Gastritis | Nursing Management

Table of Contents

Introduction

Effective management of patients with stomach and duodenal disorders involves a comprehensive approach aimed at alleviating symptoms, promoting healing, and preventing complications. Below are key aspects of management:

Gastritis

Gastritis refers to inflammation of the lining of the stomach. It can be acute, occurring suddenly and lasting for a short period, or chronic, developing gradually and persisting over time.

Pathophysiology of Gastritis

The gastric mucosa is normally shielded from the corrosive effects of stomach acid by prostaglandins. However, when there is damage to the protective barrier, injury occurs. This injury is exacerbated by the release of histamine and stimulation of the vagal nerve, which allows hydrochloric acid to penetrate back into the mucosa. This acid influx damages small blood vessels, leading to swelling, bleeding, and erosion of the stomach lining.

As gastritis progresses, the walls and lining of the stomach become thinner and may atrophy, reducing the function of parietal cells. This decline in parietal cell function results in a loss of intrinsic factor, essential for the absorption of vitamin B12. Consequently, the absorption of vitamin B12 is impaired, leading to pernicious anemia.

Acute Gastritis

Acute gastritis refers to the acute inflammation of the gastric mucosa or submucosa, characterized by the destruction of superficial epithelial cells. The condition typically lasts for a few hours to a few days (Bloom, 2005).

Causes:

Thermal Causes: Consumption of very hot fluids or food can lead to thermal injury to the gastric mucosa.
Chemical Causes:
- Ingestion of corrosive substances.
- Consumption of irritating foods such as spicy foods and alcohol.
- Certain drugs, including aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) in large doses, cytotoxic agents, caffeine, corticosteroids, antimetabolites, phenylbutazone, and indomethacin, can cause mucosal erosion.
Bacterial Causes: Endotoxins released from infecting bacteria such as Staphylococci, Escherichia coli, Salmonella, and Helicobacter pylori.
Conditions: Uremia, shock, prolonged emotional tension, major burns, hepatic diseases, renal diseases, peptic ulcers, and major surgery can precipitate acute gastritis.
Bile Reflux: Backflow of bile into the stomach from the bile tract, which connects to the liver and gallbladder, can irritate the gastric mucosa.
Exposure to Procedures: Certain medical procedures such as nasogastric tube insertion and endoscopy can irritate the gastric mucosa.

Signs and Symptoms of Acute Gastritis:

Sudden Onset: Symptoms typically appear suddenly.
Anorexia: Loss of appetite may occur.
Nausea and Vomiting: Patients may experience feelings of nausea and episodes of vomiting.
Dyspepsia: discomfort or pain in the upper abdomen, often described as indigestion or an upset stomach.
Epigastric Pains: Patients may experience varying degrees of pain or discomfort in the epigastric region (upper abdomen).
Gastrointestinal Bleeding: Hematemesis (vomiting of blood) and melena (dark, tarry stools) may occur if gastric bleeding occurs.
Water Brash Syndrome: Clear fluid may be present in the mouth due to reflex salivation in response to duodenal ulceration.
Signs and Symptoms of Pernicious Anemia: Due to the loss of intrinsic factor, patients may exhibit symptoms associated with pernicious anemia, such as fatigue, weakness, and pallor.
Colic Diarrhea: Following intake of contaminated food, patients may experience colicky diarrhea 2-4 hours later if gastritis is due to food poisoning.
Fever: Fever may be present in some cases, especially if the gastritis is caused by an infectious agent.

Diagnosis of Acute Gastritis:

Endoscopy/Gastroscopy: Visual examination of the stomach using an endoscope will reveal inflamed gastric membranes.
Laboratory Tests:
- Full Blood Count (FBC): Low hemoglobin levels may be detected due to concealed bleeding, indicated by the presence of occult blood in vomitus and stool. Elevated erythrocyte sedimentation rate (ESR) may also be observed, indicating inflammation.
Histological Examination: Biopsy specimens obtained during endoscopy can be examined histologically to assess the severity and nature of inflammation.
Serologic Testing: Serological tests for antibodies against Helicobacter pylori or a breath test may be performed to detect the presence of H. pylori infection, a common cause of gastritis.
Gastric Acid Analysis: Measurement of gastric acid levels can reveal increased hydrochloric acid (HCl) secretion, which may contribute to the development of gastritis.

Medical and Nursing Management:

The gastric mucosa possesses the ability to repair itself following a mild attack of gastritis. Typically, patients recover within a day, although a diminished appetite may persist for an additional 2 or 3 days. Management primarily focuses on symptom relief and supportive care.

Fluid and Food Management:
- During episodes of vomiting, oral fluids and food should be withheld to prevent further irritation to the stomach.
- Once vomiting subsides, oral fluids and non-irritating foods can be gradually reintroduced based on the patient’s tolerance.
- The diet can then progress to a normal intake as tolerated by the patient.
Intravenous Fluids:
- If gastritis persists beyond 12–18 hours or if dehydration and electrolyte imbalance are evident, intravenous fluids are administered.
- Hospitalization may be necessary in such cases, and complete bed rest is recommended to facilitate recovery.

The following medications may be prescribed:

Antiemetics: Promethazine can be prescribed to alleviate symptoms of nausea and vomiting. However, it should be avoided if the cause of gastritis is due to corrosive substances.
Anticholinergics: Atropine may be administered to decrease gastric secretions and induce relaxation of smooth muscle.
Cimetidine: This medication is typically given to reduce gastric acid secretion, especially in cases where there is associated hemorrhage with gastritis.

In cases where gastritis is caused by the ingestion of strong acids or alkalis, emergency treatment involves diluting and neutralizing the offending agent. To neutralize acids, common antacids, such as aluminum hydroxide, are used. For neutralizing an alkali, diluted lemon juice or diluted vinegar can be employed.

Chronic gastritis

Chronic gastritis is a long-term degeneration of the mucous membranes of the stomach, often resulting from prolonged dietary indiscretion or alcohol abuse.

Causes

Helicobacter pylori infection (most common cause).
Alcohol abuse.
Thyroid disease.
Diabetes mellitus.
Radiation therapy.
Repeated episodes of acute gastritis.
Autoimmune conditions such as pernicious anemia.
Smoking.

Signs and symptoms:

Loss of appetite leads to weight loss.
Nausea and vomiting (hematemesis), which may provide temporary relief from pain due to irritation of the gastric mucosa.
Dyspepsia (indigestion) results from impaired gastric function.
Flatulence (excessive gas) due to impaired gastric function.
Epigastric pain (heartburn) is caused by the regurgitation of gastric contents.
Abdominal pain is due to erosion of the gastric mucosa.
Passage of dark, tarry stools (melena) resulting from gastric bleeding.
Constipation is followed by diarrhea due to enteritis.
Slow progression of symptoms.

Diagnosis:

Patient history indicating recurrent episodes of acute gastritis.
Barium meal, revealing inflammation of the gastric mucosa.
Endoscopy or gastroscopy showing inflammation of the gastric mucosa.
Stool testing for occult blood.
Complete blood count (CBC) revealing low hemoglobin levels due to bleeding.
Gastric acid analysis indicates increased hydrochloric acid (HCl) secretion.

Treatment:

Chronic gastritis is managed through dietary modifications, rest promotion, stress reduction, and pharmacotherapy.
Encourage the patient to chew food thoroughly before swallowing.
Helicobacter pylori infection may be treated with a combination of drugs such as amoxicillin, metronidazole (Flagyl), and omeprazole (triple therapy).
Administer antiemetic drugs to alleviate nausea and vomiting, for example, promethazine 25–50 mg either intramuscularly or intravenously for 3 days, or metoclopramide (Plasil) 10–20 mg three times daily for 3 days.
Antacids can be given to alleviate pain or discomfort, such as aluminum hydroxide 200–400 mg three times daily for 7 days.
Histamine receptor blockers help reduce the production of hydrochloric acid; for instance, cimetidine 200–400 mg three times daily for 14 days.

Nursing Care for Gastritis

Aims

Prevent complications.
Alleviate signs and symptoms.
Assist in the healing process.
Reduce anxiety.

Environment

The patient is cared for in a general medical ward where cleanliness and proper ventilation are maintained to promote adequate air circulation and create a calm environment conducive to rest and recovery.

Positioning

The patient is positioned in a comfortable manner, preferably in a semi-fowler’s position, to prevent the regurgitation of gastric juices and to enhance respiratory function. The semi-fowler’s position involves reclining the patient’s upper body at an angle of approximately 30 to 45 degrees, which helps reduce pressure on the abdomen and minimizes reflux while facilitating ease of breathing.

Rest

Ensure a noise-free environment to promote rest and uninterrupted sleep for the patient. Perform nursing activities collectively to minimize disturbances and encourage restful periods. This includes coordinating tasks such as medication administration, assessments, and procedures to avoid unnecessary interruptions to the patient’s rest.

Observations

Regularly assess the patient’s general condition to determine if there are improvements, stability, or worsening of symptoms. Monitor vital signs including temperature, pulse rate, respiratory rate, and blood pressure, and document the findings. Elevated temperature may indicate the presence of infection, while a rapid pulse and low blood pressure could indicate bleeding.

Examine stool and vomitus for characteristics such as color, consistency, volume, and odor. If blood is present in stool or vomitus, provide ice drinks to the patient to help constrict blood vessels and minimize bleeding. Check for abdominal tenderness and observe for any signs of complications such as gastric ulcers.

Patient Weight Monitoring

Perform daily weighing of the patient to monitor for changes in weight, which can indicate fluid retention or loss. This helps in assessing the patient’s hydration status and response to treatment. Document weight measurements accurately to track trends over time.

Psychological Care

It is essential to communicate effectively with the patient and their relatives to alleviate anxiety and foster cooperation. Explain the condition in simple terms, including possible causes, the disease process, treatment options, and reasons for certain restrictions. Encourage the patient to ask questions and provide accurate answers to help them understand their condition better. Involving both the patient and their relatives in the care plan promotes independence and reduces dependency.

Nutrition and Fluids

Provide balanced, nutritious meals containing proteins, vitamins, and carbohydrates to support healing and boost immunity. Serve food in small, frequent amounts to promote appetite and prevent vomiting, especially if the patient experiences anorexia. Avoid spicy foods as they may exacerbate the condition. Ensure adequate fluid intake, either orally or intravenously, to prevent dehydration and flush out toxins. Discourage alcohol consumption as it can worsen the condition and interfere with the healing process.

Elimination

Monitor the patient’s intake and output, including observing stool and vomitus for consistency, color, amount, and odor. Record and report any abnormalities. Additionally, observe the patient’s bowel patterns to identify any changes or irregularities. Encourage the patient to consume foods rich in roughage and increase fluid intake to prevent constipation.

Exercises

Initially, the patient may require total bed rest, but as their condition improves, encourage them to engage in passive exercises. These exercises help prevent complications such as deep vein thrombosis and promote blood circulation. Passive exercises involve gentle movements of the limbs performed by the caregiver while the patient remains in a relaxed position. These exercises can help maintain muscle tone and prevent stiffness during periods of immobility.

Hygiene

If the patient is unable to bathe independently, provide a bed bath to ensure hygiene, comfort, and promote blood circulation. Perform oral care to prevent mouth infections and stimulate appetite. Additionally, provide nail care to prevent the accumulation of dirt. Change bed linens promptly when soiled or dirty to maintain cleanliness and prevent skin irritation.

IEC (Information, Education, Communication)

Explain to the patient the importance of rest in aiding recovery and managing symptoms.
Educate the patient about the disease process, including its causes, symptoms, and potential complications.
Advise the patient to avoid spicy foods and the dangers of consuming unprescribed drugs, which can exacerbate symptoms.
Help the patient identify factors that may worsen their symptoms, such as stress or certain dietary choices.
Stress the importance of medication compliance to ensure effective treatment and symptom management.
Emphasize the significance of attending scheduled review appointments with healthcare providers.
Teach the patient to recognize signs and symptoms of potential complications and when to seek medical attention.
Discuss the necessity of making lifestyle changes, such as abstaining from alcohol consumption, to improve overall health and manage the condition effectively.

Complications

Complications of gastritis can vary in severity and may include:

Gastric ulcers: Prolonged inflammation of the gastric mucosa can lead to the formation of ulcers in the stomach lining, which may cause pain, discomfort, and bleeding.
Haemorrhage: Severe inflammation and erosion of the stomach lining can result in significant bleeding, leading to haemorrhage. This can manifest as vomiting of blood (haematemesis) or passing of black, tarry stools (melena).
Anaemia: Chronic bleeding from gastric ulcers or erosion of blood vessels in the stomach can lead to iron deficiency anaemia due to the loss of red blood cells and decreased iron stores.
Obstruction: Inflammation and scarring of the stomach lining may cause narrowing of the stomach’s passageway, leading to obstruction of food flow. This can result in symptoms such as nausea, vomiting, and abdominal pain.
Perforation: Severe inflammation and erosion of the stomach wall can lead to the formation of a hole or perforation, allowing gastric contents to leak into the abdominal cavity. This is a medical emergency and requires immediate intervention to prevent peritonitis.
Peritonitis: Perforation of the stomach wall can lead to contamination of the peritoneal cavity with gastric contents, resulting in peritonitis—an inflammation of the peritoneum. Peritonitis is a life-threatening condition that requires prompt medical attention and treatment with antibiotics.
Stomach cancer: Chronic gastritis, especially when caused by infection with Helicobacter pylori or long-term exposure to irritants such as alcohol or tobacco, can increase the risk of developing stomach (gastric) cancer over time. Regular monitoring and appropriate management of gastritis are essential for reducing this risk.