GASTRITIS

Assessment - Nursing Care Plan for Gastritis:

1. Does the patient complains of heartburn, can not eat, nausea and vomiting?
2. When the occurrence of symptoms, whether before eating, after eating, after
ingesting spicy foods, certain drugs or alcohol?
3. What are the symptoms associated with anxiety, Stress, allergies, eating and drinking too
much or eating too fast?
4. What are the symptoms diminish or disappear?
5. Is there a history of previous gastric disease?
6. Does the patient have vomiting blood?
7. Is there any abdominal tenderness?
8. Dehydration or change in skin turgor or dry mucous membranes?

Diagnosis - Nursing Care Plan for Gastritis:

1. Acute pain
2. Imbalanced Nutrition Less Than Body Requirements
3. Hyperthermia
4. Risk for fluid volume deficit
5. Anxiety
6. Knowledge deficit

Intervention - Nursing Care Plan for Gastritis :

1. Relief of pain:
 Encourage clients to learn relaxation techniques
 Encourage clients to avoid foods and beverages that irritate the stomach, such as alcohol
 Encourage clients to use diet pd regular intervals.
2. Maintaining adequate nutrition remains
 Provide eat small but frequent meals and do not irritate.
 Give solid foods as soon as possible
 Provide a drink that contains no caffeine
3. Hyperthermia
 Monitor vital signs every 2 hours
 Apply a cold compress
 Management of giving antipyretics as indicated
4. Maintain body fluid volume
 Observation of fluid intake and output
 Observe for signs of dehydration
5. Reduce anxiety
 Encourage clients to express their problems and fears
 Help clients identify situations that cause anxiety
 Teach stress management strategies
6. Increase the client's knowledge about the disease
  Assess client's level of knowledge
 Provide the required information by using the right words and the corresponding time
 Reassure the client that the disease can be overcome.

Nursing Interventions for Gastritis

1. Nursing Diagnosis: Acute Pain

Purpose: Pain is gone / no pain

Nursing Interventions:
• Review the level of pain.
• Provide information about the different strategies chosen to reduce pain.
• Encourage clients to use the chosen strategy to reduce pain.
• Encourage clients to avoid eating foods that stimulate an increase in stomach acid.
• Collaboration with the medical team for the administration of anti-analgesic.

Rational:
• In order to determine the level of pain experienced by the client.
• Able to learn methods of pain reduction and can do it.
• Assist in menurunhkan experienced pain threshold.
• In order for clients to find foods that stimulate stomach acid and does not consume
them.
• Reduce the level of pain experienced by the client.

2. Nursing Diagnosis: Imbalanced Nutrition Less Than Body Requirements

Purpose: Nutrition balanced.

Nursing Interventions:
• Describe the client and family about the importance of food for the body.
• Monitor the amount of food intake.
• Monitor and record the number of vomiting, frequency and color
• Provide a varied diet according to his diet to stimulate appetite.
• Provide food in small portions but frequently.
• Collaboration with the medical team for the administration of anti-emetic drugs.

Rational
• Clients and families can learn the importance of
• To know the food is consumed.
• As the data to perform nursing actions and subsequent treatment.
• To klirn be motivated and stimulates appetite.
• To reduce the feelings and needs food for patients.
• As a therapy for inhibiting / stimulating nausea and vomiting.

3. Nursing Diagnosis: Risk for Fluid Volume Deficit

Purpose: volume of body fluids are met

Nursing Interventions:
· Assess the possibility of signs of dehydration and record intake and output.
· Assess the balance of fluids and electrolytes every 24 hours.
· Encourage clients to keep the peroral intake is to eat and drink a little but often.
· Encourage clients to avoid consuming foods and beverages that contain caffeine.

Rational:
· Detecting the early signs of dehydration.
· Detecting early indicator of fluid and electrolyte imbalance.
· In order for the client's body fluid balance can be maintained.
· Caffeine is a central nervous system stimulant that can increase the activity of gastric
and pepsin secretion leading to increased secretion of gastric acid that can cause
reactions of nausea and vomiting.

4. Nursing Diagnosis: Anxiety

Purpose: No Anxiety

Nursing Interventions:
• Assess the client's anxiety.
• Give the client an opportunity to express his anxiety.
• Explain to clients that can challenge dijalankankan diet after recovery.
• Explain to the client about medical procedures / treatments will be done and
encouraged cooperative therein.
• Provide motivation to the client about his recovery.

Rational:
• As the initial data to determine the client's anxiety level.
• In order to determine the cause of anxiety is experienced as well as reduce the
psychological burden of the client.
• The client can adhere to diet and avoid disease relapse again.
• Able to understand and accept all the measures taken to cure the disease process.
• Clients and families are optimistic for the healing of disease and comply with all
recommended clients are given.

NURSING CARE PLAN FOR GASTRITIS

Gastritis is an inflammation of the lining of the stomach, and has many possible
causes. The main acute causes are excessive alcohol consumption or prolonged use
of nonsteroidal anti-inflammatory drugs (also known as NSAIDs) such as aspirin
or ibuprofen. Sometimes gastritis develops 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, stress and certain autoimmune disorders can cause gastritis as well. The
most common symptom is abdominal upset or pain. Other symptoms are
indigestion, abdominal bloating, nausea, and vomiting and pernicious anemia.
Some may have a feeling of fullness or burning in the upper abdomen. A
gastroscopy, 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 or antibiotics, and avoiding hot or spicy foods. For those
with pernicious anemia, B12 injections are given. wikipedia

Nursing Care Plan for Gastritis : Nursing Diagnosis for Gastritis

1. Risk for Imbalanced Fluid Volume and Electrolytes : less than body
requirements related to inadequate intake, vomiting

2. Imbalanced Nutrition: Less Than Body Requirements related to decreased

nutrition intake.

3. Activity Intolerance related to physical weakness.

4. Deficient Knowledge: about diseases related to lack of information.

5. Acute Pain related to an increase in stomach acid.

Nursing Care Plan for Gastritis : Nursing Interventions for Gastritis

1. Risk for Imbalanced Fluid Volume and Electrolytes : less than body
requirements related to inadequate intake, vomiting

Goal:
Disorders of fluid balance did not occur.

Expected results:
Moist mucous membranes, good skin turgor, electrolytes returned to normal,
capillary filling pink, vital signs stable, the balance of input and output.

Nursing Intervention :

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

intake and output, encourage clients to drink ± 1500-2500ml, observation of skin
and mucous membranes, collaboration with doctor in the provision of intravenous
fluids.
2. Imbalanced Nutrition: Less than Body Requirements: less than body
requirements related to inadequate intake, anorexia

Goal:
Nutritional deficiencies resolved.

Expected results:
Normal albumin value, no nausea and vomiting, weight within normal limits,
normal bowel sounds.

Nursing Intervention :

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

Nursing Diagnosis for Gastritis Imbalanced Nutrition Less Than Body

Requirements related to anorexia, vomiting

Nursing Interventions for Gastritis:

1. Allow clients to choose foods (low-calorie foods are not allowed)
2. Make mealtime structure with a time limit (eg 40 minutes)
3. Eliminate distractions (eg conversation, watching television) during the meal.
4. Specify the time to eat, serve food, and eating time limit; inform the client that if the food
is not eaten during the time that has been provided, will be the replacement of other
feeding methods.
5. When food is not eaten, do feeding through a tube, NGT to order.
6. Perform a replacement feeding method each time the client refuses to eat by mouth.
7. Keep your attention during the meal if the client refuses to eat.
8. Reduce attention while eating.

Behavior Modification Therapy

 1. Clients achieve increased body weight every day because of the desire of the client.
2. Separation from family for some time would be very helpful.
3. Switch on a fun activity.
4. Nursing interventions are technical limitations.
5. Social isolation.
6. Useful communication.
7. Give the award to the client only when he is likely to gain weight.
8. Consistent action should be maintained.
9. Each staff member must have a final report per shift on a decision
10. Measure weight accurately;
Expected outcome:
1. Clients indicate hydration, necessary to adequately.
2. Balance between inputs and outputs.

Related Articles
Gastritis
 4 Nursing Interventions for Gastritis
 Nursing Care Plan for Gastritis
 6 Nursing Diagnosis and Interventions for Gastritis
Gastritis - Imbalanced Nutrition Less Than Body Requirements

Peptic Ulcer
  is a lesion in the mucosa of the lower esophagus, stomach, pylorus, or duodenum.
 also known as ulcus pepticum, PUD or peptic ulcer disease, is an ulcer (defined as
mucosal erosions equal to or greater than 0.5 cm) of an area of the gastrointestinal tract
that is usually acidic and thus extremely painful
 Causative factors include mucosal infection by the bacterium Helicobacter pylori
(mechanism unclear).
 Use of non-steroidal anti-inflammatory drugs (NSAIDs), especially aspirin.
 Genetic factors such as cigarette smoking, stress, and lower socio-economic status may
play a role.
 Complications include GI hemorrhage, perforation, and gastric outlet obstruction.

Classification

 Stomach (called gastric ulcer)

 Duodenum (called duodenal ulcer)
 Oesophagus (called Oesophageal ulcer)
 Meckel’s Diverticulum (called Meckel’s Diverticulum ulcer)

Types of peptic ulcers

 Type I: Ulcer along the lesser curve of stomach

 Type II: Two ulcers present – one gastric, one duodenal
 Type III: Prepyloric ulcer
 Type IV: Proximal gastroesophageal ulcer
  Type V: Anywhere along gastric body, NSAID induced

Assessment

1. Abdominal pain
o Occurs in the epigastric area radiating to the back; described as dull, aching, and
gnawing.
o Pain may increase when the stomach is empty, at night, or approximately 1 to 3
hours after eating. Pain is relieved by taking antacids (common with duodenal
ulcers).
2. Nausea, anorexia, early satiety (common with gastric ulcers), belching.
3. Dizziness, syncope, hematemesis, melena with GI hemorrhage:
o Positive fecal occult blood
o Decreased hemoglobin and hematocrit, indicating anemia.
o Orthostatic blood pressure and pulse changes.
4. Peptic ulcer disease may be asymptomatic in up to 50% of persons affected
5. Differentiating Gastric and Duodenal Ulcers:
Gastric Ulcer Duodenal Ulcer
Gnawing epigastric pain Gnawing epigastric pain
occurring 30 minutes to 1 occurring 2-3 hours after
hour after meals meals
Aggravated by eating Relieved by food (because the
(because acid secretion pyloric sphincter, at the
increase at meal time) leads junction of stomach and
to weight loss duodenum, closes upon eating
to concentrate food in the
stomach) causes weight gain
Relieved by vomiting Not relived
(because acid is expelled out)
No pain at hours of sleep Pain at hours of sleep
(HCl production decreases at (because gastric emptying
hours of sleep) continuous at hours of sleep)
More common in persons More common between ages
older than age 50 25 and 50
Diagnostic Evaluation

1. Upper GI series usually outlines ulcer or area of inflammation.

2. Endoscopy (esophagogastroduodenoscopy) visualizes duodenal mucosa and helps
identify inflammatory changes, lesions, bleeding sites, and malignancy (through biopsy
and cytology).
3. Gastric secretory studies ( gastric acid secretion test, serum gastrin level tst) are elevated
in Zollinger-Ellison syndrome.
4. H. pylori antibody titer may be positive, especially in recurrent ulcers; however, there is
high rate of false positive results; C-urea breath test or biopsy testing is more definitive
test for H. pylori.

Pharmacologic Interventions

1. Histamine2 (H2) receptor antagonists such as ranitidine to reduce gastric acid secretions.
2. Antisecretory or proton-pump inhibitor, such as omeprazole, to help ulcer heal quickly in
4 to 8 hours.
3. Cytoprotective drug sucralfate, which protects ulcer surface against acid, bile, and pepsin.
4. Antacids to reduce acid concentration and help reduce symptoms.
5. Anti-biotic as part of a multi-drug regimen to eliminate H. pylori to prevent reoccurrence.

Surgical Interventions

Surgery is indicated for hemorrhage, perforation, obstruction, and when unresponsive

to medical therapy. Procedures include:

1. Gastroduodenostomy (Billroth I)
o Partial gastrectomy with removal of antrum and pylorus; gastric stump is
anastomosed to duodenum.
2. Gastrojejunostomy (Billroth II)
 o Partial gastrectomy with removal of antrum and pylorus; gastric stump is
anastomosed to jejunum.
3. Antrectomy
o Antrum (lower half of stomach), pylorus and small cuff of duodenum are
resected; stomach is anastomosed to jejunum and duodenal stump is closed.
4. Total gastrectomy
o Removal of stomach with anastomosis of esophagus to jejunum or duodenum.
5. Pyloroplasty
o Longitudinal incision is made in the pylorus, and closed transversely to permit the
muscle to relax and established an enlarged outlet; often performed with
vagotomy.

Nursing Interventions

1. Monitor the patient for signs of bleeding through fecal occult blood, vomiting, persistent
diarrhea, and change in vital signs.
2. Monitor intake and output.
3. Monitor the patient’s hemoglobin, hematocrit, and electrolyte levels.
4. Administered prescribed I.V. fluids and blood replacements if acute bleeding is present.
5. Maintain nasogastric tube for acute bleeding, perforation, and postoperatively, monitor
tube drainage for amount and color.
6. Perform saline lavage if ordered for acute bleeding.
7. Encourage bed rest to reduce stimulation that may enhance gastric secretion.
8. Provide small, frequent meals to prevent gastric distention if not actively bleeding.
9. Watch for diarrhea caused by antacids and other medications.
10. Restrict foods and fluids that promote diarrhea and encourage good perineal care.
11. Advise patient to avoid extremely hot or cold food and fluids, to chew thoroughly, and to
eat in a leisurely fashion to reduce pain.
12. Administer medications properly and teach patient dose and duration of each medication.
13. Advise patient to modify lifestyle to include health practices that will prevent recurrences
of ulcer pain and bleeding.

Peptic Ulcer Nursing Care Plan

Related Nursing Articles

1. Nursing Care Plan – Peptic UlcerPeptic Ulcer is a lesion in the mucosa of the lower
esophagus, stomach, pylorus, or duodenum. Also known as ulcus pepticum, PUD or
peptic ulcer disease, is an ulcer (defined as mucosal erosions equal to...
2. Drug Study – Ranitidineby: ishi21, RN Zantac, Zantac EFFERdose, Zantac GELdose,
Zantac-75 Action: Potent anti-ulcer drug that competitively and reversibly inhibits
histamine action at H2-receptor sites on parietal cells, thus blocking gastric acid
secretion. Indirectly reduces pepsin secretion...
3. Billroth SurgeryBillroth Surgery is a partial resection of the stomach with anastomosis to
the duodenum (Billroth I) or to the jejunum (Billroth II). It is a standard treatment for
ulcer disease, stomach cancer, injury and other...
 4. What is Hiatal HerniaIs a protrusion of part of the stomach through the hiatus of the
diaphragm and into the thoracic cavity. Two types of hiatal hernias: Sliding hernia – the
upper stomach and gastroesophageal junction move upward...
5. Gastric CancerIt is also called malignant tumor of the stomach. It is usually an
adenocarcinoma. It spreads rapidly to the lungs, lymph nodes, and liver. Risk factors
include chronic atrophic gastritis with intestinal metaplasia; pernicious anemia...
nursing management: to manage this means to care plan for it. that means you must
engage the nursing process to break down the disease into its signs and symptoms
because that is essentially what nursing interventions will target as well as how the
patent's reactions to these signs and symptoms affect their ability to perform their
activities of daily living (adls). follow the steps of the nursing process to do all of this:

step 1 assessment - collect data from medical record, do a

physical assessment of the patient, assess adl's, look up
information about your patient's medical
diseases/conditions to learn about the signs and symptoms
and pathophysiology - much of this information can be collected
from the two references i supplied above as well as from your
textbooks.
 peptic ulcer causes: nsaids, helicobacter pylori (90-100% in duodenal
ulcers; 70-90% in gastric ulcers), acid induced, chronic disease (stress
ulcers in chronic debilitated conditions, copd, cystic fibrosis, alpha-1-
antitrypsin deficiency, systemic mastocytosis, basophilic leukemia,
chronic renal failure, cirrhosis)
 gnawing or burning sensation, occurs 2-3 hours after meals, relieved
by food or antacids
 patient awakens with pain at night, may radiate to the back (possible
penetration)
step #2 determination of the patient's problem(s)/nursing
diagnosis part 1 - make a list of the abnormal assessment
data
 duodenal ulcer
o mid-epigastric pain, deep recurring ache
o pain relieved with food or antacids
o nocturnal pain is present
 gastric ulcer
o mid-epigastric pain
o pain relieved by antacids
o anorexia
o weight loss
o nausea or vomiting
 dyspepsia (epigastric burning, abdominal bloating, belching, flatulence,
nausea, halitosis)
  fatty food intolerance
 hematemesis or melena and/or guaiac-positive stool (from
gastrointestinal bleeding)
step #2 determination of the patient's problem(s)/nursing
diagnosis part 2 - match your abnormal assessment data to
likely nursing diagnoses, decide on the nursing diagnoses to
use
 deficient fluid volume r/t gi bleeding aeb hematemesis or
melena and/or guaiac-positive stool [+ other symptoms of
dehydration or the effects of hemorrhage]
 imbalanced nutrition: less than body requirements r/t inability
to ingest food, nausea & vomiting aeb weight loss, anorexia
and intolerance of fatty foods
 nausea r/t gastric irritation and distension aeb reports of
nausea and vomiting, abdominal bloating, belching, flatulence
and halitosis
 acute pain r/t gi irritation aeb mid-epigastric pain and may be
relieved with food or antacids, epigastric burning sensation,
and presence of epigastric pain at night
step #3 planning (write measurable goals/outcomes and
nursing interventions) - goals/outcomes are the predicted
results of the nursing interventions you will be ordering and
performing - interventions specifically target the etiology of
the problem or abnormal data/signs and
symptoms/evidence that supports the existence of the
problem - your overall goal is always aimed to alter or
change something about the problem
example: nausea r/t gastric irritation and distension aeb
reports of nausea and vomiting, abdominal bloating,
belching, flatulence and halitosis
goal: the patient will report no nausea and improvement of
intestinal gas.

nursing interventions:
 assess/monitor/evaluate/observe (to evaluate the patient's condition)
o assess frequency, character and amount of any nausea
o assess the duration of nausea
o assess what conditions cause or make the nausea worse
 care/perform/provide/assist (performing actual patient care)
o place an emesis basin within patient's reach
o assist with or offer mouth care after each episode of emesis or
q4h
 o offer ice chips, ginger ale or warm both if allowed per diet
o if allowed, offer dry (toast, crackers) and bland foods (broth,
rice, bananas, jell-o)
o do not give fried or greasy foods
o give antiemetics as ordered by the doctor
o give antacids as ordered by the doctor
 teach/educate/instruct/supervise (educating patient or caregiver)
o teach the patient that his symptoms of distension, belching and
flatulence are a result of the disease process and as medical
treatment is effective they will disappear.
(http://www.webmd.com/a-to-z-guides/flatulence-gas)
o teach the patient to change positions slowly
o teach the patient about the appropriate foods to eat when
nauseated and those to avoid
o teach the patient the importance of maintaining fluid intake
o teach the patient that they need to contact the doctor if vomiting
persists for more than 24 hours
 manage/refer/contact/notify (managing the care on behalf of the
patient or caregiver)
o notify the doctor if the patient vomits black or bloody emesis or
develops a fever
 this is done for each nursing diagnosis (problem) with attention to the
symptoms of the problem since that is what you are aiming your
nursing treatments at. so, you will be looking for nursing interventions
for the following:
o hematemesis
o melena
o symptoms of dehydration
o symptoms of hemorrhage
o weight loss
o anorexia
o intolerance of fatty foods (you don't want the patient eating fried
or greasy food anyway!)
o mid-epigastric pain (burning sensation) sometimes presence at
night
and this is how you use the nursing process to think critically and
work out the answer to your question.

TREATMENT.
Peptic ulcer disease is characterized by ulcer formation in the esophagus, stomach, or
duodenum, areas of the gastro intestinal mucosa that are exposed to gastric acid and
pepsin. Gastric and duodenal ulcers are more common then esophageal ulcers. Peptic
ulcers are attributed to an imbalance between cell-destructive and cell-protective
effects . Cell-destructive effects include those of gastric acid , pepsin, Helicobacter
pylori infection, and ingestion of nonsteroidal anti-inflammatory drugs . Gastric acid,
a strong acid that can digest the stomach wall, is secreted by parietal cells in the
mucosa of the stomach antrum, near the pylorus. The parietal cells contain receptors
for acetylcholine, gastrin, and histamine, substances that stimulate gastric acid
production. Acetylcholine is released by vagus nerve endings in response to stimuli,
such as thinking SECTION 10 DRUGS AFFECTING THE DIGESTIVE SYSTEM
about or ingesting food. Gastrin is a hormone released by cells in the stomach and
duodenum in response to food ingestion and stretching of the stomach wall. It is
secreted into the bloodstream and eventually circulated to the parietal cells. Histamine
is released from cells in the gastric mucosa and diffuses into nearby parietal cells. An
enzyme system catalyzes the production of gastric acid and acts as a gastric acid pump
to move gastric acid from parietal cells in the mucosal lining of the stomach into the
stomach lumen. Pepsin is a proteolytic enzyme that helps digest protein foods and also
can digest the stomach wall. Pepsin is derived from a precursor called pepsinogen,
which is secreted by chief cells in the gastric mucosa. Pepsinogen is converted to
pepsin only in a highly acidic environment . H. pylori is a gram-negative bacterium
found in the gastric mucosa of most clients with chronic gastritis, about 75% of clients
with gastric ulcers, and more than 90% of clients with duodenal ulcers. It is spread
mainly by the fecal-oral route. However, iatrogenic spread by contaminated
endoscopes, biopsy forceps, and nasogastric tubes has also occurred. Once in the
body, the organism colonizes the mucus-secreting epithelial cells of the stomach
mucosa and is thought to produce gastritis and ulceration by impairing mucosal
function. Eradication of the organism accelerates ulcer healing and significantly
decreases the rate of ulcer recurrence. Cell-protective effects normally prevent
autodigestion of stomach and duodenal tissues and ulcer formation. A gastric or
duodenal ulcer may penetrate only the mucosal surface or it may extend into the
smooth muscle layers. When superficial lesions heal, no defects remain. When smooth
muscle heals, however, scar tissue remains and the mucosa that regenerates to cover
the scarred muscle tissue may be defective. These defects contribute to repeated
episodes of ulceration. Although there is considerable overlap in etiology, clinical
manifestations, and treatment of gastric and duodenal ulcers, there are differences as
well. Gastric ulcers are often associated with stress , NSAID ingestion, or H. pylori
infection of the stomach. They are often manifested by painless bleeding and take
longer to heal than duodenal ulcers. Gastric ulcers associated with stress may occur in
any age group and are usually acute in nature; those associated with H. pylori
infection or NSAID ingestion are more likely to occur in older adults, especially in the
sixth and seventh decades, and to be chronic in nature. Duodenal ulcers are strongly
associ BOX 60–1