Gastritis PDF - Lectures of Adult Health Nursing I

Medical Surgical Nursing Departement Lectures of Adult Health Nursing I _________________________________________________________________________________________ Gastritis Learning objectives: By the end of the lecture the stu...

Medical Surgical Nursing Departement Lectures of Adult Health Nursing I _________________________________________________________________________________________ Gastritis Learning objectives: By the end of the lecture the student will be able to: Define gastritis List causes and risk factors of gastritis Differentiate between types of gastritis Discuss pathophysiology of acute and chronic gastritis Enumerate types of chronic gastritis based on cause List manifestations of gastritis Mention diagnosis of gastritis Explain treatment of gastritis Clarify complications of gastritis Discuss prevention of gastritis List nursing management of gastritis Apply nursing care plan for patient with gastritis 1 Medical Surgical Nursing Departement Lectures of Adult Health Nursing I _________________________________________________________________________________________ Gastritis Introduction: Gastritis is a general term for a group of conditions with one thing in common: Inflammation of the lining of the stomach. The inflammation of gastritis is most often the result of infection with the same bacterium that causes most stomach ulcers or the regular use of certain pain relievers. Drinking too much alcohol also can contribute to gastritis. Gastritis may occur suddenly (acute gastritis) or appear slowly over time (chronic gastritis). In some cases, gastritis can lead to ulcers and an increased risk of stomach cancer. For most people, however, gastritis isn't serious and improves quickly with treatment. Definition Gastritis is an inflammation, irritation, or erosion of the lining of the stomach. Causes and risk factors: Weaknesses or injury to the mucus-lined barrier that protects the stomach wall allows digestive juices to damage and inflame the stomach lining including: Bacterial infection: Although infection with Helicobacter pylori is among the most common worldwide human infections, only some people with the infection develop gastritis or other upper gastrointestinal disorders. Lifestyle choices, such as smoking and diet (high fat and salt). Regular use of pain relievers: Pain relievers commonly referred to as non-steroidal anti- inflammatory drugs (NSAIDS) such as ibuprofen (Advil, Motrin IB, others) can cause both acute gastritis and chronic gastritis. Age: Older adults have an increased risk of gastritis because the stomach lining tends to thin with age and because older adults are more likely to have H. pylori infection or autoimmune disorders than younger people are. Excessive alcohol use: Alcohol can irritate and erode stomach lining, which makes stomach more vulnerable to digestive juices. Stress: Severe stress due to major surgery, injury, burns or severe infections can cause acute gastritis. Cancer treatment: Chemotherapy drugs or radiation treatment can increase risk of gastritis. Diseases and conditions: Gastritis may be associated with other medical conditions, including HIV/AIDS, Crohn's disease, celiac disease, sarcoidosis and parasitic infections. 2 Medical Surgical Nursing Departement Lectures of Adult Health Nursing I _________________________________________________________________________________________ Autoimmune disease: In some people, the body’s immune system attacks healthy cells in the stomach lining. Bile reflux: Bile reflux occurs when bile flows back into the stomach instead of moving through the small intestine. Types: Erosive gastritis (Acute): This means the inflammation wears away the stomach lining. Eventually, this can cause lesions or ulcers. It is usually an acute gastritis and is more serious than the non-erosive form. Gastrointestinal (GI) bleeding is more common with erosive gastritis. Non-erosive gastritis (Chronic): This means the stomach lining does not wear away. Instead, the lining can degenerate, or atrophy. The lining can also undergo a process called metaplasia. Non-erosive gastritis is usually a form of chronic gastritis and is often asymptomatic. Pathophysiology: a- Acute gastritis: The decrease in the prostaglandin synthesis is thought to be the reason for the injury to the gastric mucosa. The gastric mucosa is safeguarded from the deleterious effects of the gastric acid by mechanisms promoted by the prostaglandins. In the majority of cases of H. pylori infection, the infection is not eliminated and there will be gradual accumulation of chronic inflammatory cells over the next 3 or 4 weeks. Following transmission, H. pylori penetrates the gastric mucosa and multiplies close to the surface epithelial cells. Following adhesion to epithelial cells, the bacteria releases lipopolysaccharides (endotoxin) and chemotactic mediators which penetrate the surface epithelial cells B- Chronic gastritis is characterized by the accumulation of lymphocytes and plasma cells in the lamina propria. Chronic active gastritis implies that ongoing active inflammation is causing damage to epithelial cells. The most common cause of chronic gastritis is chronic bacterial infection of the stomach by 3 Medical Surgical Nursing Departement Lectures of Adult Health Nursing I _________________________________________________________________________________________ Helicobacter pylori. H. pylori is adapted to live in the low pH environment of the gastric lumen, and infection is common and often persists throughout life unless it is eradicated by treatment with antibiotics (often a combination of three antibiotics is employed) H. pylori initiates a chronic immunoreaction that usually results in the formation of germinal centers in the gastric mucosa (antrum and fundus). While the bulk of organisms remain extracellular in the mucous layer adherent to gastric mucosa, the ongoing immunoreaction results in persistent acute and chronic inflammation with ongoing injury to the gastric epithelium. Over time, infection can result in metaplasia of the gastric mucosa to small intestinal type mucosa or loss of specialized gastric epithelium (atrophy). Chronic Helicobacter gastritis and the resulting oxygen free radicals and inflammatory mediators predispose to the development of adenocarcinoma that can arise in metaplastic gastric mucosa. Types of chronic gastritis based on cause: Autoimmune gastritis (e.g., pernicious anemia and cancer) that specifically destroys parietal cells and can ultimately result in gastric atrophy with the loss of all acid-producing parietal cells. Infectious gastritus: the most common type, is caused by H. pylori bacteria, and can cause stomach ulcers, intestinal ulcers, and cancer. Chemical gastritis: is caused by chemical irritants like nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, or bile. And it can also cause stomach lining erosion and bleeding. Other types of gastritis include giant hypertrophic gastritis, which can be related to protein deficiencies. There is also eosinophilic gastritis, which can happen alongside other allergic conditions like asthma or eczema. Manifestations: Many people with gastritis don’t have symptoms. People who do have symptoms often mistake them for indigestion. Signs of gastritis include : Upper abdominal pain or discomfort. Nausea and vomiting. Loss of appetite. Losing weight without meaning to. Bloating. Feeling extra full during or after a meal. Indigestion Heartburn Stomach ulcers. 4 Medical Surgical Nursing Departement Lectures of Adult Health Nursing I _________________________________________________________________________________________ Vomiting blood. Black, tarry stool. Shortness of breath or light-headedness Diagnosis: Breath test: During an H. pylori breath test, patient swallows a capsule or liquid containing urea, a harmless radioactive material then exhale into a balloon-like bag. H. pylori bacteria change urea into carbon dioxide. If having the bacteria, the breath test will show an increase in carbon dioxide. Blood test: A blood test checks for anemia and antibodies titers that fight H. pylori bacteria. Stool test: This test checks for bleeding or H. pylori bacteria in stool. Upper endoscopy: The doctor inserts the scope through esophagus, which connects mouth to stomach. An upper endoscopy procedure allows provider to examine the stomach lining. May also have a tissue sample (biopsy) taken from stomach lining to test for infection. Upper gastrointestinal (GI) exam: During an upper GI exam, one swallows barium. The liquid coats stomach lining, providing more detailed X-ray images. Treatment: Treatment for gastritis varies depending on the cause. Certain medications kill bacteria, while others alleviate indigestion-type symptoms. Options include: Antibiotics: Antibiotics can treat the bacterial infection. One may need to take more than one type of antibiotic for couple of weeks. Antacids: Calcium carbonate medications reduce stomach acid exposure. They can help relieve inflammation. Antacids, such as Tums® and Rolaids®, also treat heartburn. Histamine (H2) blockers: Cimetidine (Tagamet®), ranitidine (Zantac®) and similar medications decrease the production of stomach acid. Proton pump inhibitors: These medications, such as omeprazole (Prilosec®) and esomeprazole (Nexium®), reduce the amount of acid stomach produces. Iron supplements can be prescribed if the patient has developed anemia due to gastritis. If gastritis is causing vit B12 anemia, B12 injections can be given to reverse the deficiency. Complications: If left untreated, gastritis can lead to serious problems, such as: Peptic ulcers Stomach bleeding 5 Medical Surgical Nursing Departement Lectures of Adult Health Nursing I _________________________________________________________________________________________ Anemia: H. pylori can cause gastritis or stomach ulcers (sores in stomach) that bleed, thereby lowering red blood counts. Nutritional deficiencies (vitamin b12, vitamin D, folic acid, calcium) Perforation of the stomach Peritonitis: Gastritis can worsen stomach ulcers. Ulcers that break through the stomach wall can spill stomach contents into the abdomen. This rupture can spread bacteria, causing a dangerous infection called bacterial translocation or peritonitis. It also can lead to a widespread inflammation called sepsis. Sepsis can be fatal. Stomach cancer: Gastritis caused by H. pylori and autoimmune disease can cause growths in the stomach lining. These growths increase risk of stomach cancer. Achlorhydia (inability of stomach to produce sufficient acids for digestion) Prevention: Practice good hygiene: H. pylori is one of the top causes of gastritis, but most people don’t know they’re infected. The bacteria are easily transmitted. One can lower risk of infection by practicing good hygiene, including hand-washing. Eating smaller meals throughout the day: Eating smaller meals frequently could lessen the effect of stomach acids on the stomach wall. Avoiding fatty, fried, spicy or acidic foods: Such foods damage the gastric mucosa. Cutting back on caffeine. Reducing alcohol consumption: Alcohol irritates the mucosal lining and thus should be avoided. Managing stress. Not taking NSAIDs: If gastritis is due to painkiller medication, ask physician about other painkillers which doesn’t affect the stomach. Not lying down for 2 to 3 hours after a meal. Recommended foods generally include: All fruits and vegetables Foods high in probiotics, such as yogurt and kefir Lean meats, such as chicken, turkey, and fish Plant based proteins like beans and tofu 6 Medical Surgical Nursing Departement Lectures of Adult Health Nursing I _________________________________________________________________________________________ Whole grain pasta, rice, and breads Some foods may help stomach get rid of H. pylori and relieve symptoms: Garlic may have antimicrobial properties that are especially effective against H. pylori bacteria. Cranberries may kill the bacteria, along with changing how it interacts with the stomach. Ginger may block the growth of the bacteria. Turmeric may aid in healing ulcers and blocking growth of the bacteria. Nursing management: If the patient is vomiting, give antiemetics. Administer I.V. fluids as ordered to maintain fluid and electrolyte imbalance. When the patient can tolerate oral feedings, provide a bland diet that takes into account his food preference. Restart feedings slowly. Offer smaller, more frequent servings to reduce the amount of irritating gastric secretions. Help patient identify specific foods that cause gastric upset and eliminate them from his diet. Administer antacids and other prescribed medications as ordered. If pain or nausea interferes with the patient’s appetite, administer pain medications or antiemetics about 1 hour before meals. Monitor the patient’s fluid intake and output and electrolyte levels. Assess the patient for presence of bowel sounds. Monitor the patient’s response to antacids and other prescribed medications. Monitor the patient’s compliance to treatment and elimination of risk factors in his lifestyle. Teach the patient about the disorder. Urge the patient to seek immediate attention for recurring signs and symptoms, such as hematemesis, nausea, or vomiting. Nursing care plan 1- Nursing diagnosis: Imbalanced Nutrition: less than body requirements r/t insufficient absorption of nutrients Expected Outcome: The patient can absorb an adequate amount of nutrients 7 Medical Surgical Nursing Departement Lectures of Adult Health Nursing I _________________________________________________________________________________________ Interventions: Obtain the patient’s weight and other body measurements. Obtain information about the patient’s eating habits. Some food items can exacerbate the symptoms of gastritis. Acidic or citrus food items may worsen symptoms. Place the patient NPO (nothing by mouth) in case of vomiting. In the acute case of gastritis, gastric rest may be indicated. If the symptoms subside, the nurse may slowly introduce ice chips, and after that, clear liquids if tolerated. Monitor lab values such as CBC, PTT, platelet count, and fibrinogen. Discourage the patient from consuming spicy foods, caffeine, and alcohol. Acidic food items, such as tomatoes, or citrus items, may worsen the patient’s condition and interfere with the treatment and the healing process. Anticipate total parenteral nutrition (TPN(. Especially during flare-ups of gastritis, the patient might not be able to tolerate oral intake. Consult a dietitian if indicated. The patient might need an addition of supplements to compensate for insufficient nutrient intake. The patient might need an addition of supplements to compensate for insufficient nutrient intake. Administer medications as prescribed. Encourage small, frequent meals rather than three full meals. Educate the patient about medications. Patients might be sent home with new medications. Knowledge about newly prescribed medication promotes patient safety. 2- Nursing diagnosis: Acute Pain r/t inflammation of the gastric lining Expected Outcome: The patient verbalizes pain as being controlled at an acceptable level. Interventions: Assess the patient’s pain level at least every four hours. Use a pain assessment tool to assess pain. Note the characteristics of pain: (Onset, Quality, Severity, Location, and Duration). Assess for contributing factors that cause pain. Spicy food and large portion sizes might contribute to making the pain worse. Also, different medications such as NSAIDs, aspirin, or corticosteroids, might worsen gastritis. Teach other pain management techniques. Relaxation techniques might be beneficial since stress can contribute to the worsening of gastritis. Administer gastric medications as prescribed. 8 Medical Surgical Nursing Departement Lectures of Adult Health Nursing I _________________________________________________________________________________________ 3- Nursing diagnosis: Risk for Fluid Volume Deficit R/T Vomiting; Decreased intake Expected Outcome: The patient will have a stable fluid volume as evidenced by normal blood pressure, at least 30ml hourly urine output, and elastic skin turgor. Interventions: Assess for signs of dehydration. Vital signs, especially blood pressure, urine output, and skin turgor, provide information about the patient’s hydration status. Monitor how many times the patient vomits and note the amount of emesis each time. Frequent vomiting causes fluid loss and can lead to dehydration. Monitor the patient’s BP and HR. Monitor electrolytes closely. Frequent vomiting can cause a loss of electrolytes, especially potassium. Assess the patient’s skin turgor and mucus membranes. Non-elastic skin turgor and dry, cracked mucus membranes are signs of dehydration. Monitor urine output hourly and note the color. Urine output should be at least 30ml per hour. A decrease in urine output may be a sign of dehydration. Dark and amber urine can be signs of dehydration. Anticipate parenteral hydration measures. Often patients cannot take in oral fluids. Patients then receive fluids intravenously to replace lost fluid volume. Provide oral care frequently. Often patients are unable to eat or drink, which can leave the mouth dry. Administer antiemetics as prescribed. 9