gastritis

TABLE OF CONTENT

Bil Content Page1 Acknowledgment2 Introduction of diagnosis

2.1-Etiology2.2-Pathophysiology2.3-Types2.4-Clinical manifestation2.5-Complication

3 Patient profile4 Social history5 Family history6 Previous medical and surgical illness7 Presence history-Assessment8 Daily report

8.1-Condition of patient8.2-Complaint from patient8.3-Nursing care8.4-Vital signs8.5-Preview by doctor8.6-Order by doctor8.7-Medication and diet

9 Investigation10 Management11 Nursing care plan12 On discharge13 Health education14 Summary15 Conclusion16 Reference

Acknowledgment

First and foremost I would like to thankfully to Allah SWT for giving me opportunity to complete my case study on gastritis. Then I would like to thanks to my beloved clinical instructor (CI) Madam Siti Zahara Bt.Mahmood for giving me a lot of supporting and encouragement to finish this case study.

Apart from that, I also would like to thanked to all my friends especially my partner group for their effort giving me some useful tips in order to make this case study complete. Furthermore, I also would like to give my great thankful to staff nurse and doctor at An-Nisa Medical Centre, Kota Bharu, Kelantan who give their opinion to me. So that, I can finish my case study competed.

Last but not least, I again want to say thankfully to the entire person who had involved directly and indirectly in helped me to complete my case study sharp on time. Thank you for you all.

Introduction of diagnosis

Definition: -Gastritis is inflammation and irritation of the inner lining of the

Stomach.

-Gastritis can be brief and sudden illness (acute gastritis), a longer-

lasting condition (chronic gastritis) or a special condition, perhaps as

part of another medical illness.

Reason that could cause the irritation/Etiology

1. Acid related

2. Medications

-Aspirin (more than 300 drug products contain some form of aspirin)-Non steroidal anti inflammatory drugs (NSAID, such as ibuprofen or Naproxen)-Steroids (Prednisolone is one example)

3. Helicobacter Pylori

4. Rarely infections with certain viruses

5. Having tubes or foreign objects placed in the stomach (such as a nasogastric

tube.

Pathophysiology

Gastric mucus membranes become edematous and hyperemic (congested with fluid and blood), undergoes superficial erosion.

Secretes scanty amount of gastric juice, containing very little acid but much mucus.

Superficial ulceration may occur and can lead to hemorrhage.

Damage from irritants result in increased intracellular PH, impaired enzyme function, disrupted cellular structures, ischemia, vascular stasis and tissue death.

Gastritis.

Types

1. Acute gastritis

an example of acute gastritis is stomach upset that may follow the use of

alcohol, aspirin, caffeine or food.

Pathophysiology - disruption of mucosal barrier by a local irritant

-Hcl and pepsin come in contact with gastric tissue>

irritation, inflammation and superficial erosion.

-Mucosa rapidly regenerates> heals in a few days.

2. Chronic gastritis

Helicobacter Pylori is a type of bacteria that infects in the stomach. infection with these bacteria may lead to chronic gastritis.

Progressive and irreversible changes in the gastric mucosa.

Common in elderly, chronic alcohol drinkers and cigarette smokers.

Start with inflammation leading to atrophy. decreased mucus Gastric mucosa disrupts and destroyed. Goes deeper, lining becomes thin and atrophy.

.

Clinical manifestation

1. Acute gastritis

Asymptomatic to mild heartburns to severe distress, vomiting and bleeding with

hematemesis.Anorexia.

2. Chronic gastritis

pain and discomfort region of stomachepigastric pain after mealsVomiting possibly of blood (hematemesis)Heartburn after eatingLoss of appetite and sour taste in the mouthHiccupsIndigestion (dyspepsia)Dark stools

Complication

Patient Profile

Name: Mr. Z

IC: 710414-03-5695

Status: Married

Registered number: 891250

Ward: Melor

Address: No 19, Jalan Sultan Yahya Petra, Lundang, 15200, Kota Bharu, Kelantan.

Date of Birth: 14 April 1971

Age: 39 years

Sex: Male

Race: Malay

Religion: Islam

Weight: 72 kg

Height: 178cm

Phone number: 019-9737573

Date of admission: 8 Jun 2010

Date of discharge: 11Jun 2010

Diagnosed: Chronic Gastritis

Family History

Mr.Z lives at Kota Bharu, Kelantan. He is working as a Tenaga National Berhad (TNB) officer. His wife is a teacher at Sekolah Menengah Kebangsaan Kubang Kerian 1, Kota Bharu, Kelantan. Mr.Z was married in 1997 year and has two boys and one girl. Both of his children study in Kota Bharu.

Seven years ago, his father was death because disease heart attack. His father like smoking and have a chronic cough. A chronic cough, such as occurs from smoking increases high risk of

heart attack. However, his father also has a chronic gastritis. Now, Mr.Z also has disease gastritis.

Social History

Mr.Z is a Tenaga National Berhad (TNB) officer at Kota Bharu. He is 39 years old. On weekend, he spends time to watching television at home with his family. Mr.Z no active in sport and he did not do any activities outside his house. He is also a great smoker and he smoker about 8-15 cigarette per day. Besides that, Mr.Z like take fatty food and spicy food such Kentucky Fried Chicken (KFC).

One day, he feels pain and discomfort region of stomach especially after take meals. He also feels heartburn and vomiting possibly of blood (hematemesis). After that, he goes to the hospital to get the information and get treatment his disease. The doctor diagnosed his as gastritis. When he knows he had gastritis, his work and activity disturb.

From day to day, he become slowly, and always feels pain and loss of appetite. He must rest more time himself in enough time and limited activities.

Previous Medical and Surgical Illness

In year 2008, Mr.Z admitted in ward at Hospital Kubang Kerian, Kota Bharu, Kelantan with diagnosed of Acute Gastritis.

His admitted in hospital, his blood pressure is 130/84, pulse rate 94 beat per minute, temperature 37.5 C, respiration 22 per minute and spo2 98%.

He follows the treatment in ward and checked by Dr.Maheran. Doctor order antibiotic and antihiatamine for Mr.Z. Antibiotic (Omeprazole) to treat for kill bacteria and aanti histamine 2 (H2) receptor blocker (Ranitidine) to prevent pepsin or treat acute stress gastritis and to reduce amount or effects of HCL.

After his condition stable, Mr.Z discharge from ward. His did’t get any surgery treatment.

Presence History – Assessment

Diagnostic tests

1. Gastric analysis

-Asses HCL secretions

-Less in patient with chronic gastritis

2. Hemoglobin, Hematocrit and Red blood Cell indices for evidence of anemia.

3. Serum vitamin B12 levels are reduced in elderly patients.

4. Upper endoscopy for inspection of gastric mucosa.

Nursing Care Plan

1. High risk for fluid and electrolyte imbalance related to inadequate intake of food/fluids and abnormal loss of fluid and electrolytes.

2. Pain related to irritation of gastric mucosal layer.

3. Imbalanced nutrition less than body requirement related to anorexia and poor food intake.

4. Anxiety related to the disease and anticipated treatment.

5. Knowledge deficit related to disease process and dietary management.

Nursing diagnosis Goal Nursing intervention Evaluation

1. High risk for fluid and electrolyte imbalance related to inadequate intake of food/fluids and abnormal loss of fluid and electrolytes.

-Patient

maintains fluid and electrolyte balance.

1. Observation-monitor and record vital signs 2hourly till stable then 4hourly blood pressure, respiration, pulse rate and temperature.R-tachycardia, tachypnea and hypotension may indicate fluid volume deficit and as a baseline data.

2. Assessment-monitor skin turgor, color, condition and status of oral mucus membrane frequently.R-skin turgor and mucus membrane assessment indicate hydration status.

3. Weight daily-monitor daily body weight to see any changes of body weight with nutritional status.R-daily weight is an accurate indicator of fluid volume.

4. Nutrition-administer IV fluids as ordered by doctor.R-IV fluids restore or maintain hydration until adequate oral intake is started.

-fluid and electrolyte balance.

5. Hygienic-provide skin and mouth care frequently like brush the teeth with soft brush.R-good skin and mouth care are necessary to maintain skin and mucus membrane integrity.

2. Pain related to irritation of gastric mucosal layer.

-patient able to bear pain until effects of medication is at its maximum.

1. Assessment-asses nature of pain including location, intensity pattern use pain scale levelR-to know where the pain scale start and how the pain feel to patient.

2. Position-assist patient to comfortable position such as semi fowlers position and change 2hourlyR-to prevent pressure sore and make patient comfortable.

3. Activity daily life-restrict activity that may aggravate pain as help in toilet or give bedpan when neededR-to reduce pain at location side

4. Nutrition-advice patient to avoid foods that are too spicy and fatty foodsR-to reduce irritation of gastric mucosa.

-pain reduce

-advice patient to drink a lot of water at least 8glass per dayR-to neutralize the acid in stomach.

5. Medication-administer analgesic tablet Paracetamol 500mg order by doctorR-to reduce pain and instruct patient to correct uses of medication to effectiveness of medication actions.

3. Imbalanced nutrition less than body requirement related to anorexia and poor food intake.

-patient maintains balanced nutrition with evidence of appropriate body weight.

1. Monitor I/O chart-monitor and record food and fluid intake and any abnormal lossR-careful monitoring can help in developing a dietary plan to meet calorie needs.

2. weight-monitor weight and lab studies such Sr albumin, hemoglobin and Red Blood Cell indicesR-weight and lab values provide data regarding nutritional status and the effectiveness of interventions.

3. Nutrition

-

-provide nutritional supplements between meals and frequent small mealsR-many patient tolerate small better than 3 large meals a day.

4. Dietician-arrange for dietary consultation and refer dieticianR-to determine calorie and nutrients needs.

5. Medication-Administer antiemetic (Maxolon) and other drug as ordered by doctorR-to relieve vomiting and facilitate oral fluid intake.

4. Anxiety related to the disease and anticipated treatment.

5. Knowledge deficit related to disease process and dietary management.

Medication

Pharmacologic agent Major action Nursing considerations

1. Antibiotics

Amoxicillin(Amoxil)

-A bactericidal antibiotic that

-may cause diarrhea

Clarithromycin(Bioxin)

Metronidazole(Flagyl)

Tetracycline

assists with eradicating H.Pylori bacteria in the gastric mucosa.

-Exerts bactericidal effects to eradicate H.Pylori bacteria in the gastric mucosa.

-A synthetic antibactericidal and antiprotozoal agent that assists with eradicating H.Pylori bacteria in the gastric mucosa when administered with other antibiotics and PDI.

-Exerts bacteriostatic effects to eradicate H.Pylori bacteria in the gastric mucosa.

-should not be used in patients allergic to Penicillin.

-may cause GI upset, headache, altered taste.-many drug interactions (eg Cisapride, Lovastatin, Colchicine, Warfarin [Coumadin]).

-Should be administered with meals to decrease GI upset, may cause anorexia and metallic taste.-Patient should avoid alcohol, Flagyl increase blood thinning effects of Warfarin (Coumadin).

-may cause photosensitivity reaction, warm patient to use sunscreen.-may cause GI upset.-must be used with caution in patient with renal to

hepatic impairment.-milk or daily products may reduce effectiveness.

2. Antidiarrheal Bismuth Subsalicylate (Pepto-Bismol)

-suppresses H.Pylori bacteria in the gastric mucosa and assists with healing of mucosal ulcers.

-given concurrently with antibiotics to eradicate H.Pylori infection.-should be taken on empty stomach.

3. Histamine2 (H2) receptor antagonists.

Cimetidine(Tagamet)

Famotidine(Pepaid)

-decrease amount of Hcl produced by stomach by blocking action of histamine receptors.

-decrease amount of Hcl produced by stomach by blocking action of histamine receptors.

-least expensive of H2receptor antagonists.-may cause confusion, agitation or coma I the elderly or those with renal or hepatic insufficiency.-short term use may cause diarrhea dizziness, and gynecomastia.

-best choice for critically ill patient; because it is known to have the least risk of drug-drug interactions does not either liver metabolism.-prolonged half life

Nizatidine(Axid)

Ranitidine(Zantac)

-decrease amount of Hcl produced by stomach by blocking action of histamine receptors.

-decrease amount of Hcl produced by stomach by blocking action of histamine receptors

in patient with renal insufficiency.-short term relief for GERD.

-use for treatment of ulcers and GERD.-may cause headache, dizziness, diarrhea, nausea and vomiting, GI upset as well as urticaria.

- Prolonged half life in patient with renal and hepatic insufficiency.-cause fever side effects than Cimetidine.- may cause headache, dizziness, constipation, nausea and vomiting or abdominal discomfort.

4. Proton Pump Inhibitors

Esomeprazol(Nexium)

-decreases gastric acid secretion by slowing the hydrogen-potassium adenosine triphosphatase

-used mainly for treatment of duodenal ulcer disease and H.Pylori infection.-a delayed release capsule that is to

Lansoprazole(Prevacid)

Omeprazole(Prilosec)

Pantoprazole(Protonix)

Rabeprazole(AcipHex)

pump on the surface of the parietal cells of the stomach.

- decreases gastric acid secretion by slowing the hydrogen-potassium adenosine triphosphatase pump on the surface of the parietal cells.

- decreases gastric acid secretion by slowing the hydrogen-potassium adenosine triphosphatase pump on the surface of the parietal cells.

- decreases gastric acid secretion by slowing the hydrogen-potassium adenosine triphosphatase pump on the surface of the parietal cells.

be swallowed whole and taken before meals.

- A delayed release capsule that is to be swallowed whole and taken before meals.

- A delayed release capsule that is to be swallowed whole and taken before meals.-may cause diarrhea, nausea, constipation, abdominal pain, vomiting, headache and dizziness.-a delayed release capsule that is to be swallowed whole and taken before meals.-may cause diarrhea, hyperglycemia, headache abdominal pain and abnormal liver function tests.

-a delayed released tablet to be

- decreases gastric acid secretion by slowing the hydrogen-potassium adenosine triphosphatase pump on the surface of the parietal cells.

swallowed whole.-may cause abdominal pain, diarrhea, nausea and headache.-drug interaction with Digoxin, iron and Warfarin(Coumadin).

5. Prostaglandin E1 analog

Misoprostal(Cytotec)

Sucralfate(Carafate)

-synthetic prostaglandin, protects the gastric mucosa from agents that cause ulcers, also increases mucus production and bicarbonate levels.

-creates a viscous substance in the presence of gastric acid that forms a protective barrier, binding to the surface of the ulcer and prevents digestion by pepsin.

-use to prevent ulceration in patient using NSAIDS.-administer with food.-may cause diarrhea and cramping.

-used mainly for the treatment of duodenal ulcers.-should be taken without food but with water.-other medications should be taken 2hours before or after this medication.-may cause constipation or

nausea.

Health Education

Maintaining optical nutrition Dietary modifications Usage of prescribed medication Avoiding known gastric irritants like aspirin, alcohol and

cigarette smoking.

Summary

Conclusion

As a conclusion, I’m very happy because looking Mr.Z was discharge from ward Melor. From the case study, I can do conclusion, most patients with gastritis if symptoms including pain or discomfort region of stomach, especially epigastric pain after meals and vomiting possibly of blood (hematemesis). Istudy how to method for the treatment gastritis. Then, with have skill and knowledge, I’m sure can become nurse leather and have responsibility to our patient needs.

Lastly, I say thank you to doctor, staff nurse and clinical instructor (CI) madam Siti Zahara Bt.Mahmood because they assist in my case study. I also say thank you to patient because give cooperation with me.

References

Le Mone and Burke (2000) Medical Surgical Nursing critical thinking in client (2nd ed).

Pearson’s Professional (1997). Tabblner’s Nursing Care: Theory and Practice. (3rd ed). Churchill Livingstone.