Chronic Gastritis Case Study

PAPER

CHRONIC GASTRITIS CASE STUDY

An Nisa Rushtika Kersana 220110090033

Ermawati 220110100048

Restu Pratama Widyananda 220110100023

FAKULTAS ILMU KEPERAWATAN

UNIVERSITAS PADJADJARAN

Jln. Raya Sumedang-Bandung Km 21 Jatinangor

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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.

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

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

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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.

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.

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.

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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

Blood test

Breath test

Upper gastrointestinal endoscopy

Upper gastrointestinal X-Ray

Stool test

COMPLICATION

Stomach ulcer

Stomach bleeding

Increased risk of stomach cancer

Thinning of the stomach lining and changes in the lining cells.

PREVENTION

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.

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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.

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CASE STUDY

NAME : Shiwon

MRN : 585151

BED NO : 229 B

GENDER : MALE

AGE : 27 YEARS OLD 10 MONTH

DOA : 1 Desember 2012

DICIPLINE : MEDICAL

SPECIALIST : DR. Gumilang

VITAL SIGNS

BLOOD PRESSURE : 130/87

HEART RATE : 82 bpm

TEMPERATURE : 37’C

SPO2 : 99% ON AIR

DIAGNOSES

CHRONIC GASTRITIS

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ADMISSION HISTORY

Mr. Shiwon first came to Padjadjaran Clinic at 1 Desember 2012 complaining to have an

abdominal pain since at home. He came to Padjadjaran Clinic 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. Shiwon 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. Shiwon is psychologically comfortable. He also have done his OGDS. On

admission, Mr. Shiwon receive a soft and normal diet due to his disease condition.

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PROGRESS NOTES

New admission at 14.00 by car with his relatives and family member who live nearby. And then

transferred to Padjadjaran Clinic. The patient is complaining to have a chronic abdominal pain

on the abdomen.

DAY BY DAY PROGRESS NOTE

1 Desember 2012 – 14.00 H

- 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 : 112/86

- P : 71

- temp : 36.8’c

14.00H

- Seen by DR. Gumilang, 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)

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1 Desember 2012

- 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.

BP PULSE TEMP.

14.00 112/81 74 36.8’C

16.00 128/76 68 37’C

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NURSING DIAGNOSIS

IMBALANCE NUTRITION LESS THAN BODY REQUIREMENT r/t POOR APPETITE

INTERVENTION RATIONALE

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 RATIONALE

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.

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SELF CARE DEFICIT r/t IMMOBILITY

INTERVENTION RATIONALE

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 RATIONALE

Assess the skin turgor and condition. Dry skin shows that the patient is

dehydrated.

Encourage patient to drink a lot of water. To maintain body fluid and hydration status.

Administer total parenteral nutrition and IV

infusion.

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.

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TREATMENT

PAIN MANAGEMENT – MEDICATION

- CONTROLOC

- MORTILIUM

- ENZYPLEX

- 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. N-acetyl 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.

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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.

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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 :

- Hypersensitivity.

SPECIAL PRECAUTION :

- Pregnancy and lactation.

ADVERSE REACTION :

- Nausea, upper abdominal pain, rash, pruritus, dizziness.

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MOTILIUM – DOMPERIDONE

INDICATION :

- Nausea, vomiting of functional.

DOSAGE :

- Adult – 10mg tds

- Children – 2.5mls

ACTION :

- Take 15-30min before meals.

CONTRAINDICATION :

- GI hemorrhage.

SPECIAL PRECAUTION :

- Babies <1yr

- Pregnancy, lactation.

ADVERSE REACTION :

- Rarely.

- Mild abdominal cramps.

- Rash.

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ENZYPLEX

USE :

- Digestive disorder, manifested by bloating, belching, flatulence, abdominal discomfort.

DOSAGE :

- 1-2 tab w/ or after meals.

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REFERENCES

BOOK :

TEXTBOOK OF MEDICAL SURGICAL NURSING – ELEVENTH EDITION –

BRUNNER & SUDDATH (GASTROINTESTINAL TRACT DISORDER AND

DISEASE CONDITION)

INTERNET :

HTTP://EN.WIKI.FREE.NET/CHRONIC-GASTRITIS/info.php

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