WESLEYAN UNIVERSITY – PHILIPPINES

COLLEGE OF NURSING AND ALLIED MEDICAL SCIENCES

MABINI EXTENSION, CABANATUAN CITY,

NUEVA ECIJA

ACUTE GATRITIS WITH DEHYDRATION

_____________________________________________________________

Dr. Josephine O. Samonte

Clinical Instructor

In Partial Fulfillment of the Course

Requirements in

Care Of Clients With Problems In Oxygenation, Fluid And

Electrolyte Balance Metabolism And Endocrine (RLE)

Submitted by:

KATE VALERIE G. QUIBAN

BSN 3-1
 INTRODUCTION

Types of Gastritis

Some may present with a dull pain and a feeling of fullness or loss of appetite
after a few bites of food. Gastritis can be erosive or non-erosive: Erosive gastritis can
cause the stomach lining to wear away, causing erosions—shallow breaks in the
stomach lining—or ulcers—deep sores in the stomach lining. Non-erosive gastritis
causes inflammation in the stomach lining; however, erosions or ulcers do not
accompany non-erosive gastritis. Stress gastritis is a form of acute erosive gastritis
which is stress-induced, complication of life-threatening condition (Curling’s ulcer
with burns); gastric mucosa becomes ischemic and tissue is then injured by acid of
stomach. Stress gastritis can cause mucosal erosions and superficial hemorrhages in
patients who are critically ill or in those who are under extreme physiologic stress,
resulting in minimal-to-severe gastrointestinal (GI) blood loss. Depending on the
cause, gastritis may be acute or chronic, may persist and develop serious conditions
such as atrophy of the stomach.

Chronic gastritis develops slowly over time. If chronic gastritis is not treated, it
may last for years or even a lifetime. Many people with chronic gastritis are
asymptomatic.

Definition of Acute Gastritis

Acute gastritis on the other hand is characterized by polymorphonuclear (PMN)

infiltration of the mucosa of the antrum and body. Acute gastritis starts suddenly and
lasts for a short time. It is a term that encompasses a broad spectrum of entities that
induce inflammatory changes in the gastric mucosa. Several different etiologies share
the same general clinical presentation; however, they differ in their unique histologic
characteristics. The inflammation may involve the entire stomach (eg, pangastritis) or
a region of the stomach (eg, antral gastritis).
Acute gastritis can be divided into two categories: erosive (eg, superficial
erosions, deep erosions, hemorrhagic erosions) and nonerosive (generally caused
by Helicobacter pylori)

H. Pylori Bacterial Infection and Nonsteroidal Anti-Inflammatory Drug (NSAIDS)

H. Pylori Bacterial Infection and Nonsteroidal Anti-Inflammatory Drugs (Nsaids)

are the two main causes of acute gastritis. H. pylori bacterial infection is the most
common cause of gastritis worldwide. Many people first become infected during
childhood, but not everyone experiences symptoms. While H. pylori infection can
cause both acute and chronic gastritis, it is not often associated with erosive gastritis.
Researchers think H. pylori spreads through infected food, water, salvia and other
bodily fluids.
 When NSAIDs irritate the gastric mucosa, they weaken the resistance to acid,
causing gastritis, ulcers, bleeding, or perforation. The damage ranges from superficial
injury to single or multiple ulcers, some of which may bleed.

Dehydration

This occurs when you use or lose more fluid than you take in, and your body
doesn't have enough water and other fluids to carry out its normal functions. If you
don't replace lost fluids, you will get dehydrated.

PATHOPHYSIOLOGY

The inner surface of the stomach is lined by a mucous membrane known

as the gastric mucosa. The mucosa is always covered by a layer of thick mucus that is
secreted by tall columnar epithelial cells. Gastric mucus is a glycoprotein that serves
two purposes: the lubrication of food masses in order to facilitate movement within the
stomach and the formation of a protective layer over the lining epithelium of the
stomach cavity—the membranes lining the stomach wall protect it from acid and
germs. If this protective lining is irritated or damaged, it can become inflamed. Long-
lasting inflammations can further damage the stomach lining and lead to stomach
(gastric) ulcers. Inflammation of the stomach lining is called gastritis. It's usually
caused by certain bacteria or the regular use of anti-inflammatory painkillers.

Stomach

The stomach is a muscular sac that is located on the left side of the abdominal
cavity, just inferior to the diaphragm. In an average person, the stomach is about the
size of their two fists placed next to each other. This major organ acts as a storage
tank for food so that the body has time to digest large meals properly. The stomach
also contains hydrochloric acid and digestive enzymes that continue the digestion of
food that began in the mouth.

• The stomach is an organ of the digestive system, located in the abdomen just
below the ribs.

• Swallowed food is mixed with gastric juices containing enzymes and

hydrochloric acid.

• The lining of the stomach, called the epithelium, is layered with multiple folds.

• The epithelium is coated with mucus (gastric mucosa) secreted by special

glands. Inflammation caused by gastritis occurs in this lining.
Predisposing Factors: Precipitating Factors:
Dietary Indiscretion (the person Overuse of aspirin and other non-
eats food that is contaminated steroidal anti-inflamatory drugs.
the disease causing bacteria) Bile reflux
Excessive alcohol Intake Radiation Therapy
Ingestion of strong Acid or alkali
(more severe form; causes
mucosa to become gangrenous)
 Gastric mucous membrane becomes edematous and hyperemic (congested with
blood and fluid)

Gastric mucous membrane undergoes superficial obstruction

Scanty amount of gastric juices is secreted with very little acid but much mucus.

Superficial Ulceration

Signs and Symptoms

Diarrhea Nausea
Vomiting Abdominal discomfort
Anorexia Headache
hiccuping

If treated: If not treated:

Patient recovers within 24 hrs., although GI bleeding
Output the appetite maybe diminished for an
Water Loss
exceeds additional of 2-3 days.
intake Loss of
appetite
Shock
Dehydration

Death

SIGNS AND SYMPTOMS

 The typical symptoms of gastritis may include stomach pain or discomfort, as
well as loss of appetite, nausea or even vomiting. In some cases, however, there may
only be mild symptoms, or even no symptoms at all. Food intake can sometimes
reduce or increase the abdominal discomfort.

 Stomach pain or discomfort - This can be absent, or range from mild to severe.
The pain can be aching, burning, or gnawing.
 Heartburn
 Loss of appetite
 Nausea and vomiting
 Vomiting of blood

- This may occur if the gastritis leads to tears or deep sores of the stomach lining. If
this is the case, the condition is referred to as erosive gastritis. Bleeding can occur
several days after the onset of acute gastritis.

 Fever

- This may occur in rare cases indicating serious infection - caused by pathogens
other than H. pylori.

 an unusual feeling of fullness in the stomach area

 feeling full too quickly after eating
 Black, tarry stool, vomiting blood or material that looks like coffee grounds - If
you have erosive gastritis, you might experience different symptoms

DIAGNOSTIC PROCEDURES

The healthcare provider will give a physical exam and ask about past health. Including
the tests:

Physical examination - To find out what is causing the symptoms, the doctor will
first feel your stomach and upper abdomen area. Depending on the type of symptoms,
your stomach might also be examined from the inside to find out more. Often, there
are no or only mild findings, such as a slight stomach tenderness. However, signs of
other conditions, as well as possible complications can be detected this way.

 Upper GI (gastrointestinal) series or barium

swallow. This X-ray checks the organs of the top
part of your digestive system. It checks the
esophagus, stomach, and the first part of your
small intestine (duodenum). You will swallow a
metallic fluid called barium. Barium coats the
organs so that they can be seen on the X-ray. 
 NR: Instruct the patient to drink plenty of
fluids, unless contraindicated, to help eliminate
 the barium. Give cathartic as prescribed. Tell the patient to notify the physician
if he fails to expel the barium in 2 to 3 days.  
 Upper endoscopy (EGD). This test looks at  the
inside of your esophagus, stomach, and duodenum. It
uses a thin, lighted tube, called an endoscope. The
tube has a camera at one end. Your healthcare
provider puts the tube into your mouth and throat.
Then the provider moves it into your esophagus,
stomach, and duodenum. Your provider can see the
inside of these organs. He or she can also take a small
tissue sample (biopsy) if needed.
 NR: Observing patient vital signs, keeping the patient informed throughout the
duration of the procedure, preparing the instruments, equipment and supplies
for the procedure and providing assistance to doctors throughout the
procedure.
 Blood tests. May show if H pylori is causing your gastritis by checking for
antibodies titers that fight H. pylori bacteria.
 Stool sample. This test checks to see if you have stomach bacteria that can
cause gastritis. A small sample of your stool is collected and sent to a lab. Another
stool test can check for blood in your stool. This may be a sign of gastritis if you
have bleeding.
 NR: Nurses educate clients about the purposes, required preparation,
procedures, results and the implications of abnormal and normal
diagnostic tests including the results of all laboratory tests and testing.
 Breath test. You may have a test where your breath is collected and analyzed
for a stomach bacteria. During an H. pylori breath test, you swallow a capsule or

liquid containing urea, a harmless radioactive material. You then exhale into a
balloon-like bag. H. pylori bacteria change urea into carbon dioxide. If you have the
bacteria, the breath test will show an increase in carbon dioxide.

MEDICAL MANAGEMENT
 Some cases of acute gastritis go away without treatment, and eating a bland
diet can aid in a quick recovery. Foods that are low in natural acids, low in fat, and
low in fiber may be tolerated best. Lean meats like chicken or turkey breast can be
added to the diet if tolerated, though chicken broth or other soups might be best if
vomiting keeps happening.

However, many people do need treatment for acute gastritis, with treatment and
recovery times depending on the cause of the gastritis. H. pylori infections may require
one or two rounds of antibiotics, which could last for two weeks apiece. Other
treatments, like those used to treat viruses, will involve taking medication to reduce
symptoms.

Medications

 Proton pump inhibitors (PPIs): These medications are very powerful blockers of
the stomach's ability to secrete acid. Examples are, ansoprazole (Prevacid),
rabeprazole (Aciphex), esomeprazole (Nexium), dexlansoprazole (Dexilant)

- Pantoprazole is a the amount of acid produced in the stomach.

- Omeprazole (Prilosec) blocks the enzyme in the wall of the stomach that produces
acid. By blocking the enzyme, the production of acid is decreased, and this allows
the stomach and esophagus to heal.

 Antiemetics: Antiemetic medications help control nausea and vomiting. A

number of different antiemetics can be used to control gastritis symptoms.
Some of these medications are available by prescription for home use as well.
Note that these medications do not improve the gastritis, but rather only
decrease the symptoms of gastritis.

- Domperidone is used for the relief of symptoms of excessive fullness, nausea,

stomach bloating and belching occasionally accompanied by stomach discomfort

 Histamine blockers: This class includes drugs whose mechanism of action is

competitive inhibition of histamine at the histamine 2 (H2) receptor. Histamine
plays an important role in gastric acid secretion, thereby making H2 blockers
effective suppressors of basal gastric acid output and acid output stimulated by
food and the neurological system. There are different drugs with different
potencies and half-lives (eg, cimetidine, ranitidine, famotidine, nizatidine

- Cimetidine (Tagamet) inhibits histamine at H2 receptors of gastric parietal cells,

which results in reduced gastric acid secretion, gastric volume, and hydrogen
concentration.
  Antibiotics: Bacterial infections also can cause gastritis. The most common
causative organism is H pylori. A number of therapeutic regimens are effective
against H pylori.

- Clarithromycin (Biaxin) inhibits bacterial growth, possibly by blocking the

dissociation of peptidyl t-RNA from ribosomes and causing arrest of RNA-
dependent protein synthesis.

- Metronidazole (Flagyl), Imidazole ring-based antibiotic active against various

anaerobic bacteria and protozoa.

- Amoxicillin (Amoxil, Trimox) interferes with the synthesis of cell wall

mucopeptides during active multiplication, resulting in bactericidal activity against
susceptible bacteria.

 Antacids such as Pepto-Bismol, TUMS, or milk of magnesia can be used to

neutralize stomach acid. These can be used as long as a person experiences
gastritis, with a dose taken as often as every 30 minutes if needed.
 Aside from those above medications, Rebamipide is also therapeutic and
effective as an anti-gastritis and anti-gastric ulcer drug used for mucosal
protection.

- Rebamipide is prescribed for the treatment of peptic ulcer, gastroduodenal ulcers,

and gastric disorders. It is indicated during bleeding, erosion, redness, and edema (all
signs of gastric mucosal lesions) that occur in acute gastritis and acute exacerbation
of chronic gastritis.

NURSING MANAGEMENT

 Assess signs and symptoms of dehydration, observation of vital signs,

measuring intake and output, encourage clients to drink ± 1500-2500ml,
observation of skin and mucous membranes, collaboration with doctor in the
provision of intravenous fluids.

 Assess food intake, body weight measured regularly, give oral care on a regular
basis, encourage clients to eat little but often, give food in warm, auscultation
bowel sounds, assess food preferences, check the laboratory.

Nursing care

Acute gastritis is self-limiting lasts few hours to a few days and complete
healing of gastric mucosa is expected. Decreased appetite and food intake persist for a
few days after symptoms subside. Client need intravenous access, client is usually
placed on NPO until symptoms subsides. When client can take oral nourishment
nonirritating diet is recommended.
 If client is vomiting, dehydration can occur quickly, intravenous fluid need to be
administered, promote rest and administer parenteral antiemetic as prescribed.
Observe client for signs of hemorrhage and check vomitus for blood. Monitor vital
signs very closely. Administer medications as ordered to reduce gastric mucosal
irritation and relief symptoms.

Client education

Teach the patient about gastritis

 Medication regimen, dose, and potential side effects.

 Keep food diary and avoid food and substances that trigger gastritis symptoms.

 Life style changes: Limit or avoid alcohol consumption, cigarette smoking.

 Avoid the use of aspirin and other NSAIDS if clinical feasible. If client must continue
to use NSAIDS, PPI maintenance is recommended to prevent recurrences.

 Good hand hygiene and safe food handling to decrease exposure to microbes
including H. pylori.

 Close medical follow-up.

 WESLEYAN
A METHODIST AUTONOMOUS UNIVERSITY
COLLEGE OF NURSING AND ALLIED MEDICAL SCIENCES
NURSING CARE PLAN
ASSESSMENT NURSING NURSING GOAL NURSING RATIONALE EVALUATION
DIAGNOSIS INTERVENTION

Subjective Data:  Deficient fluid volume Short term:  Independent:     Short Term Goal:
related to active fluid
- Loss of Appetite, volume loss After 12 hours, patient retain - Monitor vital signs at least - Increased After 12 hours, patient
“nawawalan na po ako ng feedings without experiencing every four hours. temperature and should be able retain
ganang kumain” as vomiting and no signs of respiratory rate feedings without
verbalize by the patient dehydration will be noted. contribute to fluid experiencing vomiting,
loss. blood pressure and
- Vomiting patient’s temperature
- Encourage patient to drink - To replace fluid should be at normal
Objective Data: loss without causing
prescribed fluid amounts. range.
Long term: further stomach
Vital Signs:
irritation Long Term Goal:
Temperature – 38.7C After 5 days of nursing
intervention, the patient - Weight patient daily and - Changes in After 5 days of nursing
Blood Pressure – 100/80 exhibit fluid and electrolyte monitor trends. weight can provide intervention, the patient
balance and should be able to information in fluid should be able to
Pulse Rate – 76bpm maintain his normal weight. balance and the exhibit fluid and
adequacy of fluid electrolyte balance and
Respiratory Rate – 19bpm
volume replacement should be able to
maintain his normal
- Accurate records
weight.
Method: - Ensure accurate intake and are critical in
output assessing patient’s
Inspection fluid.
Dependent:
 Palpation - Administer antiemetic meds
as ordered
Auscultation - To prevent further
- Administer IV therapy as fluid loss.
prescribed. - Parenteral fluid
replacement is
indicated to prevent
  shock.
Collaborative
 
- Report to the physician and
document output less than 30 - To encourage
ml/hr for 2 consecutive hours immediate response
and intervention.

DRUG STUDY FORM

Medication Dosage and Route of Action and Side effects and Indications and Nursing
Preparation Administration Classification Adverse Effects Contraindications Responsibilities and
(Generic Name, Considerations
Brand Name) (Tablet)
 - Delayed released         Indication: - Assess history
tablets (40 mg or of hypersensitivity to any
Generic Name: 20mg), - Oral Classification: - Headache, Oral: Short-term proton pump inhibitor or
Dizziness, Anxiety, (8weeks or less) and any drug components.
Pantroprazole Proton-pump inhibitor Diarrhea, Rash, long-term treatment of
- Delayed-Release
Oral Suspension Action: Abdominal pain, Duodenal ulcer;  - Arrange for further
administered Nausea, Constipation gastric ulcer; moderate evaluation of patient after
Brand Name: approximately 30 - Intravenous - Blocks the enzyme in and severe forms of 4weeks of therapy for
Protonix minutes prior to a the wall of the stomach - Seizures, tingling reflux esophagitis gastro-esophageal reflux
meal via oral that produces acid. By and numbness of disorders.
administration in blocking the enzyme, hands and feet, IV: Short-term (7-
apple juice or the production of acid watery stool 10days) treatment in - Maintain supportive
applesauce is decreased, and this patients unable to treatment as appropriate for
allows the stomach and continue oral therapy underlying problem.
-Intravenous (IV) esophagus to heal
form (40mg) Contraindication:
reconstituted with 10 Contraindicated with
mL of 0.9% Sodium hypersensitivity to any
Chloride Injection, proton pump inhibitor
USP, per vial to a
or any drug
final concentration of
components
approximately 4
mg/mL.

Medication Dosage and Route of Action and Side effects and Indications and Nursing Responsibilities
Preparation Administratio Classification Adverse Effects Contraindications and Considerations
(Generic Name,
 Brand Name) (Tablet) n
 Film-coated    Indication: - Take this medication by
Tablet (10 mg) mouth as prescribed
Generic Name: Oral Classification: - Dry mouth, The relief of nausea usually 30 minutes before
- It should be dizziness, anxiety, and vomiting,
Domperidone Prokinetic Drugs  meals and at bedtime
taken 15 to 30 flushing, diarrhea, epigastric sense of
Brand: minutes daily Action: painful or tender fullness, upper - Monitor for persistence
before meals breasts, absence or abdominal discomfort of nausea and vomiting to
Motilium and before Antiemetic: Facilitates suppression of and regurgitation of evaluate the effectiveness
bedtime. gastric emptying and menstruation gastric contents of the drug.
decreases small bowel (amenorrhea), milk
Domperidone transit time by increasing discharge from breasts Contraindication: - Monitor for signs of
1mg/ml Oral esophageal and gastric (galactorrhea). abdominal discomfort such
Suspension This product should
peristalsis and by as epigastric pain or
not be given to
lowering esophageal abdominal fullness.
- 10 ml (of oral patients with known
sphincter pressure
suspension allergy or intolerance - Monitor vital signs to
containing to domperidone or to determine signs of
domperidone any of its components, dehydration
1mg per ml) up those with
to three times gastrointestinal - Perform oral care
per day with a bleeding, obstruction - Do not increase your
maximum daily or perforation, and dose or take this more
dose of 30 ml prolactinoma.
per day. - Tell patient that she may
get dizzy or drowsy with
this drug, tell him not to sit
or stand quickly

Medication Dosage and Nursing

Route of Side effects and Indications and
(Generic Name, Preparation Action and Classification Responsibilities and
Administration Adverse Effects Contraindications
Brand Name) (Tablet) Considerations

     Classification:   CNS: drowsiness,   Indication: - Monitor BP upon

abnormal thinking, administration. <
Generic Name: Dosage: 30mg IV Non-opioid analgesics and dizziness, euphoria Short-term 90/80never
IV Non-steroidal anti- headache management of pain administer. Refer to
Ketorolac inflammatory drugs (up to 5 days) doctor.
RESPIRATORY:
Frequency: PRN - Patients who have
Action: asthma, dyspnea-
asthma, aspirin-
Brand Name: Inhibits prostaglandin CV: edema, pallor, Contraindication: induced allergy, and
synthesis, producing vasodilation nasal polyps are at
Toradol peripherally mediated Contraindicated with increased risk for
analgesia- Also has GI: GI Bleeding, significant renal developing
antipyretic and anti- abnormal taste, impairment, aspirin hypersensitivity
inflammatory properties.- diarrhea, dry mouth, allergy, recent GI reactions.
Therapeutic effect: dyspepsia, GI pain, bleed or perforation - Assess for rhinitis,
Decreased pain nausea- Use cautiously with
asthma, and urticaria.
impaired hearing;
GU: oliguria, renal - Assess pain (note
allergies; hepatic
toxicity, urinary type, location, and
condition
frequency intensity) prior to
and1-2 hr following
administration.
- Ketorolac therapy
should always be
given initially by the
IM or IV route. Oral
therapy should be
used only as a
continuation of
parenteral therapy.
- Caution patient to
avoid concurrent use
of alcohol, aspirin,
NSAIDs

Medication Dosage and Route of Action and Side effects and Indications and Nursing
Preparation Administration Classification Adverse Effects Contraindications Responsibilities and
(Generic Name, Considerations
Brand Name) (Tablet)
          
Generic Name: Tablet (100mg) Oral Classification: Rash, pruritus, Indication: -Monitor for any
constipation, adverse reaction-it
Rebamipide Antacids, Anti- Short-term management should be administer
- Usual Dose: 1 tab diarrhoea, nausea,
reflux Agents dizziness, loss of of pain (up to 5 days) before meals.
orally 3 times daily.
&Anti-ulcerant appetite, dry mouth
Brand Name: and blurred vision - Check the BP after
Action: giving the medication
Contraindication:
Mucosta
-A mucosal -Let the patient
protective agent Contraindicated with
significant renal verbalize discomfort
and is postulated after administration
to increase gastric impairment, aspirin
blood flow, allergy, recent GI bleed
prostaglandin or perforation Use
biosynthesis and cautiously with impaired
decrease free hearing; allergies;
oxygen radicals. hepatic condition