Gastritis

i Inflammation of the gastric or stomach mucosa i Gastritis may be: Acute lasting several hours to a few days Chronic resulting from repeated exposure to irritating agents or recurring episodes of acute gastritis Causes of Gastritis Acute Gastritis o Dietary indiscretion o Overuse of aspirin and NSAID o Excessive alcohol intake o Bile reflux o Radiation therapy o Ingestion of strong acid or alkali Chronic Gastritis o Benign or malignant ulcers of the stomach o Helicobacter pylori o Autoimmune diseases (Pernicious Anemia) o Use of medications, especially NSAID o Alcohol o Smoking o Reflux of intestinal contents into the stomach.

Lassitude Anorexia Nausea and vomiting Chronic Gastritis Anorexia Heartburn after eating Belching Sour taste in the mouth Nausea and vomiting Mild epigastric discomfort Intolerance to spicy or fatty foods Slight pain that is relieved by eating Assessment and Diagnostic Findings i Gastritis is sometimes associated with: Achlorhydria (absence of HCl) Hypochlorhydria (low levels HCl) Hyperchlorhydria (high levels of HCl) Diagnosis can be determined by: Endoscopy Upper GI radiographic studies Histologic examination of a tissue specimen obtained by biopsy Determine the presence of H. Pylori by serologic testing for antibodies against the H. pylori antigen H. Pylori test (Urea-Breath test)

Medical Management i Antibiotic Amoxicillin Action a bactericidal antibiotic that assist with eradicating H. Pylori bacteria in the gastric mucosa. Side effects vaginal itching or discharges headache swollen tongue oral thrush (white patches inside the mouth or throat) nausea, vomiting, stomach pain Nursing Consideration May cause diarrhea Should no be used in patient allergic to penicillin i Antidiarrheal Bismuth subsalicylate Action Suppress H. Pylori bacteria in the gastric mucosa and assist with healing of mucosal ulcer Side effect Stools may appear gray-black in color Nursing consideration Given concurrently with antibiotic to eradicate H. pylori infection Should be taken on empty stomach i Histamine2 Receptor Antagonist Cimetidine Action Decreases amount of HCl produced by stomach by blocking the action of histamine on histamine

Signs and Symptoms Acute Gastritis Abdominal discomfort Headache

receptors of parietal cells in stomach Side effect Long term use may cause diarrhea Dizziness Gynecomastia Nursing Consideration May cause confusion Agitation Coma in the elderly for those with renal or hepatic insufficiency i Proton pump inhibitor Omeprazole Action Decreases gastric acid secretion by allowing hydrogen potassium adenosine triphospate pump on the surface of the parietal cells in the stomach Side effects Headache Diarrhea or constipation Flatulence Nausea and vomiting Dry mouth Nursing consideration Taken before meal i Prostaglandin E1 Analog Sucralfate Action Create a viscous substance in the presence of gastric acid that form a protective barrier, binding to the surface of the ulcer, and prevents digestion by pepsin Side effects

Constipation Flatulence Headache Hypophosphatemia Dry mouth Nursing consideration Should be taken without food but with water Other medication should be taken hours before or after his medication May cause constipation and nausea Nursing Management I. Assessment History taking Signs and symptoms allergies Medication taken Past medical history Last oral intake Events leading to illness Signs to note during physical examination Abdominal tenderness Dehydration Evidence of any systemic disorder that might be responsible for the symptoms of gastritis II. Nursing Diagnosis Anxiety related to treatment Imbalanced nutrition, less than body requirements, related to inadequate intake of nutrients Risk for imbalanced fluid volume related to insufficient fluid intake and

excessive fluid loss subsequent to vomiting Deficient knowledge about dietary management and disease process Acute pain related to irritated stomach III. Planning and Goals i The major goals for the patient include: i Reduce anxiety i Avoidance of irritating food i Adequate intake of nutrients i Maintenance of fluid balnce i Increase awareness of dietary management i Relief of pain IV. Nursing Interventions Reducing anxiety Important to explain all procedures and treatment base on the patients level understanding Promoting optimal nutrition Help the patient manage the symptoms including nausea, vomiting heartburn and fatigue The patient should take no foods or fluids by mouth until the acute symptoms subside allowing the gastric mucosa to heal If IV therapy is necessary, the nurse monitors intake and output along with serum

electrolyte values If IV therapy is necessary, the monitors intake and output along with serum electrolyte values Offer ice chips until symptoms subside followed by clear As food is introduced, the nurse evaluates and reports and symptoms that suggest a repeated episode of gastritis Discourage intake of alcohol and caffeinated beverages to because its is as CNS stimulant that increases gastric activity and pepsin secretion Discourage cigarette smoking because nicotine reduces the secretion of pancreatic bicarbonate, which inhibits the neutralization of gastric acid in the duodenum. Promoting fluid balance Detect early signs of DHN (minimal urine output of 30 ml/hr or minimal intake of 1.5 L/day If NPO, IVF are prescribed Assess electrolyte values q24H (Na, K, Cl) Alert indicators of hemorrhagic gastritis (hematemesis, tachycardia and hypotension) if this occurs notify physician immediately. Relieving Instruct the patient to avoid foods and beverages

that may be irritating to the gastric mucosa Instruct the patient about the correct use of medication to relieve chronic gastritis Promoting home and community based Self care teaching Stress management Diet Medication Continuing care Ongoing assessment on patient symptoms Lifelong Vit. B12 injection Emphasized the importance of follow up appointments V. Evaluation Exhibit low level of anxiety Avoid eating irritating food or drinking caffeine beverages or alcohol Maintain fluid balance Oral fluid intake of at least 1.5 L a day Drink 6-8 glasses of water daily Has a urinary output of approximately 1L daily Display adequate skin turgor Adhere to medical regimen Select non-irritating foods and beverages Take medication as prescribed Maintain appropriate weight Report less pain