PILAR COLLEGE OF ZAMBOANGA CITY, INC.

R.T Lim Blvd., Zamboanga City

Tertiary Department

Care of Client with Acute Gastritis and Primary

Hypertension
 MEMBERS:

Parian, Pinabelle D.
Pisco, Vhince Norben C.
Portuito, Marvie Therese E.
Quitoy, Cedric James F.
Raveche, Afrin Nicole T.
Resurreccion, Benzreccli S.
Salialam, Shalamae A.
Salinas, Krystal Jane B.
Suarez, Marian T.
Tagayan, Ayrah A.
Tuti Rhidab L.
Villanueva, Sarah Kate M.
Yasin, Farnaiza S.

PANELIST:
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DATE:
 TABLE OF CONTENTS
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Significance of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Review of Related Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Definition of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Anatomy and Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . 10

Pathophysiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Patient's Profile and History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Gordon's 11 Functional Health Patterns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Cephalo-caudal Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Laboratory Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Drug Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Comprehensive Nursing Care Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Health Teaching Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Conclusions and Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Exhibits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
 TABLE OF CONTENTS

FIGURES

Figure 1 (Anatomy of Gastrointestinal Tract) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Figure 2 (Anterior View of the Human Heart) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Figure 3 (Anatomy of the Circulatory System) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Figure 4 (Pathophysiology of Acute Gastritis) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Figure 5 (Pathophysiology of Hypertension) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Figure 6 (Pathogenesis of Acute Gastritis) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Figure 7 (Pathogenesis of Hypertension) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

TABLES

Table 1 (Cardiac enzyme results) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Table 2 (ECG result) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

Table 3 (ABG results) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Table 4 (ABG results 1 days since admission) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Table 5 (sodium bicarbonate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Table 6 (omeprazole) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Table 7 (metoclopramide hydrochloride) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Table 8 (amoxicillin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Table 9 (dextrose) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Table 10 (Plain NSS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Table 11 (nifedipine) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Table 12 (cimetidine) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Table 13 (Nursing Care Plan No. 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Table 14 (Nursing Care Plan No. 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Table 15 ( Nursing Care Plan No. 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Table 16 (Health Teaching Plan) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

 EXECUTIVE SUMMARY

Gastritis is the inflammation of the lining in the stomach, and it is a common GI problem.
Gastritis may be acute, lasting for several hours to a few days, or chronic, resting from repeated
exposure to irritating agents or recurring episodes of acute gastritis. It is often caused by Dietary
indiscretion – a person eats food that is irritating, too highly seasoned, or contaminated with
disease-causing organisms. It may also develop after major surgery, traumatic injury, burns, or
severe infections. Many people with gastritis experience no symptoms at all. However, upper
central abdominal pain is the most common symptom. Other symptoms are indigestion,
abdominal bloating, belching, nausea, vomiting, and pernicious anemia.

This study concluded that the past and present health history, as well as lifestyle choices,
plays a significant role in the development of gastritis. Among all the possible causes of gastritis,
history of H. Pylori infection, extreme consumption of spicy foods, chronic stress, and probable
GERD condition are the existing precipitating factors. Epigastric pain is the primary symptom of
gastritis that is aggravated by the intake of food, positioning, and turning to sides may exacerbate
its symptoms. Healthy lifestyle choices are necessary to prevent the development of gastritis, and
also early medical interventions and medication administration help improve a patient’s
condition.

Acute gastritis should be managed through a unified team approach including medical,
pharmacologic, nutritional, and assistive management. Signs and symptoms manifest by the
patient must not be ignored for it may cause further injury, immediate medical and
pharmacological assistance is necessary. An individual must observe a healthy lifestyle and must
seek medical intervention when signs and symptoms are first noticed. Utilize the family
members to establish effective techniques to manage the patient's demands and provide support
to strengthen their relationship as a support system. Client-centered nursing care plans shall be
applied in all areas in providing quality nursing care.

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 INTRODUCTION

Identification of Focal Problem/Case

Gastritis is inflammation of the lining of the stomach and is a common GI problem.

Gastritis maybe acute, lasting for several hours to a few days, or chronic, resting from repeated
exposure to irritating agents or recurring episodes of acute gastritis. It has many possible
causes. Common causes of gastritis include excessive alcohol consumption or prolonged use
of nonsteroidal anti-inflammatory drugs (also known as NSAIDs) such as aspirin or ibuprofen.
Acute Gastritis is often caused by Dietary indiscretion – person eats food that is irritating, too
highly seasoned or contaminated with disease causing organisms. It may also develop after major
surgery, traumatic injury, burns, or severe infections. Gastritis may also occur in those who have
had weight loss surgery resulting in the banding or reconstruction of the digestive tract. Chronic
causes are infection with bacteria, primarily Helicobacter pylori, chronic bile reflux, and stress;
certain autoimmune disorders can cause gastritis as well.

Many people with gastritis experience no symptoms at all. However, upper

central abdominal pain is the most common symptom, other symptoms are indigestion,
abdominal bloating, belching, nausea, vomiting and pernicious anemia. Some may have a feeling
of fullness or burning in the upper abdomen. The pain may be dull, vague, aching, gnawing, sore,
or sharp. Pain is usually located in the upper central portion of the abdomen, but it may occur
anywhere from the upper left portion of the abdomen around to the back. The early signs of
gastritis are loss of appetite and unexplained weight loss.

An esophagogastroduodenoscopy, blood test, complete blood count test, or a stool test

may be used to diagnose gastritis. Treatment includes taking antacids or other medicines, such
as proton pump inhibitors, antibiotics, and avoiding hot or spicy foods. For those with pernicious
anemia, B12 injections are given, but more often oral B12 supplements are recommended. 

Hypertension is commonly referred to as ‘High blood pressure’, HTN, or HPN, it is a

medical condition in which the blood pressure is chronically elevated. Hypertension is rarely
severe enough to cause symptoms. These typically only surface with systolic blood pressure of
over 240 mmHg and/or a diastolic pressure of over 120 mmHg. Hypertension can be classified as
either Primary (Essential) or Secondary. Primary hypertension is the form of hypertension that

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by definition has no identifiable cause, but there are many risk factors such as sedentary lifestyle,
obesity, alcohol intake, salt sensitivity, and vitamin deficiency. It is also related to aging and
genetics. Initial first-line therapy for stage 1 hypertension related to primary hypertension
includes thiazide diuretics, CCBs, and ACE inhibitors or ARBs. Secondary hypertension is
caused by another condition such conditions that affect your kidneys, arteries, heart or endocrine
system. Secondary hypertension can also occur during pregnancy. Proper treatment of secondary
hypertension can often control both the underlying condition and the high blood pressure, which
reduces the risk of serious complications including heart disease, kidney failure and stroke.

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 SIGNIFICANCE OF THE STUDY

This case analysis will be of great benefit to the following people:

Patient:  Equip the patient with knowledge regarding the condition so that lifestyle change will
be possible, and optimize the patient’s level of functioning to achieve early recovery and
independence.
Patient’s Family: Utilize the family members to establish effective techniques to manage the
patient's demands and provide support in order to strengthen their relationship as a support
system.
Nursing Students:   Improve the critical-thinking, attitude, and problem-solving skills with the
goal of providing high-quality, evidence-based nursing care to patients with similar diseases, and
use this study as a foundation for future study.

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 REVIEW OF RELATED LITERATURE

Gastritis is swelling of the gastric mucosa caused by inflammation due to irritation and
infection. One of the pathogens that causes infection in the stomach is Helicobacter Pylori
bacteria (Sandi et al, 2021). According to Zhao Y et al., (2020) Helicobacter pylori, is a kind of
human pathogen, have infected an estimated 50% of the global population. It can lead to loss of
gastric glands and increase the risk of dysplasia, gastritis, digestive ulcer, and gastric cancer. H.
pylori infection has been suggested to be associated with other kinds of gastrointestinal cancers
and gastroesophageal reflux disease (GERD) as one of the most common upper gastrointestinal
disorders worldwide with the typical symptoms of heartburn and regurgitation.

Aside from Helicobacter pylori, long-term use of NSAIDs can also cause irritation to the
stomach. NSAIDs reduce the production of the hormone prostaglandin. One of the things
prostaglandins does is increase the production of gastric (stomach) mucus and substances that
neutralize stomach acid. If there is too little prostaglandin, the stomach lining becomes more
susceptible to damage from stomach acid. It can then become inflamed, and eventually ulcers
may develop (NCBI, 2018). Other factor that may contribute to the development of gastritis are
smoking, diet and stress.

Gastritis is classified as "acute" or "chronic" from a clinical and pathological perspective.

These two phrases are frequently used interchangeably to mean self-limitation and non-self-
limitation (Rugge, 2020). Acute (sudden) gastritis affects about 8 out of every 1,000 people.
While chronic or long-term gastritis is less common. Affecting approximately 2 out of 10,000
people (Cleveland Clinic, 2020).

An acute gastritis is an inflammation or irritation of the stomach lining. It affects people

of all ages, though it’s more common in adulthood and old age. The typical symptoms may
include stomach pain or discomfort, as well as loss of appetite, nausea or even vomiting
(Novorol, 2021). Rose Kivi (2019) also stated that acute gastritis comes on suddenly, and can be
caused by injury, bacteria, viruses, stress, or ingesting irritants such as alcohol, NSAIDs,

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steroids, or spicy food. It is often only temporary. While chronic gastritis, on the other hand,
comes on more slowly and lasts longer. Untreated gastritis can lead to ulcers, persistent pain, and
bleeding. In some cases, it can become life-threatening.

According to Debra Fulghum Bruce, PhD (2021) In stage 1 hypertension, also known as
prehypertension, the systolic (top number) reading is 120 mmHg-139 mmHg, or the diastolic
(bottom number) reading is 80 mmHg-89 mmHg. Prehypertension is a warning sign that you may
get high blood pressure in the future. High blood pressure increases your risk of heart attack, stroke,
coronary heart disease, heart failure, and kidney failure. There's no cure for high blood pressure, but
there is treatment with diet, lifestyle habits, and medications. We know that starting as low as 115/75
mmHg, the risk of heart attack and stroke doubles for every 20-point jump in systolic blood pressure
or every 10-point rise in diastolic blood pressure for adults aged 40-70. MFine (2020), also stated
the connection between high blood pressure and heartburn/gastritis has been a long researched
one. A research study from China published in the Journal of Clinical Gastroenterology in 2018
confirmed that GERD and hypertension may have the link in the form of elevated BP during
reflux attacks in patients already suffering from hypertension.

Gastritis is more common among the adolescents, but it can affect anyone at any age. A
variety of mild to severe stomach symptoms may indicate gastritis. Gastrointestinal system is one
of the systems of our body which deals with Diet-its intake, absorption, metabolism and
elimination. Gastritis can be cured with appropriate antibiotic treatment. However, many
healthcare providers do not treat gastritis patient with antibiotics rather than by lifestyle
modification. As a part of global health programmed in the 21st century, it is necessary to
explore alternative approaches to provide better health services to people and the focus of
nursing intervention is education and modification of client’s behaviors to promote health and
lifestyle pattern (Padmavathi GV et al, 2018).

Treatments for gastritis vary and depend on successful treatments of its underlying cause
and regardless of the cause or severity of symptoms, making dietary and lifestyle adjustments
may help treat gastritis or prevent it from occurring. Managing stress and pain with relaxation
techniques and practices may also be helpful. Davis et al, (2021) also stated that a diet that
avoids hot, fried, and/or spicy foods, alcohol drinking, or eating items you may be allergic to is
another good way to both treat and reduce the risk of gastritis, as well as using over-the-counter
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(OTC) and prescription medications for symptom relief. Some medications used to treat gastritis
are the following: H2 blockers medicine is used to reduce the amount of acid in the stomach,
including cimetidine, nizatidine, and famotidine. Proton pump inhibitors also reduce the amount
of acid in the stomach. They include omeprazole, esomeprazole, lansoprazole, rabeprazole and
pantoprazole. Proton pump inhibitors are very safe and effective for short-term use. But long-
term use isn’t recommended for most people, especially older people. If taking proton pump
inhibitors for a long time, the patient should talk to a doctor about whether to reduce the dose or
not (Health Direct, 2021).

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 DEFINITION OF TERMS

ACUTE GASTRITIS - Acute gastritis is a sudden inflammation or swelling in the lining of the
stomach that causes severe and nagging pain. However, the pain is temporary and usually lasts
for short bursts at a time. (Healthline, 2019)

CHRONIC GASTRITIS - is a long-term condition in which the mucus lined layer of the
stomach, also known as the gastric mucosa, is inflamed or irritated over a longer period of time.
Symptoms tend to appear slowly, over time. (Ada, 2020)

EROSIVE GASTRITIS - is gastric mucosal erosion caused by damage to mucosal defenses. It

is typically acute, manifesting with bleeding, but may be subacute or chronic with few or no
symptoms. Diagnosis is by endoscopy. Treatment is supportive, with removal of the inciting
cause and initiation of acid-suppressant therapy. (MSD Manuals, 2021)

ESOPHAGUS - is the muscular tube that carries food and liquids from your mouth to the
stomach. You may not be aware of your esophagus until you swallow something too large, too
hot, or too cold. You may also notice it when something is wrong. You may feel pain or have
trouble swallowing. (Medline, 2020)

DIGESTIVE ULCER - is a round or oval sore where the lining of the stomach or duodenum
has been eaten away by stomach acid and digestive juices. (MSD Manuals, 2021)

DYSPHAGIA - difficulty swallowing (dysphagia) means it takes more time and effort to move
food or liquid from your mouth to your stomach. Dysphagia may also be associated with pain. In
some cases, swallowing may be impossible. (MayoClinic, 2019)

DYSPLASIA - is a proliferative lesion that is characterized by a loss in the uniformity of

individual cells in a tissue and loss in the architectural orientation of the cells in a tissue.
(Essential Concepts in Molecular Pathology, Second Edition, 2020)

ESOPHAGOGASTRIC JUNCTION - is a muscle, not a mucosal, junction. The boundary of

the esophagus is at the upper esophageal sphincter and lower esophageal sphincter (LES) at the
oral and anal ends, respectively. The distal end of the LES is the esophagogastric junction.
(PubMed, 2015)

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GASTRITIS - is an inflammation, irritation, or erosion of the lining of the stomach. (WebMD,
2020)

GASTRIC CANCER - is a disease in which malignant (cancer) cells form in the lining of the
stomach. Age, diet, and stomach disease can affect the risk of developing gastric cancer.
Symptoms of gastric cancer include indigestion and stomach discomfort or pain. (Cancer.Gov,
2021)

GERD - (gastroesophageal reflux disease, or chronic acid reflux) is a condition in which acid-
containing contents in your stomach persistently leak back up into your esophagus, the tube from
your throat to your stomach. (Cleveland Clinic, 2021)

GASTRIC MUCUS MEMBRANE - is 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. (Britannica, 2016)

HELICOBACTER PYLORI - (H. pylori) is a gram-negative bacterium that causes chronic

inflammation and is contagious. These bacteria are sometimes termed "ulcer bacteria."
(Medicinenet, 2021)

NAUSEA - is an uneasiness of the stomach that often comes before vomiting. Vomiting is the
forcible voluntary or involuntary emptying ("throwing up") of stomach contents through the
mouth. (WebMD, 2020)

PREHYPERTENSION - is defined as a systolic pressure from 120–139 millimeters of mercury

(mm Hg) or a diastolic pressure from 80–89 mm Hg. Because blood pressure changes often, your
health care provider will check it on several different days before deciding whether your blood
pressure is too high. (Kidney.org, 2014)

PYROSIS - A technical term for what is popularly called heartburn, a burning sensation in the
upper abdomen. In many languages there is a technical term such as pyrosis and a popular term
for the same phenomenon. (Rxlist, 2021)

REGURGITATION - happens when a mixture of gastric juices, and sometimes undigested

food, rises back up the esophagus and into the mouth. (Healthline, 2019)

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STOMACH - is a muscular organ located on the left side of the upper abdomen. The stomach
receives food from the esophagus. As food reaches the end of the esophagus, it enters the
stomach through a muscular valve called the lower esophageal sphincter. (WebMD, 2020)

STOMACH ACID - or gastric acid, is a watery, colorless fluid that’s produced by your
stomach’s lining. (Healthline, 2019)

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 ANATOMY AND PHYSIOLOGY

Gastrointestinal tract

The GI tract is a 23- to 26-foot-long pathway that extends from the mouth through the
esophagus, stomach, and intestines to the anus. The esophagus is located in the mediastinum in
the thoracic cavity, anterior to the spine and posterior to the trachea and heart. This collapsible
tube, which is about 25 cm (10 inches) in length, becomes distended when food passes through
it. It passes through the diaphragm at an opening called the diaphragmatic hiatus.

The remaining portion of the GI tract is located within the peritoneal cavity. The stomach
is situated in the upper portion of the abdomen to the left of the midline, just under the left
diaphragm. It is a distensible pouch with a capacity of approximately 1500 mL. The inlet to the
stomach is called the esophagogastric junction; it is surrounded by a ring of smooth muscle
called the lower esophageal sphincter (or cardiac sphincter), which, on contraction, closes off the
stomach from the esophagus. The stomach can be divided into four anatomic regions: the cardia
(entrance), fundus, body, and pylorus (outlet). Circular smooth muscle in the wall of the pylorus
forms the pyloric sphincter and controls the opening between the stomach and the small intestine

The small intestine is the longest segment of the GI tract, accounting for about two thirds
of the total length. It folds back and forth on itself, providing approximately 7000 cm of surface
area for secretion and absorption, the process by which nutrients enter the bloodstream through
the intestinal walls. The small intestine is divided into three anatomic parts: the upper part, called
the duodenum; the middle part, called the jejunum; and the lower part, called the ileum. The
common bile duct, which allows for the passage of both bile and pancreatic secretions, empties
into the duodenum at the ampulla of Vater. The junction between the small and large intestine,
the cecum, is located in the right lower portion of the abdomen. The ileocecal valve is located at
this junction. It controls the passage of intestinal contents into the large intestine and prevents
reflux of bacteria into the small intestine. The vermiform appendix is located near this junction.

The large intestine consists of an ascending segment on the right side of the abdomen, a
transverse segment that extends from right to left in the upper abdomen, and a descending
segment on the left side of the abdomen. The terminal portion of the large intestine consists of
two parts: the sigmoid colon and the rectum. The rectum is continuous with the anus. A network

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of striated muscle that forms both the internal and the external anal sphincters regulates the anal
outlet.

FUNCTION OF THE DIGESTIVE SYSTEM

All cells of the body require nutrients. These nutrients are derived from the intake of food
that contains proteins, fats, carbohydrates, vitamins and minerals, and cellulose fibers and other
vegetable matter of no nutritional value. The primary digestive functions of the GI tract are the
following:

 To break down food particles into the molecular form for digestion
 To absorb into the bloodstream the small molecules produced by digestion
 To eliminate undigested and unabsorbed foodstuffs and other waste products from the
body
After food is ingested, it is propelled through the GI tract, coming into contact with a
wide variety of secretions that aid in its digestion, absorption, or elimination from the GI
tract

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 Figure 1: Anatomy of Gastrointestinal Tract

Heart
The cardiovascular system can be compared to a muscular pump equipped with one-way
valves and a system of large and small plumbing tubes within which the blood travels.
The heart is composed of three layers. The inner layer, or endocardium, consists of
endothelial tissue and lines the inside of the heart and valves. The middle layer, or myocardium,
is made up of muscle fibers and is responsible for the pumping action. The exterior layer of the
heart is called the epicardium. The heart is encased in a thin, fibrous sac called the pericardium,
which is composed of two layers. Adhering to the epicardium is the visceral pericardium.
Enveloping the visceral pericardium is the parietal pericardium, a tough fibrous tissue that
attaches to the great vessels, diaphragm, sternum, and vertebral column and supports the heart in
the mediastinum. The space between these two layers (pericardial space) is filled with about 30
mL of fluid, which lubricates the surface of the heart and reduces friction during systole.

Figure 2. Anterior View of the Human Heart

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 The cardiac conduction system generates and transmits electrical impulses that stimulate
contraction of the myocardium. Under normal circumstances, the conduction of the system first
stimulates contraction of the atria and then the ventricles.
The synchronization of the atrial and ventricular events allows the ventricles to fill
completely before ventricular ejection, thereby maximizing cardiac outputs. Three physiologic
characteristics of two types of specialized electrical cells, the Nodal Cells, and the Purkinje
Cells, provide this synchronization:
1. Automaticity: Ability to initiate an electrical impulse
2. Excitability: Ability to respond to an electrical impulse
3. Conductivity: Ability to transmit an electrical impulse
Circulatory Sytem
The circulatory system moves blood throughout the body. The circulatory system is
composed of the heart, arteries, capillaries, and veins. This remarkable system transports
oxygenated blood from the lungs and heart throughout the body via the arteries. The blood goes
through the capillaries which are situated between the arteries and veins. And the blood that has
been depleted of oxygen by the body is then returned to the lungs and heart via the veins.
Arteries carry blood away from the heart and veins carry blood back to the heart. The
circulatory system carries oxygen, nutrients, and hormones to cells, and removes waste products,
like carbon dioxide. These roadways travel in one direction only, to keep things going where
they should.

14
 Figure 3. Anatomy of the Circulatory System
PATHOPHYSIOLOGY

Gastritis is a general term for a group of conditions with one thing in common: inflammation
in the lining of the stomach. There are two (2) types of gastritis, the one that occur suddenly is
called acute gastritis and if it will last from weeks to years then it results to chronic gastritis.
Acute gastritis is a term that encompasses a broad spectrum of entities that induce inflammatory
changes in the gastric mucosa. It is a sudden onset inflammation of the stomach lining due to the
injury of the mucosal layer that serves as a protectant from its stomach acid. Exposure of the
mucosa to stomach acid can lead to swelling, inflammation, and erosion of mucosal lining.

The inflammation of gastritis is most often the result of infection with the same bacterium
(Helicobacter pylori) that causes most stomach ulcers. Regular use of certain pain relievers
(NSAID) that may reduce a key substance that helps preserve the protective lining of your
stomach, drinking too much alcohol as it likely irritates and erode your stomach lining, which
makes your stomach more vulnerable to digestive juices and chronic stress are all factors that
contribute to acute gastritis. And if it is left untreated, gastritis may lead to stomach ulcers or
worn away areas of the stomach lining that can lead to bleeding of the GI tract. Rarely, some
forms of chronic gastritis may increase your risk of hypovolemic shock and worst death.

15
 Risk Factor

Modifiable Factor

Non-Modifiable Factor -Dietary Factor (Consumption of spicy foods, caffeine

and high acidic food)
-Age (Women:45-64 yrs. old, Men: > 65 years
- Bile Reflux - Underlying condition (GERD)
old)
-Excessive Alcohol Intake
-Gender (Both)
-Overuse of aspirin and NSAID
-Family History
-Stress
-Race (Asian and Hispanic people)
-Ingestion of bacteria (Helicobacter Pylori)

Gastric mucous membrane becomes Gastric mucous membrane undergoes

edematous and hyperemic superficial erosion

Superficial ulceration and inflammation

of stomach lining Scanty amount of gastric juice is secreted
with very little acid but much mucus

Appearance of Signs and Symptoms

(Diarrhea, anorexia, nausea, epigastric pain,
vomiting, headache, fever and hiccups)

If treated: If not treated:

GI ulcers/bleeding (hemorrhage)
Patient recovers within 24 hours although
the appetite maybe diminished for an
additional of 2-3 days
Shock (Hypovolemic)

16
Death
 Blood pressure is the product of cardiac output multiplied by peripheral resistance.
Figure 4: Pathophysiology of Acute Gastritis
Cardiac output is the product of the heart rate multiplied by the stroke volume. Each time the
heart contracts, pressure is transferred from the contraction of the heart muscle to the blood and
then pressure is exerted by the blood as it flows through the blood vessels. Hypertension can
result from increases in cardiac output, increases in peripheral resistance (constriction of the
blood vessels), or both. Increases in cardiac output are often related to an expansion in vascular
volume. Although no precise cause can be identified for most cases of hypertension, it is
understood that hypertension is a multifactorial condition. Because hypertension can be a sign, it
is most likely to have many causes, just as fever has many causes. For hypertension to occur
there must be a change in one or more factors affecting peripheral resistance or cardiac output. In
addition, there must also be a problem with the body’s control systems that monitor or regulate
pressure.
The tendency to develop hypertension is inherited; however, genetic profiles alone cannot
predict who will and will not develop hypertension. In fact, researchers estimate that genetics
play a role in explaining blood pressure variation between individuals in 30% to 70% of many
causes of hypertension, increased sympathetic nervous system activity related to dysfunction of
the autonomic nervous system increased renal reabsorption of sodium chloride, and water related
to a genetic variation in the pathways by which the kidneys handle sodium. Increased activity of
the renin–angiotensin–aldosterone system, resulting in expansion of extracellular fluid volume
and increased systemic vascular resistance, decreased vasodilation of the arterioles related to
dysfunction of the vascular endothelium Resistance to insulin action, which may be a common
factor linking hypertension, type 2 diabetes, hypertriglyceridemia, obesity, and glucose
intolerance Activation of the innate and adaptive components of the immune response that may
contribute to renal inflammation and dysfunction.
Stage 1 hypertension, also known as prehypertension, the systolic (top number) reading is
120 mmHg-139 mmHg, or the diastolic (bottom number) reading is 80 mmHg-89 mmHg.
Prehypertension is a warning sign that you may get high blood pressure in the future. High blood
pressure increases your risk of heart attack, stroke, coronary heart disease, heart failure, and

17
kidney failure. There's no cure for high blood pressure, but there is treatment with diet, lifestyle
habits, and medications. We know that starting as low as 115/75 mmHg, the risk of heart
attack and stroke doubles for every 20-point jump in systolic blood pressure or every 10-point
rise in diastolic blood pressure for adults aged 40-70.

18
 Modifiable:
Non-Modifiable:
-Obesity -Excessive Alcohol Consumption
-Family History
-Smoking -Stress
-Age (18-65 years old)
-High Salt Intake

Increased sympathetic activity

Changes in arteriolar bed

Systemic vascular resistance

Afterload
Beta-receptor activation

Arterial vasoconstriction
Adrenal cortex
stimulation

Sodium reabsorption

Increased blood pressure H2O reabsorption

Figure 5. Pathophysiology of Hypertension

19
 Risk Factors
PATHOGENESIS

The current classification of gastritis is based on the time course of the disease as well as the
underlying pathological mechanism. Factors that play a crucial role in the pathogenesis of acute
gastritis include bacterial infection (Helicobacter pylori), dietary factors (excessive consumption
of spicy food), chronic stress and probably acid reflux (GERD). Several mechanisms that may
contribute to the development of ulceration of the gastric mucosa include the imbalanced
production of stomach acid and the bicarbonate buffer system, which cause excessive exposure
of the mucosa to stomach acid. All of this will lead to inflammation of the gastric mucosa. These
are the following signs and symptoms that appear in the patient, such as epigastric pain, fever,
nausea, vomiting, difficulty of breathing, and heartburn.
The pathogenesis of essential hypertension is multifactorial and highly complex. The
kidney is both the contributing and the target
Blood flow to organs
organ of the hypertensive processes, and the disease
involves the interaction of multiple organ
Juxtaglomerular cells
systems and numerous mechanisms of
independent or Kidney release renin into the bloodstream interdependent
Angiotensinogen Angiotensin I
pathways. Factors that play an important role in
the pathogenesis of hypertension include genetics, activation of neuro-hormonal systems such as
Angiotensin-Converting Enzyme (ACE)
the sympathetic nervous system and renin-angiotensin-aldosterone system, obesity,II and
Angiotensin
increased dietary salt intake. Arterial hypertension is the condition of persistent elevation of
systemic blood pressure (BP). BP is the product of cardiac output and total peripheral vascular
resistance.
Peripheral resistance

Aldosterone

20
 Risk Factors:
-Dietary Factor (Consumption of
spicy foods (Meegoreng/Satti)
-Chronic Stress
-Underlying condition (GERD)
-History of Pyrosis

Increased stomach acid production Decreased production of HC03 buffer

Interference with the protective

mechanism of gastric mucosa

Decreased production of gastric Increased vulnerability to gastric acid

mucus

Irritation, erosion and inflammation of

stomach lining

Appearance of sign and Symptoms

(Epigastric pain, nausea, vomiting, abdominal
discomfort, fever) ACUTE GASTRITIS

21
 Figure 6. Pathogenesis of Acute Gastritis

Persistent psychological stress, increasing age, diet,

Physical inactivity

Increased
sympathetic activity

Vasoconstriction

Increased Decreased
peripheral
resistance Blood flow
Decreased
Increased intravascular oxygen supply
Pressure

-Shortness of breath
BP= 150/100 mmHg
-Oxygen saturation= 93%
-PR= 108 b/min
-RR= 24 br/ min

Hypertension

Figure 7. Pathogenesis of Hypertension

22
 PATIENT’S PROFILE

Name: Patient S

Age: 46 years Old

Sex: Female

Civil Status: Married

Occupation: Bank Manager

Religion: Islam

Weight: 51 Kilograms

Height: 5’6

HISTORY OF PRESENT ILLNESS:

Two days PTA the patient complained of epigastric pain but did not paid much attention
to it. One day PTA the patient complained of epigastric pain that worsens with food, shortness of
breath, nausea and vomiting, difficulty swallowing, diaphoresis and loss of appetite. Hours prior
to the admission the patient was at the bank entertaining clients. According to the patient’s
secretary the patient reported to her and verbalized that she was in pain, while grabbing her
abdomen with facial grimacing. An ambulance was called and the patient was rushed to the
hospital. The admitting diagnosis was “Acute Gastritis probably from GERD, Stage 1
Hypertension; r/o Myocardial Injury”

HISTORY OF PAST ILLNESS:

According to the husband of the patient, the patient was diagnosed with Primary
hypertension at the age of 32 with nifedipine (Calcibloc) 30mg PO as her daily maintenance, the
patient was diagnosed with Streptococcal Pharyngitis 4 years ago, oral antibiotics (Amoxicillin)

23
was prescribed to the patient. The patient had a history of Pyrosis 11 months ago, Antacids was
advised. The patient underwent a cesarean section at the age of 28 years old. She was first
admitted at the age of 5 due to Cholera, been isolated and antibiotic therapy was given.

GORDONS 11 FUNCTIONAL HEALTH PATTERNS

Health perception- Health Management pattern

According to the husband of the patient, the patient was first admitted when she was still
5 years old because of cholera and was isolated and given antibiotic therapy that time, he
classified that the patient had history of Streptococcal Pharyngitis 4 years ago with some oral
antibiotics called amoxicillin prescribed. According to the husband of the patient, the patient was
diagnosed of Primary Hypertension at the age of 32 with nifedipine (Calcibloc) 30mg PO as
daily maintenance.

Nutrition and Metabolism Pattern

The husband of the patient stated that she eats three times a day on regular days, her
favorite foods were meegoreng and satti. According to the husband, two days ago before the
epigastric pain the patient complained of nausea and stomach cramps but did not pay much
attention to it, and a day before the admission the patient complained of nausea, vomiting, and
difficulty swallowing.

At present, according to the patient she is still experiencing epigastric pains twice; once
at 6 AM and another at 9 AM. According to the patient, she is still in pain and had a poor
appetite. Currently, she is on NPO, with IVF D5%W and 0.9% NaCl alternately at a total of
3,000 mL/ day with 2,200 ml input in the past 24 hours. Her current body weight is 51 kilograms
with a BMI of 18.13 which is underweight.

Elimination Pattern

According to the husband of the patient, she has a regular bowel habit and complained of
episodes of loose bowel movement at times. Since admission patient S has no urine output, her
bladder was distended but no sensation was reported. After 24 hours since admission patient S
had an output of 2,400Ml and urinated 4 times.

Activity and Exercise Pattern

24
 Patient husband claimed that her wife spends more time at work and to serve people, and
lacks time for her own self. At present, because of admission the patient is currently confined to
bed.

Cognitive and Perceptual Pattern

The husband says that before admission, patient S is loud and talkative. Currently, the patient is
conscious, moderately responsive with signs of irritability, can follow simple directions when
instructed, and can recognize her daughter and the hospital where she is.

Sleep-Rest Pattern

The patient’s husband verbalized that she works overtime in most cases, comes home
late, sleeps late to finish reports, goes to work even during holidays, and stays late at night for
Zoom conferences. The husband claimed that during the admission, the patient was placed in a
private room for bed rest and was kept under observation. According to the patient’s husband,
the patient has been seen awake most of the time since last night, and she kept asking how the
kids at home are doing.

Self-Perception-Self-Concept Pattern

The patient’s husband verbalized that she is a very kind person. The husband claimed that
she was always loud and talkative, but since yesterday she was quiet most of the time and seen
going to the bathroom often due to nausea.

Role-Relationship Pattern

According to the husband, they have been married for 20 years, and they have two
children, all girls, and they are both in senior high school now. The patient's husband verbalized
that she is a very kind person but a disciplinarian as a mother.

Sexuality-Reproductive Pattern

25
 The husband of the patient claimed that she is still menstruating regularly with no reports
of anything unusual. According to the husband, she underwent a Cesarean section when she was
28 years old.

Coping- Stress Tolerance Pattern

The patient was accompanied by her husband upon admission and served as her watcher. At
present, the patient is on bed rest, and she is awake most of the time since last night. No
additional data was obtained.

Value-Belief Pattern

The husband of the patient verbalized that her religion is Islam but she seldom goes to the
Masjid. Her husband verbalized that she prefers to do the 'salah' quietly alone.

26
 CEPHALOCAUDAL ASSESSMENT

General Appearance:
During the initial contact, the patient was wearing a seven-buttoned office uniform paired
with a hijab and semi-tight light brown pants. She was wearing her eyeglasses. The patient’s face
was grimacing every time she opens and closes her mouth. The patient was moderately
responsive during admission but could not immediately answer questions when asked. Signs of
irritability were also noted. The patient’s weight is 51 kilograms with a height of 5’6.

I. Head

a. Hair, cranial bones/ skull, fontanels, sutures, others

- Dyed hair completely distributed in head, no dandruff, no lesions, no scars, no
wounds noted.
b. Eyes
- Wears eyeglasses +1.5 (since 20 years old), pupils were reactive to light and
accommodation, corneal blinking reflexes present, sclerae were white and correctly
identified letters in the magazine when shown to her.
c. Nose
- Nasal passageways were patent, the septum was in place, upon illumination, the
sinuses revealed faint red color, able to identify the scent of mild soap when
introduced.
d. Ears

27
 - During the whisper test, the patient kept asking the nurse to repeat what she said
because she “did not hear” anything from the right ear. Ears had intact ear canal with
minimal cerumen noted; no discharges present.
e. Mouth and throat
- Mouth was clean, with missing right upper molar 1, left lower molar 1, and right
lower molar 1. No odor was noted from the mouth, the uvula is intact, and tonsils
were not inflamed. Able to drink well from a cup, Speech was soft but clear.
Sometimes took pauses before answering questions due to “epigastric pain”.
f. Sinuses
- The sinuses revealed faint red color when illuminated with penlight.

II. Integumentary system

- The patient’s skin is warm to touch with a body temperature of 38.8 degrees Celsius;
diaphoresis was noted upon assessment.
III. Neck and Shoulders
a. Trachea
- Neck was aligned, no complaints of discomfort claimed.
b. Thyroid glands
- The thyroid was hardly palpable.
c. Great Vessels
- No bruit or abnormal sounds identified, large vessels were intact and not swollen,
carotid pulse rate was 108 b/min.
IV. Lungs and Thorax
a. Anterior Thorax
- Anterior thorax showed no evidence of lesions, both breasts showed no signs of mass
or discharges, breath sounds were clear, RR -24 br/min.
b. Posterior Thorax
- Posterior thorax showed no evidence of lesions, scars, or wounds, percussion sounds
showed no abnormal results, no lesions nor masses palpated, breath sounds were
clear. RR – 24 br/min.
V. Circulatory system

28
 - The patient’s HR is 108 b/min
- Blood pressure is 150/100 mmHg
- ABG: pH= 7.33, aPco2 = 56mmHg, aPo2= 85mmHg, HCO3= 25mEq/L, O2 sat= 93%
VI. Gastrointestinal System
a. Abdomen
- The patient complains of Epigastric pain. Upon inspection, there was a scar
(cesarean) noted, and no lesions were noted. Upon auscultation, bowel sounds were
not heard in all 4 quadrants within 1 minute of waiting. Upon palpation, tenderness
identified with light palpation and hard palpation was not done due to non-tolerance.
Percussion was not done due to non-tolerance. Bowel habits are regular. No
hemorrhoids were noted.
-
VII. Extremities
a. Upper Extremities
- 2+ scores in both upper areas for resistance. Able to raise arms independently but
weakly; can identify dull and sharp stimulations in all four limbs with some
“difficulty and pain” experienced during the activity.
b. Lower Extremities
- 3+ scores in both lower areas for resistance. Able to raise legs independently but
weakly; can identify dull and sharp stimulations in all four limbs with some
“difficulty and pain” experienced during the activity.
VIII. Genitourinary System
- The patient’s abdomen is distended, no urine output since admission. The genital
area appeared intact, no discharges were noted or any sign of abnormality with
inspection and palpation.
IX. Special Areas (Neurologic Assessment)
Cranial Nerves revealed:
CN I – Can identify the scent of mild soap.
CN II – Blurred vision, wears eyeglasses +1.5, correctly identified letters in the magazine
when shown.

29
 CN III, CN IV, CN VI – Pupils were reactive to light and accommodation, corneal
blinking reflexes present.
CN V - Temporal and masseter muscles contracts as noted.
CN VII – There is a presence of face grimacing.
CN VIII – Some hearing difficulty was noted on the right ear.
CN IX – Difficulty of swallowing was noted.
CN X – PR – 108 b/min, RR – 24 br/min
CN XI – No presence of stiff neck noted.
CN XII - Speech was soft but clear, tongue protrudes midline and moves symmetrically.

LABORATORY RESULTS
Table 1. Shows diagnostic exam upon admission in the medical units revealed:
CARDIAC Result Normal range Interpretation
ENZYME TEST
Troponin I 0.40ng/mL 0-0.4ng/mL High
Troponin T 0.12ng/mL 14ng/mL Low
LDH 86ng/mL (10.36U/L) 140-280 U/L Low
CK-MB 6.8ng/mL < 5.0ng/mL High

Table 2. Shows the ECG result.

ECG Result Normal range Interpretation

Shows shortened R-R Shortened R-R 0.6-1.2 seconds Sinus tachycardia

intervals in all leads interval
with no apparent
abnormalities.

30
Table 3. Shows the ABG result.
ARTERIAL BLOOD Result Normal range Interpretation
GAS
pH 7.33 7.35-7.45 Low
aPCO2 56mmHg 35-45mmHg High
aPO2 85mmHg 80-100mmHg Normal
HCO3 25mEq/L 22-26mEq/L Normal
O2 sat 93% 95-100% Low

Uncompensated
respiratory acidosis

Table 4. Shows the ABG result 24 hours since admission.

ARTERIAL BLOOD Result Normal range Interpretation
GAS
pH 7.33 7.35-7.45 Low
aPCO2 47mmHg 35-45mmHg High
aPO2 91mmHg 80-100mmHg Normal
HCO3 19mEq/L 22-26mEq/L Low
O2 sat 94% 95-100% Low

Combined
respiratory and
metabolic acidosis

31
 DRUG STUDY
Table 5. sodium bicarbonate drug study
DRUG MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECT RESPONSIBILITES
Generic Name: Chemical effects: Indicated in the Contraindicated to patient CNS: Observe the 12 rights in
sodium Rapidly neutralizes treatment of with hypersensitivity to Mood changes administering medication.
bicarbonate gastric acid to form hyperacidity drug or its component and
sodium chloride, hypocalcemia in which CV: 1. Monitor patient for
Brand Name: carbon dioxide, and alkalosis may lead to Irregular hypersensitivity.
Zegerid, Alka- water. After tetany, hypochloremic heartbeat
Seltzer, absorption of sodium alkalosis secondary to 2. Monitor sodium intake of
Citrocarbonate bicarbonate, plasma vomiting, diuretics, or EENT: Dry patient taking sodium
alkali reserve is nasogastric suction. mouth bicarbonate (Hypernatremia,
Dosage: increased and excess stop the medication directly).
5 mEq/kg sodium and GI:
bicarbonate ions are Abdominal 3. Avoid rapid I.V. infusion
Frequency: excreted in urine, cramps (cause drop of blood
Q4h thus rendering urine pressure).
less acid. MS:
Route: Muscle spasms 4. Monitor vital signs,
IV Infusion Therapeutic Effects: laboratory results and level
To increasing plasma SKIN: of consciousness frequently.
Classification bicarbonate levels, Ulceration
Pharmacologic which are known to 5. Monitor patient for
class: buffer excess possible adverse effects.
Alkalinizing hydrogen ion
Agents concentration,
thereby raising
Therapeutic solution pH to
Class: combat clinical
Antacid manifestations of
acidosis.
Reference: Jones & Bartlett Learning 2015 Nurse’s Drug Handbook (14th Edition). Ismail A. P.1122-1124

32
 DRUG STUDY
Table 6. omeprazole drug study
DRUG MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECT RESPONSIBILITES
Generic Name: Chemical effects: To treat Gastric Contraindicated to patient CNS: Observe the 12 rights in
omeprazole It suppresses ulcer and with having Headache, administering medication.
stomach acid Gastroesophageal hypersensitivity to Dizziness,
Brand Name: secretion by specific Reflux Disease omeprazole, other proton Drowsiness 1. Monitor patient for
Prilosec inhibition of the (GERD). pump inhibitors, or their hypersensitivity.
Hydrogen potassium components. GI:
ATPase system Abdominal 2. To give the medication
Dosage: found at the Pain, before meals, preferably in
40mg secretory surface of Nausea, the morning and evening.
gastric parietal cells. Vomiting,
Frequency: Flatulence, 3. Avoid foods that cause
Stat Therapeutic Effects: Acid an increase in GI irritation
By decreasing the regurgitation, during therapy.
Route: amount of acid made Constipation.
IV Infusion in the stomach. 4. Observe patient level of
consciousness, when patient
Neuromuscular feels confuse stop the
Classification and Skeletal: medication directly.
Pharmacologic Fatigue
class: 5. Monitor patient for
Proton Pump possible adverse effects.
Inhibitor

Therapeutic
Class:
Antiulcer drug

Reference: Jones & Bartlett Learning 2015 Nurse’s Drug Handbook (14th Edition). Ismail A. P.910-912

33
 DRUG STUDY
Table 7. metoclopramide hydrochloride drug study
DRUG MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECT RESPONSIBILITES
Generic Name: Chemical effects: To treat Contraindicated to patient CNS: Observe 12 rights of
metoclopramide Antagonizes the Gastroesophageal with hypersensitivity to Mood changes, medications
hydrochloride inhibitory effect of Reflux Disease metoclopramide or its Anxiety,
dopamine on GI (GERD). components, GI Dizziness, 1. Monitor patient for
Brand Name: smooth muscles. haemorrhage, mechanical Restlessness, hypersensitivity to
Plasil This causes gastric obstruction, or perforation, Fatigue, metoclopramide.
metoclopramide should not
contractions, which Headache,
be used in epileptics or
promotes gastric Insomnia, 2. Educate the patient about
patients receiving other
Dosage: emptying and drugs which are likely to Irritability, the adverse and side effect
5mg/mL peristalsis, thus cause extrapyramidal of the drugs.
reducing reactions GI:
Frequency: gastroesophageal Constipation, 3. Assess signs of intestinal
Q8h reflux. Nausea obstruction, abnormal
bowel sounds, diarrhea,
Route: Therapeutic Effects: nausea and vomiting before
IM @  It works by administering
0.15mg/kg body increasing the metoclopramide.
weight movements or
contractions of the 4. Monitor patient for
Classification stomach and possible adverse effects.
Pharmacologic intestines. 
class:
Dopamine
antagonist

Therapeutic
Class:
Antiemetic
Reference: McGraw-Hill Nurse's Drug Handbook (7th edition) Schull P. P791-793

34
 DRUG STUDY
Table 8. amoxicillin drug study
DRUG MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECT RESPONSIBILITES
Generic Name: Chemical effects: To treat Contraindicated to patient CNS: Observe 12 rights of drug
amoxicillin Kills bacteria by infections of with history of severe Anxiety, , medications.
binding to and the ear, nose, hypersensitivity reactions Dizziness,
Brand Name: inactivating and throat, due to other beta-lactam 1. Monitor patient for
Fatigue,
Moxatag penicillin-binding to susceptible antibiotics. hypersensitivity.
proteins on the inner Insomnia,
Amoxil (ONLY β- Hypersensitivity to 2. Expect to start therapy
bacterial cell wall, Mood changes,
lactamase– amoxicillin or its before culture and sensitivity
weakening the test result are known.
Dosage: bacterial cell wall and negative) components. GI:
500mg causing lysis. isolates of
Nausea, 3. Advise patient that
Streptococcus
Vomiting, treatment may last at least 10
Frequency: Therapeutic Effects: species. (α-and
Q12h β-hemolytic Abdominal pain, days for hemolytic
They work by Gastritis streptococci infections.
killing bacteria or isolates only),
Route: preventing them 4. Inform patient to report
PO from reproducing adverse reactions.
and spreading.
5. Inform patient that the drug
Classification
may be taken with or without
Pharmacologic food.
class:
Aminopenicillin 6. Monitor patient for
possible adverse effects.
Therapeutic
Class:
Antibiotics
Reference: McGraw-Hill Nurse's Drug Handbook (7th edition) Schull P. P69-72

35
 DRUG STUDY
Table 9. dextrose drug study
DRUG MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECT RESPONSIBILITES
Generic Name: Chemical effects: For calorie Contraindicated to patient CV: Observe 12 rights of drug
Dextrose (d- Prevents protein replacement. with Hypersensitivity to Hypertension medications
glucose) and nitrogen loss, drug or to its component,
promotes glycogen hyperglycemia, diabetic Metabolic: 1. Monitor patient for
Brand Name: deposition and coma, Hemorrhage, heart Hyperglycemia, hypersensitivity
B-D Glucose, ketone f.0ailure Hypervolemia. 2. Monitor blood pressure
Glutose Insta- accumulation regularly.
glucose (through osmotic
diuretic action) 3. Monitor fluid intake and
Dosage: output.
5% in water Therapeutic
1500mL Effects:
4. Use aseptic technique
Used to treat very
Frequency: low blood sugar when preparing and
QD (hypoglycaemia). administering the solution
Route:
IV 5. Do not use solutions if out
Classification: dated, cloudy or the seal is
Pharmacologic voided.
class:
Monosaccharide 6. Monitor infusion site
frequently to prevent
Therapeutic irritation, and phlebitis.
Class:
Carbohydrate 7. Monitor patient for
caloric nutritional possible adverse effects.
supplement
Reference: McGraw-Hill Nurse's Drug Handbook (7th edition) Schull P. P359-360

36
 DRUG STUDY
Table 10. Plain NSS drug study
DRUG MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECT RESPONSIBILITES
Generic Name: Chemical effects: To treat for Contraindicated in Skin: Observe the 12 rights in
Plain NSS May replace the dehydration patients with heart failure, Hyperthermia administering medication.
deficiency of sodium purposes, to to normal or high
Brand Name: and chloride and manage electrolytes levels. Circulatory: 1. Monitor patient for
0.9% Sodium maintains the hypovolemia Extravasation, hypersensitivity.
Chloride electrolytes at and prevents Hypervolemia,
Solution adequate levels. sodium loss. Sodium retention 2. Check and regulate the
drop rate according to the
Dosage: Therapeutic Effects: prescribed physician’s order.
1500mL Provide hydration.
3. Label the IV fluid with the
Frequency: date and time of insertion,
OD and type of gauge needle
used then document.
Route:
IVF 4. Monitor patient frequently
for signs of infiltration and
Classification phlebitis.
Pharmacologic
class: 5. Observe patient for signs
Electrolyte of fluid overload by
supplement checking vital signs.

Therapeutic 6. Monitor patient for

class: possible adverse effects.
Sodium
replacement
Reference: Schull, P. (2013) McGraw-Hill Nurses Drug Handbook (7th ed.)

37
 DRUG STUDY
Table 11. nifedipine drug study
DRUG MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECT RESPONSIBILITES
Generic Name: Chemical effects: To manage the Contraindicated in CNS: Observe the 12 rights in
nifedipine May inhibit calcium patient’s patients hypersensitive to Nausea administering medication.
ion influx across hypertension calcium channel blocker Dizziness
Brand Name: cardiac and smooth- or any drug of its Weakness 1. Monitor patient for
Calcibloc muscle cells, components. Drowsiness hypersensitivity.
decreasing Light-headedness
Dosage: myocardial 2. Urge patient to take the
30mg contractility and CV: drug exactly as prescribed
oxygen demand; Hypotension by the physician.
Frequency: may dilate coronary
OD arteries and GI: 3. Monitor patient carefully
arterioles. Difficulty (BP, cardiac rhythm, and
Route: swallowing, output).
PO Therapeutic Effects: Constipation
Reduces blood 4. Report if the patient
Classification pressure. Musculoskeletal: experiencing pronounced
Pharmacologic Fatigue dizziness.
class: Lethargy
Calcium channel 5. Monitor patient for
blocker possible adverse effects.

Therapeutic
class:
Antihypertensiv
e

Reference: Schull, P. (2013) McGraw-Hill Nurses Drug Handbook (7th ed.)

38
 DRUG STUDY
Table 12. cimetidine drug study
DRUG MECHANISM OF INDICATION CONTRAINDICATION ADVERSE NURSING
ACTION EFFECT RESPONSIBILITES
Generic Name: Chemical effects: To manage Contraindicated in CNS: Observe the 12 rights in
cimetidine May inhibit Gastroesophageal patients hypersensitive to Nausea administering medication.
histamine and H2 Reflux Disease the drug or any of its Dizziness
Brand Name: receptors of the (GERD) and to components. Weakness 1. Monitor for any signs of
Tagamet gastric parietal cells manage gastric Mood changes hypersensitivity.
ulcer. Confusion
Dosage: Therapeutic Effects: Disorientation 2. Identify if patient is
150mg Decrease gastric acid taking another drug
secretion, gastric Musculoskeletal: medication.
Frequency: volume and Fatigue
Continuous IV hydrogen ion 3. Administer drug in 0.9%
for 6 hours concentration. GI: NSS slowly to consume in 6
Vomiting hours as prescribed by the
Route: Constipation physician.
Continuous IV
infusion 4. Monitor patient’s Level
of Consciousness.
Classification
Pharmacologic 5. Monitor for cardiac
class: arrhythmias and
Histamine2- hypotension.
Receptor
Antagonist 6. Monitor patient for
possible adverse effects.
Therapeutic
class:
Antiulcer drug

39
Reference: Ismail Aw-Abdi. (2015) Jones & Bartlett Learning 2015 Nurse’s Drug Handbook (14th Edition).
COMPREHENSIVE NURSING CARE PLAN
Table 13: Nursing Care Plan No. 1
ASSESSMENT NURSING PLANNING IMPLEMENTATION EVALUATION
DIAGNOSIS
Subjective cues: Acute pain After 4 hours of nursing intervention, After 4 hours of nursing
The patient related to the patient will be able to report that intervention results revealed:
verbalized irritation of pain is reduced or controlled to a - Goal partially met
-“aray, masakit gastric mucosa tolerable level.
talaga ang tiyan secondary to
ko.” “Ouch! My psychological
stomach hurts so stress and diet P- Evaluate the patient’s pain intensity - Utilized the pain - Patient reported a pain
much.” starting from the time she was rating scale and asked rating scale of 8/10 during her
-“Aray ko, hindi ko admitted and after 24 hours of the patient to rate the admission and 7/10 after 4
na kaya ang sakit.” admission. pain from 0 to 10 from hours of giving nursing
“Ouch! I can no R: Pain is subjective and cannot be felt the time she was interventions.
longer tolerate the by others. In order to fully understand brought to the hospital - Able to turn to sides with
pain.” as reported the patient’s pain symptoms and and after 24 hours of some assistance but
by her secretary identify improvement in status, an being admitted. complained of epigastric pain
- Loss of Appetite evaluation of the patient’s pain when moving.
as reported by the intensity must be done, also to
husband establish a baseline data for the
patient.
Objective cues: -Vital Signs after 24 hours:
- Facial grimacing - Administered medica- BP: 150/100 mmHg
was noted P: Administer medication as indicated: tion as prescribed by Temp: 38.8 °C
- Elicited guarding omeprazole, cimetidine, the doctor. RR: 21 br/min
movement metoclopramide, sodium bicarbonate, PR: 105 b/min
according to her oxygen, and nifedipine O2 sat: 97%
secretary R: To reduce stomach acidity and - 24 hours input – 2,200 mL

40
- Shortness of irritation of the gastric mucosa. To and output – 2,400 mL
breath, control the blood pressure
Diaphoresis,
Vital Signs: - Patient was able to turn to
BP: 150/100mmHg - Adjusted the HOB and the side with some assistance.
Temp: 38.8 °C P- Place the patient on semi-fowler’s placed the patient on Patient had been seen awake
RR: 24 br/min position while on bed and advise the semi-fowler’s position, since last night.
PR: 108 b/min patient to sleep on the left side of the and advised the patient
O2 sat: 93% bed. to sleep on the left side.
R: Due to gravity that keeps the gastric
contents inside the stomach, the shape
of the stomach, and the angle of the
connection between it and the
esophagus, semi-fowler’s position and
sleeping on your left side can greatly
reduce reflux. - The patient verbalized
- Established trust with “Sumasakit talaga ang tiyan
P- Encourage verbalization of feelings the patient and SO. ko kapag gumagalaw ako.”
about the pain. Encouraged the patient “My stomach hurts everytime
R: To evaluate coping abilities and to to express her concerns I move.”
identify areas of additional concern about the pain and used - The patient still complained
and to enhance understanding and Active Listening and of epigastric pain twice,
reduce level of anxiety and fear. Focusing techniques in difficulty of breathing and
communication. poor appetite.

- Guided imagery was not

P- Provide comfort measures through
relaxation techniques and ensure quiet
environment
R: To promote non-pharmacologic
pain management and to distract
attention to pain and reduce tension.
-Introduced ‘focus finished because the patient
breathing and guided refused. Ensured that the
imagery’ to the patient’. environment is quiet
Checked the AC for
noises. Informed the
husband of the patient
to keep the room quiet.

41
 References:
Nurse’s Pocket Guide 14th Edition,
https://badgut.org/information-centre/a
-z-digestive-topics/gerd/
COMPREHENSIVE NURSING CARE PLAN
Table 14: Nursing Care Plan No. 2
ASSESSMENT NURSING PLANNING IMPLEMENTATION EVALUATION
DIAGNOSIS
Subjective Cues: Impaired Gas Goal of Care: At the end of 8- - Goal Partially Met!
The patients Exchange hour nursing interventions, the
husband reported Related to client will be able to manifest - Patient manifested improved
that the patient was Altered Oxygen improved oxygenation as oxygenation as evidenced by an
brought to the Supply as evidenced by within normal adequate breathing pattern,
hospital because Evidenced by breathing pattern, respiratory respiratory rate of 21 cycles per
of, “The epigastric Shortness of rate, oxygen saturation. minute, and oxygen saturation of
pain worsens with Breath, 97% after 8 hours of nursing
food, shortness of Respiratory interventions.
breath, nausea and Rate of 25
vomiting, difficulty Cycles Per P: Administer oxygen as - Started intermittent - Oxygen therapy was initiated
swallowing, Minute and ordered to maintain oxygen oxygen therapy via nasal during manifestations of
diaphoresis and Oxygen saturation above 90%. cannula at 2 L/minute. shortness of breath, increased
loss of appetite.” Saturation of R: Supplemental oxygen respiratory rate as well as
93% improves gas exchange and dropped in oxygen saturation.
oxygen saturation. The patient
may need a nasal cannula or
Objective Cues: other devices such as a venturi
- Shortness of mask or opti-flow to maintain
breath an oxygen saturation above
- RR: 25 cpm 90%.
- O2: 93% - Administered omeprazole, The medications were given to
P: Administer medications as cimetidine, metoclopramide, help with the patients’ current

42
ordered. sodium bicarbonate and condition which can
R: Medications depend on the nifedipine accordingly and inadvertently prevent
etiology of the disease process. as ordered. occurrences of pain sensation
The treatment plan is very that worsens the patient’s
dependent on the condition that difficulty of breathing.
is being treated. - Elevated the head of bed - Patient was placed in a
P: Assist the patient in an of the patient into a semi- semi-Fowler’s position to help
upright (30 to 45 degrees) Fowler’s position. ease the difficulty of breathing
position as their condition especially during occurrences of
allows. pain.
R: A proper body alignment
allows for adequate lung
expansion and movement of
respiratory muscles to support
the lungs.
- Educated the patient about - Patient was performing
P: Educate about coughing and the pursed-lip breathing pursed-lip breathing as shortness
deep breathing methods. technique when there was of breath was identified.
R: Exercises such as pursed-lip absence of any discomfort.
breathing and using the tripod
position aid in clearing
secretions and increasing lung
expansion, helping facilitate
gas exchange.
- Scheduled nursing care - Schedules of nursing care was
P: Schedule nursing care to considering the patients oriented to the patient prior such
provide rest and minimize well-being. as the time of administrations of
fatigue. prescribed medications so that
R: The hypoxic patient has patient had the idea of the time
limited reserves; inappropriate when to expect nursing care and
activity can increase hypoxia. when to take a rest.

References:

43
 https://rnlessons.com/impaired-
gas-exchange/
https://nurseslabs.com/
impaired-gas-exchange/

COMPREHENSIVE NURSING CARE PLAN

Table 15: Nursing Care Plan No. 3
ASSESSMENT NURSING PLANNING IMPLEMENTATION EVALUATION
DIAGNOSIS
Subjective cues: Elevated body After 2 hours of nursing intervention, the After 2 hours of nursing
The patient temperature patient’s temperature will lower down intervention, results
verbalized “aray, related to from 38.8 °C to 37.9 °C. revealed:
masakit talaga ang inflammation of
tiyan ko.” “Ouch! gastric mucosa - Goal not met
My stomach hurts as evidenced by
so much.” epigastric pain P: Administer medications such as - Administered D5% W - Temp: 38.8 °C
-“Aray ko, hindi ko that worsens replacement fluids and electrolytes as and 0.9% NaCl - Still NPO; Same IV
na kaya ang sakit.” with food, ordered, as well as antipyretic drug alternately at a total of fluids ongoing.
“Ouch! I can no nausea, and (paracetamol) as needed. 3,000 mL for 24 hrs. The -24 hours input –2,200
longer tolerate the vomiting R: To support circulating volume and patient was given mL and output 2,400
pain.” as reported tissue perfusion. Suppressing fever with paracetamol 500 mg PO mL, urinated 4 times in
by her secretary antipyretic drug can reduce elevated body on sips of water. the past 24 hours.
-Nausea temperature and its unpleasant effects. - The patient still
-Difficulty Paracetamol can be taken safely on an complained of
swallowing empty stomach. epigastric pain,
- Loss of appetite difficulty of breathing
as reported by the and she still has poor
husband appetite.

Objective cues: P: Encourage the husband to participate - Assisted the husband in - The patient was able

44
 -Temp: 38.8 °C in bathing the patient in the bathroom. giving bath to the patient. to take a bath in the
-RR: 24 br/min R: To promote heat loss by evaporation bathroom with
-The patient’s skin and conduction and decrease temperature assistance. The patient
is warm to touch of areas with high blood flow and to is now resting on bed.
-Diaphoresis enhance the relationship between the
-Epigastric Pain patient and her husband.
-Vomiting P: Promote surface cooling by means of - Assisted the husband in
changing the patient’s clothing. changing the patient’s - The patient was seen
R: To promote heat loss by radiation and clothing. Advised the wearing a duster and
conduction, and decrease temperature of patient not to wear her she is not wearing her
areas with high blood flow. hijab in the meantime. hijab and eyeglasses.

P: Provide supplemental oxygen - Oxygen given

R: To offset increased oxygen demands intermittently at 2 L/min - Oxygen saturation at
and consumption. via nasal cannula 97% while in
intermittent Oxygen at
References: 2 L/min via nasal
Nurse’s Pocket Guide 14th Edition cannula
https://www.nhs.uk/medicines/
paracetamol-for-adults/

The theory we used as basis in prioritizing the nursing diagnosis is according to the sequence of prioritization of the 21
Nursing Problem Theory of Faye Glenn Abdellah. The 1st nursing problem of the theory is "To maintain good hygiene and physical
comfort," since acute pain r/t irritation of the gastric mucosa secondary to psychological stress and diet altered the physical comfort
and hindered the patient to perform functioning that is essential in maintaining good hygiene, therefore we put it as first in priority.
The 5th nursing problem in the theory is "To facilitate the maintenance of supply of oxygen to all body cells," hence we prioritized
next, impaired gas exchange r/t altered oxygen supply as evidenced by shortness of breath, RR 25 cpm, O2 Sat 93%, these objective
cues are evident the patient is experiencing altered oxygen supply. The last we prioritized is elevated body temperature r/t
inflammation of gastric mucosa as evidenced by epigastric pain that worsens with food, nausea and vomiting, because the 9th nursing

45
problem is "To recognize the physiologic responses of the body to disease conditions-pathologic, physiologic and compensatory." The
elevated body temperature manifested by the patient is the body's response to the gastric condition that is possibly from an infection.
Faye Glenn Abdellah's theory focuses not on utilizing nursing for the disease but for the patient which we think is suitable for our
patient's case.

HEALTH TEACHING PLAN

Purpose: To provide the patient and significant of others knowledge about the disease and lifestyle modification.
LEARNING NEED: Knowledge about the disease condition (ACUTE GASTRITIS, GERD AND HYPERTENSION)
Goal: The patient and her husband will be able to verbalized understanding about the importance of healthy living.

Table 16: Heath Teaching Plan for the Patient and her Husband

LEARNING CONTENT OUTLINE TEACHING TIME RESOURCES METHOD OF

OBJECTIVE STRATEGIES ALLOTTED EVALUATION

Within 45 minutes of Question &

health teaching the answer
patient and her
husband will be able
to:

46
1. Define what is Ask the patient
Gastritis, Gerd and to briefly explain
What is gastritis? Lecture 5 Minutes Pamphlet
Hypertension what she
Discussion (visible text and
- The term gastritis refers to any understood
images) and
condition that involves about Gastritis,
verbal
inflammation of the stomach GERD and
discussion
lining. Eating certain foods and Hypertension.
avoiding others can help people
manage gastritis symptoms.

What is GERD?

- GERD (gastroesophageal reflux

disease, or chronic acid reflux) is a
condition in which acid-containing
contents in your stomach
persistently leak back up into your
esophagus, the tube from your
throat to your stomach.

What is Hypertension?

- Hypertension, also known as high

47
 or raised blood pressure, is a
condition in which the blood
vessels have persistently raised
pressure. Blood is carried from the
heart to all parts of the body in the
vessels. Each time the heart beats,
it pumps blood into the vessels.

2. Describe the Ask the patient

What are the common factors
common factors and the husband
that causes gastritis, Gerd and Lecture 5 Minutes Pamphlet
that causes to enumerate and
Hypertension? Discussion (visible text and
Gastritis, GERD, briefly explain
images) and
and Hypertension the factors that
- Stress verbal
can cause
discussion
- Bacterial infection by H. pylori Gastritis, GERD,

- Stomach lining damage and

Hypertension
- Food allergies

- Obesity

- Smoking

- Too much salt

48
 - Drinking

What is diet?
3. Define what is Ask the patient
diet? to define what is
- An eating plan in which someone
diet and lifestyle
eats less food, or only particular
change for her.
types of food, because he or she
wants to become thinner or for
medical reasons

What is lifestyle change?

4. Define what is
lifestyle change?
- Lifestyle changes are behavior
modifications or habit changes that
encourage positive changes in your
life

5. Distinguish the What are the common food that

types of food that is bad for Gastritis, GERD and Ask the patient
Hypertension?

49
is bad for this Beverages: Lecture 5 Minutes Pamphlet and her husband
condition Discussion (visible text and to enumerate at
- Whole milk and chocolate milk
images) least 8 types of
- Hot cocoa and cola foods and

- Any beverage with caffeine beverages to

limit and avoid
- Regular and decaffeinated coffee
for this
Peppermint and spearmint tea.
conditions.
- Green and black tea, with or
without caffeine

- Drinks that contain alcohol

Spices and seasonings:

- Black and red pepper

- Chili powder

- Mustard

- Salt

Other foods:

- Dairy foods made from whole

milk or cream

50
 - Chocolate

- Spicy or strongly flavored

cheeses

- Highly seasoned, high-fat meats,

such as sausage.

- Hot chili and peppers

- Tomato products, such as tomato

paste, tomato sauce, or tomato
juice

6. Identify food and Which foods can I eat and

drinks that the drink?

Ask the patient
patient can take - Eat a variety of healthy foods and her husband
with Gastritis, Lecture 5 Minutes Pamphlet
from all the food groups. Eat fruits, to enumerate at
Gerd and Discussion (visible text and
vegetables, whole grains, and fat- least 8 foods or
Hypertension images) and
free or low-fat dairy foods. drinks that the
verbal
- Whole grains include whole- patient can
discussion
wheat breads, cereals, pasta, and consume.

brown rice. Choose lean meats,

51
 poultry (chicken and turkey), fish,
beans, eggs, and nuts.

- A healthy meal plan is low in

unhealthy fats, salt, and added
sugar. Healthy fats include olive
oil and canola oil.

- Ask a dietitian for more

information about a healthy meal
plan.

What are the management for

7. Identify Gastritis, GERD and Ask the patient
managements for Hypertension? to at least give 4
Lecture 5 Minutes Pamphlet
Gastritis, Gerd and types of
- For gastritis caused an infectious Discussion (visible text and
Hypertension management for
agent, the doctor will prescribe images) and
gastritis. Allow
antibiotics verbal
the husband to
- Over-the-counter medications, discussion
coach her.
including antacids, can ease
stomach complications but do not
treat the underlying condition.

52
- Avoid alcohol, aspirin, or pain
medication.
- Maintain healthy weight.
- Ask patient about their preference
of food.
- Eat small, frequent meals instead
of larger meals.
- Do not eat right before bedtime.
At least 2 hours before.
- Use wedge pillow.
- Advise to continue prescribe
medication
-Avoid and manage stress.
Tips on how to reduce stress
- Practice time management and Ask the patient
organizational skills and her husband
Lecture 5 Minutes PowerPoint
what activities
- Take a break and eat on time. Discussion Presentation
suggested on the
(Laptop)
- Sleep for about 6-7 hours PowerPoint can
be carried out
- Exercise for about 15-30 minutes.
conveniently by
(Active ROM)
the patient or her

53
- Use relaxation techniques family.

- Provide leisure time for family

and self

- Advise sick leave

REFERENCES

https://www.healthline.com/
health/gastritis-diet#treatments
https://www.mayoclinic.org/
diseases-conditions/high-blood-
pressure/symptoms-causes/syc-
20373410
https://www.mayoclinic.org/
diseases-conditions/gerd/
symptoms-causes/syc-20361940

54
 CONCLUSIONS AND RECOMMENDATION
CONCLUSIONS
1. The past and present health history, as well as lifestyle choices, play a significant role in
the development of gastritis.
2. Among all the possible causes of gastritis, history of H. Pylori infection, extreme
consumption of spicy foods, and chronic stress, are the prevailing precipitating factors.
3. Epigastric pain is the primary symptom of gastritis that can be aggravated by the intake
of food.
4. Signs and symptoms such as epigastric pain, shortness of breath, diaphoresis, loss of
appetite, fever, nausea, and vomiting are the result of the continuous irritation of the
gastric lining of the stomach.
5. Activities such as turning and positioning to sides are sources of exacerbation of
epigastric pain.
6. Healthy lifestyle choices are necessary to prevent the development of gastritis.
7. Early medical interventions and medication administration helps to improve the
condition.
8. Medications such as omeprazole, cimetidine, metoclopramide, sodium bicarbonate can
aid to improve and treat the condition.
9. Quality nursing care and support system are contributing factors for a faster recovery.

55
RECOMMENDATIONS

1. Based on this study the following recommendations are made

2. Acute gastritis and hypertension should be managed with care coordination and holistic
approach including medical, nutritional, pharmacologic and non-pharmacologic interventions
that will improve health related quality of life.

3. Individuals must observe healthy lifestyle and should seek medical intervention when signs
and symptoms are first noticed.

4. The family must be informed in order to better understand the disease and participate in the
maintenance and provision of effective treatments.

5. Healthcare practitioners including nursing students must formulate patient-centered, evidence-

based nursing care plans to be able to provide high quality patient care.

56
EXHIBITS

57
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Charles Patrick Davis, MD, PhD(2021) - What Is Gastritis? Symptoms, Treatment, and Diet

https://www.medicinenet.com/gastritis/article.htm/

Debra Fulghum Bruce, PhD (2021) - Prehypertension: Are You at Risk?

https://www.webmd.com/hypertension-high-blood-pressure/guide/prehypertension\

Dr. Claire Novorol and Ada’s Medical Knowledge Team,. (2020) Acute Gastritis
https://ada.com/conditions/acute-gastritis

Massimo Rugge MD (2020). An Gastritis update 2020

https://link.springer.com/article/10.1007/s11938-020-00298-8

Padmavathi GV, Nagaraju B, Shampalatha SP, Nirmala M , Fareeda Begum , Susan TT , Pavani
GV - Knowledge and Factors Influencing on Gastritis among Distant Mode Learners of
Various Universities at Selected Study Centers Around Bangalore City With a View of
Providing a Pamphlet - SAS Publishers – (An International Publisher for Academic and
Scientific Journals)

Yudisa Diaz Lutfi Sandi , Ade Fitriani , Lilis Lismayanti, Yanti Srinayanti , Wina Widianti
(2021),. Prevalence and Correlation of Knowledge Level, Stress, Diet Compliance and
Quality of Life in Gastritis Patients - [PDF] inspira.or.id

Zhao Y. · Li Y. · Hu J. · Wang X. · Ren M. · Lu G. · Lu X. · Zhang D. · He S., (2020) The
Effect of Helicobacter pylori Eradication in Patients with Gastroesophageal Reflux
Disease: A Meta-Analysis of Randomized Controlled Studies
https://www.karger.com/Article/FullText/504086#ref8

58
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knowledge and better understand the world. https://www.quora.com/Does-blood-
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Gastritis: Indigestion, symptoms, causes, treatment, diagnosis. (n.d.). Cleveland Clinic.

https://my.clevelandclinic.org/health/diseases/10349-gastritis

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Gastroesophageal reflux disease (GERD) - Symptoms and causes. (2020, May 22). Mayo Clinic.
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59