1. Define gastritis and list the nursing management responsibilities?

Gastritis is a group of conditions characterized by inflammation of the lining in the stomach. Usually, the inflammation comes from infection with the same bacteria that causes most stomach ulcers. Traumatic injury and regular use of certain pain relievers also contribute to gastritis. There are two types of gastritis’s, first is acute gastritis which occurs suddenly and second is chronic gastritis which occurs slowly over time.

Nursing Management Responsibilities

The nurse must monitor the patient’s symptoms. Also evaluating the patient’s response to dietary modifications and prescribed medications is very important. The nurse should also observe the color and characteristics of any vomit or stool that the patient passes. The nurse also needs to provide patient teaching. Nurses should instruct the patient to eat smart by eating smaller but frequent meals to ease the effects of stomach acid. Along with that instruct the patient to avoid foods that are irritating like spicy, acidic, fried, and fatty. Inform the patients to avoid or limit alcohol use because it can irritate and erode the mucous lining of the stomach. Patients that are taking NSAIDs for pain should ne instructed to use medications with acetemetiphen. NSAIDs can cause stomach inflammation or irritation to worsen.

2. Define peptic ulcers?

Peptic ulcers are open sores that develop on the inside lining of the stomach, upper small intestine, or esophagus. These ulcers form when they come in contact with hydrochloric acid and pepsin.

3. DISCUSS THE PATHOPHYSIOLOGY OF GASTRITIS?

Gastric secretions are very acidic. Parietal cells in the stomach increase acid production known as hydrochloric acid in response to seeing, smelling and eating food. The parasympathetic vagus nerve releases histamine and acetylcholine, chemicals that also stimulate the parietal cells. An increasing level of acid may trigger the break down of pepsinogen to pepsin, creating a chemical mixture strong enough to break down the stomach wall. Because mucus protectively coats the stomach lining, however, pepsin normally will have little effect. Prostaglandin E, a lipid compound secreted in the stomach, promotes the production of mucus, which contains buffer substances and mechanically bars penetration by stomach acids. The submucosal layers of the stomach can be inflamed, however, when irritating substances reduce or penetrate the mucous layer the person feels epigastric discomfort, can also be known as heart burn. Chronic irritation leads to ulceration.

DISCUSS THE PATHOPHYSIOLOGY OF DUODENAL DISORDER?

The pathophysiology of a duodenal disorder occurs when the normal balance between factors that promote mucosal injury such as gastric acid, pepsin, bile acid, ingested substances, and factors that protect the mucosa is bothered. The greatest factor for development of PUD is infection of an organism called helicobacter pylori. Transmission of the disease maybe by fecal, oral or oral, oral pathway. It appears that H. pylori secrete an enzyme that depletes gastric mucus, making it more susceptible to injury.

4. MEDICATION THERAPY WITH PEPTIC ULCER?

If the bacterium H. pylorus is present extensive therapy is started. A combination of antibiotics is started such as tetracycline used to treat the bacteria, Flagyl which eliminates the bacteria or microorganisms, proton pump inhibitors such as Protonix the acid production at the surface of parietal cells. Further treatment may include and bismuth salts such as Pepto Bismol suppresses the H. pylori and helps heal mucosal lesions. Zantac blocks histamine antagonist’s receptors and decreases acid secretion in the stomach.

5. List the common symptoms?

Common symptoms of Gastritis are:

Epigastric fullness
Pressure
Pain
Anorexia
Nausea & vomiting
Diarrhea
Fever
Gastric bleeding

Common symptoms of Peptic Ulcer Disease (PUD) are:

First sign of ulcer is bleeding
Burning, gnawing, dull pain after meals
Pain during night time
Hemorrhage
Hematemesis
Melena
Dizziness & syncope

6. Complete basic assessment, and recognize “high risk” clients?

Nursing assessment for client with gastritis and peptic ulcer disease:

Ask client about symptoms like indigestion, fullness, heartburn, nausea and vomiting?
How long has the client had these symptoms?
When the symptoms occur and what aggravates it?
What the client does to relieve symptoms?
Does the client have any past gastric problems or treatments?
Assess the clients abdomen noting any changes in the abdomen such as:

Distention
Tenderness
Pain

Clients at high risk for gastritis and peptic ulcer disease are:

Clients using NSAIDs, alcohol, caffeine, corticosteroids, salicylates.
Smokers
Ingestion of poisons or corrosive substances
Bacteria Infection (Helicobacter Pylori)
Clients under physiological stress

7. List the primary nursing responsiblities?

Nursing Responsibilities:

The nurse must explore each symptom of PUD in depth. For example, if pain occurs, the nurse determines its type, onset in relation to eating food, location, and duration. A dietary history must include relevant questions pertaining to foods that cause distress, the amount of foods eaten at each meal, and whether eating food relieves pain. For a client to continue eating, it may be necessary to modify ingredients, temperature, or consistency of foods, as well as to use smaller portions on smaller plates. Clients need nutritional supplements. If the client is receiving tube feedings, rein stilling the gastric residual is necessary because it contains partially digested nutrients and essential electrolytes. In addition, the nurse notes the client’s bowel patterns and stool characteristics. Nurse evaluates the client’s emotional status and response to activity. The nurse monitors the nonsurgical client closely for medical complications, which includes assessing vital signs and fluid status.

8. Recognize the most common complications of peptic ulcer?

What are the complications of peptic ulcers?
Gastrointestinal bleeding is one of the most serious complications of ulcers. It results when the ulcer erodes into a blood vessel in the wall of the stomach or duodenum. The common signs of bleeding include vomiting fresh, bright red blood or passing bloody or tarry, black stools. Pepto Bismol, often taken for relief of ulcer symptoms, may also cause black

discoloration of the stools. In the case of severe hemorrhage, weakness, fatigue, loss of consciousness and or shock may result.

Another serious ulcer complication is perforation. This can develop as stomach acid erodes through the intestinal wall and spills into the abdominal cavity. The first sign of perforation is sudden, intense, steady abdominal pain. Ulcer perforation leads to the leakage of gastric contents into the abdominal (peritoneal) cavity, resulting in acute peritonitis (infection of the abdominal cavity). These patients report a sudden onset of extreme abdominal pain, which is worsened by any type of motion. Abdominal muscles become rigid and board-like. Urgent surgery is usually required.

A third complication of ulcers is obstruction of the digestive tract, usually at the junction of the stomach and duodenum, as old ulcer scars accumulate and narrow the passageway through this area. As a result, food and fluid passing from the stomach to the duodenum may be restricted or blocked altogether, producing a distended stomach (from retained food and secretions), intense pain, and continued vomiting. The obstruction usually occurs at or near the pyloric canal. The pyloric canal is a naturally narrow part of the stomach as it joins the upper part of the small intestine called the duodenum. Upper endoscopy is useful in establishing the diagnosis and excluding gastric cancer as the cause of the obstruction.

9. List signs and symptoms of G.I. bleeding?

Bleeding from the esophagus can be caused by:

Esophagitis and gastroesophageal reflux. Stomach acid that refluxes (returns) back into the esophagus from the stomach can cause damage that may lead to bleeding at the lower end of the esophagus called esophagitis.
Varices. Abnormally enlarged veins located at the lower end of the esophagus, called varices, may rupture and bleed massively. Cirrhosis of the liver is the most common cause of esophageal varices.
Mallory-Weiss tear. This is a tear in the lining of the esophagus that usually is caused by prolonged vomiting but may also result from other causes of increased abdominal pressure, such as coughing, hiccupping, or childbirth.
Bleeding from the stomach can be caused by:

Gastritis. Alcohol, aspirin, aspirin-containing medicines, pain medicines –collectively called NSAIDs (nonsteroidal anti-inflammatory drugs) — such as Motrin, Aleve, or ibuprofen and many others can cause stomach ulcers or inflammation (gastritis).
Stomach ulcers and intestinal ulcers. Ulcers in the stomach may enlarge and erode through a blood vessel, causing bleeding. Aside from medication, the most common cause of a stomach ulcer is an infection with bacteria called Helicobacter pylori. Also, patients suffering from burns, shock, head injuries or cancer, as well as those who have undergone extensive surgery, may develop stress-related stomach ulcers. Intestinal ulcers are believed to be caused by excess stomach acid and infection with Helicobacter pylori.
Cancer of the stomach.
Hemorrhoids. These are probably the most common cause of visible blood in the lower digestive tract, especially blood that appears bright red. Hemorrhoids are enlarged veins in the anal area that can rupture and produce bright red blood, which can show up in the toilet or on toilet paper.
Anal fissures. Tears in the lining of the anus can also cause bleeding.
Colon polyps. These are growths that can occur in the colon. They can be the precursor of cancer and may cause bleeding.
Colorectal cancer.
Intestinal infections. Inflammation and bloody diarrhea can result from intestinal infections.
Ulcerative colitis. Inflammation and extensive surface bleeding from tiny ulcerations can be the reason for blood showing up in the stool.
Crohn’s disease. This condition can result in spotty bleeding.
Diverticular disease. Caused by diverticula — outpouchings of the colon wall — can result in massive bleeding.
Blood vessel abnormalities. As one gets older, abnormalities may develop in the blood vessels of the large intestine, which may result in recurrent bleeding.
How Is Bleeding in the Digestive Tract Recognized?

The signs of bleeding in the digestive tract depend on the site and severity of bleeding.

If blood is coming from the rectum or the lower colon, bright red blood will coat or mix with your stool. The stool may be mixed with darker blood if the bleeding is higher up in the colon or at the far end of the small intestine.

When there is bleeding in the esophagus, stomach or duodenum, the stool is usually black or tarry. Vomit may be bright red or have a “coffee-grounds” appearance when bleeding is from the esophagus, stomach or duodenum.

If bleeding is occult, or hidden, you might not notice any changes in stool color.

If sudden massive bleeding occurs, a person may feel weak, dizzy, faint, short of breath or have cramp-like abdominal pain or diarrhea. Shock may occur, with a rapid pulse, drop in blood pressure and difficulty in producing urine. You may become very pale.

If bleeding is slow and occurs over a long period of time, a gradual onset of fatigue, lethargy, shortness of breath and pallor (or paleness of the skin) from anemia will result. Anemia is a condition in which the blood’s iron-rich substance, hemoglobin, is diminished.

Note that iron and some foods, such as beets, can give the stool a red or black appearance, falsely indicating blood in the stool.

What Signs Indicate Bleeding in the Digestive Tract?

Bright red blood coating the stool
Dark blood mixed with the stool
Black or tarry stool
Bright red blood in vomit
“Coffee-grounds” appearance of vomit

http://www.apsfa.org/gibleed.htm

10. Define duodenal ulcer, and discuss usual assessment and nursing care?

A duodenal ulcer is a raw area in the lining in the upper part of the small intestine (duodenum), where it connects to the stomach

People who have a family history of duodenal ulcer are more likely to get them, and the problem is four times greater in men than in women over fifty years of age. Other risk factors include having a Helicobacter pylori infection, using nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen, and the use of cigarettes and alcohol.

A duodenal ulcer is caused when the lining of the stomach is eaten away by stomach acid and digestive juices.

Duodenal ulcers respond well to treatment, but changes in lifestyle may be recommended to prevent reoccurrences. Patients should consider not smoking or using other tobacco products and reduce their alcohol consumption and caffeine intake. Patients may also want to avoid drugs that cause stomach inflammation, such as aspirin, ibuprofen and naproxen. Other lifestyle changes may include eating balanced, nutritious meals, learning how to manage stress, and getting plenty of rest and exercise.

References

www.cdc.gov

www.mayoclinic.com

Introductory Medical-Surgical Nursing 9th Edition Barbara Timby and Nancy Smith

http://www.hmc.psu.edu/healthinfo/d/duodenalulcer.htm

T. SVN, C. SVN, H. SVN, E. SVN, D. SVN