Gastritis, Peptic Ulcer, Bariatric Care (Chapter 47)

Risk Factors

-family member who has H.pylor infx -family history of gastritis -prolonged use of NSAIDs, corticosteroids -excessive alcohol use -bile reflux disease -advanced age -radiation therapy -smoking -caffeine -excessive stress -exposure to contaminated food or water bacterial infx(hpylori, salmonella, streptococci, staphylococci, ecoli) autoimmune disease: lupus, rheumatoid arthritis, pernicous anemia

Nursing Care for Gastritis

-monitor fluid intake and urine output -IV fluids -monitor electrolytes -assist the client in identifying foods that are triggers -provide small, frequent meals and encourage client to eat slowly -advise the client to avoid alcohol, caffeine, and foods that can cause gastric irritation -assist the client in finding ways to reduce stress -monitor for indications of gastric bleeding (coffee ground emesis; black, tarry stools) -monitor for findings of anemia (tachycardia, hypotension, fatigue, shortness of breath, pallor, feeling lightheaded or dizzy, chest pain)

Obesity

-obesity is body mass indices (BMI) above 30mg/m2 -66% of all adults are overweight or obese -obesity-related mortality rates are 30% greater for every gain of 5kg/m2 of body mass beyond a BMI of 25 kg/m2 (huge risk of dying) -increased risk for disease, disorders, low self-esteem, impaired body image, depression, and diminished quality of life

Risk factors for Peptic Ulcers

-H pylori -NSAID and corticosteroid use -severe stress -familial tendency -hypersecretory states -gastrin-secreting benign or malignant tumors of the pancreas -type O blood -excess alcohol consumption -chronic pulmonary or kidney disease -zollinger-ellison syndrome (combination of peptic ulcers, hyper secretion of gastric acid, and gastrin-secreting tumors) -pernicous anemia

Surgical Procedures for Morbid Obesity

-Roux-en-Y Gastric Bypass -Gastric Banding -Vertical-Banded Gastroplasty -Sleeve Gastrectomy -Biliopancreatic Diversion with Duodenal Switch

Peptic Ulcer

-an erosion of the mucosal lining of the stomach, esophagus, or duodenum -EROSION of a mucous membrane forms an excavation in the STOMACH LINING, pylorus, duodenum (most common), or esophagus -associated with infection of H.Pylori Risk Factors: excessive secretion of stomach acid, dietary factors, chronic use of NSAIDs, alcohol, smoking, and familial tendency

Nursing dx: anxiety for peptic ulcers Goal: decrease anxiety

-assess anxiety -explain all procedures and treatments -help identify stressors -explain various coping and relaxation methods such as biofeedback, hypnosis, and behavior modification

Nursing Process: The care of the patient with peptic ulcer assessment

-assess pain and methods used to relieve pain -what is the usual food over72 hour period -lifestyle and habits such as cigarette and alcohol use -medications: include use of NSAIDs, don't take them -sign and symptoms of anemia or bleeding, monitor for orthostatic changes in vital signs and tachycardia, as these findings are suggestive of gastrointestinal bleeding or perforation -administer saline lavage via NG tube -abdominal assessment--check for localized tenderness -for post op always look for bleeding

Nursing Dx: Acute pain for peptic ulcer Goal: to relieve pain

-assess pain level -treat with prescription medications -eat meals at regular paced intervals -avoid aspirin, NSAIDs, and alcohol -relaxation exercises -distraction/non-pharmaceutical treatment

Health Promotion and Disease Prevention

-assist in the reduction of anxiety related to gastritis -follow prescribed diet -decrease or eliminate alcohol use -client with pernicous anemia will need vitamin B12 injections due to a decrease of the intrinsic factor by the stomach parietal cells -watch for indications of GI bleeding -follow the prescribed medication regimen -eat small, frequent meals, avoiding foods and beverages that cause irrigation -report constipation, nausea, vomiting, or bloody stools

Health Promotion and Disease Prevention

-drink alcohol in moderation -stop smoking and use of tobacco products -use stress management techniques -avoid NSAIDs as indicated -limit caffeine-containing beverages -consume a balanced diet -engage regularly in exercise

Expected Findings

-dyspepsia, general abdominal discomfort, indigestion -headache -long hiccuping episodes -upper abdominal pain or burning can increase or decrease after eating -nausea and vomiting -reduced appetite and weight loss -hematemesis (bloody emesis) and stools that test positive for occult blood (manifestations can have rapid onset with acute gastritis) Erosive Gastritis: -black, tarry stools:coffee-ground emesis -acute abdominal pain

Expected Findings

-dyspepsia: heartburn, bloating, nausea, and vomiting (vomiting is rare but can be caused by a gastric outlet obstruction). can be perceived as uncomfortable fullness or hunger. -dull, gnawing pain or burning sensation at the midepigastrium or the back. -pain or epigastric tenderness or abdominal distension -bloody emesis (hematemesis) or stools (melena) -weight loss

Complication for Peptic Ulcers: Dumping Syndrome

-occurs with vagotomy, billroth and billroth 11 -stomach has no control over the amount of gastric chyme entering the small intestine. -client will not take up any of the nutrients when eating -hypertonic fluid enters the intestine and results in fluid being drawn into the bowel lumen -will also occur for someone who had bariatric surgery symptoms: -weakness, SWEATING, PALPITATIONS, DIZZINESS -abdominal cramps, borborygmi (rumbling, gurgling sounds) -urge to defecate Treatment: -lie down after meal because it is all about gravity (this will be able to slow it down)

Gastritis Practice Questions

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What is the best time to teach a client to take proton pump inhibitors? A. 30 minutes before each meal B. With a meal C. Immediately after the meal D. One to three hours after a meal

30 minutes before each meal

Nursing Dx

Anxiety: -because it is so painful they might not be sleeping -explain all procedures and treatments Imbalanced Nutrition: -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 alcohol counseling and smoking cessation.

Surgical Procedures for peptic ulcers (don't have to know in detail)

Bilroth 1: gastroduodenostomy (duodenal anastomosis); partial gastrectomy with removal of distal 2/3 of the stomach, with anastomosis of gastric stump to the duodenum Bilroth 11: gastrojejunostomy-->anastomosis of antrum to proximal end of jejunum, duodenal stump retained so that bile can enter jejunum Pyloroplasty&Vagotomy (cut the vagus nerve) -vagotomy:the vagus nerve is cut to decrease gastric acid production in the stomach. often done laparoscopically to reduce postoperative complications. -pyroplasty: the opening between the stomach and small intestine is enlarged to increase the rate of gastric emptying

Lab tests

CBC (check for anemia) -women: Hgb less than 12 and RBS less than 4.2 -men: Hgb less than 14 and RBS less than 4.7 Serum and stool antibody/antigen test for presence of h pylori C13 urea breath test: used to measure h pylori

Interventions

Dx: Risk for fluid volume imbalance (think about low volume and hemorrhaging) -promote fluid balance (1.5L or 3L if NPO)...in hospital as soon as someone is NPO you put in an IV for hydration -monitor I&O, for signs of dehydration -electrolyte imbalance (Na+, K+, CL-) -*Hemorrhage* (TACHYPNEA, HYPOTENSION, TACHYCARDIA) Dx: Acute Pain -measures to relieve pain: diet and medications

A nurse is planning care for a client who has acute gastritis. Which of the following nursing interventions should the nurse include in the plan of care? (select all that apply) A. Evaluate intake and output B. Monitor lab reports of electrolytes C. Provide three large meals a day D. Administer ibuprofen for pain E. Observe stool characteristics

Evalute intake and output Monitor lab reports of electrolytes observe stool characteristics

A nurse is teaching about pernicious anemia with a client who has chronic gastritis. Which of the following information should the nurse include in the teaching? A. Pernicous anemia is caused when the cells producing gastric acid are damaged. B. Expect a monthly injection of vitamin B12 C. Plan to take vitamin K supplements D. Pernicous anemia is caused by an increased production of intrinsic factor

Expect a monthly injection of vitamin B12

Medications

H2 Antagonists Antacids PPI Prostaglandins Anti-ulcer/mucosal barriers Antibiotics

Collaborative Problems and Potential Complications

Hemorrhage (symptom:hypotension) Bile reflux Dumping Syndrome (symptom: DIZZY, PALPATATIONS, DIAPHORETIC) and you want to lay them down, to reposition the patient Dysphagia (symptom:cough, choke, clear the throat) Bowel or gastric outlet obstruction--NG tube contraindicated

A nurse is teaching a client who has a new prescription for famotidine. Which of the following statements by the client indicates understanding of the teaching? A. The medication coats the lining of my stomach B. The medication should stop the pain right away C. I will take my pill 1hr before meals D. I will monitor for bleeding from my nose

I will take my pill 1 hour before meals

Obesity Management

Medical Management: -lifestyle modifications -pharmacotherapy--Orlistat (Xenical) over the counter as Alli Surgical Management -bariatric surgery

Treatment

Meds: -ANTIBIOTICS (amoxicillin to treat H.pylori) only if H.pylori is the cause -PPI (ianoprazole) is used to reduce gastric acid secretions -Bismuth salts (pepto-bismol)--take 30 minutes prior to meal, these meds coat the ulcer and protect it from the action of pepsin and acid -antacids: give 1-2 hours apart from other meds to avoid reducing the absorption of other meds, monitor kidney function Lifestyle changes: -stop smoking -dietary changes (AVOID FOOD THAT CAUSES PAIN: caffeine, acidic foods), typically ask the client what food they eat and they realize they have increasing pain Surgery may be needed (go in and cut peptic ulcer out) -vagotomy with or without pyloroplasty -Antrectomy with anastomosis to either duodenum or jejunum

Bariatric Surgery

Morbid obesity: persons more than two times IBW, BMI exceeds 30kg/m2, or more than 100 pounds greater than IBW; high risk for health complications surgery is performed only after nonsurgical methods have failed selection factors include body weight, patient history, failure to lose weight using other means, absence of endocrine disorders, and psychological stability--MOTIVATED for successful bariatric surgery is psychological stability, the patient will have to want it, it is not that they can just get the surgery

Types of Gastritis

Nonerosive (acute or chronic): is most often caused by an infection, H. pylori Erosive: is likely caused by NSAIDs, alcohol use disorder, or recent radiation treatment

Peptic Ulcer: Management of Potential Complications

Perforation Signs: -severe upper abdominal pain that may be referred to the shoulder -vomiting and collapse -TENDER BOARDLIKE ABDOMEN WHEN PALPATING -symptoms of shock or impending shock -THIS IS A MEDICAL EMERGENCY Treatment: -patient requires immediate surgery--PREVENT PERITONITIS (inflammation of the peritoneum)

Nursing Care of the Patient Undergoing Bariatric Surgery

Preoperative Care: Evaluation and counseling Postoperative Care: -pain management -tubes and catheters -HOB 35-40 degrees -vomiting -compression devices/low dose heparin -risk of wound dehiscence -water and sugar-free clear liquids 30mL every 2 hours (SMALL VOLUME, CLEAR LIQUIDS) Postoperative diet: SIX SMALL FEEDINGS TOTALING 600 to 800 CALORIES PER DAY -patients require psychosocial interventions to modify their eating behaviors -follow-up care -education regarding long-term effects

Medical Management of *ACUTE* Gastritis

Refrain from alcohol and food until symptoms subside (stop taking advil) supportive therapy: IV, NG tube, antacids, H2 blockers (rantidine), PPI (omeprazole) let the stomach and rest and heal so maybe stop eating and get an IV and NG tube If something is red and raw (inflamed) it might start to bleed so then you might need surgery Emergency surgery: gastric resection, or gastrojejunostomy (to treat pyloric obstruction)

A nurse in the emergency department is completing an assessment of a client who has suspected stomach perforation due to a peptic ulcer. Which of the following findings should the nurse expect? (select all that apply) A.Rigid abdomen B.Tachycardia C.Elevated BP D.Circumoral cyanosis E.Rebound tenderness

Rigid abdomen tachycardia rebound tenderness

A charge nurse is teaching a group of unit nurses about a client who has chronic gastritis and is scheduled for a selective vagotomy. Which of the following statements by a unit nurse indicates understanding of the purpose of the procedure? A. the client will have increased duodenal gastric emptying B. The client will have a reduction of gastric acid secretions C. The client will have an increase of gastric mucus secretion D. The client will have an increased secretion of hydrogen/potassium ATPase enzymes

The client will have a reduction of gastric acid secretions

Diagnostic Test

Upper endoscopy -down the throat looking around the stomach looking for the inflammation

Client has chronic gastritis. Monitor client, knowing the client is at risk for which vitamin deficiency? A. Vitamin A B. Vitamin B12 C. Vitamin C D. Vitamin E

Vitamin B12

Gastritis

an inflammation in the lining of the stomach, either erosive or non erosive, common GI problem, can be acute or chronic WHY IS STOMACH INFLAMED

A nurse is completing an assessment of a client who has a gastric ulcer. Which of the following findings should the nurse expect? (select all that apply) A. Client reports pain relieved by eating B. Client states that pain often occurs at night C. Client reports a sensation of bloating D. Client states that pain occurs 30 minutes to 1 hour after a meal E. Client experiences pain upon palpation of the epigastric region.

client reports a sensation of bloating client states that pain occurs 30 minutes to 1 hour after a meal client experiences pain upon palpation of the epigastric region

Peptic ulcer complications

hemorrhage: EMERGENCY -assess for evidence of bleeding: dizziness, hematemesis or melena, and symptoms of impending shock and anemia ---tachy ---hypotension ---tachypnea treatment: -IV fluids FLUID -NG, and saline or water lavage -oxygen -treatment of potential shock including monitoring of VS and UO -may require endoscopic coagulation or surgical intervention

A nurse is completing discharge teaching for a client who has an infection due to Hpylori. which of the following statements by the client indicates understanding of the teaching? A. i will continue my prescription for corticosteroids B. I will schedule a CT scan to monitor improvement C. I will take a combination of medications for treatment D. I will have a throat swabbed to recheck for this bacteria

i will take a combination of medications for treatment

A nurse is teaching a client who has a new diagnosis of dumping syndrome following gastric surgery. Which of the following information should the nurse include in the teaching? A. Eat three moderate sized meals a day B. Drink at least one glass of water with each meal C. Eat a bedtime snack that contains a milk product D. Increase protein in the diet

increase protein in the diet

Peptic Ulcer

manifestations include a dull gnawing pain or burning in the mid-epigastrium; heartburn and vomiting may occur, PAIN RESOLVES WITH EATING...so if someone has a peptic ulcer give them food clients experiencing trauma often receive PPI prophylaxis to prevent the development of stress ulcers.

Medical Management of *CHRONIC* Gastritis

modify diet, promote rest, reduce stress, avoid alcohol and NSAIDs pharmacologic therapy: antacids, H2 blockers, PPIs

Nursing dx: Deficient knowledge Goal: increase knowledge about the management and prevention of peptic ulcer recurrence

patient education: -assess client's knowledge -medication education: no NSAIDs -dietary restrictions: -lifestyle changes: NO smoking and drinking -prevention of complications: dumping syndrome

Chronic Gastritis

prolonged inflammation due to benign or malignant ulcers of the stomach or by H.pylori. may also be associated with some autoimmune diseases, dietary factors, medications (NSAIDS), alcohol, smoking, or chronic reflux of pancreatitis secretions or bile. 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, end up with this deficiency due to chronic gastritis. can be related to autoimmune disease, such as pernicous anemia, and H.pylori extensive gastric mucosal wall damage can cause erosive gastritis (ulcers) and increase the risk of stomach cancer.

Peptic Ulcer: Management of potential complications

pyloric obstruction: -nausea, vomiting, constipation, epigastric fullness, and later weight loss -BACK UP OF FOOD -priorities of care: ---insert NG tube to decompress the stomach ---provide IV fluids and electrolytes ---balloon dilation or surgery may be required ---PYLORIC SPHINCTER

Acute Gastritis

rapid onset of symptoms usually caused by dietary indiscretion. other causes include medications (NSAIDS), alcohol, bile reflux, and radiation therapy. abdominal discomfort, headache, lassitude, nausea, vomiting, hicupping short duration, can result in gastric bleeding if severe. A severe form of acute gastritis is caused by the ingestion of an irritant, (such as strong acid or alkali) and can result in the development of gangrenous tissue or perforation. Scarring can result leading to pyloric stenosis

A nurse is teaching a client who has a duodenal ulcer and a new prescription for esomeprazole. Which of the following information should the nurse include in the teaching? (select all that apply) A. Take the medication 1 hour before a meal B. Limit NSAIDs when taking this medication C. Expect skin flushing when taking this medication D. Increase fiber intake when taking this medication E. Chew the medication thoroughly before swallowing

take the medication 1 hour before a meal limit NSAIDs when taking this medication

A nurse is providing discharge teaching to a client who has a new prescription for aluminum hydroxide. Which of the following information should the nurse include in the teaching? A. Take the medication with food B. Monitor for diarrhea C. Wait 1 hour before taking the oral medications D. Maintain a low fiber diet

wait 1 hours before taking other oral medications