Primary Nursing Diagnosis

Altered nutrition: Less than body requirements related to decreased appetite, food intolerance, vomiting

OUTCOMES. Nutritional status: Food and fluid intake; Nutrient intake; Biochemical measures; Body mass; Energy; Endurance

INTERVENTIONS. Nutrition management; Nutrition therapy; Nutritional counseling and monitoring; Fluid/electrolyte management; Medication management

U PLANNING AND IMPLEMENTATION Collaborative

The immediate treatment for acute gastritis is directed toward alleviating the symptoms and withdrawing the causative agents. The physician usually prescribes an H2 antagonist. The medical goal is to maintain the pH of gastric contents above 4.0. Acute hemorrhagic gastritis may disappear within 48 hours because of rapid cell proliferation and restoration of gastric mucosa. If the bleeding is profuse and persistent, blood replacement is necessary. An infusion of vaso-pressin (Pitressin) or embolization of the left gastric artery is used to halt hemorrhage. Surgical intervention is not performed unless hemorrhage is uncontrollable. In this rare situation, vago-tomy with pyloroplasty is usually performed.

There is no known treatment that will reverse the pathogenesis of chronic gastritis. Eradication of H. pylori bacteria halts active gastritis in approximately 92% of the cases unless there is permanent damage to the gastric epithelium. The medical regimen for eradicating H. pylori is a combination of bismuth salts and two antibiotics over a 2-week period. An important part of management of patients with chronic gastritis is long-term follow-up for early detection of gastric cancer. Patients who have either chronic type A or B gastritis may develop pernicious anemia; destruction of parietal cells in the fundus and body of the stomach leads to inadequate vitamin B12 absorption.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

H2 receptor antagonist

Varies with drug

Ranitidine (Zantac); Cimetidine (Tagamet); famotidine (Pepcid); nizatidine (Axid)

Blocks gastric secretion and maintains the pH of gastric contents above 4.0, thereby decreasing inflammation

Sulcrafate (Carafate)

1 g qid

Mucosal barrier fortifier; antiulcer

Forms adhesive gel to protect damaged gastric mucosa

Vasopressin (Pitressin)

0.2-0.4 U/min with progressive increases to 0.9 U/min IV

Vasopressor, antidiuretic

Halts acute hemorrhage from gastritis

Antibiotics to treat

Helicobacter pylori

Varies with drug

Clarithromycin, amoxicillin, metronidazole, tetracycline, and furazolidone

Cure rates from a single antibiotic are low; regimens vary but may include bismuth, metronidazole, tetracycline; or clarithromycin plus either omepra-zole or ranitidine bismuth citrate

Other Drugs: Antacids used as buffering agents to neutralize gastric acid and maintain gastric pH above 4.0 include aluminum hydroxide with magnesium hydroxide (Maalox, Mylanta) or aluminum hydroxide (Amphojel); vitamin B12 prevents pernicious anemia.

Independent

Encourage the patient to avoid aspirin and NSAIDs (indomethacin and ibuprofen) unless they have been prescribed. Reinforce the need to take these medications with food or to take enteric-coated aspirin. Other drugs that may contribute to gastric irritation include chemotherapeutic agents, corticosteroids, and erythromycin. Explain the importance of reading the labels of OTC drugs to identify those that contain aspirin. Instruct the patient about the action, dosage, and frequency of the medications (antacids, H2 antagonists, antibiotic regimen) that are administered while the patient is in the hospital. Discuss the possible complications that can develop with acute or chronic gastritis (hemorrhage, pernicious anemia, iron deficiency anemia, or gastric cancer). Explain the pathophysiology and treatment of each possible complication. Discuss how ingestion of caffeine and spicy foods results in irritation and inflammation of the mucosa of the stomach.

Be sure the patient understands how smoking and alcohol aggravate gastritis and that abstaining from both will facilitate healing and reduce recurrence. Provide information about various smoking and alcohol rehabilitation programs available in the community. Explain the rationale for the need for support during this very difficult lifestyle change for permanent abstinence.

Assist the patient in identifying her or his personal physical and emotional stressors. Review coping skills that the patient has used previously to change behaviors. Talk about how to adapt the environment to which the patient must return in order to meet the needs of lifestyle changes. Involve the family in assisting with the patient's needed changes. Assess the family's response and ability to cope.

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