CHRONIC GASTRITIS Gastritis is an inflammation of the lining of the stomach. There are many possiblecauses.

Gastritis is caused by excessivealcoholconsumption, prolonged use of nonsteroidal antiinflammatory drugs, a l s o k n o w n a s N S A I D s , s u c h a s aspirinoribuprofen, o r i n f e c t i o n w i t h b a c t e r i a , s u c h a s Helicobacter p ylori. S o m e t i m e s gastritis develops after major surgery,traumatic injury, burns, or severe infections.Certain diseases, such aspernicious anemiaand chronic bile reflux, orautoimmune disorders, can cause gastritis as well. Gastritis may also occur in those who havehad weightloss surgery resulting in the banding or reconstruction of the digestivetrack. The most common symptom is abdominal upset or pain. Other symptoms areindigestion, abdominal bloating,nausea, a n d vomiting, o r a f e e l i n g o f f u l l n e s s o r burning in the upper abdomen.Bloodin your vomit or black stools may be a sign of bleeding in the stomach, which may indicate a serious problem. CAUSES : Bacterial infection. People infected with Helicobacter pylori (H. pylori) canexperience gastritis most commonly chronic gastritis. Regular use of pain killers. Nonsteroidal anti-inflammatory drugs(NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen(Aleve), can cause both acute gastritis and chronic gastritis. Using thesed r u g s r e g u l a r l y o r t a k i n g t o o m u c h o f t h e s e d r u g s m a y r e d u c e a k e y substance that helps preserve the protective lining of your stomach. Excessive alcohol intake. A l c o h o l c a n i r r i t a t e a n d e r o d e y o u r s t o m a c h lining, which makes your stomach more vulnerable to digestive juices. Stress. S e v e r e s t r e s s d u e t o m a j o r s u r g e r y , t r a u m a t i c i n j u r y , b u r n s o r severe infections can cause gastritis. Bile reflux disease. Bile a fluid that helps you digest fats is producedi n y o u r l i v e r a n d s t o r e d i n y o u r g a l l b l a d d e r . W h e n i t ' s r e l e a s e d f r o m t h e gallbladder, bile travels to your small intestine through a series of thin tubes.Normally, a ring -like sphincter muscle (pyloric valve) prevents bile from flowingi n t o y o u r s t o m a c h f r o m y o u r s m a l l i n t e s t i n e . B u t i f t h i s v a l v e d o e s n ' t w o r k properly, or if it has been removed because of surgery, bile can flow into yourstomach, leading to inflammation and chronic gastritis.

Autoimmune disease. Called autoimmune gastritis, this rare conditionoccurs when your body attacks the cells that make up your stomach lini ng. This produces a reaction by your immune system that can wear away at yours t o m a c h ' s p r o t e c t i v e b a r r i e r . A u t o i m m u n e g a s t r i t i s i s m o r e c o m m o n i n people with autoimmune disorders. Other diseases and conditions. Gastritis may be associated with other medical conditions, including HIV/AIDS, Crohn's disease, parasitic infections, someconnective tissue disorders, and liver or kidney failure.2 SIGN & SYMPTOMS A gnawing or burning ache or pain (indigestion) in your upper abdomen that may become either worse or better when you eat Nausea Vomiting Loss of appetite Belching or bloating A feeling of fullness in your upper abdomen after eating Weight loss RISK FACTOR Factors that may increase your risk of gastritis include: H. pylori infection. The most significant risk factor for gastritis is infection with H. pylori bacteria. Regular use of aspirin or other NSAIDs. If you regularly takeaspirin to prevent a heart attack or stroke, you'r e a t r i s k o f d e v e l o p i n g gastritis. The same is true if you take anti inflammatory pain relievers fora r t h r i t i s o r a n o t h e r c h r o n i c c o n d i t i o n . T h a t ' s b e c a u s e l o n g t e r m u s e o f aspirin and other NSAIDs can cause stomach irritation and bleeding. Older age. Older adults have an increased risk of gastritis becausethe stomach lining tends to thin with age and because older adults are

morel i k e l y t o h a v e H . p y l o r i i n f e c t i o n o r a u t o i m m u n e d i s o r d e r s t h a n y o u n g e r people are. TESTS & DIAGNOSES Blood test Breath test Upper gastrointestinal endoscopy Upper gastrointestinal X-Ray Stool test COMPLICATION Stomach ulcer Stomach bleeding Increased risk of stomach cancer Thinning of the stomach lining and changes in the lining cells. PREVENTION Eat smart. I f y o u e x p e r i e n c e f r e q u e n t i n d i g e s t i o n , e a t s m a l l e r , m o r e frequent meals to help ease the effects of stomach acid. In addition, avoidany foods you find irritating, especially those that are spicy, acidic, fried or fatty. Limit or avoid alcohol. Excessive use of alcohol can irritate and erode themucous lining of your stomach, causing inflammation and bleeding. Don't smoke. Smoking interferes with the protective lining of the stomach,making your stomach more susceptible to gastritis as well as ulcers. Smokingalso increases stomach acid, delays stomach healing and is a leading riskfactor for stomach cancer. Switch pain killers. If possible, avoid taking NSAIDs aspirin, ibuprofena n d n a p r o x e n . T h e s e o v e r - t h e c o u n t e r m e d i c a t i o n s c a n c a u s e s t o m a c h inflammation or make existing irritation worse. CASE STUDY N A M E : T I A N G L A M P H U M R N : 5 8 5 1 5 1 B E D N O : 2 2 9

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G E N D E R : M A L E A G E : 2 7 E A R S O L D 1 0 M O N T H D O A : 1 0 N O V E M B E R 2 0 0 8 D I C I P L I N E : M E D I C A L SPECIALIST: DR. DATO SELVA VITAL SIGNS BLOOD PRESSURE: 130/87H E A R T R A T E : 8 2 b p m T E M P E R A T U R E : 3 7 C S P O 2 : 9 9 % O N A I R DIAGNOSES CHRONIC GASTRITIS# came to hospital by car with relatives# non-trauma / alert and conscious ADMISSION HISTORY Mr. Tiang first came to A&E TAMAN DESA MEDICAL CENTRE at 10 NOVEMBER 2008complaining to have an abdominal pain since at home. He came to A&E TamanDesa Medical Centre by car with relatives. He is been resting on bed at home andimmobilize due to gastrointestinal tract disorder and chronic abdominal pain forabout 2 month. He also having a sleeping pattern disturbance due to his abdominalpain. Because immobility, he is having a superficial pressure sore on his sacrum. Onadmission to GENERAL WARD, he is totally dependent to wheel chair due toabdominal discomfort. Mr. Tiang got allergies to Paracetamol and able to take hismedication well except PCM. He looks like stress and sometimes request fordischarge frequently. At PCU, his head of bed was elevated to 70 to ensure airwayclearance, & stomach reflux. His relatives visited every day to ensure Mr. Tiang ispsychologically comfortable. He also have done his OGDS. On admission, Mr. Tiangreceive a soft and normal diet due to his disease condition. PAST SURGICAL HISTORY APPENDICECTOMY PAST MEDICAL HISTORY DENGUE FEVER PROGRESS NOTES New admission in A&E at 1400 by car with his relatives and family member who livenearby. And then transferred to GENERAL WARD at TAMAN DESA MEDICAL CENTRE. The patient is complaining to have a chronic abdominal pain on the abdomen.DAY BY DAY PROGRESS NOTE10 NOVEMBER 2008 1330HWheel chair admission via A&E.- A c c o m p a n i e d b y s t a f f . h / o a b d o m i n a l p a i n o n / o f f f o r 2 / h o u r s . -At A&E IV line set up, blood taken, IV N/S in progress order from Dr. Bornia.- T o k e e p p a t i e n t N B M . -DMH admitted at Ipoh Hospital for dengue fever last Sunday- P S H A p p e n d i c e c t o m y d o n e 1 1 y e a r s a g o . A l l e r g i c P C M -On admission, vital signs taken.BP : 112/86P : 7 1 -

t e m p : 3 6 . 8 c 1430H-Seen by Dato Selva, patients examined noted patient still c/o abdominalpain for ultrasound whole abdomen today.- F B C , H , p y l o r i c t e s t - S t o o l G S , F E M E r e q u i r e d . -KIV OGDS for tomorrow. (morning) 11 NOVEMBER 2008- T o t a l i n t a k e 5 5 0 m l s . - T o t a l output PUx2, BNO-For maintain NBM.O G D S t o d a y . 0 9 1 5 d o n e . ULTRASOUND ABDOMEN-The liver is not yet enlarged. Not local lesion Sun. the parenchyma chew arenormal.- T h e gallbladder, bile duct, pancreas and spleen are normal. -Both kidney and urinary bladder are normal.- T h e a b d o m i n a l a s s e s s s e e n . The prostate is not enlarged.Vital signs taken.B P P U L S E T E M P . 1 3 3 0 1 1 2 / 8 1 7 4 3 6 . 8 C 1 6 0 0 1 2 8 / 7 6 6 8 3 7 C 8 Nursing diagnosis: Imbalance nutrition less than body requirement r/t poor appetite Risk for infection r/t pressure sore I N T E R V E N T I O N R A T I O N A L E Always ask the patient to turn andreposition himself on bed. To prevent pressure on the site of commonly occurs bedsore.Apply pillows under the pressured partof the body. To make patients feels morecomfortable while on his bed.U s i n g a u t o m a t i c a i r p u m p b e d . T o p r e v e n t t h e s k i n f r o m s u p e r f i c i a l l y bruising.M a i n t a i n g o o d h y g i e n e o n p a t i e n t . K e e p t h e p a t i e n t c l e a n a n d t i d y t o prevent infection.A p p l y c r e a m o r l o t i o n o n p a t i e n t s s k i n . T o k e e p m o i s t u r e s k i n . 9

Self care deficit r/t immobility I N T E R V E N T I O N R A T I O N A L E Do sponging to the p a t i e n t e v e r y d a y . T o c l e a n p a t i e n t b o d y f r o m o d o r , secretion and microorganism.D o h a i r w a s h i n g 3 t i m e s a w e e k . T o e n s u r e p a t i e n t c o m f o r t . Keep his nail s clean and tidy.To prevent microorganism u n d e r t h e nails.D o o r a l c a r e e v e r y m o r n i n g . T o e n s u r e t h e p a t i e n t s b r e a t h e s m e l l s good and

prevent stomatitis.Do perineum care to the patienteveryday. To prevent infection on the patientsperineum and lower body extremities. ALTERED BODY FLUID (LESS THAN BODY REQUIREMENT) R/T VOMITTING I N T E R V E N T I O N R A T I O N A L E Assess the skin turgor and condition.Dry skin shows that the p a t i e n t i s dehydrated.Encourage patient to drink a lot of water. To maintain body fluid and hydrationstatus.Administer total parenteral nutritionand IV infusion. To provide continuous fluidreplacement.Always prepare mineral water on thecardiac table or near the patient. To make patient easier to reach anddrink the water.Give the patient a meal that containlarge amount of water. Example soup. To keep patient always hydrated.10 TREATMENT PAIN MANAGEMENT MEDICATION- C O N T R O L O C M O R T I L I U M - E N Z Y P L E X -BUSCOPAN (BEFORE OGDS) HEALTH EDUCATION -Avoid dairy products, caffeine, alcohol, and sugar. Coffee, evendecaffeinated, should be eliminated because it contains potentially irritatingoils.-Include sulfurcontaining foods such as garlic, onions, broccoli, cabbage, Brussels sprouts, and cauliflower in the diet. Sulfur is the basis for formingglutathione, which provides antioxidant protection to the stomach lining. N-acetyl cysteine (200 mg twice a day between meals) is also the basis forforming glutathione.-Vitamin C (1,000 mg three times per day) decreases nitrosamines,substances that have been linked to stomach cancer.- Z i n c ( 3 0 t o 5 0 m g p e r d a y ) h e l p s p a t i e n t s h e a l i n g . Eliminate any known food allergens from your diet. CONCLUTION SUMMARY Nearly everyone has experienced a bout of indigestion and stomach irritation.Most cases of indigestion are short-lived and don't require medical care. Butif you experience signs and symptoms of gastritis consistently for a week orlonger, see your doctor. And be sure to tell your doctor if you experiencestomach problems after taking any prescription or over-the-counter drug,especially aspirin or other pain relievers. If you are vomiting blood or have blood in your stools, see your doctor rightaway to determine the cause.GENERAL RECOMMENDATION : Do not smoke, and avoid secondhand smoke. As much as possible avoid stress, and learn ways to manage the stress youcan not avoid.From these case, I would like to give a conclusion that I get so many informationabout the case of chronic gastritis from my patient. How to give care plan and theexpected outcome for my nursing intervention. I also found out that the chronicgastritis disease can be prevented by avoid taking

the alcohol and certain drugs, andmedications used to control inflammation. Also learn how to manage stress well and having a healthy diet as well