Gastritis

Gastritis

1. Nursing Interventions

   • Give medications as prescribed
   • Assess vital signs to monitor for hemorrhage
   • Monitor labs for signs of anemia and cobalamin deficiency
   • Moitor for dehydration
   • Educate about diet and nutritional intake
   • Assess for H. pylori
   • Assess medical history for autoimmune gastritis
   • Teach patients about the therapeutic effects of PPIs and H2-receptor blockers
   • Education about quitting smoking and drinking alcohol
   • Insert NG tube as needed
   • Provide reassurance and emotional support to patient and caregiver
   • Monitor intake and output, level of consciousness, and bowel sounds
   • Monitor CBC and Vitamin B12 to detecct blood loss and anemia

2. Nursing Diagnosis

   • Epigastric pain related to irritation of gastric mucosa
   • Risk for developing chronic gastritis
   • Risk for developing stomach cancer
   • Deficiency related to imbalanced diet
   • Risk for drug-related gastritis
   • Risk for decreased cardiac output related to blood loss
   • Deficit fluid volume related to acute loss of blood and gastric secretions
   • Ineffective peripheral tissue perfusion related to loss of circulatory volume
   • Anxiety related to pain, hospitalization, uncertain outcome, source of bleeding

3. Clinical Manifestations

   • Acute gastritis
     • anorexia, nausea and vomiting, epigastric tenderness, and a feeling of fullness
     • Hemorrhage that is commonly associated with alcohol abuse and can sometimes be the only symptom
     • Self-limiting and can last for a few hours to a few days
     • Complete healing
   • Chronic gastritis
     • Similar to acute gastritis
     • Some patients are asymptomatic
     • Parietal cells lost due to atrophy cause the loss of the source of intrinsic factor which is essential for absorption of cobalamin in the terminal ileum
       • Cobalamin deficiency exists when cobalamin stores in the liver are depleted
         • Cobalamin is essential for the growth and maturation of red blood cells (RBCs) , and when it is lacking, it results in pernicious anemia and neurological complications

4. Interprofessional Care

   • Pharmacist to educate on medications and interactions
   • Dietitian to help patient develop a meal plan
   • Nursing to monitor patient for Signs, symptoms, and risk factors
   • PCP to assess the patient's health and manage medications
   • Laboratory personnel to draw labs and report abnormal labs

5. Pathophysiology

   • Breakdown in gastric mucosal barrier
     • Mucosal barrier protects the stomach tissue from corrosive action of HCl acid and pepsin
       • When barrier broken, HCl acid and pepsin can diffuse back into the mucosa
         • Back diffusion results in tissue edema, disruption of capillary walls with loss of plasma in the gastric lumen, and possible hemorrhage
   • Drugs can inhibit the synthesis of prostaglandins that are protective to the gastric mucosa
     • Make mucosa more susceptible to injury
   • Dietary indiscretions from alcoholic bingeing causes acute damage to the gastric mucosa and can range from localized injury of superficial epithelial cells to destruction of the mucosa with mucosal congestion, edema, and hemorrhage.
     • Prolonged damage induced by repeated alcohol abuse results in chronic gastritis
       • Eating large quantities of spicy, irritating foods can cause acute gastritis
   • H. pylori infection causes acute gastritis in most infected persons and chronic gastritis in some patients
     • prolonged inflammation leads to functional changes in the stomach and in some cases, stomach cancer
   • Other bacterial, viral, and fungal infections are associated with chronic gastritis
     • Gastritis can occur from reflux of bile salts from the duodenum into the stomach because of anatomic changes following surgical procedures (e.g., gastroduodenostomy, gastrojejunostomy)
       • Prolonged vomiting may cause reflux of bile salts
         • Intense emotional responses and CNS lesions may produce inflammation of the mucosal lining from hypersecretion of HCl acid.
   • Autoimmune metaplastic atrophic gastritis is an inherited condition in which there is an immune response directed parietal cells.
     • Loss of parietal cells leads to low chloride levels, inadequate production of intrinsic factor, cobalamin (vitamin B12) malabsorption, and pernicious anemia. It is associated with an increased risk of stomach cancer.

6. Diagnostic Studies

   • Based on symptoms and history of drug and alcohol use
   • Endoscopic examination with biopsy to provide definitive diagnosis
   • Breath, urine, serum, stool, and gastric tissue biopsy tests are used to assess for H. pylori infection
   • Complete blood count (CBC) may show anemia from blood loss or lack of intrinsic factor
   • Stools are tested for occult blood
   • Serum tests for antibodies to parietal cells and intrinsic factor may be done
   • Tissue biopsy to rule out gastric cancer

7. Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2017). Medical-surgical nursing: Assessment and management of clinical problems (10th ed.). St. Louis, MO: Elsevier, Inc.

   • References