Gastritis Nursing Concepts - Assessment

Assessments were conducted in patients with gastritis include:

1. Activity / Rest
   
   • Signs: tachycardia, tachypnea / hyperventilation (in response to activity)
   • Symptoms: weakness, fatigue
   
   
2. Circulation
   
   • Symptoms:
     • hypotension (including postural)
     • tachycardia, dysrhythmias (hypovolemia / hypoxemia)
     • weakness / weak peripheral pulses
       capillary refill underlayer / slowly (vasoconstriction)
     • skin color: pale, cyanosis (depending on the amount of blood loss)
     • weakness of skin / mucous membranes = sweating (shows status of shock, acute pain, psychological responses)
   
   
3. Ego integrity
   
   • Signs: signs of anxiety, such as: anxiety, pallor, sweating, attention narrows, shaking, trembling voice.
     
   • Symptoms: acute or chronic stress factors (financial, labor relations), feeling helpless.
   
   
4. Elimination
   
   • Signs:
     • Abdominal tenderness, distention
       
     • Bowel sounds: often hyperactive during bleeding, hypoactive after bleeding.
       
     • Stool Characteristics : diarrhea, blood dark, brownish or sometimes bright red, frothy, foul smell (steatorrhoea). Constipation can occur (changes in diet, use of antacids).
       
     • Urine output: decreased, concentrated.
       
     
     
   • Symptoms: a history of previous hospitalization for gastro intestinal bleeding or GI related problems, eg wound peptic / gastric, gastritis, gastric surgery, gastric irradiation area. Changes in bowel habit / characteristic stool.
   
   
5. Food / fluid
   
   • Symptoms:
     • Vomiting: color: dark coffee or bright red, with or without blood clots.
     • Dry mucous membranes, decreased mucous production, poor skin turgor (chronic bleeding).
     
     
   • Symptoms:
     • Anorexia, nausea, vomiting (vomiting which extends suspected pyloric obstruction in relation to the outside of the duodenal injury).
     • Problems swallowing: hiccup
     • Heartburn, belching sour smell, nausea / vomiting


6. Neurosensory
   
   • Symptoms:
     • Feeling beat, dizziness / light headaches, weakness.
     • Mental status: level of consciousness can be disturbed, ranges from slightly inclined sleeping, disorientation / confusion, fainting and coma (depending on the volume of circulation / oxygenation).
   
   
7. Pain / Leisure
   
   • Signs: wrinkled face, be careful in the area of ​​pain, pallor, sweating, narrowed attention.
   • Symptoms: pain, described as sharp, shallow, burning, pain, sudden severe pain can be accompanied by perforation. Sense of discomfort / distress faint after eating a lot and lost a meal (acute gastritis). Pain epigastrum left till the middle / back or spreading to occur 1-2 hours after eating and lost with antacids (gastric ulcer). Pain epigastrum left until / or spread to the back occurred about 4 hours after eating when the stomach is empty and relieved by food or antacids (duodenal ulcer). There was no pain (esofegeal varices or gastritis).
     Trigger factors: food, cigarettes, alcohol, use of certain drugs (salicylates, reserpine, antibiotics, ibuprofen), psychological stressors.


8. Security
   
   • Signs: an increase in temperature, spider angioma, palmar erythema (indicating cirrhosis / portal hypertension)
   • Symptoms: allergies to medications / sensitive eg ASA


9. Counseling / Learning
   
   • Symptoms: the use of prescription / OTC containing ASA, alcohol, steroids. NSAIDs cause GI bleeding. Complaints can be accepted at this time due to (eg anemia) or diagnoses unrelated (eg, head trauma), intestinal flu, or episodes of severe vomiting. Long health problems eg cirrhosis, alcoholism, hepatitis, eating disorders (Doengoes, 1999, p: 455).
     

Gastritis Nursing Diagnosis and Nursing Interventions

Management of Acute Gastritis and Chronic Gastritis

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Management of Acute Gastritis and Chronic Gastritis

Gastritis is inflammation of the gastric mucosa.

Gastritis is divided into 2, namely:

1. Acute gastritis
   One form of acute gastritis are frequently encountered in the clinic is acute erosive gastritis. Acute erosive gastritis is an acute inflammation of the gastric mucosa to erosive damage. Called when the erosive damage is not deeper than the muscularis mucosa.


2. Chronic gastritis
   Chronic gastritis is an inflammation of the chronic gastric mucosal surface.
   Chronic gastritis is an inflammation of the mucosal surface of the stomach caused by either prolonged benign and malignant gastric ulcers or by bacteria helicobacter pylori. (Brunner and Suddart, 2000, p: 188).

Causes

The cause of gastritis is an anti-inflammatory analgesic drugs, especially aspirin; chemicals, such lisol; smoking; alcohol; physical stress caused by burns, sepsis, trauma, surgery, respiratory failure, kidney failure, damage to the central nervous system; gastrointestinal reflux (Inayah , 2004, p: 58).

Gastritis can also be caused by medications, especially aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), can also be caused by impaired microcirculation of the gastric mucosa such as trauma, burns and sepsis (Mansjoer, Arif, 1999, p: 492).

Gastritis Clinical Manifestations

Dyspepsia syndromes such as epigastric pain, nausea, bloating and vomiting is one of the complaints that often arise. Gastrointestinal bleeding was also found in the form of hematemesis and melena, followed by signs of anemia after bleeding. Usually if done anamnesa deeper, there is a history of the use of drugs or certain chemicals. Patients with gastritis also accompanied by dizziness, weakness and discomfort in the abdomen (Mansjoer, Arif, 1999, p: 492-493).

Management of Gastritis

Treatment of gastritis include:

1. Overcoming medical emergencies occur.
2. Overcoming or avoiding the cause if it can be found.
3. Giving drugs antacids or gastric ulcer medications to another.

In gastritis, management can be done by:

Management of Acute Gastritis

• Instruct patient to avoid alcohol.
• If the patient is able to eat by mouth nutritious diet is recommended.
• If symptoms persist, fluids should be given parenterally.
• If bleeding occurs, do gastromfestinal channel management to hemorrhage.
• To neutralize the acids commonly used antacids.
• To neutralize the alkali used diluted lemon juice or vinegar diluted.
• Emergency surgery may be needed to remove gangrene or perforation.
• The reaction needed to overcome obstruction gastric pylorus.

Management of Chronic Gastritis

• Can be overcome by modifying the patient's diet, eating soft diet was given little but more often.
• reduce stress
• H. Pylori treated with antibiotics.

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Why does Coffee Cause Gastritis?

According Warianto (2011), coffee is a drink that consists of different types of materials and chemicals; including fats, carbohydrates, amino acids, vegetable acid called phenol, vitamins and minerals.

Coffee is known to stimulate the stomach to produce stomach acid, creating an environment that is more acidic and can irritate the stomach. There are two elements that can affect the health of the stomach and the stomach lining, namely caffeine and chlorogenic acid.

The study, published in Gastroenterology found that various factors such as acidity, caffeine or other mineral deposits in the coffee can trigger high stomach acid. So that no single component should be responsible (Anonymous, 2011).

Caffeine can cause stimulation of the central nervous system (brain), respiratory system and cardiovascular system. Therefore, no wonder every cup of coffee in reasonable amounts (1-3 cups), your body feels refreshed, excited, thinking power more quickly, not easily tired or sleepy. Caffeine can cause central nervous system stimulation, thereby increasing the activity of the stomach and gastrin on gastric secretion and pepsin. The hormone gastrin released by stomach has the effect of gastric secretion which is very acidic sap of the gastric fundus. Increased secretion of acid can cause irritation and inflammation of the gastric mucosa (Okviani, 2011).

Thus, digestive disorders are vulnerable are often owned by people who drink coffee are gastritis (inflammation of the lining of the stomach). Some people who have digestive problems and discomfort in the abdomen or stomach are usually advised to avoid or limit drinking coffee, so the condition is not worse. (Warianto, 2011).

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Eating Patterns that Cause Gastritis

According to Farida Yayuk Baliwati (2004), the occurrence of gastritis can be caused by bad diet and irregular, the frequency of meals, type and amount of food, so that the stomach becomes sensitive when stomach acid to rise.

1. Frequency of Eating

Frequency of eating is the number of daily feeding in both qualitative and quantitative. Processed foods naturally in the body through the digestive tools from the mouth to the small intestine. Old food in the stomach depends on the nature and type of food. If on average, usually between 3-4 hours empty stomach. This feeding schedule was then fit to empty the stomach (Okviani, 2011).

People who have irregular eating patterns susceptible to disease gastritis. At the time of the stomach should be filled, but left empty, or delayed filling, sour stomach will digest the mucosal lining of the stomach, causing pain (Ester, 2001).

Naturally, the stomach will continue to produce acid in the stomach every time a small amount, after 4-6 hours after meal blood glucose levels usually have much absorbed and used up, so the body will feel hungry and when it is stimulated gastric acid number. If someone is late to eat up to 2-3 hours, then the stomach acid produced and over-the more so that it can irritate the gastric mucosa and cause pain around the epigastrium (Baliwati, 2004).

Irregular eating habits will make it difficult to adapt to the stomach. If it is prolonged, excessive production of stomach acid so it can be irritating to the mucosal lining of the stomach and may progress to peptic ulcer. This can cause intense pain and nausea. These symptoms can go up into the esophagus causing a burning sensation burning (Nadesul, 2005). Gastric acid production is affected by the regulation include cephalic, the setting up by the brain. The presence of food in the mouth will reflexively stimulate gastric acid secretion. In humans, seeing and thinking about food can stimulate gastric acid secretion (Ganong 2001).

2. Type of Food

Type of food is a variation of a food that if eaten, digested, and absorbed at least the arrangement will result in a healthy and balanced menu. Provides a variety of foods depends on the person, certain foods can cause indigestion, as well as spicy foods (Okviani, 2011).

Consuming excessive spicy foods, will stimulate the digestive system, especially the stomach and intestines to contract. This will cause a burning sensation and pain in the gut is accompanied by nausea and vomiting. The symptoms are making people increasingly reduced appetite. When the habit of eating spicy food more than once a week for at least 6 months left to constantly irritate the stomach known as gastritis (Okviani, 2011).

Gastritis can be caused also from the foods that do not match. Certain foods that can cause gastritis, such as raw fruit, raw meat, curry, and food containing cream or butter. Not that the food is not digested, but because the stomach takes longer to digest food gets forward earlier and slow The rest of his intestines. As a result, the stomach contents and gastric acid stay in your stomach for a long time before passing into the duodenum and spent acid causes a burning sensation in the pit of the stomach and can irritate (Iskandar, 2009).

3. The Portion or Amount of Food

The portion or amount of food, as well as the dose is a measure of food consumed at each meal. Everyone must eat foods in the correct amount of fuel for all the needs of the body. If excessive food consumption, the excess will be stored in the body and cause obesity (overweight). In addition, food in large portions may lead to reflux of stomach contents, which in turn makes the power of the stomach wall decreased. Such conditions can lead to inflammation or injury to the stomach (Baliwati, 2004).

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Gastritis Nursing Diagnosis and Nursing Interventions

1. Gastritis Nursing Diagnosis : Pain (acute / chronic)

Pain (acute / chronic) associated with inflammation or irritation of the gastric mucosa due to increased gastric acid.

Nursing Interventions for Pain - Gastritis:

• Assess the patient's general condition
• Assess vital signs
• Assess pain scale
• Provide a quiet environment and comfortable
• Teach relaxation techniques

2. Gastritis Nursing Diagnosis : Imbalanced Nutrition Less Than Body Requirements

Imbalanced Nutrition Less Than Body Requirements related to anorexia, vomiting, and irregularities in body perception.

Nursing Interventions for Imbalanced Nutrition Less Than Body Requirements - Gastritis

• Allow clients to choose foods (low-calorie foods are not allowed)
• Make mealtime structure with a time limit (eg 40 minutes)
• Eliminate distractions (eg conversation, watching television) during mealtimes
• 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.
• When food is not eaten, do feeding through a tube, NGT to order in this state do not give offerings to the client.
• Perform a replacement feeding method each time the client refuses to eat by mouth.
• Keep your attention during the meal if the client refuses to eat.

Evaluation Criteria

• Client expressed understanding of nutritional needs.
• Receive adequate caloric intake to maintain normal body weight.
• Following the return of a normal diet.

3. Gartitis Nursing Diagnosis - Fluid Volume Deficit

Nursing Interventions for Fluid Volume Deficit - Gastritis

• Monitor input and output; keep records in the nurse's office, and observations with as simple as possible.
• Monitor the administration of fluids with electrolytes to order; accompany the client when the bath to prevent the emptying of intravenous fluids.
• Monitor vital signs as needed.

Evaluation Criteria

• Clients are required to demonstrate adequate hydration.
• Balance between input and output.

4. Gastritis Nursing Diagnosis - Knowledge Deficit

Knowledge deficit and information related to the conditions and lack of coping skills

Nursing Diagnosis for Knowledge deficit - Gastritis

• Guidelines emphasize nutrition and how to cope with a diet when away from home.
• Discuss with the client the importance of reviewing the needs of calories every 2 to 4 weeks.
• Encourage the use of stress management techniques.
• Increase peogram regular practice.
• Encourage follow-up care visits with physicians and counselors.

Evaluation Criteria

• Clients expressed the importance of lifestyle changes to maintain a normal weight.
• Clients seeking counseling resources to help make changes.
• Clients trying to maintain weight.

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Nursing Interventions for Gastritis

Gastritis is not a single disease, but means inflammation of the stomach lining. Gastritis can be caused by drinking too much alcohol, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), or infection with bacteria such as Helicobacter pylori. Sometimes gastritis develops after major surgery, traumatic injury, burns, or severe infections. Certain diseases, such as pernicious anemia, autoimmune disorders, and chronic bile reflux, can cause gastritis as well.



Symptoms of Gastritis

The most common symptoms are abdominal upset or pain. Other symptoms are belching, abdominal bloating, nausea, and vomiting or a feeling of fullness or of burning in the upper abdomen. Blood in your vomit or black stools may be a sign of bleeding in the stomach, which may indicate a serious problem requiring immediate medical attention.

Nursing Diagnosis and Nursing Interventions for Gastritis

1. Acute pain related to obstruction / spasm of the duct, the inflammatory process and tissue ischemia.

Nursing Interventions for Gastritis

• Observe and record the location and character of pain (persistent, intermittent, colicky)
• Record the response to pain
• Increase bed rest, let the patient make a comfortable position.
• Control the temperature of the environment
• Encourage use of relaxation techniques

Collaboration:

• Anticholinergics: Atropine, Propentelin (Pro-banthine)
• Sedatives: Phenobarbital
• Narcotics: meperidine hydrochloride
• Monoktanoin
• Relaxation of smooth muscle

2. Imbalanced nutrition less than body requirements related to obstruction of bile flow

Nursing Interventions for Gastritis

• Assess abdominal distension
• Calculate the calorific intake, keep the comments about the appetite to a minimum.
• Provide a pleasant atmosphere at mealtime
• Ambulation and activities corresponding increase tolerance

Collaboration:

• Add the appropriate diet tolerance, high fiber, low fat
• Provide an overview of bile
• Supervise laboratory examination
• Give local nutritional support as needed

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