Download Chapter 37 Management of Patients With Gastric and Duodenal

Management of Patients
With Gastric and Duodenal
Disorders
Gastritis
• Inflammation of the stomach
• A common GI problem
• Acute: rapid onset of symptoms usually caused by dietary
indiscretion. Other causes include medications, alcohol,
bile reflux, and radiation therapy. Ingestion of strong acid
or alkali may cause serious complications.
• Chronic: prolonged inflammation due to benign or
malignant ulcers of the stomach or by Helicobacter pylori.
May also be associated with some autoimmune diseases,
dietary factors, medications, alcohol, smoking, or chronic
reflux of pancreatic secretions or bile.
Erosive Gastritis
Manifestations of Gastritis
• Acute: abdominal discomfort, headache,
lassitude, nausea, vomiting, hiccuping.
• Chronic: epigastric discomfort, anorexia,
heartburn after eating, belching, sour taste in the
mouth, nausea and vomiting, intolerance of some
foods. May have vitamin deficiency due to
malabsorption of B12.
• May be associated with achlorhydria,
hypochlorhydria, or hyperchloryhydria.
• Diagnosis is usually by UGI X-ray or endoscopy
and biopsy.
Medical Management of Gastritis
• Acute
– Refrain form alcohol and food until symptoms subside
– If due to strong acid or alkali treatment to neutralize the agent, avoid
emetics and lavage due to danger of perforation and damage to
esophagus
– Supportive therapy
• Chronic
– Modify diet, promote rest, reduce stress, avoid alcohol and NSAIDs
– Pharmacologic therapy (See Table 37-1)
Peptic Ulcer
• Erosion of a mucous membrane forms an excavation in
the stomach, pylorus, duodenum, or esophagus
• Associated with infection of H. pylori
• Risk factors include excessive secretion of stomach
acid, dietary factors, chronic use of NSAIDs, alcohol,
smoking, and familial tendency.
• Manifestations include a dull gnawing pain or burning
in the mid-epigastrium; heartburn and vomiting may
occur
• Treatment includes medications, lifestyle changes, and
occasionally surgery (See Tables 37-1 and 37-3)
Deep Peptic Ulcer
Surgical Procedures for Peptic Ulcers
Nursing Process: The Care of the Patient
with Gastritis—Assessment
• History including presenting signs and
symptoms
• Dietary history and dietary associations with
symptoms
• 72 hour diet; diary may be helpful
• Abdominal assessment
Nursing Process: The Care of the Patient
with Gastritis—Diagnoses
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Anxiety
Imbalanced nutrition
Risk for fluid volume imbalance
Deficient knowledge
Acute pain
Nursing Process: The Care of the Patient
with Gastritis—Planning
• Major goals may include reduced anxiety,
avoidance of irritating foods, adequate intake
of nutrients, maintenance of fluid balance,
increased awareness of dietary management,
and relief of pain.
Interventions
• Reduce anxiety; use calm approach and explain all
procedures and treatments.
• Promote optimal nutrition; for acute gastritis, the patient
should take no food or fluids by mouth. Introduce clear
liquids and solid foods as prescribed. Evaluate and report
symptoms. Discourage caffeinated beverages, alcohol,
cigarette smoking. Refer for alcohol counseling and
smoking cessation.
• Promote fluid balance; monitor I&O, for signs of
dehydration, electrolyte imbalance, and hemorrhage.
• Measures to relieve pain: diet and medications.
• See Chart 37-1.
Nursing Process: The Care of the Patient
with Peptic Ulcer—Assessment
• Assess pain and methods used to relieve pain
• Dietary intake and 72 hour diet diary
• Lifestyle and habits such as cigarette and
alcohol use
• Medications; include use of NSAIDs
• Sign and symptoms of anemia or bleeding
• Abdominal assessment
Nursing Process: The Care of the Patient
with Peptic Ulcer—Diagnoses
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Acute pain
Anxiety
Imbalanced nutrition
Deficient knowledge
Collaborative Problems/Potential
Complications
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Hemorrhage
Perforation
Penetration
Pyloric obstruction (gastric outlet obstruction)
Nursing Process: The Care of the Patient
with Peptic Ulcer—Planning
• Major goals for the patient may include relief
of pain, reduced anxiety, maintenance of
nutritional requirements, knowledge about
the management and prevention of ulcer
recurrence, and absence of complications.
Anxiety
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Assess anxiety
Calm manner
Explain all procedures and treatments
Help identify stressors
Explain various coping and relaxation methods
such as biofeedback, hypnosis, and behavior
modification
Patient Teaching
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Medication teaching
Dietary restrictions
Lifestyle changes
See Chart 37-2
Management of Potential Complications
• Management of hemorrhage
– Assess for evidence of bleeding, hematemesis or melena, and symptoms
of shock/impending shock and anemia.
– Treatment includes IV fluids, NG, and saline or water lavage; oxygen,
treatment of potential shock including monitoring of VS and UO; may
require endoscopic coagulation or surgical intervention.
• Pyloric obstruction
– Symptoms include nausea and vomiting, constipation, epigastric fullness,
anorexia, and (later) weight loss.
– Insert NG tube to decompress the stomach, provide IV fluids and
electrolytes. Balloon dilation or surgery may be required.
Management of Potential Complications
• Management of perforation or penetration
– Signs include severe upper abdominal pain that
may be referred to the shoulder, vomiting and
collapse, tender board-like abdomen, and
symptoms of shock/impending shock.
– Patient requires immediate surgery.