Chronic Gastritis Case Study
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CHRONIC GASTRITIS Gastritis is an inflammation of the lining of the stomach. There are many possible causes. Gastritis is caused by excessive alcohol consumption, prolonged use of nonsteroidal anti-inflammatory drugs, also known as NSAIDs, such as aspirin or ibuprofen, 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 and chronic bile reflux, or autoimmune disorders, can cause gastritis as well. Gastritis may also occur in those who have had weightloss surgery resulting in the banding or reconstruction of the digestive track. The most common symptom is abdominal upset or pain. Other symptoms are indigestion, abdominal bloating, nausea, and vomiting, or a feeling of fullness or 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.
CAUSES : •
Bacterial infection. People infected with Helicobacter pylori (H. pylori) can experience gastritis — most commonly chronic gastritis.
Regular use of pain killers. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve), can cause both acute gastritis and chronic gastritis. Using these drugs regularly or taking too much of these drugs may reduce a key substance that helps preserve the protective lining of your stomach.
Excessive alcohol intake. Alcohol can irritate and erode your stomach lining, which makes your stomach more vulnerable to digestive juices.
• Stress. Severe stress due to major surgery, traumatic injury, burns or severe infections can cause gastritis. • Bile reflux disease. Bile — a fluid that helps you digest fats — is produced in your liver and stored in your gallbladder. When it's released from the gallbladder, bile travels to your small intestine through a series of thin tubes. Normally, a ring-like sphincter muscle (pyloric valve) prevents bile from flowing into your stomach from your small intestine. But if this valve doesn't work properly, or if it has been removed because of surgery, bile can flow into your stomach, leading to inflammation and chronic gastritis. •
Autoimmune disease. Called autoimmune gastritis, this rare condition occurs when your body attacks the cells that make up your stomach lining. This produces a reaction by your immune system that can wear away at your stomach's protective barrier. Autoimmune gastritis is more common in people with autoimmune disorders. 1
• Other diseases and conditions. Gastritis may be associated with other medical conditions, including HIV/AIDS, Crohn's disease, parasitic infections, some connective tissue disorders, and liver or kidney failure.
SIGN & SYMPTOMS • A gnawing or burning ache or pain (indigestion) in your upper abdomen that may become either worse or better when you eat • Nausea • Vomiting • Loss of appetite • Belching or bloating • A feeling of fullness in your upper abdomen after eating • Weight loss
RISK FACTOR Factors that may increase your risk of gastritis include: • H. pylori infection. The most significant risk factor for gastritis is infection with H. pylori bacteria.
• Regular use of aspirin or other NSAIDs. If you regularly take aspirin to prevent a heart attack or stroke, you're at risk of developing gastritis. The same is true if you take anti-inflammatory pain relievers for arthritis or another chronic condition. That's because long-term use of aspirin and other NSAIDs can cause stomach irritation and bleeding.
• Older 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.
TESTS & DIAGNOSES •
Upper gastrointestinal endoscopy
Upper gastrointestinal X-Ray
Increased risk of stomach cancer
Thinning of the stomach lining and changes in the lining cells.
Eat smart. If you experience frequent indigestion, eat smaller, more frequent meals to help ease the effects of stomach acid. In addition, avoid any foods you find irritating, especially those that are spicy, acidic, fried or fatty.
• Limit or avoid alcohol. Excessive use of alcohol can irritate and erode the mucous lining of your stomach, causing inflammation and bleeding. •
Don't smoke. Smoking interferes with the protective lining of the stomach, making your stomach more susceptible to gastritis as well as ulcers. Smoking also increases stomach acid, delays stomach healing and is a leading risk factor for stomach cancer.
Switch pain killers. If possible, avoid taking NSAIDs — aspirin, ibuprofen and naproxen. These over-the-counter medications can cause stomach inflammation or make existing irritation worse.
CASE STUDY NAME
: TIANG LAM PHU
: 229 B
: 27 YEARS OLD 10 MONTH
: 10 NOVEMBER 2008
SPECIALIST : DR. DATO’ SELVA
VITAL SIGNS BLOOD PRESSURE : 130/87 HEART RATE TEMPERATURE SPO2
: 82 bpm : 37’C : 99% ON AIR
# came to hospital by car with relatives # non-trauma / alert and conscious
ADMISSION HISTORY Mr. Tiang first came to A&E TAMAN DESA MEDICAL CENTRE at 10 NOVEMBER 2008 complaining to have an abdominal pain since at home. He came to A&E Taman Desa Medical Centre by car with relatives. He is been resting on bed at home and immobilize due to gastrointestinal tract disorder and chronic abdominal pain for about 2 month. He also having a sleeping pattern disturbance due to his abdominal pain. Because immobility, he is having a superficial pressure sore on his sacrum. On admission to GENERAL WARD, he is totally dependent to wheel chair due to abdominal discomfort. Mr. Tiang got allergies to Paracetamol and able to take his medication well except PCM. He looks like stress and sometimes request for discharge frequently. At PCU, his head of bed was elevated to 70’ to ensure airway clearance, & stomach reflux. His relatives visited every day to ensure Mr. Tiang is psychologically comfortable. He also have done his OGDS. On admission, Mr. Tiang receive a soft and normal diet due to his disease condition.
PAST SURGICAL HISTORY •
PAST MEDICAL HISTORY •
PROGRESS NOTES New admission in A&E at 1400 by car with his relatives and family member who live nearby. And then transferred to GENERAL WARD at TAMAN DESA MEDICAL CENTRE. The patient is complaining to have a chronic abdominal pain on the abdomen.
DAY BY DAY PROGRESS NOTE 10 NOVEMBER 2008 – 1330H -
Wheel chair admission via A&E.
Accompanied by staff.
h/o abdominal pain on / off for 2/hours.
At A&E IV line set up, blood taken, IV N/S in progress order from Dr. Bornia.
To keep patient NBM.
DMH – admitted at Ipoh Hospital for dengue fever last Sunday
PSH – Appendicectomy done 11 years ago.
Allergic – PCM
On admission, vital signs taken. - BP
Seen by Dato’ Selva, patient’s examined noted patient still c/o abdominal pain for ultrasound whole abdomen today.
FBC, H, pyloric test
Stool GS, FEME required.
KIV OGDS for tomorrow. (morning) 7
11 NOVEMBER 2008 -
Total intake 550mls.
Total output PUx2, BNO
For maintain NBM.
OGDS today. 0915 done.
ULTRASOUND ABDOMEN -
The liver is not yet enlarged. Not local lesion Sun. the parenchyma chew are normal.
The gallbladder, bile duct, pancreas and spleen are normal.
Both kidney and urinary bladder are normal.
The abdominal assess seen.
The prostate is not enlarged.
Vital signs taken.
NURSING DIAGNOSIS IMBALANCE NUTRITION LESS THAN BODY REQUIREMENT r/t POOR APPETITE INTERVENTION
Ensure the patient environment is clean.
Clean and clear environment makes patient gain his appetite.
Ask the relative to bring his favorite food but must maintain diet disciplinary.
Bringing the patient’s favorite food increases the patient appetite.
Ask the relative to feed the patient instead of eating by himself.
This will make the patient feel like being at home.
Frequently change the patient’s daily meal.
To prevent the patient from being bored of having the same meal everyday.
Giving the patient a multi vitamin.
To gain more appetite.
RISK FOR INFECTION r/t PRESSURE SORE INTERVENTION
Always ask the patient to turn and reposition himself on bed.
To prevent pressure on the site of commonly occurs bedsore.
Apply pillows under the pressured part of the body.
To make patients feels more comfortable while on his bed.
Using automatic air pump bed.
To prevent the skin from superficially bruising.
Maintain good hygiene on patient.
Keep the patient clean and tidy to prevent infection.
Apply cream or lotion on patient’s skin.
To keep moisture skin.
SELF CARE DEFICIT r/t IMMOBILITY INTERVENTION
Do sponging to the patient everyday.
To clean patient body from odor, secretion and microorganism.
Do hairwashing 3 times a week.
To ensure patient comfort.
Keep his nails clean and tidy.
To prevent microorganism under the nails.
Do oral care every morning.
To ensure the patient’s breathe smells good and prevent stomatitis.
Do perineum care to the patient everyday.
To prevent infection on the patient’s perineum and lower body extremities.
ALTERED BODY FLUID (LESS THAN BODY REQUIREMENT) R/T VOMITTING INTERVENTION
Assess the skin turgor and condition. Encourage patient to drink a lot of water. Administer total parenteral nutrition and IV infusion.
Dry skin shows that the patient is dehydrated. To maintain body fluid and hydration status. To provide continuous fluid replacement.
Always prepare mineral water on the cardiac table or near the patient.
To make patient easier to reach and drink the water.
Give the patient a meal that contain large amount of water. Example soup.
To keep patient always hydrated.
TREATMENT PAIN MANAGEMENT – MEDICATION -
BUSCOPAN (BEFORE OGDS)
HEALTH EDUCATION -
Avoid dairy products, caffeine, alcohol, and sugar. Coffee, even decaffeinated, should be eliminated because it contains potentially irritating oils.
Include sulfur-containing foods such as garlic, onions, broccoli, cabbage, Brussels sprouts, and cauliflower in the diet. Sulfur is the basis for forming glutathione, which provides antioxidant protection to the stomach lining. Nacetyl cysteine (200 mg twice a day between meals) is also the basis for forming glutathione.
Vitamin C (1,000 mg three times per day) decreases nitrosamines, substances that have been linked to stomach cancer.
Zinc (30 to 50 mg per day) helps patient’s healing.
Eliminate any known food allergens from your diet.
CONCLUTION – SUMMARY
Nearly everyone has experienced a bout of indigestion and stomach irritation. Most cases of indigestion are short-lived and don't require medical care. But if you experience signs and symptoms of gastritis consistently for a week or longer, see your doctor. And be sure to tell your doctor if you experience stomach problems after taking any prescription or over-the-counter drug, especially aspirin or other pain relievers.
If you are vomiting blood or have blood in your stools, see your doctor right away to determine the cause.
GENERAL RECOMMENDATION : • •
Do not smoke, and avoid secondhand smoke. As much as possible avoid stress, and learn ways to manage the stress you can not avoid.
From these case, I would like to give a conclusion that I get so many information about the case of chronic gastritis from my patient. How to give care plan and the expected outcome for my nursing intervention. I also found out that the chronic gastritis disease can be prevented by avoid taking the alcohol and certain drugs, and medications used to control inflammation. Also learn how to manage stress well and having a healthy diet as well.
MEDICATION CONTROLOC – PANTOPRAZOLE NA DOSAGE : -
Tab adult and adolescent >12yr symptomatic treatment of mild reflux oesophagitis 20mg daily for 4-8 weeks. Long term management of relapse of reflux oesophagitis 20mg daily. May increase 40mg/day.
ACTION : -
Take 1hr before meals. Swallow whole. Do not chew or crush.
CONTRAINDICATION : -
SPECIAL PRECAUTION : -
Pregnancy and lactation.
ADVERSE REACTION : -
Nausea, upper abdominal pain, rash, pruritus, dizziness.
MOTILIUM – DOMPERIDONE INDICATION : -
Nausea, vomiting of functional.
DOSAGE : -
Adult – 10mg tds
Children – 2.5mls
ACTION : -
Take 15-30min before meals.
CONTRAINDICATION : -
SPECIAL PRECAUTION : -