Pathophysiology of Acute Gastritis and Chronic Gastritis

Pathophysiology of Acute Gastritis

Acute gastritis can be caused by stress, chemical substances such as drugs and alcohol, spicy foods, hot and sour. In experiencing the stress will occur sympathetic nerve stimulation NV (vagus nerve), which will increase the production of hydrochloric acid (HCl) in the stomach. The presence of HCl that is in the stomach will cause nausea, vomiting and anorexia.

Chemicals or stimulating foods will cause columnar epithelial cells, whose function is to produce mucus, reducing production. While it is the function of mucus to protect gastric mucosa that did not participate undigested. The response of the gastric mucosa due to decreased vasodilation, mucous secretion varies among gastric mucosal cells. There gastric mucosal lining cells produce HCl (especially the fundus) and blood vessels. Vasodilatation gastric mucosa will cause increased production of HCl. Anorexia can also cause pain. The pain inflicted by HCl contact with the gastric mucosa. Response due to decreased gastric mucosal mucus secretion may be eksfeliasi (exfoliation). Gastric mucosal cell exfoliation will lead to erosion of the mucosal cells. Mucosal cell loss due to erosion lead to bleeding. Bleeding happens to people with life-threatening, but it can also stop yourself because the process of regeneration, so that erosion disappear within 24-48 hours after hemorrhage.

Pathophysiology of Chronic Gastritis

Helicobacter pylori is a gram-negative bacteria. These organisms invade the gastric surface cells, aggravate the onset of cell desquamation and chronic inflammatory responses appeared on gastric ie: destruction of the gland and metaplasia. Metaplasia is one of the body's defense mechanism against irritation, namely by replacing the gastric mucosal cells, such as cells desquamosa stronger. Because cell desquamation stronger then the elasticity is also reduced. At the time of digesting food, the stomach peristaltic movement but as a replacement cells will give rise to inelastic stiffness, which in turn cause pain. Metaplasia also cause loss of mucous cells in the lining of the stomach, so it will cause damage to the mucosal lining of the blood vessels. Damage to blood vessels will cause bleeding (Price, Sylvia and Wilson, Lorraine, 1999: 162).

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Gastritis

Assessment of Gastritis

During the collecting history of the disease, the nurse asked about the signs and symptoms in patients. Does the patient have heartburn, can not eat, nausea or vomiting? Do the symptoms occur at anytime, before or after meals, after ingesting spicy foods or causing irritation or after ingesting certain drugs or alcohol? What are the symptoms associated with anxiety, stress, allergies, eating or drinking too much, or eating too fast? how the symptoms disappear? Is there a history of previous gastric or stomach surgery? A history of diet plus a new type of diet eaten for 72 hours, will help. Complete history is essential in helping nurses to identify whether a known reckless excess diet, associated with current symptoms, whether others in the environment of patients had similar symptoms, whether the patient vomited blood and whether the cause of the known elements have been ingested.

Nursing Diagnosis for Gastritis

1. Anxiety
2. Imbalanced Nutrition, Less Than Body Requirements
3. Risk for Fluid Volume Deficit
4. Knowledge Deficit
5. Acute Pain

Sample of Nursing Diagnosis and Interventions for Gastritis

Nursing Diagnosis : Anxiety related to treatment

Goal : The client will show relaxed and report anxiety dropped to manageable levels.

Intervention:

Independent:
1. Assess physiological responses eg, tachypnea, palpitations, dizziness, headaches, etc..
Rational: It can be indicative of the degree of fear experienced by the patient but may also relate to the physical condition / state of shock.

2. Note the behavior of the example instructions anxiety, irritability, lack of eye contact, behavior against / attack.
Rational: Indicators of the degree of fear experienced by patients eg, patients will feel out of control of the situation or achieve status panic.

3. Encourage a statement of fear and anxiety, give feedback.
Rational: Creating a therapeutic relationship. Help the patient accept the feelings and provide an opportunity to clarify misconceptions.

4. Acknowledge that this is a scary situation and others expressed similar fear. Assist patients in expressing feelings by listening actively.
Rational: If the patient has his own fear, this feeling of validation that is normal can help patients feel less isolated.

5. Provide accurate information, real about what to do.
Rational: Involving patients in the plan of care and reduce unnecessary anxiety about the unknown.

6. Provide a quiet environment to rest.
Rationale: Increase relaxation, improve coping skills.

7. Provide opportunities for the people closest to expressing feelings / problems. Encourage the person closest to the real show positive behavior.
Rational: Helping people closest to accept the anxiety / fear itself that can be transplanted into patients. Improve the behavior of the support that can facilitate healing.

8. Show relaxation techniques, eg, deep breathing exercises, guidance imagination.
Rational: Learn how to relax can help reduce fear and anxiety.


Collaboration

1. Give the drug as an indication
Rational: Drugs that can be used occasionally to reduce anxiety and improve the rest, especially in patients with ulcers.

2. Refer to the psychiatric nurse / religious advisor
Rational: It may take an additional aid for healing to accept the consequences of emergency situations / decisions to the need / demand changes in lifestyle.

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Sample of Nursing Diagnosis - Interventions for Gastritis

Nursing Care Plan for Gastritis : Sample of Nursing Diagnosis and Nursing Interventions


1. Nursing Diagnosis: Risk for Fluid Volume Deficit related to inadequate intake and excessive fluid output (nausea and vomiting)

Goal:
After nursing actions, adequate fluid intake.

Expected outcomes are:

• The mucosa of the lips moist
• Good skin turgor
• Good capillary refill
• Input and output balanced

Nursing Interventions:

• Fill your individual needs. Encourage clients to drink.
• Provide additional IV fluids as indicated.
• Monitor vital signs, evaluation of skin turgor, capillary refill and mucous membranes.
• Collaboration: the provision of drugs.

Rational:

• Adequate fluid intake will reduce the risk of patient dehydration.
• Replacing lost fluids and improve fluid balance in the immediate phase.
• Indicate the status of dehydration or the possibility of the need to increase fluid replacement.
• Provision of drugs serves to inhibit gastric acid secretion.

2. Nursing Diagnosis: Acute pain related to irritation of the gastric mucosa secondary to psychological stress.

Goal:
After the act of nursing, pain can be reduced, patients can rest and generally good condition.

Expected outcomes are:

• Clients express the pain diminished or disappeared.
• The client does not grimace in pain.
• Vital signs are within normal limits.
• The pain intensity was reduced (reduced pain scale 1-10).
• Demonstrate relax, rest, sleep, increased activity quickly.

Nursing Interventions:

• Investigate complaints of pain, note the location, intensity of pain, and pain scale.
• Instruct patient to report pain as soon as it began.
• Monitor vital signs.
• Explain the causes and effects of pain on the client and his family.
• Encourage rest during the acute phase.
• Encourage relaxation techniques.
• Provide an environment conducive situation.
• Collaboration with the medical team in the delivery of the action.

Rationale:

• To find out where the pain and facilitate interventions to be performed.
• Early intervention to facilitate recovery of muscle control pain by decreasing muscle tension.
• Autonomic responses include, changes in blood pressure, pulse, respiration, associated with pain relief.
• With the causes and consequences of pain the client is expected to participate in treatment to reduce pain.
• Reduce pain that was exacerbated by movement.
• Decrease muscle tension, increase relaxation, and increased sense of control and coping abilities.
• Provide support (physical, emotional, increased sense of control, and coping skills).
• Eliminate or reduce the client's complaints of pain.

3. Nursing Diagnosis : Imbalanced Nutrition: Less Than Body Requirements related to the lack of food intake.

Goal:
After the patient's nutritional needs of nursing actions are met.

Expected outcomes are:

• General condition is quite
• Good skin turgor
• Increased weight
• Difficulty swallowing is reduced

Nursing Interventions :

• Instruct patient to eat small meals but frequently.
• Give soft foods.
• Perform oral hygiene.
• Measure weight basis.
• Texture observation, the patient's skin turgor.
• Observations of nutritional intake and output.

Rationale:

• Keeping the patient remained stable nutritional prevent nausea and vomiting.
• To facilitate the patient to swallow.
• Oral hygiene can stimulate the appetite of the patient.
• Knowing the development of nutritional status of patients.
• Knowing a patient's nutritional status.
• Knowing a patient's nutritional balance.

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Sample of Assessment - Nursing Care Plan Gastritis

Sample of Nursing Care Plan for Gastritis

Nursing Assessment

1. Anamnese include:
   • Name :
     
   • Age :
     
   • Gender :
     
   • Type of work :
     
   • Address :
     
   • Tribe / Nation :
     
   • Religion :
     
   • The level of education: for those with low education level / low gain knowledge of gastritis, it will underestimate the disease, even just think of gastritis as upset stomach and will eat regular foods that can cause and exacerbate the disease.
   • History of illness and health
     • The main complaint: Pain in the pit of the stomach and lower right abdomen.
     • History of the disease at this time: Covers the journey of illness, initial symptoms are felt from the client, complaints arise suddenly or gradually felt, trigger factors, efforts to resolve the issue.
     • Past history of disease: Includes diseases associated with the disease now, history of the hospital, and a history of drug use.
   
   
   
2. Physical examination, the Review of systems (ROS)
   
   General condition: there was pain on physical examination there is tenderness in the epigastric quadrants.
   
   • B1 (breath): tachypnea
   • B2 (blood): tachycardia, hypotension, dysrhythmias, weak peripheral pulses, peripheral charging slow, pale skin color.
   • B3 (brain): headache, weakness, level of consciousness can be disturbed, disorientation, pain epigastrum.
   • B4 (bladder): oliguria, fluid balance disorders.
   • B5 (bowel): anemia, anorexia, nausea, vomiting, heartburn, intolerance to spicy foods.
   • B6 (bone): fatigue, weakness



3. Assessment Focus
   1. Activity / Rest
      Symptoms: weakness, fatigue
      Signs: tachycardia, tachypnea / hyperventilation (in response to activity)
   
   
   2. Circulation
      Symptoms: weakness, sweating
      Signs:
      
      • Hypotension (including postural)
      • Tachycardia, dysrhythmias (hypovolemia / hypoxemia)
      • Weak peripheral pulse
      • Slow capillary refill (vasoconstriction)
      • Skin color pale, sianosis (depending on the number of blood loss)
      • Weakness of skin / mucous membranes, sweating (shows status of shock, acute pain, psychological responses)
      
      
   3. Ego integrity
      Symptoms: acute or chronic stress factors (financial, labor relations), feelings of helplessness.
      Sign: a sign of anxiety, such as anxiety, pallor, sweating, narrowing of attention, shaking, trembling voice.
   
   
   4. Elimination
      Symptoms: a history of previous hospitalization due to bleeding gastroenteritis (GE) or problems associated with GE, such as injury or gastric ulcer, gastritis, gastric surgery, gastric irradiation area. Changes in bowel habit / characteristic stool.
      Signs:
      
      • Abdominal tenderness, distention
      • Bowel sounds: often hyperactive during hemorrhage, hypo-active after the bleeding.
      • The characteristics feses: diarrhea, blood color of dark, brownish or sometimes red bright, foamed, odor rotten (steatorrhoea), constipation can occur (a change diet, the use of antacids).
      • Urinary output: decreased, concentrated.
      
      
   5. Food / fluid
      Symptoms:
      
      • Anorexia, nausea, vomiting (throwing up that extends beyond the pyloric obstruction suspected in connection with a duodenal injury),
      • Swallowing problems: hiccups
      • Heartburn, sour belching, nausea or vomiting
      Symptoms: vomiting with a dark coffee color or bright red, with or without blood clots, dry mucous membranes, decreased mucus production, poor skin turgor (chronic bleeding).
   
   
   6. Neurosensory
      Symptoms: flavor pulsed, dizziness / sick heads because of rays, weakness.
      Sign: the level of consciousness can be impaired, the range of slightly inclined to sleep, disorientation / confusion, fainting and coma (depending on the volume of circulation / oxygenation).
   
   
   7. Pain / Comfort
      Symptoms:
      
      • Pain, described as a sharp, shallow, burning, stinging, sudden severe pain may be accompanied by perforation. Sense of discomfort / distress faint after eating a lot and lost with a meal (acute gastritis).
      • Pain epigastrum left until the middle / back or spread to occur 1-2 hours after eating and relieved by antacids (gastric ulcers).
      • Pain left to epigastrum / or spread to his back occurred approximately 4 hours after eating when the stomach is empty and relieved by food or antacids (duodenal ulcer).
      • No pain (esofegeal varices or gastritis).
      • Trigger factors: food, cigarettes, alcohol, the use of certain drugs (salicylates, reserpine, antibiotics, ibuprofen), psychological stressors.
      Signs: wrinkled face, be careful in the area of ​​pain, pallor, sweating, narrowing attention.
   
   
   8. Security
      Symptoms: allergy to the drug / sensitive
      Sign: an increase in temperature, spider angioma, palmar erythema (showing cirrhosis / portal hypertension)
   
   
   9. Guidance / Learning
      Symptoms: the use of prescription drugs

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