KMC COLLEGE OF NURSING, MEERUT

Advance Nursing Practice

Case study On
Gastritis

Submitted to: - SubmittedBy:-

Mrs Zeba Azam Tyagi Mrs Jyoti Katiyar

Assistant professor,
KMC College Of Nursing M.Sc. (N) 1st Year
GENERAL MEDICAL WARD

CASE STUDY
 ON GASTRITIS

PATIENT ASSESSMENT

Profile of the Patient

Name : Mr. Dindayal Sharma

Age / Sex : 45yrs / male
Name of Hospital : J.A. Hospital
Ward : M.M.W. II
Bed No. : 17
C.R. No. : 155457
Qualification : 10th pass
Occupation : laborer
Marital Status : Married
Religion : Hindu
Income : 3000/- per month
Immunization : Not known
Date of Admission : 4/10/2019
Diagnosis : Chronic Gastritis
Dr.concerned : Dr. Jain
Chief complaints : My patient has the following complaints:
1) Epigastric pain
2) Nausea and vomiting
 3) Anorexia
4) Fear and anxiety
5) Belching
6) Intolerance to hot and spicy food

FAMILY HISTORY
Head of the Family : Mr. Dindayal Sharma
Family Status : Nuclear
No. of Children : 2

Name of Age / Relationship with Occupation Any Disease

Members Sex patient
Mr. 45yrs/M Self laborer Chronic
Dindayal Gastritis
Sharma

Mrs. 39/ F Wife House Wife hypertension

Devki
Sharma
laborer -
Mr. 19/ M Son
Sudhan
Ms. 17/ F Daughter Student -
Shefali
ENVIRONMENTAL HISTORY

House : Own
Locality : Rural
Type of House : Semi Pucca
Ventilation : Proper
Kitchen : Separate
Bathroom : Separate
Drainage : proper
Water Supply : Well/hand pump
Electricity : Adequate

SOCIO-ECONOMIC STATUS

Income : 3000/- per month

Source of Income : Building construction
Earning members : 2
Language : Hindi
Relation with neighbor : Good

NUTRITIONAL STATUS

Vegetarian/Non Vegetarian : Non Vegetarian

No. of Meals per Day : 3 times

Types of Food Consumed
Before illness : All types of food
During illness : Dalia, Milk, biscuits

OTHER HABITS

Smoking : Yes, since the past 15 years

Alcohol : No
Tobacco Chewing : No
HISTORY OF ILLNESS
Past Medical History : The patient has no significant past medical
history
Past Surgical History : The patient has no significant past surgical
history
Present Surgical History : The patient has no significant present surgical
history
Present Medical History : For the past 5 years, the patient used to complain
about feeling of fullness, anorexia and excessive belching. A week ago, the patient
started experiencing epigastric pain, dyspepsia, nausea and vomiting due to which
he was admitted on 4/10/2019 in male medical ward, J.A Hospital, Gwalior

VITAL SIGNS

PARAMETERS PATIENT’S NORMAL VALUE REMARKS

 VALUE
TEMPERATURE 99 F 98.6 F Pyrexia
PULSE 104 beats /min 60-100 beats/min Tachycardia
RESPIRATION 24 breaths/min 18-24 breaths/min Normal
B.P. 122/84 mmHg 120/80 mmHg Normal

INVESTIGATIONS

INVESTIGATIONS PATIENT’S NORMAL REMARKS

VALUE VALUE
Hb% 12 gm% 13-18 gm% Normal
Blood Sugar 78 mg% 60-120 mg% Normal
Blood Urea 27 mg% 20-46 mg% Normal
W.B.C. 12400/cumm 4000- Indicates infection
11000/cumm
Sr. creatinine 0.43 mg% 0.2-1.2 mg% Normal
MEDICATION CHART
Medication Dose Route Time Action
Tab Ampicillin 500 mg Oral BD Antibiotic
Inj. Ranitidine 50mg I/V BD H2 receptor
antagonist
Tab Biminox 1 capsule Oral OD Vit suppl.

Tab Iron ferrous 1 tablet Oral OD Iron suppl.

sulphate

PHYSICAL EXAMINATION

1) General appearance

Nourishment :well nourished

Body build :medium build
Health :healthy
Activity :dull and tired
2) Mental status

Consciousness :conscious
Look :worried and depressed
3) Posture
Body curves :no abnormal curves found
 Movement :NAD
4) Height and weight :5’6”,56kgs
5) Skin conditions
Color :pallor
Texture :dryness
Temperature :cold and clammy
Lesion :NAD
6) Head and face
Scalp :clean
Face :pale, fatigued
7) Eyes
Eyeballs :sunken
Conjunctiva :pale
Sclera :normal
Pupils :normally react to light
Vision : normal
7) Ears
External ear :no abnormal discharges
Hearing :normal
8) Nose
External nares :no abnormal discharges
Nostrils :normal
9) Mouth and pharynx
Lips : pale but no redness, swelling etc.
Odor of the mouth : no foul smell
Teeth :clean
Gums :no inflammation and swelling
Tongue :coated
 Throat and pharynx :NAD
10) Neck
Lymph nodes :non palpable
Thyroid gland :non palpable
Range of motion :normal ROM

11) Chest
Thorax :normal shape and symmetry of
expansion
Breath sounds :normal
Heart :normal heart sounds

12) Abdomen
Observation :no scar and skin rashes
Auscultation :bowel sounds heard
Palpation :no liver and spleen enlargements
Percussion :gas present but no fluid present

13) Extremities : normal

14) Back : no abnormal curves

15) Genitals and rectum : no abnormalities found such as

enlarged inguinal lymph nodes, presence of STDs, hemorrhoids, enlarged prostate
and pelvic masses
 ANATOMY & PHYSIOLOGY OF THE STOMACH

The stomach has four main regions: the cardia, fundus, body, and pylorus.
The cardia surrounds the superior opening of the stomach. The rounded portion
superior to and to the left of the cardia is the fundus. Inferior to the fundus is the
large central portion of the stomach, called the body. The region of the stomach
that connects to the duodenum is the pylorus; it has 2 parts, the pyloric antrum,
which connects to the body of the stomach, and the pyloric canal, which leads into
the duodenum. When the stomach is empty, the mucosa lies in large folds, called
rugae. The concave medial border of the stomach is called the lesser curvature,
and the convex lateral border is called the greater curvature.

The stomach wall is composed of the same four basic layers as the rest of
the rest of the GI tract. The surface of the mucosa is a layer of simple columnar
cells called mucous surface cells. The mucosa contains a lamina propria and
muscularis mucosae. Epithelial cells extend down into the lamina propria, where
they form columns of secretory cells called gastric glands that line many narrow
channels called gastric pits. The gastric glands contain 3 types of exocrine gland
cells namely: mucous neck cells, chief cells, parietal cells. Both mucous surface
cells and mucous neck cells secrete mucous. The chief cells (zymogenic) cells
secrete pepsinogen and gastric lipase. Parietal cells produce hydrochloric acid and
intrinsic factor (needed for the absorption of vitamin B12). The secretions of the
mucous, chief and parietal cells form gastric juice which totals 2000-3000ml per
day.

FUNCTIONS OF THE STOMACH

1) Mixes saliva, food, and gastric juice to form the chyme.

2) Reservoir for holding food before release into small intestine.
3) Secretes gastric juice which contains HCl, pepsin, intrinsic factor and
gastric lipase.
4) Secretes gastrin into blood.
5) HCL kills bacteria and denatures proteins. Pepsin begins the digestion of
proteins. Intrinsic factor aids absorption of vitamin B12. Gastric lipase aids
digestion of triglycerides.

DESCRIPTION OF DISEASE

GASTRITIS
DEFINITION
 It is the inflammation of the stomach mucosa.
TYPES
Chronic Gastritis appears in 3 different forms:-
1) Superficial gastritis: - Causes a reddened, edematous mucosa with
hemorrhage and small erosions.
2) Atrophic gastritis: - Occurs in all levels of the stomach, develops
frequently in association with gastric ulcer and gastric cancer and is
invariably present in pernicious anemia characterized by decreased number
of parietal and chief cells.
3) Hypertrophic gastritis: - Produces a dull and nodular mucosa with irregular
thickened or nodular rugae. Hemorrhage occur frequently
ETIOLOGY

IN BOOK IN PATIENT
1) DRUGS:-
a) Aspirin
b) Corticosteroids
c) NSAIDS
2) Diet 1) Spicy irritating food
a) Alcohol
b) Spicy irritating food
3) Micro organism
a) H pylori
 b) Salmonella
c) Staphylococcus organisms
4) Environmental factors 2) smoking
a) Radiation
b) Smoking
5) Pathophysiologic conditions 3) Reflux of bile and pancreatic
a) Burns secretions
b) Large Hiatal Hernia
c) Physiologic stress
d) Reflux of bile and pancreatic
secretions
e) Renal Failure
f) Sepsis
g) Shock
6) Other Factors 4) Psycho logic stress
a) Endoscopic procedures
b) NG tube
c) Psycho logic stress

RISK FACTORS
IN BOOK IN PATIENT
1) Drug related gastritis
2) H pylori 1)Diet
3) Autoimmune
4) Diet

PATHOPHYSIOLOGY
Due to etiological factors

Breakdown in the normal gastric mucosal barrier

HCl and pepsin can diffuse back into the mucosa

Tissue edema, disruption of capillary walls with loss of plasma into the gastric
lumen and possible hemorrhage
CLINICAL MANIFESTATIONS

IN BOOK IN PATIENT
1) Common Anorexia
Anorexia Feeling of fullness
Nausea and vomiting Dyspepsia
Abdominal cramping or diarrhea Belching
Epigastric pain epigastric pain
Fever Nausea, vomiting
Painless GI bleeding may occur Intolerance of hot and
and is more likely if the person spicy food
uses aspirin or NSAIDS regularly
2) Chronic
Symptoms maybe vague or absent
Anorexia
Feeling of fullness
Dyspepsia
Belching
Vague epigastric pain
Nausea, vomiting
Intolerance of spicy or fatty foods
DIAGNOSTIC EVALUATION

IN BOOK IN PATIENT
History taking History taking
Physical examination Physical examination
Complete blood count Complete blood count
Gastroscopic examination with
biopsy
Breath, urine, serum and stool
test

COMPLICATIONS:

 pernicious anemia
 gastrointestinal bleeding
 peptic ulcer
 gastric cancer
MANAGEMENT
MEDICATION CHART
S.n Medication Dose Rou Ti Action Side effects Nurses’
o (trade te me responsibility
name/generic
name)
01 Tab 500 Oral BD Antibiot INTEG: rash, Monitor I &O
Ampicillin mg ic urticaria chart
HEMA: Culture,
anemia, sensitivity before
increased drug therapy
bleeding Monitor bowel
time, bone movement before
marrow and after drug
depression, therapy
granulocytop Assess
enia respiratory status
GI: nausea, Monitor for any
vomiting, allergic reactions
diarrhea before initiation
GU: oliguria, of treatment
proteinuria, Teach patient or
hematuria, family about the
vaginitis, different aspects
moniliasis of drug therapy
CNS: The drug must
lethargy, be taken in equal
hallucinations intervals of time
, anxiety,
depression,
twitching,
coma,
convulsions
02 Inj. 50mg I/V BD H2 INTEG: rash, Administer with
Ranitidine receptor urticaria, meals for
antagon
ist fever prolonged effect
GI: Storage at room
constipation, temperature
abdominal Teach that
pain, impotence and
diarrhea, gynaecomastia
nausea, are reversible
vomiting, Teach that the
hepato patient is to
toxicity avoid driving,
GU: other hazardous
impotence, activities until
gynaecomasti stabilized on this
a medications
CNS: The drug is to be
hallucinations continued for
prescribed time
, depression, to be effective
headache,
sleeplessness,
confusion,
dizziness,
agitation
EENT:
blurred
vision,
increased
IOP
03 Tab 1 Oral OD Vit INTEG: Administer with
Biminox/Vita capsu suppl. itching, rash, fruit juice to
min B le
complex pain at the disguise taste
injection site With meals if
CV: CHF, possible for
peripheral better absorption
vascular By IM injection
thrombosis, for pernicious
pulmonary anemia
edema IV route not
GI: diarrhea recommended
CNS: but may be
admixed in TPN
flushing, solution
optic nerve
atrophy
META:
Hypokalemia
04 Tab Iron 1 Oral OD Iron INTEG: Administer in
ferrous tablet suppl. temporarily between meals
sulphate
discolored for best
tooth enamel absorption
and eyes May give with
GI: nausea, juice
constipation, Do not give with
 epigastric antacids and
pain, black milk
and red tarry Teach patient
stools, that iron will
diarrhea, change color of
vomiting stool to black or
dark green
That iron
poisoning may
occur if increased
beyondrecomme
nded level

IN BOOK
A) Acute gastritis
1) Intervention involves removing the cause or treating the condition
symptomatically.
2) Vomiting frequently responds to phenothiazine group.
3) Pain responds to antacids or H2 antagonists such as aluminium –
magnesium combinations (Maalox) or ranitidine hydrochloride.
4) Foods and fluids are withheld until nausea and vomiting subside.
 5) Avoid spicy food, caffeine and large heavy meals.
6) In the continued absence of nausea, vomiting and bloating, the client can
slowly return to a normal diet.
B) Chronic gastritis
1) Discomfort may lessen with a bland diet.
2) A non irritating diet consisting of 6 small feedings a day
3) Antacid after meals may help relieve symptoms.
4) Cholinergic
5) Sedatives
6) Avoidance of food that cause symptoms.
7) Administer Vitamin B12 if the client has pernicious anemia.
8) Antibiotic combinations are used for eradicating infection with H.pylori.
9) For patient with pernicious anemia, oral cobalamin, or injection of
cobalamin is needed.
10) Smoking is contraindicated in all forms of gastritis.
11) Incidence of gastric cancer is higher in the patient who has a history
of chronic gastritis, especially atrophic gastritis; close medical follow-up
should be stressed.

NURSING MANAGEMENT
 Assessment –

S.N SUBJECTIVE DATA OBJECTIVE DATA

O
01 The patient is complaining about On observation it was found that the
pain in the stomach patient is having epigastric pain due
to decreased gastric mucosa
02 The patient is complaining about On observation it was found that the
loss of appetite patient is having anorexia due to
dyspepsia
03 The patient is complaining about It was found that the patient is
weakness having nausea and vomiting
04 The patient is restless and anxious It was found that the patient is
having fear and anxiety about
hospitalization and disease prognosis
05 The patient is asking lot of It was found that the patient is
questions regarding the disease having knowledge deficit regarding
condition and drugs that are being disease condition and drug regimen
administered

NURSING DIAGNOSIS:
1) Pain related to increased gastric secretions and decreased mucosal
protection.
2) Altered nutritional balance, anorexia, less intake of food, related to
dyspepsia
3) Fluid and electrolyte balance, nausea and vomiting, related to disease
condition
4) Fear and anxiety related to hospitalization and disease prognosis
5) Knowledge deficit related to disease condition and drug regimen.
 NURSING CARE PLAN
NURSING GOAL INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Pain related To Assess the Provide base
to increased relieve intensity, duration line data for The following
gastric pain & frequency of better interventions
secretions pain interventions helped to
and decreased Encourage patient To relieve relieve the
mucosal patient’s pain to
for bed rest pain
protection some extent.
Monitor the vital To assess the
signs of the patient nature of pain
Provide To relieve the
comfortable patient’s pain
position to the To avoid the
patient irritation of
Avoid hot, spicy the gastric
 food mucosa
Administer H2 To decrease
antagonist as the gastric
prescribed by the secretions
physician

NURSING GOAL INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Altered To Assess the general Provide base
nutritional maintai condition of the line data for The following
balance, n the patient better interventions
anorexia, less nutritio Monitor vital signs interventions helped to
intake of nal every 4 hourly Any deviation maintain the
food, related status nutritional
Provide small, in vital signs
to dyspepsia of the status of the
frequent meals indicates the
patient patient
Provide food progression of
according to the the disease
likes and dislikes of To maintain
the patient the nutritional
Provide calm and status of the
quiet environment patient
free of foul odors To maintain
Provide oral the nutritional
hygiene status of the
Establish an IV patient
line To avoid
nausea and
vomiting
To enhance
the appetite of
the patient
To maintain
the fluid
balance of the
patient
NURSING GOAL INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
Fluid and To Assess the general Provide base
electrolyte reduce condition of the line data for
balance, the patient better All the
nausea and nausea interventions following
vomiting, and Observe the To know measures
related to vomitin frequency, helped in
about the
disease g of the consistency and nature of the reducing the
condition patient color of the vomitus patient’s
vomitus vomiting
Provide a
To reduce the
comfortable
patient’s
position to the
discomfort
patient
To reduce the
Provide a odorless
environment to the feeling of
patient nausea
 Provide food To reduce the
according to the episodes of
likes and dislikes of vomiting
the patient For better
Provide small and digestion
frequent meals
To avoid
Establish an IV
dehydration
line as prescribed
by the physician
To reduce
Administer an
antiemetic as vomiting
prescribed by the
physician, if
necessary

NURSING GOAL INTERVENTIO RATIONALE EVALUATIO

DIAGNOSIS N N

Fear and To Assess the Provide base line

anxiety decrease general condition data for better
related to the fear of the patient interventions
hospitalizatio
n and disease and Avoid visitors To prevent
prognosis anxiety The fear and
Provide a warm aggravating of
of the anxiety of the
and friendly fear and anxiety
patient patient as
and his hospital To reduce the well as his
family environment fear and anxiety relatives has
members Emphasize the of the patient reduced to a
importance of the So that the great extent

treatment for patient may

better prognosis strictly follow
Encourage the drug regimen
patient and his To prevent the
relatives to report progression of
about any disease
abnormal To reduce the
manifestations fear and anxiety
Assure the of the patient
patient and his
 relatives that the
patient is in safe
hands

NURSING GOAL INTERVENTION RATIONALE EVALUATION

DIAGNOSIS
Knowledge To Assess the general Provide base
deficit related provide condition of the line data for The following
to disease knowle patient better interventions
condition and dge to Listen to the interventions helped to
drug regimen the doubts of the To find out upgrade the
patient patient and his the knowledge level
about family deficiencies in of the patient
his Clarify their the knowledge and his family
disease doubts and queries level of the
conditi about the disease patient and
 on and condition his family
drug Provide a warm To provide
regime and friendly knowledge to
n hospital the patient
environment and his family
Upgrade the To reduce the
patient’s and fear and
family’s knowledge anxiety of the
about the disease patient
condition To provide
knowledge to
the patient
and his family

HEALTH EDUCATION
1) The patient is advised to modify his diet.
2) He is to avoid smoking and drinking alcohol
 3) Promotion of rest
4) Reducing stress
5) The patient has to adhere to the pharmacotherapy.
6) The patient is advised to consult the physician if symptoms persist.
7) Close medical follow-up should be stressed.
8) Discussion about life long need for cobalamin is provided.

NURSES’ NOTES
Name of the patient : Mr. Dindayal Sharma Diagnosis:
Chr.Gastritis
Age/sex : 45yrs/M Dr. concerned: Dr. Jain
Ward/bed no : M.M.W II/17
Date : 5/10/2019

TIME VITAL MEDICATIO I/V URINE/VOMI NURSES’

SIGNS NS FLUI TUS RESPONSIBILI
DS TY
8:00a Tab I/V Urine:250ml  Bed
o
m T-98.6 FAmpicillin DNS 8:30am making
P- Inj.
1O
Ranitidine  Monitorin
74beats Tab Biminox g vital
/min Tab ferrous
sulphate signs
R-20
breaths/mi  Drawing
n blood for
investigati
ons
 I/V
infusion
 Administe
ring
medicatio
 ns

10: T-98.6oF Urine: 50ml  Diet :

00am P- fruits,
78beats - - milk,
/min biscuits
R-
 Giving
24breaths/
min health
education
to the
patient
about his
diet and
life style
 Monitorin
g vital
signs

12: T-98.6oF Urine: 150ml  Diet :

00md P- I/V khichdi,
-
72beats DNS pappad
/min 2O  Monitorin
R- g vital
26breaths/
signs
min
 I/V
infusion
Name of the patient : Mr. Dindayal Sharma Diagnosis:
Chr. Gastritis
Age/sex : 45yrs/M Dr. concerned: Dr.
Jain
Ward/bed no : M.M.W II/17
Date : 6/10/2019

TIME VITAL MEDICATIO I/V URINE/VOMI NURSES’

SIGNS NS FLUI TUS RESPONSIBILI
DS TY
8:00a Tab I/V Urine:250ml  Bed
m T-98.6oF Ampicillin DNS 8:30am making
P- Inj.
1O
Ranitidine  Monitorin
74beats Tab Biminox g vital
/min Tab ferrous
sulphate signs
R-20
breaths/mi  Drawing
n blood for
investigati
ons
 I/V
infusion
  Administe
ring
medicatio
ns

10: T-98.6oF Urine: 50ml  Diet :

00am P- fruits,
78beats - - milk,
/min biscuits
R-
 Giving
24breaths/
min health
education
to the
patient
about his
diet and
life style
 Monitorin
g vital
signs
12: T-98.6oF Urine: 150ml  Diet :
00md P- I/V khichdi,
-
72beats DNS pappad
/min 2O
 Monitorin
R-
g vital
26breaths/
min signs
 I/V
infusion
Name of the patient : Mr. Dindayal Sharma Diagnosis:
Chr. Gastritis
Age/sex : 45yrs/M Dr. concerned: Dr.
Jain
Ward/bed no : M.M.W II/17
Date : 8/10/2019

TIME VITAL MEDICATIO I/V URINE/VOMI NURSES’

SIGNS NS FLUI TUS RESPONSIBILI
DS TY
8:00a Tab I/V Urine:250ml  Bed
m T-98.6oF Ampicillin DNS 8:30am making
P- Inj.
1O
Ranitidine  Monitorin
74beats Tab Biminox g vital
/min Tab ferrous
sulphate signs
R-20
breaths/mi  Drawing
n blood for
investigati
ons
 I/V
infusion
  Administe
ring
medicatio
ns

10: T-98.6oF Urine: 50ml  Diet :

00am P- fruits,
78beats - - milk,
/min biscuits
R-
 Giving
24breaths/
min health
education
to the
patient
about his
diet and
life style
 Monitorin
g vital
signs
12: T-98.6oF I/V Urine: 150ml  Diet :
00md P- DNS khichdi,
-
72beats 2O pappad
/min
 Monitorin
R-
g vital
26breaths/
min signs
 I/V
infusion
 BIBLIOGRAPHY
1. Brunner &Suddharth, “TEXT BOOK OF MEDICAL SURGICAL NURSING”,
Gastritis, 9th edition 2001, Lippincott, Pp. 1305-1318

2. Lewis, Heitkemper,” MEDICAL SURGICAL NURSING,” Gastritis, 7th

edition 2007, Mosby Elsevier, Pp 1013-1014

3. Linda Skidmore-Roth , “MOSBY’S NURSING DRUG REFERENCE”,

Ampicillin, Ranitidine, Vitamins. Ferrous Sulphate”, printed 1999, Page no
126-128,452-54, 880-81, 66

4. Sister Nancy,” PRINCIPLES AND PRACTICE OF NURSING”, Physical

Examination, 5th edition, reprinted 2005, N.R publishing house, pp 155-158

5. Tortora Gerard J. & Grabowski S.R.,”PRINCIPLES OF ANATOMY AND

PHYSIOLOGY”, Anatomy Of Stomach,9th edition 2000,John Wiley and sons,
Pp 833-36