CHAPTER 50

UNIT 7 NURSING CARE OF CLIENTS WHO HAVE HEALTH PROMOTION AND

GASTROINTESTINAL DISORDERS
SECTION: UPPER GASTROINTESTINAL DISORDERS
DISEASE PREVENTION
Assist in the reduction of anxiety related to gastritis.

Acute and
●●

●● Follow a prescribed diet.

CHAPTER 50

Chronic Gastritis
●● Decrease or eliminate alcohol use.
●● The client who has pernicious anemia will need vitamin
B12 injections due to a decrease of the intrinsic factor by
the stomach parietal cells.
●● Watch for indications of GI bleeding.
Cyclooxygenase (COX) is an enzyme that ●● Follow the prescribed medication regimen.
produces mucosal prostaglandins, decreases ●● Eat small, frequent meals, avoiding foods and beverages
that cause irritation.
gastric acid, increases secretion of bicarbonate ●● Report constipation, nausea, vomiting, or bloody stools.
and cytoprotective mucus, and provides ●● Stop smoking.

maintenance of submucosal blood flow to

protect the gastric mucosa. ASSESSMENT
Gastritis is an inflammation in the lining of the
RISK FACTORS
stomach, either erosive or nonerosive, and can ●● Family member who has H. pylori infection
be acute or chronic. ●● Family history of gastritis
●● Prolonged use of NSAIDs, corticosteroids (stops
prostaglandin synthesis)
TYPES OF GASTRITIS ●● Excessive alcohol use
Nonerosive gastritis ( acute or chronic) is most often ●● Bile reflux disease
caused by an infection, Helicobacter pylori. ●● Advanced age
●● Radiation therapy
Erosive gastritis i s likely caused by NSAIDs, alcohol use ●● Smoking
disorder, or recent radiation treatment. ●● Caffeine
Acute gastritis has sudden onset, is of short duration, and ●● Excessive stress
can result in gastric bleeding if severe. A severe form of ●● Exposure to contaminated food or water
acute gastritis is caused by the ingestion of an irritant,
BACTERIAL INFECTION: Helicobacter pylori, Salmonella,
(such as a strong acid or alkali) and can result in the
Streptococci, Staphylococci, or Escherichia coli
development of gangrenous tissue or perforation. Scarring
can result leading to pyloric stenosis. AUTOIMMUNE DISEASES: Systemic lupus, rheumatoid
arthritis, and pernicious anemia
Chronic gastritis c
 an be related to autoimmune disease,
such as pernicious anemia, and H. pylori.

E xtensive gastric mucosal wall damage

can cause erosive gastritis (ulcers) and 50.1  H. pylori gastritis
increase the risk of stomach cancer.

RN ADULT MEDICAL SURGICAL NURSING CHAPTER 50  Acute and Chronic Gastritis 321

 EXPECTED FINDINGS PATIENT‑CENTERED CARE
PHYSICAL ASSESSMENT FINDINGS
●● Dyspepsia, general abdominal discomfort, indigestion NURSING CARE
●● Headache ●● Monitor fluid intake and urine output.
●● Hiccupping that can last for a few hours to several days ●● Administer IV fluids as prescribed.
●● Upper abdominal pain or burning can increase or ●● Monitor electrolytes. (Diarrhea and vomiting can
decrease after eating
deplete electrolytes and cause dehydration.)
●● Nausea and vomiting ●● Assist the client in identifying foods that are triggers.
●● Reduced appetite and weight loss ●● Provide small, frequent meals and encourage the client
●● Abdominal bloating or distention
to eat slowly.
●● Hematemesis (bloody emesis) and stools that test ●● Advise the client to avoid alcohol, caffeine, and foods
positive for occult blood
that can cause gastric irritation.
Manifestations can have rapid ●● Assist the client in identifying ways to reduce stress.
onset with acute gastritis. ●● Monitor for indications of gastric bleeding
(coffee‑ground emesis; black, tarry stools).
Erosive gastritis ●● Monitor for findings of anemia (tachycardia,
●● Black, tarry stools; coffee‑ground emesis

hypotension, fatigue, shortness of breath, pallor, feeling

●● Acute abdominal pain

lightheaded or dizzy, chest pain).

LABORATORY TESTS MEDICATIONS

Noninvasive tests
Histamine2 antagonists
CBC t o check for anemia
●● Women, Hgb less than 12 g/dL and RBC less than
ACTION: Decreases gastric acid output by blocking gastric
histamine2 receptors
4.2 cells/mcL
●● Men, Hgb less than 14 g/dL and RBC less than MEDICATIONS
4.7 cells/mcL ●● Nizatidine
●● Famotidine
Serum and stool antibody/antigen testfor presence of ●● Ranitidine
H. pylori ●● Cimetidine
C13 urea breath test: Used to measure H. pylori
NURSING INTERVENTIONS
●● Allow 1 hr before or after to administer antacid.
DIAGNOSTIC PROCEDURES Antacids can decrease the effectiveness of H2
receptor antagonists.
Upper endoscopy ●● Monitor for neutropenia and hypotension.
●● Dilute and administer slowly when given IV; rapid
A small flexible scope is inserted through the mouth
administration can cause bradycardia and hypotension.
into the esophagus, stomach, and duodenum to visualize
the upper digestive tract. This procedure allows for a CLIENT EDUCATION
biopsy, cauterization, removal of polyps, dilation, or ●● Advise clients not to smoke or drink alcohol.
diagnosis. (See CHAPTER 46: GASTROINTESTINAL DIAGNOSTIC ●● Advise clients to take oral dose with meals. Take
PROCEDURES.) famotidine 1 hr before meals to decrease heartburn, acid
indigestion, and sour stomach.
CLIENT EDUCATION ●● Advise clients to wait 1 hr prior to or following H2
●● Instruct the client to maintain NPO status 6 to 8 hr
receptor antagonist to take an antacid.
prior to procedure. ●● Advise clients to monitor for indications of GI bleeding
●● Advise the client to have a ride home available after
(black stools, coffee‑ground emesis).
the procedure.
●● Inform the client that a local anesthetic will be sprayed
onto the back of the throat, but throat can be sore
following the procedure.
●● Instruct the client to monitor for indications of
perforation (chest or abdominal pain, fever, nausea,
vomiting, and abdominal distention) and have
emergency contact numbers available.

322  CHAPTER 50  Acute and Chronic Gastritis CONTENT MASTERY SERIES

 Antacids Anti‑ulcer/mucosal barriers
ACTION ACTION: Inhibits acid and forms a protective coating
●● Increases gastric pH and neutralizes pepsin over mucosa
●● Improves mucosal protection
MEDICATIONS: Sucralfate
MEDICATIONS
NURSING INTERVENTIONS: Allow 30 min before or after to
●● Aluminum hydroxide
give antacid.
●● Magnesium hydroxide with aluminum hydroxide
CLIENT EDUCATION
NURSING INTERVENTIONS ●● Advise to take on an empty stomach.
●● Do not give to clients who have acute kidney injury or ●● Advise not to smoke or drink alcohol.
chronic kidney failure. ●● Advise to continue to take medication even if
●● Monitor aluminum antacids for aluminum toxicity and
manifestations subside.
constipation. Monitor magnesium antacids for diarrhea
or hypermagnesemia.
Antibiotics
CLIENT EDUCATION
ACTION: Eliminates H. pylori infection
●● Advise clients to take antacids on an empty stomach.
●● Advise clients to wait 1 hr to take other medications. MEDICATIONS
●● Clarithromycin
Proton pump inhibitors ●● Amoxicillin
●● Tetracycline
ACTION: Reduces gastric acid by stopping the hydrogen/ ●● Metronidazole
potassium ATPase enzyme system in parietal cells,
blocking acid production NURSING INTERVENTIONS
●● Monitor for increased abdominal pain and diarrhea.
MEDICATIONS ●● Monitor electrolytes and hydration if fluid is depleted.
●● Omeprazole ●● Should be administered with meals to decrease GI upset.
●● Lansoprazole ●● Use cautiously in clients who have kidney or
●● Rabeprazole sodium
hepatic impairment.
●● Pantoprazole
●● Esomeprazole CLIENT EDUCATION
●● Advise clients to complete prescribed dosage.
NURSING INTERVENTIONS ●● Advise clients to notify the provider of persistent
●● Can cause nausea, vomiting, and abdominal pain.
diarrhea, which can indicate superinfection of the bowel.
●● Use filter for IV administration for pantoprazole and
lansoprazole.

CLIENT EDUCATION
THERAPEUTIC PROCEDURES
●● Advise clients to allow 60 min before eating when Upper endoscopy: Surgery is prescribed for clients
taking esomeprazole. who have ulcerations or significant bleeding, or
●● Do not to crush or chew if any of the medications are when nonsurgical interventions are ineffective.
enteric‑coated or sustained‑release. (See CHAPTER 49: PEPTIC ULCER DISEASE.)
●● It can take up to 4 days to see the effects.
Vagotomy or highly selective vagotomy: A highly selective
●● Advise clients to take medication with or without food
vagotomy severs only the nerve fibers that control gastric
according to the instructions.
acid secretion, and often is done laparoscopically to reduce
postoperative complications. Pyloroplasty is usually done
Prostaglandins
at the same time as the vagotomy.
ACTION: Replacement for endogenous prostaglandins
Partial gastrectomy: Removal of the involved portion of
that stimulates mucosal protection. Reduces gastric
the stomach.
acid secretion.

MEDICATIONS: Misoprostol
INTERPROFESSIONAL CARE
NURSING INTERVENTIONS ●● A nutritionist can assist in alterations to diet.
●● May be given with NSAIDs to prevent gastric ●● Supportive care might be needed to reduce stress,
mucosal damage.
increase exercise, and stop smoking.
●● Can cause abdominal pain and diarrhea.

CLIENT EDUCATION
●● Advise clients to use contraceptives.
●● Advise clients not to take if there is a chance of
becoming pregnant.
●● Advise clients to take with food to reduce gastric effects.

RN ADULT MEDICAL SURGICAL NURSING CHAPTER 50  Acute and Chronic Gastritis 323

 COMPLICATIONS Dehydration
CAUSE: Loss of fluid due to vomiting or diarrhea
Gastric bleeding
NURSING ACTIONS
CAUSES ●● Monitor fluid intake and urine output.
●● Severe acute gastritis with deep tissue inflammation ●● Provide IV fluids if needed.
extending into the stomach muscle. ●● Monitor electrolytes.
●● In chronic erosive gastritis, bleeding can be slow or
profuse as in a perforation of the stomach wall. CLIENT EDUCATION: Instruct the client to contact a
provider for vomiting and diarrhea.
NURSING ACTIONS
●● Monitor vital signs and airway.
Pernicious anemia
●● Provide fluid replacement and blood products.
●● Monitor CBC and clotting factors. CAUSES
●● Insert a nasogastric (NG) tube for gastric lavage ●● Chronic gastritis can damage the parietal cells. This can
(irrigate with normal saline or water to stop active lead to reduced production of intrinsic factor, which is
gastric bleed) as indicated. Obtain an x‑ray to confirm necessary for the absorption of vitamin B12.
placement of NG tube prior to fluid instillation to ●● Insufficient vitamin B12 can lead to pernicious anemia.
prevent aspiration.
NURSING ACTIONS: Instruct the client of the need for
●● Monitor NG tube for absence or presence of blood, assess
monthly vitamin B12 injections.
the amount of bleeding, and prevent gastric dilation.
●● Administer IV medications (proton‑pump inhibitors,
Dumping syndrome
H2‑receptor antagonists) as prescribed.
CAUSES: The rapid release of metabolic peptides following
CLIENT EDUCATION: Instruct the client to monitor for
the ingestion of a food bolus.
indications of slow gastric bleeding (coffee‑ground
emesis; black, tarry stools). Seek immediate medical MANIFESTATIONS
attention with severe abdominal pain or vomiting blood. ●● Early manifestations: Feeling of fullness, weakness,
Take medications as directed. dizziness, palpitations, sweating, abdominal cramping,
and diarrhea
Gastric outlet obstruction ●● Manifestations resolve after having a bowel movement.
However, late or residual vasomotor manifestations can
CAUSE: Severe acute gastritis with deep tissue
occur 10 min to 3 hr after eating.
inflammation extending into the stomach muscle
NURSING ACTIONS
NURSING ACTIONS ●● Instruct client to lay down following meals to slow
●● Monitor fluids and electrolytes because continuous
movement of food through intestine and prevent
vomiting results in loss of chloride (metabolic alkalosis)
injury.
and severe fluid and electrolyte depletion. ●● Instruct the client to eat a high‑protein, high‑fat, low to
●● Provide fluid and electrolyte replacement. Monitor I&O.
moderate carbohydrate diet
●● Prepare to insert a NG tube to empty stomach contents. ●● Instruct to eat small meals and limit taking liquids
●● Prepare for a diagnostic endoscopy.
with meals.
CLIENT EDUCATION: Instruct the client to seek medical ●● Instruct client on self‑administration of octreotide
attention for continuous vomiting, bloating, and nausea. subcutaneous injection two to three times daily before
meals, as prescribed.

324  CHAPTER 50  Acute and Chronic Gastritis CONTENT MASTERY SERIES


1. A nurse is teaching about pernicious
anemia with a client who has
chronic gastritis. Which of the
following information should the
nurse include in the teaching?
A. Pernicious anemia is caused
when the cells producing
gastric acid are damaged.
B. Expect a monthly
injection of vitamin B12.
C. Plan to take vitamin
K supplements.
D. Pernicious anemia is caused
by an increased production
of intrinsic factor.
2. A nurse is providing discharge
teaching to a client who has a
new prescription for aluminum
hydroxide. Which of the following
information should the nurse
include in the teaching?
A. Take the medication with food.
B. Monitor for diarrhea.
C. Wait 1 hr before taking
other oral medications.
D. Maintain a low‑fiber diet.
RN ADULT MEDICAL SURGICAL NURSING CHAPTER 50  Acute and Chronic Gastritis 325
Application Exercises
3. A nurse is planning care for a client 5. A charge nurse is teaching a group
who has acute gastritis. Which of of unit nurses about a client who has
the following nursing interventions chronic gastritis and is scheduled
should the nurse include in the plan for a selective vagotomy. Which of
of care? (Select all that apply.) the following statements by a unit
A. Evaluate intake and output. nurse indicates understanding of
the purpose of the procedure?
B. Monitor laboratory
reports of electrolytes. A. “The client will have increased
duodenal gastric emptying.”
C. Provide three large
meals a day. B. “The client will have a reduction
of gastric acid secretions.”
D. Administer ibuprofen for pain.
C. “The client will have an increase
E. Observe stool characteristics.
of gastric mucus secretion.”
4. A nurse is teaching a client D. “The client will have an
who has a new prescription for increased secretion of
famotidine. Which of the following hydrogen/potassium
statements by the client indicates ATPase enzymes.”
understanding of the teaching?
A. “The medicine coats the
lining of my stomach.”
B. “The medication should
stop the pain right away.”
C. “I will take my pill 1 hr
before meals.”
D. “I will monitor for bleeding
from my nose.”
PRACTICE  Active Learning Scenario
A nurse is reviewing acute and chronic gastritis with
a group of clients. What should the nurse include
in this discussion? Use the ATI Active Learning
Template: System Disorder to complete this item.
ALTERATION IN HEALTH (DIAGNOSIS)
Describe gastritis.
●●
Compare/contrast acute vs. chronic gastritis.
●●
PATHOPHYSIOLOGY RELATED TO CLIENT
PROBLEM: Describe as related to client problem.
RISK FACTORS: Describe six.
 Application Exercises Key
1. A. Damage to parietal cells has occurred, which leads
to pernicious anemia and causes a decrease of the
intrinsic factor by the stomach parietal cells.
B. CORRECT: The nurse should include in the information that the client
will receive a monthly injection of vitamin B12 to treat pernicious anemia
due to a decrease of the intrinsic factor by the stomach parietal cells.
C. Vitamin K supplements are given to clients
who have a bleeding disorder.
D. Parietal cell damage results in insufficient production
of intrinsic factor by the stomach parietal cells.
NCLEX® Connection: Physiological Adaptation,
Alterations in Body Systems
2. A. The nurse should advise the client to take
aluminum hydroxide on an empty stomach.
B. The nurse should include in the teaching that
aluminum hydroxide can cause constipation.
C. CORRECT: The nurse should advise the client not to
take oral medications within 1 hr of an antacid.
D. The nurse should include in the teaching for the client to increase
dietary fiber due to the constipating effect of the medication.
NCLEX® Connection: Pharmacological and Parenteral Therapies,
Medication Administration
3. A. CORRECT: The nurse should evaluate the client’s intake
and output to prevent electrolyte loss and dehydration.
B. CORRECT: The nurse should monitor the client’s electrolyte
laboratory values to prevent fluid loss and dehydration.
C. The nurse should instruct the client to eat small, frequent meals.
D. The nurse should instruct the client to avoid taking
ibuprofen, an NSAID, because of its erosive capabilities.
E. CORRECT: The nurse should instruct the client to report
to the provider any indication of the presence of blood in
the stools, which can indicate gastrointestinal bleeding.
NCLEX® Connection: Physiological Adaptation,
Illness Management
4. A. Famotidine decreases gastric acid output. It
does not have a protective coating action.
B. The client might need to take famotidine for several days
before pain relief occurs when starting this therapy.
C. CORRECT: The client should take famotidine 1 hr before meals
to decrease heartburn, acid indigestion, and sour stomach.
D. The nurse should instruct the client to monitor
for GI bleeding when taking famotidine.
NCLEX® Connection: Pharmacological and Parenteral Therapies,
Medication Administration

5. A. Pyloroplasty will increase gastric emptying, which is performed

to widen the opening from the stomach to the duodenum.
B. CORRECT: Selective vagotomy will reduce gastric acid secretions.
C. Prostaglandin analog medication will stimulate mucosal
protection and decrease gastric acid secretions.
D. A histamine2 antagonist medication will inhibit gastric
secretion by inhibiting hydrogen/potassium ATPase
enzyme system in the gastric parietal cells.
NCLEX® Connection: Physiological Adaptation,
Alterations in Body Systems

PRACTICE Answer

Using the ATI Active Learning Template: System Disorder

ALTERATION IN HEALTH (DIAGNOSIS): Gastritis is an inflammation RISK FACTORS

of the lining of the stomach as a result of irritation to the mucosa. ●●
Bacterial infection (H. pylori, ●●
Autoimmune diseases
●●
Acute: Sudden onset, short duration, can result in gastric bleeding. Salmonella, Streptococci, ●●
Advanced age
●●
Chronic: Slow onset; when profuse, it can damage Staphylococci, E. coli) ●●
Radiation therapy
parietal cells, resulting in pernicious anemia. ●●
Family history of H. pylori ●●
Smoking
PATHOPHYSIOLOGY RELATED TO CLIENT PROBLEM: Gastric acid
●●
Prolonged use of NSAIDs ●●
Caffeine
overwhelms the production of COX 1 enzymes, which provide mucosal or corticosteroids ●●
Excessive stress
prostaglandins that line the stomach. This results in an erosion of
●●
Excessive alcohol use ●●
Exposure to contaminated
the mucosa and increases the risk for ulcers and stomach cancer. ●●
Bile reflux disease food or water
NCLEX® Connection: Physiological Adaptation, Alterations in Body Systems

326  CHAPTER 50  Acute and Chronic Gastritis CONTENT MASTERY SERIES