therapy for duodenal ulcer at reduced dosage after healing
Orphan drug use: Treatment of oral and esophageal ulcers due to radiation,
chemotherapy, and sclerotherapy
Unlabeled uses: Accelerates healing of gastric ulcers, long-term treatment of
gastric ulcers, treatment of reflux and peptic esophagitis, treatment of NSAID or
aspirin-induced GI symptoms and GI damage, prevention of stress ulcers in
critically ill patients
Nursing considerations
Assessment
History: Allergy to sucralfate; chronic renal failure or dialysis; pregnancy, lactation
Physical: Skin color, lesions; reflexes, orientation; mucous membranes, normal output
Interventions
Give drug on an empty stomach, 1 hr before or 2 hr after meals and at bedtime.
Monitor pain; use antacids to relieve pain.
Administer antacids between doses of sucralfate, not within 30 min before or
after sucralfate doses.
Measure and record regular weight to monitor mobilization of edema fluid.
Avoid giving food rich in potassium.
Arrange for regular evaluation of serum electrolytes, BUN.
Teaching points
Take the drug on an empty stomach, 1 hour before or 2 hours after meals and at
bedtime.
If you are also taking antacids for pain relief, do not take antacids 30 minutes
before or after taking sucralfate.
You may experience these side effects: Dizziness, vertigo (avoid driving or
operating dangerous machinery); indigestion, nausea (eat frequent small meals);
dry mouth (use frequent mouth care, suck on sugarless lozenges); constipation
(request aid).
Report severe gastric pain.
Uses
Management of diabetic gastric stasis (gastroparesis); to prevent nausea and vomiting
associated with emetogenic cancer chemotherapy (e.g., cisplatin, dacarbazine); to
facilitate intubation of small bowel; symptomatic treatment of gastroesophageal reflux.
Contraindicatons
Sensitivity or intolerance to metoclopramide; allergy to sulfiting agents; history of
seizure disorders; concurrent use of drugs that can cause extrapyramidal symptoms;
pheochromocytoma; mechanical GI obstruction or perforation; history of breast cancer.
Safety during pregnancy (category B) or lactation is not established.
Cautious Use
CHF; hypokalemia; kidney dysfunction; GI hemorrhage; history of intermittent porphyria.
Nursing Implications
Assessment & Drug Effects
Report immediately the onset of restlessness, involuntary movements, facial
grimacing, rigidity, or tremors. Extrapyramidal symptoms are most likely to occur
in children, young adults, and the older adult and with high-dose treatment of
vomiting associated with cancer chemotherapy. Symptoms can take months to
regress.
Be aware that during early treatment period, serum aldosterone may be elevated;
after prolonged administration periods, it returns to pretreatment level.
Lab tests: Periodic serum electrolyte.
Monitor for possible hypernatremia and hypokalemia, especially if patient has
CHF or cirrhosis. Adverse reactions associated with increased serum prolactin
concentration (galactorrhea, menstrual disorders, gynecomastia) usually
disappear within a few weeks or months after drug treatment is stopped.
Assessment:
Nursing Diagnosis
Nursing interventions:
Instruct to avoid foods and beverages that may be irritate the gastric
mucosa
Review pain scale and location of pain, observation of vital signs, provide
a quiet and comfortable environment, encourage relaxation techniques
with breath in, do the collaboration in the provision of drugs in accordance
with the indication to reduce the pain.
Assess food intake, body weight balanced on a regular basis, give oral
care on a regular basis, encourage clients to eat little but often, give food
in warm, auscultation bowel sounds, assess food preferences, supervised
laboratory tests such as: Hb, Ht, Albumin
Avoid caffeine drinks
Avoid alcohol and nicotine.
Provide physical and emotional support
Avoid foods and liquids by mouth until acute symptoms of decreases
Assess signs and symptoms of dehydration, vital sign observation,
measuring intake and encourage clients to drink out ± 1500-2500ml,
observation of skin and mucous membranes, in collaboration with the
medical provision of intravenous fluids.
Beware of the indicator gastritis hemorragis (Hematemesis, tachycardia,
hypotension).
Evaluation:
Pain gone / controlled, looked relaxed and able to sleep / rest, pain scale
shows the number 0.
Stable weight, normal laboratory values albumin, no nausea and vomiting
weight within normal limits, normal bowel sounds.
Moist mucous membranes, good skin turgor, electrolytes returned to
normal, capillary filling pink, stable vital signs, input and output balance.
http://www.mayoclinic.org/diseases-conditions/gastritis/basics/definition/con-20021032
http://www.drugs.com/omeprazole.html
http://www.healthline.com/health/gastritis-acute#Diagnosis5
http://www.webmd.com/digestive-disorders/digestive-diseases-gastritis
http://rnspeak.com/drug-study/drug-study-tranexamic-acid/
http://www.mayoclinic.org/diseases-conditions/gastritis/basics/treatment/con-20021032