Gastritis and Peptic Ulcer Disease (Sherpath)

The nurse is educating a patient newly diagnosed with gastritis. Which statements by the patient confirm an understanding of gastritis' pathophysiology?

"It may be local." Gastritis may be local. The ulcer erodes the layers of the mucosa in either a diffuse or local process, and once the hydrochloric acid and pepsin erode the capillaries, bleeding can occur. "It may be diffuse." Gastritis may be diffuse. The ulcer erodes the layers of the mucosa in either a diffuse or local process, and once the hydrochloric acid and pepsin erode the capillaries, bleeding can occur. "It causes edema and disruption of capillaries." Gastritis causes edema and disruption of the capillaries. The ulcer erodes the layers of the mucosa in either a diffuse or local process, and once the hydrochloric acid and pepsin erode the capillaries, bleeding can occur. "It is caused by the breakdown of the mucosal barrier by pepsin." Gastritis may be caused by the breakdown of the mucosal barrier by pepsin. The ulcer erodes the layers of the mucosa in either a diffuse or local process, and once the hydrochloric acid and pepsin erode the capillaries, bleeding can occur.

A patient has been treated in the hospital for peptic ulcer disease (PUD) and is now looking forward to recovery. The patient has a 2-week postoperative appointment scheduled and asks the nurse what to expect in terms of healing time. Which is an appropriate response?

"The ulcer will not be completely healed by the first postoperative appointment."

A patient with a suspected Helicobacter pylori infection and complications is being prepared for an endoscopy. The patient asks why the procedure is being done. How can the nurse respond?

"This study will confirm the infection is present." "We need to take a sample of the stomach lining." "The procedure allows us to determine whether there is any internal damage."

Complications - Dumping syndrome

(occurs with procedures for gastric outlet obstruction and ulcer removal/reduction): loss of control over the amount of chyme entering the small intestine, which causes a large fluid shift into the bowel, creating a decrease in plasma volume and distention of the bowel lumen and rapid intestinal transit. Patient will complain of weakness, sweating, palpitations, dizziness, and abdominal cramps. This occurs within 15-30 minutes of eating and usually lasts about an hour after eating. Postprandial hypoglycemia: results from an uncontrolled gastric emptying of a large bolus of fluid high in carbohydrates, causing hyperglycemia, excessive amounts of insulin, and resultant hypoglycemia. Bile reflux gastritis: Surgery involving the pylorus can result in bile reflux into the stomach. Bile is very irritating to the gastric mucosa and causes gastritis.

A patient with H. pylori infection is prescribed a triple-drug regimen. Which medications are included in this therapy?

A proton pump inhibitor (PPI), amoxicillin, and clarithromycin

A patient presents with a history of hypertension and has just started treatment for peptic ulcer disease (PUD). What important medication topic needs to be discussed in the management of this patient?

Antacids need to be used with caution.

Early detection of peptic ulcer disease (PUD) needs to be the priority in a nursing management plan for patients with symptoms of chronic gastritis. Which action is the nurse's next priority?

Assess for anemia and guaiac-positive stools.

A patient is suspected of having a gastric ulcer. The patient cannot have an endoscopy because a non-life-threatening cardiac arrhythmia is present. Which diagnostic test should the patient undergo?

Barium contrast study

A patient with chronic peptic ulcer disease (PUD) does not respond to medical therapy. After the treatment team finishes discussing a certain surgical treatment option, the patient asks for more information on how the procedure will affect his small intestine. Which surgical treatments have likely been discussed?

Billroth I Partial gastrectomy with removal of the distal two thirds of the stomach and anastomosis of the gastric stump to the duodenum is called a gastroduodenostomy or Billroth I operation. Billroth II Partial gastrectomy with removal of the distal two thirds of the stomach and anastomosis of the gastric stump to the jejunum is called a gastrojejunostomy or Billroth II operation. Gastrectomy Gastrectomy involves the removal of the stomach and anastomosis of the gastric stump to the jejunum or duodenum (Billroth II or I, respectively). Pyloroplasty A pyloroplasty will affect the small intestine and therefore is an appropriate treatment option. A pyloroplasty is a procedure in which the pylorus valve is cut and restructured, allowing the pyloric sphincter to be more relaxed. This allows food to be dumped into the small intestine quickly.

Which action by the nurse demonstrates the first step in providing care to a patient with nausea and a new diagnosis of gastritis?

Confirming medical history accuracy

A patient with gastritis asks the nurse about the bodily process behind the diagnosis. The nurse explains that which physiologic event is responsible for the patient's symptoms?

Disruption of the stomach mucosa

Which statements accurately reflect dietary advice needed to help prevent dumping syndrome in a patient who underwent gastrectomy?

Divide meals into six small feedings. Take fluids 45 minutes before meals. Eliminate consumption of fluids with meals

A patient presents 2 weeks after removal of a large portion of the stomach and pyloric sphincter. The patient is complaining of abdominal cramping, dizziness, and a sensation of fullness. On assessment, the patient's heart rate is 125 bpm. The nursing team will prepare to treat which condition?

Dumping syndrome

A patient complains of burning pain across the midepigastric area 3 hours after eating dinner. The pain is relieved by antacids. Which diagnosis would the nurse suspect based on these symptoms?

Duodenal ulcer

A nurse is treating a patient with acute gastritis. Which information should the nurse provide to help the patient prevent future exacerbations?

Eat only bland food. Join a smoking cessation support group. Graze on food throughout the day.

When educating a patient with gastritis, which recommendations should the nurse include regarding preventing an exacerbation? Select all that apply.

Eliminate smoking. Reduce coffee intake. Decrease alcohol consumption. Practice relaxation techniques.

A patient presents with symptoms of acute gastritis. Which diagnostic tool would be used to definitively diagnose the patient with this disease?

Endoscopy with biopsy Endoscopic examination with biopsy is used to obtain a definitive diagnosis of gastritis.

A patient with a history of smoking complains of burning in the upper abdomen and upper back 45 minutes after eating. Which condition would be suspected by the nurse?

Gastric ulcer Pain will be present 1 to 2 hours after eating, since the hydrochloric acid is working to digest the food and further erodes the mucosa and causes pain. Gastric ulcers are also associated with use of nonsteroidal anti-inflammatory drugs.

If a patient presents with acute exacerbation of peptic ulcer disease, which collaborative interventions need to be taken?

Give patient NPO orders Nasogastric (NG) suction Administration of intravenous Ringer's lactate solution Intravenous administration of a proton pump inhibitor

The nurse would identify which parts of the medical and social history as placing a patient at increased risk for development of gastritis?

Habitual use of nonsteroidal anti-inflammatory drugs Previous Helicobacter pylori infection Consumption of spicy foods

Acute Exacerbation with Complications: Hemorrhage, Perforation, Gastric Outlet Obstruction Treatments:

Hemorrhage: frequent vital signs, lab values (possible blood transfusions), maintain NG patency, Perforation: notify healthcare provider immediately, frequent vital signs (q 15 min), NPO, maintain IV rate or increase, antibiotic therapy, ready the patient for possible OR Gastric Outlet Obstruction: NG suction with regular irrigation to maintain patency, IV fluids Stomach lavage (possible)

A patient presents with vomiting and nausea. On assessment, the nurse notes epigastric tenderness. Endoscopic studies confirm infection with H. pylori. The patient is prescribed triple-drug therapy. What patient education topic is a priority to ensure symptoms do not recur?

Importance of completing antibiotics

A patient is taking a corticosteroid. Which action of the corticosteroid places the patient at risk for development of gastritis?

Inhibition of prostaglandin synthesis

A nurse is caring for a patient diagnosed with acute gastritis who has a nasogastric tube inserted. The patient asks why the tube has been inserted. Which statements by the nurse would describe the purpose of the nasogastric tube?

It is used for performing lavage." "It keeps the stomach empty." "It is used to monitor for bleeding."

Diet Principles

Meals should be divided into smaller feedings (eg, six) to prevent stomach or intestinal discomfort. Fluids should be consumed 30 to 45 minutes before or after meals, not with meals. This helps prevent distention or a feeling of fullness. Concentrated sweets (eg, honey, sugar, jelly, jam, candies, sweet pastries, and sweetened fruit) need to be avoided. These sweets may cause dizziness, diarrhea, and a sense of fullness. Intake of protein and fats, such as meat, cheese, and eggs, should be increased to meet energy needs. This will promote rebuilding of body tissues. The health care provider will determine the length of time for the patient to remain on this specific diet based on the patient's clinical condition.

Peptic ulcer disease (PUD) is most likely to affect which areas of the gastrointestinal (GI) lining?

Mucosa The mucosa is the outermost layer of the GI lining and the first affected by PUD. Submucosa The submucosa will eventually be affected in PUD. It is the second layer of the GI lining. Muscularis The muscularis will also be affected in a chronic case of PUD. When the ulcer has reached this point, it will likely form fibrous scar tissue.

Acute Exacerbation without Complications Treatments:

NPO (to include regular mouth care) NG suction with intermittent not constant suction Adequate rest promotes ulcer healing IV fluid replacement Drug therapyPPIsH2-receptor blockersAntibiotics for H. pylori infectionCytoprotective drugsAntacidsAnticholinergics (used rarely)

To help Mrs. Baker with her "hunger pains," why is it necessary to encourage her to continue taking her arthritis medication? CASE STUDY DETAILS

NSAIDS are the cause of her presenting symptoms, so continuing to take her arthritis medication will help to reduce her gastritis. The NSAIDs may be causing her peptic ulcer symptoms, and they need to be avoided if possible. If she switches back to her arthritis medications, the inflammation may resolve.

A patient is diagnosed with acute gastritis associated with a diet heavy in spicy foods and is currently experiencing severe nausea. Which treatment is appropriate for this patient?

Nasogastric tube

A patient with gastritis presents with vomiting and nausea after an overdose of nonsteroidal anti-inflammatory drugs (NSAIDs). What care is indicated for this patient?

Nothing by mouth (NPO) The patient should NPO until symptoms subside and gastritis is controlled. Antiemetics Antiemetics are indicated for the patient's nausea and vomiting. Gastric lavage A gastric lavage may be used to remove the NSAIDs from the patient's stomach.

A patient with peptic ulcer disease (PUD) presents with severe upper abdominal pain that spreads to the back. The patient reports that they cannot find any way to relieve the pain. On assessment, the abdomen is rigid and the patient has tachycardia. Which treatment is indicated for this patient?

Omentum graft

The care team is treating a post-operative patient who has recently undergone a gastrectomy. The patient is showing signs of anxiety and lab results reveal excessive amounts of insulin. The nurse understands that these symptoms may be indicative of which postoperative complication?

Postprandial hypoglycemia

A patient with gastritis asks the nurse how to prevent future exacerbations. The patient is a heavy smoker and drinker, takes an aspirin daily for heart problems, and eats a relatively simple and bland diet. The patient walks 1 mile every night for exercise. What is the best response by the nurse?

Stop drinking Cease smoking

Why would the nurse discuss vitamin B12 deficiency with a patient who has undergone a gastrectomy?

The parietal cells of the stomach produce intrinsic factor, which is needed for vitamin B12 absorption.