Chronic gastritis is a disease of the stomach that occurs with damage to the mucous membrane of the digestive organ. To get rid of the disease you will need complex treatment, as well as a special diet. But sometimes the patient cannot adhere to the doctor’s recommendations on his own. IN in this case The main assistant in a hospital setting is the nurse. Her task is to monitor treatment, care, and provide recommendations for a speedy recovery. This is the basis of the nursing process for chronic gastritis.
The nursing process for chronic gastritis consists of the following stages:
- Survey– anamnesis is collected, test results are studied.
- Problem Definition– presumably it is established what disease the patient suffers from, what the risk is for him in the future, and the data is transferred to the attending physician.
- Setting goals– how long it will take the nurse to completely cure the patient.
- Realization of goals– actions of the nurse that will help the patient become healthy.
- Performance Evaluation– whether the patient received assistance and how high quality it was.
The overall result depends on right actions carried out at each stage.
Stage 1: examination
The task nurse is to determine the nature of the patient's complaints. It is necessary to establish what pains bother him, when they appear, how quickly the feeling of satiety occurs, whether nausea, vomiting and others are present. characteristic symptoms. As for pain, with this disease they can appear immediately after eating, after 20 minutes or 2 hours.
Objective examination methods are as follows:
- visual inspection– detection of bruises under the eyes, white coating on the tongue, pain on palpation in the abdominal area;
- study of instrumental and laboratory diagnostic methods– stool examination, general analysis urine and blood, biopsy, etc.
Stage 2: Identifying Problems
People suffering from this disease have impaired physiological needs related to eating, sleeping, etc. This means that nursing care for chronic gastritis involves solving these problems.
Based on the symptoms, it is presumably determined what disease the patient has. Problems associated with inflammatory processes occurring on the mucous membrane are studied. In this regard, pain in the stomach and abdomen and a feeling of heaviness are observed. In addition, there are problems that arose due to digestive disorders. These include bloating, nausea and vomiting, belching, heartburn, and complete or partial lack of appetite.
If all these problems are identified, the patient must be hospitalized for a full diagnosis and accurate diagnosis.
Stages 3−4: defining goals and their implementation
Nursing assistance for chronic gastritis has the main goal, which is to create all the conditions for the patient’s complete recovery and the successful completion of the assigned tasks.
Information about the disease and possible consequences must be provided, and the need for complex treatment, following all doctor’s recommendations. During an exacerbation, it is advisable to provide bed rest for several days.
Monitoring compliance with the treatment regimen is as follows:
- timely administration of medications in certain dosages and according to the established regimen;
- protection of the central nervous system from external stimuli;
- organization of gentle nutrition, developed individually;
- ensuring comfortable conditions and proper daily routine.
The result of proper organization of the treatment regimen is a decrease in intensity clinical signs and improvement of general condition.
The nurse is obliged to ensure that comfortable conditions are created in the ward to promote the patient’s recovery. Timely wet cleaning, regular change of bed linen, and silence are necessary. Patients must be fully committed to treatment and not be exposed to stress and other negative external factors. Their relatives must be informed about what is allowed to be transmitted from food.
The nurse's task is also to provide assistance with meals and hygiene measures. In this regard, it is necessary to have a conversation regarding personal hygiene. In addition, it is important to explain and then monitor the patient’s compliance with the diet developed personally for him. It is necessary that mineral water be included in his diet.
Step 5: Performance Assessment
If nursing care is organized correctly, within a certain time frame the patient will fully recover and he can be discharged from the hospital with instructions further actions during the rehabilitation period. The patient must be aware of how necessary it is for him to follow a diet and take certain medications at home. If symptoms appear that indicate an exacerbation of the disease, it is necessary to go to the hospital in a timely manner without self-medicating.
The role of the nurse during the rehabilitation period
At the stage of remission, the patient continues treatment, but already in outpatient setting. The nurse should inform the patient about what diet he needs to adhere to during the rehabilitation period, notify him of the need fractional meals. It is advisable to eat at the same time every day. Portions should be small. Fasting is unacceptable. The diet must contain all the necessary nutrients in certain quantities.
The nurse should explain to the patient, as well as his relatives, about the prohibitions on certain foods. In particular, you should not drink cocoa and coffee, since these drinks irritate the gastric mucosa. Spicy and fried foods and spices are also excluded. As for alcohol and carbonated drinks, they are strictly contraindicated.
People with this disease, which develops against the background of low acidity, should be registered with a dispensary. They should undergo gastroscopy once a year, even if there are no signs of exacerbation of the disease. The fact is that they are at risk for the disease developing into stomach cancer.
Not the least place during the rehabilitation period is occupied by sanitary spa treatment. The nurse’s task is to notify the patient about how useful it is for him to go to Essentuki, Kislovodsk and other resort areas with medical treatment. mineral water. It improves digestive function in chronic gastritis, restores gastric motility, dissolves accumulated mucus and generally has a beneficial effect on health.
Do not underestimate the role of the nurse in the treatment of chronic gastritis. The result of therapy, the speed of recovery and the possibility of further complications. The right approach during treatment gives a chance for a quick and successful recovery.
Gastritis is inflammation of the gastric mucosa. Gastritis is divided into acute and chronic.
Acute gastritis.Acute gastritis- inflammatory damage to the gastric mucosa, which is accompanied by impaired motility and secretion. Acute gastritis is a polyetiological disease.
Etiology and pathogenesis. There are four main forms acute gastritis: 1) simple, 2) corrosive, 3) fibrinous, 4) phlegmonous. Depending on the cause and mechanism of development, they distinguish exogenous And endogenous etiological factors.
Acute gastritis occurs as a result of ingestion of poor quality food, abuse of spicy seasonings, strong alcoholic drinks and especially their surrogates (moonshine). Food that is too hot has a harmful effect. One of the causes of acute gastritis may be the side effects of certain medications: acetylsalicylic acid, bromine, iodine, sulfonamides, digitalis. Overeating can lead to acute gastritis, as this overstrains and depletes the digestive glands that produce gastric juice.
The cause of acute simple (catarrhal) gastritis may be the consumption of stale foods. Toxic substances formed in stale food lead to inflammation of the gastric mucosa. In addition, if stored for too long, food may develop pathogenic microorganisms that can cause food poisoning.
Acute changes in the gastric mucosa can be a consequence of the introduction of pathogenic microorganisms from various chronic foci of inflammation in the body (otitis media, sinusitis, tonsillitis, cholecystitis, etc.).
Endogenous etiological factors of metabolic disorders (pulmonary failure, diabetes, kidney failure, allergic diseases etc.) massive breakdown of proteins (burns, blood transfusion of another group).
The essence of acute gastritis comes down to the development of an inflammatory process of varying severity - from superficial to deep inflammatory-necrotic.
Clinical picture. The disease develops acutely under the influence of the listed reasons. Worried discomfort in the epigastrium, a feeling of heaviness, burning, there is moderate pain, an unpleasant taste in the mouth, belching of eaten food, there may be vomiting, intestinal dysfunction (diarrhea), dizziness, weakness. Skin pale, tongue coated grayish-white coating. In some cases of acute gastritis, there is an increase in body temperature, chills, and weakness.
When palpating the abdomen, moderate diffuse pain in the epigastric region is possible. The pulse is usually rapid, blood pressure is slightly reduced. In severe cases, collapse may develop. Neutrophilic leukocytosis is sometimes observed.
Diagnosis of acute gastritis is usually not difficult and is carried out on the basis of anemnesis and clinical picture. When diagnosing, it is necessary to exclude salmonellosis and other intestinal infections if symptoms of enteritis (diarrhea) occur.
Simple(banal, catarrhal) gastritis With timely treatment, it lasts 2-3 days and ends with recovery. Spicy corrosive gastritis proceeds more severely. It develops when substances enter the stomach that significantly damage the stomach tissue (nitric, sulfuric, acetic acids, alkalis - ammonia, sodium hydroxide).
Patients complain of pain in the mouth, behind the sternum and in the epigastric region, repeated vomiting; The vomit contains blood, mucus, and tissue fragments.
On the mucous membrane of the mouth, lips, cheeks there are traces of burns (swelling, hyperemia, ulcerations). Perforation of the stomach wall is possible. There may be jaundice due to hemolysis of red blood cells.
Phlegmonous gastritis develops as a result of infection in the wall of the stomach or as a complication of stomach cancer, peptic ulcer, sepsis, typhoid fever. Gastritis is characterized by acute heartburn, fever, trembling, nausea, vomiting, and pain on palpation in the epigastric region. The general condition is progressively worsening. In the blood - leukocytosis, increased ESR. Allergic gastritis accompanied by a skin rash.
Complications of acute gastritis are determined by the type of gastritis. This is intoxication, disturbances in cardiovascular system. With corrosive gastritis - perforation of the stomach wall, with phlegmonous - mediastinitis, purulent pleurisy, subphrenic abscess, etc.
Treatment. The patient must remain in bed. In the first 1-2 days, fasting with sufficient fluid is prescribed. Subsequently, a gradually expanding diet.
To eliminate pain, belladonna preparations (besalol, bealgin) are prescribed. Treatment of acute gastritis associated with intoxication consists primarily of quickly neutralizing and removing the harmful factor that has entered the body. To do this, wash the stomach through a thick probe with warm water (Fig. 36). For the gastric lavage algorithm, see the Appendix. Assign antibacterial drugs and adsorbents (activated carbon, white clay). For acute allergic gastritis it is prescribed antihistamines. For dehydration, parenteral administration of saline and 5% glucose solution is used. For acute cardiovascular failure, cordiamine, caffeine, and mesaton are prescribed.
With the so-called medicinal gastritis caused by side effect medications used without medical supervision, you must stop taking the medication that caused the disease.
For phlegmonous gastritis - antibiotics.
Prevention. Prevention of acute gastritis consists of a balanced diet, eating good-quality foods, and following personal hygiene rules by catering workers. The fight against alcoholism matters.
Chronic gastritis.Chronic gastritis- chronic inflammation of the gastric mucosa with restructuring of its structure and progressive atrophy, disturbances of motor, secretory and endocrine functions.
Classification of chronic gastritis. Accepted International Congress in Sydney in 1990. Gastritis is distinguished:
by etiology- associated with Helicobacter pyloricus, autoimmune;
by localization- pangastritis (common), antral (pyloroduodenal), fundic (body of the stomach);
according to morphological data(endoscopically) - erythematous, atrophic, hyperplastic, hemorrhagic, etc.;
by the nature of juice secretion- with preserved or increased secretion, with secretory insufficiency.
Etiology and pathogenesis. There are exogenous and endogenous factors.
Exogenous factors: 1) violations of the diet and quality of nutrition; 2) abuse of alcoholic beverages and smoking; 3) long-term use of medications that irritate the gastric mucosa (glucocorticoids, acetylsalicylic acid, etc.); 4) occupational hazards; 5) infection with pyloric Helicobacter; 6) neuropsychic stress; 7) repeated acute gastritis; 8) allergies to certain products, etc.
Endogenous factors: 1) inflammatory diseases organs abdominal cavity; 2) chronic infections in the nasopharynx, infection with Helicobacter pyloricus (HP); 3) endocrine diseases; 4) diseases in which tissue hypoxia develops (CHF, chronic renal failure, chronic lung diseases); 5) autointoxication; 6) genetic and allergic factors.
Pathogenetic essence chronic gastritis is: damage to the gastric mucosa by Helicobacter or another etiological factor, dysregulation of its regeneration processes, changes in the regulation of gastric secretion, microcirculation disorder, motor function, immunological disorders (characteristic of atrophic and autoimmune gastritis).
Clinical picture. Chronic gastritis is a gradually progressive disease.
Any form of gastritis is characterized by basic syndromes.
Pain syndrome- occurs in 80-90% of patients with chronic gastritis. Usually the pain is localized in the epigastric region.
Gastric dyspepsia -permanent syndrome gastritis. Symptoms: appetite disturbances, belching, heartburn, nausea, sometimes vomiting, feeling of discomfort in the stomach after eating.
General condition disorders- weight loss, hypovitaminosis, changes in the liver, gall bladder, pancreas.
Each type of gastritis has different symptoms.
Antral gastritis. It is mainly associated with Helicobacter pyloricus and is accompanied by hypertrophy of the mucous membrane and increased (or normal) gastric secretion. More common in young people.
Complaints of heartburn after sour food, sour belching, constipation, and sometimes vomiting. Pain appears 1-1.5 hours after eating; “hungry” pain is possible - night pain that subsides after eating. Appetite decreases only during exacerbation; outside of exacerbation it is normal or increased. General condition and body weight are disturbed. The tongue is coated, palpation of the epigastric region is painful.
A study of gastric secretion reveals increased acidity (especially stimulated).
X-ray thickening of the folds of the gastric mucosa and signs of hypersecretion are detected.
Fundal (autoimmune) gastritis. It occurs more often in mature and elderly people, and is characterized by primary atrophy of the mucous membrane and secretory insufficiency.
Complaints of dull, bursting pain in the epigastric region immediately after eating, rapid satiety, sharply decreased appetite, unpleasant taste in the mouth.
Belching in patients with the smell of a rotten egg after protein foods, heartburn - after eating carbohydrate foods. Frequent symptoms: rumbling and bloating, diarrhea. The tongue is coated. Poor milk tolerance. Body weight is reduced, the skin is dry, pale (B 12 deficiency anemia develops). Symptoms of hepatitis, cholecystitis, colitis, pancreatitis appear.
UAC- signs of anemia.
When studying gastric secretion- anacid or hypoacid state.
With fluoroscopy- the folds of the mucous membrane are thinned.
Complications chronic gastritis. 1. Gastric bleeding (associated with HP, hemorrhagic gastritis).
2. Peptic ulcer of the stomach and duodenum (gastritis associated with HP).
3. Gastric cancer (associated with HP and autoimmune).
4. B12 deficiency anemia (autoimmune).
Patient problems suffering from gastritis: gastric discomfort, epigastric pain, changes in appetite, belching, heartburn, nausea, vomiting, emaciation, etc.
Potential problems: stomach bleeding, fear of complications (cancer, peptic ulcer).
Treatment for chronic gastritis should be complex and differentiated. Treatment begins with the normalization of work and lifestyle. Therapeutic measures, individual for each patient, are determined by the attending physician.
Great importance V complex therapy It has therapeutic nutrition. The patient should take food in small portions at relatively short intervals (5-6 times V day) at the same hours. It is necessary to avoid physical and mental stress. During the period of remission of gastritis, the patient is treated on an outpatient basis.
The dietary menu for a patient with chronic gastritis provides all the nutritional components necessary for the body’s functioning: proteins, fats, carbohydrates, mineral salts.
It is not recommended to drink coffee and cocoa, as these drinks contain substances that irritate the gastric mucosa. Pepper, mustard, horseradish, and vinegar are excluded from the diet. If the secretion of digestive juice is impaired, food is poorly digested, so large meals are contraindicated.
Alcohol, beer, and carbonated drinks are strictly contraindicated.
Drug treatment gastritis associated with HP. Seven-day courses of treatment are prescribed: ranitidine + clarithromycin + metronidazole (trichopolum) or - omeprazole + clarithromycin + trichopolum, or - famotidine + de-nol + tetracycline, etc.
For autoimmune gastritis with anemia, intramuscular administration of oxycobalamin (Vit. B 12) is prescribed for a long time according to the scheme. Held replacement therapy acidin-pepsin, enzyme preparations (festal, digestal), plantaglucide, vitamins C, PP, B 6.
If the acidity of the gastric juice is high, gastrocepin and antacids (Maalox, Gastal, Remagel, phosphalugel, etc.) are prescribed (see Fig. 37).
I. Mix the contents of the sachet between your fingers until you obtain a homogeneous gel
II. Holding the bag vertically, cut or tear off a corner of it at the designated location.
III. Squeeze the gel through the hole in the bag with your fingers.
IV. The gel is taken pure or diluted in half a glass of water before use.
Rice. 37. How to use phospholugel
Not less important Spa treatment(after an exacerbation) - Essentuki, Zheleznovodsk, Kislovodsk, etc. Mineral water is used during outpatient and inpatient treatment during an exacerbation, the greatest effect is provided by mineral waters - carbonic or alkaline. In chronic gastritis, they improve the function of the digestive glands, normalize secretory and motor activity stomach and help dissolve and remove mucus accumulated in the stomach. For gastritis with increased secretion and acidity of gastric contents, Borjomi is prescribed, and for low secretion - Essentuki No. 17.
In some cases, for gastritis, mud therapy, diathermy, electro- and hydrotherapy are prescribed. Caring for patients with chronic gastritis requires the nurse to have a good knowledge of the basics of therapeutic nutrition. It is necessary to remind him to eat at strictly defined hours (to develop the so-called digestive reflex).
Prevention. To prevent chronic gastritis, it is necessary to carefully and promptly treat various acute and chronic inflammatory diseases of the abdominal organs: colitis (inflammation of the colon), cholecystitis (inflammation of the gallbladder), appendicitis (inflammation of the vermiform appendix). Anti-smoking- a necessary element in the prevention of chronic gastritis, since under the influence of smoking the gastric mucosa initially thickens significantly and then atrophies.
There is the concept of primary and secondary prevention. Prevention of chronic gastritis is primary, and prevention of exacerbations of chronic gastritis - secondary. If therapeutic measures managed to stop the pathological process and achieve practical recovery normal functions stomach, then the stage of remission (persistent improvement) begins.
It is necessary to monitor the condition of the oral cavity, promptly treat other diseases, eliminate occupational hazards and helminthic protozoal infestations.
Patients with chronic gastritis are subject to medical examination.
educational institution Stavropol Territory
Approved
at a meeting of the methodological council
protocol No.____________
from "___"__________2017
____________ M.A. Yagyaeva
Methodological development
on the topic: “Nursing care for chronic gastritis”
for specialties 02/34/01 Nursing
Agreed Reviewed
methodologist at the meeting of the Central Committee No. 1
M.B. Grigoryan protocol No.____dated _________2017
“__”___________2017 Chairman of the Central Committee Z.A. Bayramukova
__________________ _______________________
Performed
teacher
A.S. Akulshina
________________
"___" ________2017
Kislovodsk 2016-2017 academic year year
Explanatory noteStandard
Theoretical material
Tasks for consolidation
Sample answers
List of used literature
EXPLANATORY NOTE
Gastritis – collective concept, used to designate inflammatory and dystrophic changes in the gastric mucosa of different origins and course. Damage to the mucous membrane can be primary, considered as an independent disease, and secondary, caused by other infectious and non-infectious diseases or intoxication. Depending on the intensity and duration of action of the damaging factors, the pathological process can be acute, occurring predominantly with inflammatory changes, or chronic, accompanied by structural changes and progressive atrophy of the mucous membrane. Accordingly, there are two main forms: acute and chronic gastritis. Separately, we consider alcoholic gastritis, which develops against the background of alcohol abuse.
Relevance of the topic.
The problem of gastritis is one of the most pressing in modern gastroenterology. IN last years new data have been obtained indicating that the pathological process is not limited to the stomach, but, as a rule, also affects the duodenum, which confirms the validity of using the term “gastroduodenitis”.
Almost half of the world's population suffers from diseases of the gastrointestinal tract. Statistics convincingly show that in the structure gastrointestinal diseases gastritis accounts for more than 80%. To date this serious illness Not only adults, but also school-age children suffer. The most common cause of gastritis is wrong mode food: hasty food, unchewed food or dry food; eating food that is too hot or too cold; eating savory foods (mainly spicy and very salty foods). Most often, diseases develop in people who are in a state of mental stress, neglect a healthy diet, and abuse alcohol and smoking. In Russia there are no statistics regarding different forms of gastritis. In those countries where such statistics are available, chronic gastritis is recorded in 80-90% of patients with gastritis. At the same time, the most dangerous form gastritis, related to the so-called “precancerous conditions” - atrophic gastritis is found in patients under 30 years of age in 5% of cases, in patients aged 31 to 50 years - in 30% of cases, in patients over 50 years of age - in 50-70 % of cases.
Methodological development on the topic: “Nursing care for chronic gastritis” PM 02 Participation in the treatment, diagnostic and rehabilitation processes MDK 02.01 “Nursing care for various diseases and conditions" is compiled in accordance with the requirements of the Federal State Educational Standard for Secondary Professional Education of the new generation and corresponds to the minimum content and level of training of a graduate in the specialty 34.02.01 Nursing. Methodological development is designed for 4 hours of preclinical practice.
The methodological development contains a task for monitoring the initial level of knowledge, materials for explaining the topic to the teacher, algorithms for practical manipulations, tasks for students’ independent work and consolidation of the studied material. Assessment criteria are given that allow maximum control over the level of mastery of acquired knowledge.
For students, the development includes test tasks, situational tasks on the topic, and algorithms for conducting practical manipulations.
STANDARD
According to the order of the Ministry of Education and Science of Russia dated May 12, 2014 N 502 (as amended on July 24, 2015) “On approval of the federal state educational standard average vocational education specialty 34.02.01 Nursing.
As a result of studying the topic, the student must:
have practical experience:
caring for patients with diseases of the digestive system;
carrying out rehabilitation measures for patients with diseases of the digestive system.
be able to:
prepare the patient for diagnostic and treatment interventions;
provide nursing care for patients with diseases of the digestive system;
advise the patient and his environment on use medicines;
carry out rehabilitation activities within the limits of their powers in primary health care and hospital settings;
carry out pharmacotherapy as prescribed by a doctor;
carry out measures to preserve and improve the patient’s quality of life;
maintain approved medical documentation
know:
causes, clinical manifestations, possible complications, diagnostic methods, patient problems, organization and methods of providing nursing care for diseases of the digestive system;
routes of drug administration;
types, forms and methods of rehabilitation;
rules for the use of equipment, equipment, and medical products.
The student must have:
General competencies
OK 1. Understand the essence and social significance of your future profession, show a steady interest in her.
OK 2. Organize your own activities, choose standard methods and ways of performing professional tasks, evaluate their effectiveness and quality.
Professionalcompetencies
PC 2.1. Present information in a form understandable to the patient, explain to him the essence of the interventions.
PC 2.2. Carry out therapeutic and diagnostic interventions, interacting with participants healing process.
PC 2.4. Apply medications in accordance with the rules for their use.
PC 2.5. Comply with the rules for using equipment, equipment and medical products during the diagnostic and treatment process.
PC 2.6. Maintain approved medical records.
PC 2.7. Carry out rehabilitation measures.
THEORETICAL MATERIAL
Gastritis is inflammation of the gastric mucosa. Gastritis is divided into acute and chronic.
Acute gastritis. Acute gastritis is an inflammatory damage to the gastric mucosa, which is accompanied by impaired motility and secretion. Acute gastritis is a polyetiological disease.
Etiology and pathogenesis. There are four main forms of acute gastritis: 1) simple, 2) corrosive, 3) fibrinous, 4) phlegmonous. Depending on the cause and mechanism of development, exogenous and endogenous etiological factors are distinguished.
Acute gastritis occurs as a result of ingestion of poor quality food, abuse of spicy seasonings, strong alcoholic drinks and especially their surrogates (moonshine). Food that is too hot has a harmful effect. One of the causes of acute gastritis may be the side effects of certain medications: acetylsalicylic acid, bromine, iodine, sulfonamides, digitalis. Overeating can lead to acute gastritis, as this overstrains and depletes the digestive glands that produce gastric juice. The cause of acute simple (catarrhal) gastritis may be the consumption of stale foods. Toxic substances formed in stale food lead to inflammation of the gastric mucosa. In addition, if stored for too long, food may develop pathogenic microorganisms that can cause food poisoning.
Acute changes in the gastric mucosa can be a consequence of the introduction of pathogenic microorganisms from various chronic foci of inflammation in the body (otitis media, sinusitis, tonsillitis, cholecystitis, etc.).
Endogenous etiological factors: metabolic disorders (pulmonary failure, diabetes mellitus, renal failure, allergic diseases, etc.), massive breakdown of proteins (burns, blood transfusion of another group).
The essence of acute gastritis comes down to the development of an inflammatory process of varying severity - from superficial to deep inflammatory-necrotic.
Clinical picture. The disease develops acutely under the influence of the listed reasons. Disturbing sensations in the epigastrium, a feeling of heaviness, burning, moderate pain, an unpleasant taste in the mouth, belching of eaten food, possible vomiting, intestinal dysfunction (diarrhea), dizziness, weakness. The skin is pale, the tongue is covered with a grayish-white coating. In some cases of acute gastritis there are
increased body temperature, chills, weakness.
When palpating the abdomen, moderate diffuse pain in the epigastric region is possible. The pulse is usually rapid, blood pressure is slightly reduced. In severe cases, collapse may develop. Neutrophilic leukocytosis is sometimes observed.
Diagnosis of acute gastritis is usually not difficult and is carried out on the basis of anamnesis and clinical picture. When diagnosing, it is necessary to exclude salmonellosis and other intestinal infections if symptoms of enteritis (diarrhea) appear.
Simple (banal, catarrhal) gastritis lasts 2-3 days with timely treatment and ends with recovery.
Acute corrosive gastritis is more severe. It develops when substances enter the stomach that significantly damage the stomach tissue (nitric, sulfuric, acetic acids, alkalis - ammonia, sodium hydroxide). Patients complain of pain in the mouth, behind the sternum and in the epigastric region, repeated vomiting; The vomit contains blood, mucus, and tissue fragments.
On the mucous membrane of the mouth, lips, cheeks there are traces of burns, swelling, hyperemia, ulcerations). Perforation of the stomach wall is possible. There may be jaundice due to hemolysis of red blood cells.
Phlegmonous gastritis develops as a result of infection in the stomach wall or as a complication of stomach cancer, peptic ulcer, sepsis, or typhoid fever. Gastritis is characterized by acute heartburn, fever, trembling, nausea, vomiting, and pain on palpation in the epigastric region. The general condition is progressively worsening. In the blood - leukocytosis, increased ESR.
Allergic gastritis is accompanied by a skin rash.
Complications of acute gastritis are determined by the type of gastritis. This is intoxication, disorders in the cardiovascular system. With corrosive gastritis - perforation of the stomach wall, with phlegmonous - mediastinitis, purulent pleurisy, subphrenic abscess, etc.
Treatment. The patient must remain in bed. In the first 1-2 days, fasting with sufficient fluid is prescribed. Subsequently, a gradually expanding diet.
To eliminate pain, belladonna preparations (besalol, bealgin) are prescribed. Treatment of acute gastritis associated with intoxication consists primarily of quickly neutralizing and removing the harmful factor that has entered the body. To do this, wash the stomach through a thick tube with warm water. For the gastric lavage algorithm, see the Appendix. Antibacterial drugs and adsorbents (activated carbon, white clay) are prescribed. For acute allergic gastritis, antihistamines are prescribed.
For dehydration, parenteral administration of saline and 5% glucose solution is used. For acute cardiovascular failure, cordiamine, caffeine, and mesaton are prescribed.
With the so-called drug-induced gastritis, caused by the side effects of drugs used without medical supervision, it is necessary to stop taking the medication that caused the disease. For phlegmonous gastritis - antibiotics.
Prevention. Prevention of acute gastritis consists of a balanced diet, eating good-quality foods, and following personal hygiene rules by catering workers. The fight against alcoholism matters.
Chronic gastritis.
Chronic gastritis is a chronic inflammation of the gastric mucosa with a restructuring of its structure and progressive atrophy, disturbances of motor, secretory and endocrine functions.
Classification of chronic gastritis. Adopted by the International Congress in Sydney in 1990. Gastritis is distinguished:
by etiology - associated with Helicobacter pyloricus, autoimmune;
by localization - pangastritis (widespread), antral (pyloroduodenal), fundal (body of the stomach);
according to morphological data (endoscopically) - erythematous, atrophic, hyperplastic, hemorrhagic, etc.;
by the nature of juice secretion - with preserved or increased secretion, with secretory insufficiency.
Etiology and pathogenesis. There are exogenous and endogenous factors.
Endogenous factors: 1) violations of diet and quality of nutrition; 2) abuse of alcoholic beverages and smoking; 3) long-term use of medications that irritate the gastric mucosa (glucocorticoids, acetylsalicylic acid, etc.); 4) occupational hazards; 5) infection with pyloric Helicobacter; 6) neuropsychic stress; 7) repeated acute gastritis; 8) allergies to certain products, etc.
Endogenous factors: 1) inflammatory diseases of the abdominal organs; 2) chronic infections in the nasopharynx, infection with Helicobacter pyloricus (HP); 3) endocrine diseases; 4) diseases in which tissue hypoxia develops (CHF, chronic renal failure, chronic lung diseases); 5) autointoxication; 6) genetic and allergic factors.
The pathogenetic essence of chronic gastritis is: damage to the gastric mucosa by Helicobacter or another etiological factor, dysregulation of its regeneration processes, changes in the regulation of gastric secretion, microcirculation disorder, motor function, immunological disorders (characteristic of atrophic and autoimmune gastritis).
Clinical picture.
Chronic gastritis is a gradually progressive disease. Any form of gastritis is characterized by basic syndromes.
Pain syndrome - occurs in 80-90% of patients with chronic gastritis. Usually the pain is localized in the epigastric region.
Gastric dyspepsia is a permanent gastritis syndrome. Symptoms: loss of appetite, belching, heartburn, nausea, sometimes vomiting, feeling of discomfort in the stomach after eating.
General condition disorders - weight loss, hypovitaminosis, changes in the liver, gall bladder, pancreas.
Each type of gastritis has different symptoms.
Antral gastritis. It is mainly associated with Helicobacter pyloricus and is accompanied by hypertrophy of the mucous membrane and increased (or normal) gastric secretion. More common in young people. Complaints of heartburn after sour food, sour belching, constipation, and sometimes vomiting. Pain appears 1-1.5 hours after eating; “hungry” pain is possible - night pain that subsides after eating. Appetite decreases only during exacerbation; outside of exacerbation it is normal or increased. General condition and body weight are disturbed. The tongue is coated, palpation of the epigastric region is painful.
A study of gastric secretion reveals increased acidity (especially stimulated).
X-ray reveals thickening of the folds of the gastric mucosa and signs of hypersecretion.
Fundal (autoimmune) gastritis. It occurs more often in mature and elderly people, and is characterized by primary atrophy of the mucous membrane and secretory insufficiency.
Complaints of dull, bursting pain in the epigastric region immediately after eating, rapid satiety, sharply decreased appetite, unpleasant taste in the mouth.
Belching in patients with the smell of a rotten egg after protein
food, heartburn - after eating carbohydrate foods. Frequent symptoms: rumbling and bloating, diarrhea.
The tongue is coated. Poor milk tolerance. Body weight is reduced, the skin is dry, pale (B12-deficiency anemia develops). Symptoms of hepatitis, cholecystitis, colitis, pancreatitis appear. UAC - signs of anemia. When studying gastric secretion - anacid or hypoacid state. On fluoroscopy, the folds of the mucous membrane are thinned.
Complications of chronic gastritis.
1. Gastric bleeding (associated with IR, hemorrhagic gastritis).
2. Peptic ulcer of the stomach and duodenum (gastritis associated with HP).
3. Gastric cancer (HP-associated and autoimmune).
4. B12 deficiency anemia (autoimmune).
Problems of patients suffering from gastritis: gastric discomfort, epigastric pain, changes in appetite, belching, heartburn, nausea, vomiting, weight loss, etc.
Potential problems: stomach bleeding, fear of complications (cancer, peptic ulcer).
Diagnostics.
More often it occurs without clinical changes, so the diagnosis is based on research data. Chronic autoimmune gastritis is often combined with thyroiditis and thyrotoxicosis. The history and symptoms will be due to these diseases.
Laboratory and instrumental studies.
OAC – changes are not typical, but if combined with anemia, then the changes correspond to the type of anemia.
Presence of H. pylori. In gastric juice.
Study of antibodies to gastric parietal cells (typical for types 1 and 2)
FEGDS is the main method of confirming the diagnosis; it can be performed with a biopsy.
Ultrasound of the liver, pancreas, gallbladder to confirm concomitant pathology.
Indications for consultations with other specialists.
Oncologist – when detecting stomach cancer.
Hematologist – clarification of the diagnosis with concomitant anemia.
Treatment for chronic gastritis should be comprehensive
and differentiated. Treatment begins with the normalization of work and lifestyle. Therapeutic measures, individual for each patient, are determined by the attending physician.
Nutritional therapy is of great importance in complex therapy. The patient should eat small portions at relatively short intervals (5-6 times a day) at the same hours. It is necessary to avoid physical and mental stress. During the period of remission of gastritis, the patient is treated on an outpatient basis.
The dietary menu for a patient with chronic gastritis provides all the nutritional components necessary for the body’s functioning: proteins, fats, carbohydrates, mineral salts. It is not recommended to drink coffee and cocoa, as these drinks contain substances that irritate the gastric mucosa. Pepper, mustard, horseradish, and vinegar are excluded from the diet. If the secretion of digestive juice is impaired, food is poorly digested, so large meals are contraindicated. Alcohol, beer, and carbonated drinks are strictly contraindicated.
Drug treatment of gastritis associated with HP. Seven-day courses of treatment are prescribed: ranitidine + clarithromycin + metronidazole (Trichopol) or omeprazole + clarithromycin + Trichopol, or famotidine + de-nol + tetracycline, etc.
For autoimmune gastritis with anemia, intramuscular administration of oxycobalamin (Vit. B12) is prescribed for a long time according to the scheme. Replacement therapy with acidin-pepsin, enzyme preparations (festal, digestal), plantaglucide, vitamins C, PP, B6 is carried out.
If the acidity of the gastric juice is high, gastrocepin and antacids (Maalox, Gastal, Remagel, phosphalugel, etc.) are prescribed.
No less important is sanatorium-resort treatment (after an exacerbation) - Essentuki, Zheleznovodsk, Kislovodsk, etc. Mineral water is used during outpatient and inpatient treatment during an exacerbation, the greatest effect is provided by mineral waters - carbonic or alkaline.
In chronic gastritis, they improve the function of the digestive glands, normalize the secretory and motor activity of the stomach and help dissolve and remove mucus accumulated in the stomach. At
for gastritis with increased secretion and acidity of gastric contents, Borjomi is prescribed, and with decreased secretion, Essentuki No. 17.
In some cases, for gastritis, mud therapy, diathermy, electro- and hydrotherapy are prescribed. Caring for patients with chronic gastritis requires the nurse to have a good knowledge of the basics of therapeutic nutrition. It is necessary to remind him to eat at strictly defined hours (to develop the so-called digestive reflex).
Prevention. To prevent chronic gastritis, it is necessary to carefully and promptly treat various acute and chronic inflammatory diseases of the abdominal organs: colitis (inflammation of the colon), cholecystitis (inflammation of the gallbladder), appendicitis (inflammation of the vermiform appendix). The fight against smoking is a necessary element in the prevention of chronic gastritis, since under the influence of smoking the gastric mucosa first thickens significantly and then atrophies.
There is the concept of primary and secondary prevention.
Prevention of chronic gastritis is primary, and prevention of exacerbations of chronic gastritis is secondary. If therapeutic measures managed to stop the pathological process and achieve practical restoration of normal functions of the stomach, then the stage of remission (persistent improvement) begins.
It is necessary to monitor the condition of the oral cavity, promptly treat other diseases, eliminate occupational hazards and helminthic protozoal infestations. Patients with chronic gastritis are subject to medical examination.
Nursing process for chronic gastritis
Stage I. Nursing examination.
The nurse enters into a trusting relationship with the patient, trying to reliably find out the circumstances - risk factors for chronic gastritis. Information is collected about the nature of nutrition from childhood, appetite, stool character, bad habits, about the psychological microclimate at home and at work, about industrial intoxications, past diseases, hereditary predisposition.
Objective symptoms are determined: skin color (pallor), eye expression (doom, indifference), oral cavity (coated tongue, caries), body weight assessment (weight loss), abdominal shape (asymmetry, protrusion), skin turgor (decreased), pain with palpation of the abdomen in the epigastric region. A connection is established between abdominal pain and food intake (early, late, seasonal), etc.
Stage II. Nursing identification of patient problems.
As a result of the nursing examination, the patient's problems (nursing diagnoses) are established.
1. Feeling of fear of death if stomach cancer is suspected.
2. Violation of the need for adequate nutrition and drinking - disturbances of appetite, abdominal pain (in the stomach), low body weight, nausea, belching, heartburn, melena, etc.
3. Violation of the need for physiological functions - diarrhea, constipation, weakness, dizziness.
4. Violation of the need for work and rest - fear of job loss, change environment and usual activities.
Stage III. Planning nursing interventions.
Table 1 - Planning nursing interventions
Nursing goalsinterventions
Nursing intervention plan
The patient will not experience a feeling of fear of death
1. Inform the patient about his state of health (the doctor informs him about cancer).
2. Inform him about favorable outcomes of the disease.
3. Emphasize the significance of even the smallest improvement in the course of the disease.
4. Teach relatives how to behave at the bedside of a seriously ill patient
The patient will not experience stomach pain, heartburn, or belching
1. Set 5-6 meals a day according to the prescribed diet (1a, individual).
2. Ensure strict adherence to established meal times.
3. Talk with the patient about the importance of following a diet and drinking mineral water.
4. Explain to relatives about the need
bring it in accordance with the prescribed diet.
5. Monitor physiological functions.
6. Prepare medications to relieve pain and administer them as prescribed by the doctor.
7. If necessary, organize feeding of the patient.
The patient will not experience weakness for a week
and dizziness due to stomach bleeding
1. Establish a fasting regime - the patient does not take food, water, or medications orally, except for a solution of 5% aminocaproic acid (1 tsp orally repeatedly).
2. Place an ice pack on your stomach.
3. Provide horizontal position and complete rest for the patient.
4. Prepare hemostatic agents: 10% calcium chloride solution, 1% vikasol solution, 12.5% ethamsylate solution, blood substitutes.
5. Administer hemostatic drugs as prescribed by the doctor.
6. Observe the patient’s general condition, skin color, blood pressure, and pulse every 15 minutes.
The patient will not worry about losing work and communication with friends
1. Inform the patient about a short-term or (if necessary) long-term hospital stay.
2. Tell the patient about the activities
rehabilitation for stomach diseases,
the effectiveness of which also depends on the patient’s efforts.
3. Conversation with relatives - training in communicating with the patient and caring for him after discharge from the hospital.
4. Inform employees at work about
need to visit the patient.
Stage IV. Implementation of the nursing intervention plan.
All planned activities are being carried out.
V stage. Final assessment of the effectiveness of nursing interventions -
at favorable course illnesses and interventions are usually achieved: the patient is calm, confident in the success of treatment, ready to follow the regimen, healing procedures, his abdominal pain stops, physiological functions are restored, and bleeding stops.
With a less favorable course, new problems may arise: drug intolerance (skin rash); pain is not relieved (possibility of ulcer degeneration); vomiting food eaten the day before (pyloric stenosis)
etc. For each problem that arises, the nurse sets new goals and plans nursing interventions to care for the patient. The nurse documents all data on the results of work.
Characteristics of therapeutic diets.
Diet No. 0
Indications: the diet is prescribed in the first days after operations on the digestive organs, as well as in precomatose states (brain injuries, stroke, fever).
general characteristics: the diet consists of liquid, jelly-like dishes, mucous decoctions, light meat broth, liquid pureed porridges, jelly, etc.
Diet: food is given in fractional portions often: the diet is prescribed, as a rule, for several days.
Diet No. 1a
Indications: gastric ulcer and duodenum during the period of exacerbation, chronic gastritis with impaired secretory function during the period of exacerbation.
General characteristics: physiological diet with limitation of table salt, chemical and mechanical irritants of the mucous membrane and receptor apparatus of the stomach and duodenum, stimulants
gastric secretion.
Culinary processing: all dishes are boiled or steamed, liquid and mushy consistency. Diet: 5-6 times a day.
Diet No. 1b
General characteristics: the diet contains a physiological amount of protein and fat; Table salt, carbohydrates, substances that tend to irritate the mucous membrane and the receptor apparatus of the gastrointestinal tract, and stimulants of gastric secretion are limited. Promotes healing of ulcers and erosions.
Culinary processing: food is given in pureed, liquid form with extensive use of milk and dairy products. All dishes are prepared boiled or steamed. Diet: 6-7 times a day.
Diet No. 1
Indications: peptic ulcer of the stomach and duodenum during exacerbation, chronic gastritis with impaired secretory function during an exacerbation.
General characteristics: a diet with a physiological content of proteins, fats and carbohydrates, limitation of table salt, moderate limitation of mechanical and chemical irritants of the mucous membrane and the receptor apparatus of the gastrointestinal tract, stimulants of gastric secretion.
Culinary processing: all dishes are prepared boiled or steamed. Some baked dishes are allowed. Diet: 5-6 times a day.
Diet No. 2a
Indications: acute gastritis, enteritis and colitis during the period of convalescence as a transition to a balanced diet; chronic gastritis with secretory insufficiency, enteritis, colitis during a period of stable remission without concomitant diseases of the liver, biliary system, or pancreas.
General characteristics: a diet with a physiological content of proteins, fats and carbohydrates, a limitation of table salt, a moderate limitation of mechanical and physical stimuli to the mucous membrane and the receptor apparatus of the gastrointestinal tract.
Culinary processing: All dishes are prepared boiled or steamed (mashed), rough varieties of meat and fish are allowed in pieces. Individual baked dishes without a rough crust are allowed. Free liquid up to 1.5 l, table salt - 8-10 g. Diet - 4-5 times a day.
Diet No. 2
Indications: enteritis and colitis during the recovery period; chronic gastritis with secretory insufficiency.
General characteristics: a physiologically complete diet with the preservation of extractives and other substances that stimulate the secretion of ventricular juice and do not irritate the gastric mucosa. Meat with coarse connective tissue and products containing plant fiber are given in crushed form. Legumes - beans - are excluded. Green peas, beans. Vitamins in increased quantities. Diet: 5-6 times a day.
Algorithm for gastric lavage with a thick probe
The goal is to remove the contents of the stomach in case of acute gastritis and poisoning.
Equipment: thick gastric tube, funnel, towel, napkins, container with water at room temperature, ladle, container for draining rinsing water, gloves, two aprons, container with disinfectant solution and saline solution.
Algorithm of actions:
Inform the patient about the purpose and procedure of the procedure.
Assemble the system (probe - funnel).
Measure the insertion portion of the probe from the incisors to the navel, adding the length of the patient's palm.
Place the patient in a chair (head slightly forward).
Insert a probe moistened with water into the stomach up to the established mark.
Lower the funnel to the level of the stomach and, slightly tilting it, pour 1 liter of water into it.
Slowly lift the funnel up so that the water drops to the level of the mouth of the funnel.
Lower the funnel to the level of the patient’s knees and pour water into the funnel again, lift it and repeat 2-4 times, after which (in case of poisoning) rinse once again every 20-30 minutes with saline solution (the end is decided by the doctor), using a Janet syringe.
Remove the probe with the funnel and place it in a disinfection container with a 3% chloramine solution for 1 hour.
Disinfect the rinsing water in the container (add bleach at a ratio of 1:5).
Place all used items in the disinfectant solution.
Note:
1. Contraindications for gastric lavage: esophageal and gastric bleeding, severe chemical burns of the esophagus, stomach, myocardial infarction, strokes.
2. Flush patients’ stomachs unconscious only after preliminary tracheal intubation.
3. If necessary, examine the wash water (take 100 ml from the first portion of the contents into a separate glass container and send it to the laboratory).
Algorithm for a probeless method for determining gastric secretion (acidotest)
Purpose: an indicative idea of gastric secretion, which is used during mass examinations and the presence of contraindications to the study of gastric secretion by probe methods.
Equipment: a set of sodium benzoate caffeine tablets (2 pcs) and a test dragee (3 pcs), jars with labels “Control urine”, “Sesquito urine”.
StagesNote
1. Explain to the patient the course of the study, clarify his understanding.
2. Teach the patient the “Acidotest” method - do not take food, liquid, or medications 8 hours before the test; Conduct the study in the morning, on an empty stomach.
Give written instructions if the patient has learning difficulties.
3. Empty bladder at 6 am
4. Immediately after this, take two caffeine tablets from the kit.
5. Collect urine after 1 hour in a jar labeled “Control urine.”
6. Take three test tablets with a small amount of liquid.
7. Collect urine after 1.5 hours in a jar labeled “Urine and a half”
This portion is not collected.
Labels are included with the kit.
8. Take the jars to the clinical laboratory
Result evaluation:
Normocidity – red-brown color of urine in a jar labeled “Sesqui-urine”.
Hyperacidity and hypoacidity are determined according to the color scale of the set.
Algorithm for taking gastric contents using the fractional method
Purpose: study of the secretory function of the stomach.
Equipment: sterile: tray formed for subcutaneous injection; thin gastric tube; syringe 20 ml; clamp; 9 labeled jars with a capacity of 0.2 liters for portions of gastric juice; kidney-shaped tray; parenteral stimulator of gastric secretion; watch with buzzer, overalls, gloves.
Preparation for the procedure:
establish a trusting relationship with the patient;
explain to the patient that the study is carried out in the morning on an empty stomach;
measure the length of the inserted part of the tube into the stomach;
seat the patient on a chair;
cover the patient's neck and chest with a towel, give them a tray and a napkin.
Performing the procedure:
take the probe into right hand at a distance of 10-15 cm from the blind end, moisten with water, support the free end with your left hand;
invite the patient to open his mouth, place the blind end of the probe on the root of the tongue - at this time the patient makes swallowing movements;
actively move the probe into the stomach with each swallowing movement to the desired mark;
Instruct the patient to breathe deeply through the nose;
attach a syringe to the free end of the probe, extract the entire contents of the stomach into a jar “portion No. 0”;
remove gastric contents every 15 minutes for 1 hour (portions 1, 2, 3, 4);
apply a clamp to the probe for 15 minutes;
draw a stimulant into a syringe and inject it subcutaneously;
after 15 minutes, remove portions 5, 6, 7, 8 every 15 minutes.
End of the procedure:
remove the tube from the stomach, allow the patient to rinse his mouth, wipe the skin around the mouth with a napkin;
send 9 portions to the laboratory indicating the stimulant;
process used medical products.
Care algorithm for vomiting
Purpose: to help with vomiting.
Equipment: basin, kidney-shaped tray, oilcloth apron, oilcloth or towel, napkins for oral care, mouthwash solution: 2% sodium bicarbonate solution, electric suction or pear-shaped spray bottle.
StagesRationale
I. Preparation for the procedure:
1. Conscious patient:
Sit the patient down, cover the chest with oilcloth;
Give a towel, place a basin at your feet;
Tell your doctor.
Turn the patient onto his side if it is impossible to change the position;
Call a doctor immediately;
Remove the pillow;
Remove dentures (if any);
Cover the patient's neck and chest with oilcloth or a towel;
Place a kidney-shaped tray near your mouth.
Providing conditions for conducting research. Prevention of aspiration (entry) of vomit into the respiratory tract. Monitoring the patient's condition.
II. Performing the procedure:
1. Conscious patient:
Hold the patient's head during vomiting by placing your palm on his forehead; - ensure that the mouth is rinsed with water after each act of vomiting;
Wipe the patient's face with a tissue.
2. The patient is weakened or unconscious:
Use an electric suction device and a pear-shaped balloon to suck out the vomit from the mouth and nose (if necessary);
Carry out oral and nasal care after each act of vomiting.
Note: provide an individual nursing station.
Assisting the patient during vomiting.
Ensuring infection safety and carrying out oral hygiene measures.
Monitoring the patient's condition.
III. Completing the procedure:
1. Leave the vomit until the doctor arrives.
Control of vomit.
2. Disinfect the used material. Wash and dry your hands.
Ensuring infection safety.
3. Make a record of the procedure and the patient’s reaction.
Ensuring continuity nursing care.
Help with epigastric pain
Goal: the patient notes a gradual (over 7 days) decrease in pain.
Nursing care planRationale
1. Provide a therapeutic and protective regime
For improvement psycho-emotional state patient, prevention of gastric bleeding.
2. Provide the patient with nutrition in accordance with diet No. 1a.
For physical, chemical and mechanical sparing of the patient’s gastric mucosa.
3. Teach the patient how to take prescribed medications.
To achieve complete mutual understanding between medical staff and the patient, and the effectiveness of the drugs.
4. Explain to the patient the essence of his disease, talk about modern methods of diagnosis, treatment and prevention
To remove anxiety state, increasing confidence in favorable outcome treatment.
5. Provide proper preparation patient to FGDS and gastric intubation.
To improve the efficiency and accuracy of diagnostic procedures
Algorithm for nursing care for belching
Nurse's actionsRationale
Ensure compliance with the diet, exclude carbonated drinks, whole milk, legumes, cabbage, brown bread and other foods rich in fiber.
Eat small portions of food, take liquids in small sips, do not drink through a straw. Eat slowly, being in a relaxed state before, during and after eating, keep your mouth closed while chewing, and do not use chewing gum.
Separate nutrition: taking fluids between meals.
Reduce gas formation in the gastrointestinal tract;
Reduce air entry into the stomach;
Avoid immediate gastric overfilling;
Avoid increased pressure in the stomach.
Algorithm of nursing care for diarrhea associated with enzyme deficiency
Nurse's actionsRationale
A conversation about the correct diet: high-calorie and easily digestible food in small portions, steamed or boiled, pureed, dishes with a viscous consistency (slimy soups, viscous porridges), strong tea, jelly from dried blueberries or bird cherry, white crackers, with frequent heavy bowel movements ;
Fluid intake of at least 2 liters per day, - observe the type of bowel movements, frequency of stools, body weight, and general condition of the patient;
Maintain personal hygiene;
Teach the patient how to care for the perianal area - take medications according to
doctor's prescription.
Ensure proper digestion
Astringent and enveloping effect
Replenishment of fluid deficiency - control function - infection safety
Prevention of diaper rash
Treatment of the underlying disease
Expected result: normalization of stool frequency and stool consistency.
Task No. 1
A 44-year-old female patient was hospitalized in the gastroenterology department with a diagnosis of “Chronic gastritis with high acidity.” Upon admission, he complains of frequent heartburn, aching pain in the epigastric region after eating, and decreased appetite. The condition is satisfactory, height 175 cm, body weight 68 kg, skin of normal color, body temperature 36.5* C, pulse 72 per minute, blood pressure 115/75 mm Hg. Art. the abdomen is soft, painful in the epigastrium.
Tasks
Identify the patient's problems; State goals and create a nursing care plan for the priority problem with motivation for each nursing intervention.
Explain to the patient how to prepare for stool collection. occult blood.
Demonstrate the technique of gastric intubation on a dummy.
Response standard
Patient problems:
cannot eat, drink, sleep or rest due to severe heartburn;
does not know about the rules of nutrition for gastritis;
decreased appetite.
Priority problem: unable to eat, drink, sleep or rest due to severe heartburn.
Goal: The patient will not suffer from heartburn during the hospital stay.
PlanMotivation
Maximum stomach sparing.
Prevent heartburn.
3. If heartburn occurs, the nurse will provide the patient with a glass of warm milk or alkaline mineral water without gas.
Stop heartburn.
4. M/s will talk to relatives about the nature of the transfers.
Eliminate foods that can cause heartburn from your meals.
Evaluation of effectiveness: episodes of heartburn in the patient occur rarely and are quickly relieved. The patient knows how to eat properly if he is prone to heartburn. The goal has been achieved.
Problem No. 2
Viktor Viktorovich Ivashchenko, 46 years old, single, artist by profession, was hospitalized in the gastroenterology department due to exacerbation of chronic gastritis. The patient has been suffering from gastritis for 4 years. Exacerbations occur after consuming alcoholic beverages, fatty, spicy foods and physical work in the country. He was treated in a hospital twice, but stopped treatment on his own as soon as the pain and heartburn went away, since he “didn’t see the point” in continuing it.
During last month Viktor Viktorovich is bothered by stomach pain after eating 20 minutes and before going to bed. The pain is accompanied by heartburn and sour belching, which he relieves with a soda solution.
The patient smokes frequently. I tried to quit smoking several times, but without success. He eats irrationally and combines meals with reading newspapers or watching television. Drinks alcoholic beverages with friends two to three times a week. Viktor Viktorovich’s work is interesting and brings income. It works for a long time, sometimes causing a headache, which is quickly relieved with analgin. Prefers to relax in the summer with friends in nature.
On examination: satisfactory condition, clear consciousness, active position in bed, color skin- normal, skin turgor is preserved, the skin is moist.
The patient's body weight is 84 kg, height is 176 cm, blood pressure is 140/90 Hg. Art. NPV - 20 per minute. Pulse - 92 beats/min, rhythmic. There is plaque on the teeth from cigarettes, and tartar is visible. From mouth - bad smell(“bad breath”). The tongue is covered with a white coating. Temperature - 36.7 C.
On palpation of the abdomen, pain in the epigastric region is noted. The patient has no stool for two days.
Medical diagnosis: Hyperacid chronic gastritis.
The patient was prescribed: FGS, X-ray examination of the stomach, gastric intubation, electrogastrography.
Exercise: conduct nursing assessment, identify patient problems, formulate goals and nursing interventions.
Standard answer.
Existing or priority problems are problems that are currently bothering the patient.
In this case, the patient’s priority problems are:
1) Pain.
2) Heartburn.
3) Belching sour.
4) Constipation.
1. The patient is in pain.
The nurse's goal is to improve the patient's condition and reduce pain.
Planning nursing interventions: The nurse should tell the patient how important it is to follow the plan drug therapy, timing of taking medications both in relation to each other and in relation to food intake. For example, cimetidine, which accelerates healing and reduces secretion, should be taken with food, as it slows down stimulation of hydrochloric acid food. Antacids should be taken 1 - 2 after meals, since when used simultaneously they interfere with the absorption of cimetidine. Almagel and Almagel A (1 - 2 teaspoons 30 minutes before meals 4 times a day - morning, afternoon, evening and before bed. Vikalin (1 - 2 tablets 3 times a day after meals, pre-crushed and washed down with half a glass warm water.
2. Heartburn is the patient’s second problem.
The nurse’s goal is to teach the patient the necessary rules of behavior for gastritis with increased secretion, as well as consistently and convincingly convince the patient of the need to comply with them.
Planning: As a result of this education, the patient should know the doses, times of administration, mode of action and side effects of drugs; take medications throughout the entire treatment period (even when the subjective symptoms of the disease decrease or disappear); take antacids at strictly prescribed times.
The patient should avoid self-medication, in particular the use of soda, and also follow the rules for taking medications that have aggressive properties towards the mucous membrane of the stomach and duodenum (for example, non-steroidal anti-inflammatory drugs, steroid hormones).
To relieve pain not associated with gastritis, the patient should take paracetamol or other painkillers that are less aggressive to the mucous membrane.
Smoking should be stopped or reduced to the minimum possible. The patient's daily diet should be balanced; small amounts of food should be taken between main meals.
Diet therapy - table No. 1 (exclusion of foods that irritate the gastric mucosa and stimulate the secretion of gastric juice). Meals are frequent and small. The patient should refuse or reduce to a minimum the consumption of alcohol (you cannot drink alcohol in large quantities or on an empty stomach), it is necessary to avoid stressful situations during meals, plan “quiet time” after meals, eat food slowly and chew it thoroughly. Nutritional therapy will solve another existing problem - constipation.
Diet No. 1a includes mucous soups from cereals (oatmeal, rice, pearl barley, semolina) with the addition of butter, cream, egg-milk mixture, steamed meat and fish souffles, puree from lean meats (preliminary removal of tendons, fascia, skin is required) .
Potential problems are those that do not yet exist, but may appear over time.
1. The patient has a lack of knowledge about the complications of gastritis, the development of peptic ulcers and the influence of harmful factors on his health. As a result of nursing interventions, he should not only learn the factors of the disease, but also have plans to quit smoking, alcohol and avoid taking medications such as analgin and aspirin.
The patient should know how to reduce the harmful effects of aspirin on the gastric mucosa if taking this drug cannot be avoided. You should not take aspirin after meals, since under the influence of digestive juice the acetylsalicylic acid molecule breaks down and therapeutic effect qualitatively decreases. In order to preserve it and at the same time eliminate the factor of aggression, the patient should be advised, even with single doses of aspirin, to take it on an empty stomach in soluble form or wash it down with a large amount of water (2/3 cup), and if the course of administration is long, then with neutral jelly (that is, starch in water ).
The nurse should discuss with Viktor Viktorovich previous attempts to quit smoking and think through other ways to get rid of this habit (visiting special groups at the School of Health), and also convince the patient of the need to reduce the frequency of drinking alcohol.
He should also be advised to see an ophthalmologist. After all headache may be caused by blurred vision, glaucoma.
2. Another potential problem for Viktor Viktorovich is fear and anxiety about gastroduodenoscopy.
The nurse's short-term goal is to provide psychological support and prepare the patient for the procedure.
Long-term goals are aimed at preventing relapses of the disease, complications, their prevention, and acquiring knowledge about health.
Fulfillment of intended goals.
Dependent nursing intervention performed on the basis of written instructions from a doctor and under his supervision. The main task in preparing a patient for this study is to clear the stomach and duodenum of contents. To do this, the patient must have dinner no later than 20:00 the day before, and in the morning before the study he is prohibited from eating, drinking water and smoking.
If the antrum of the stomach is obstructed, before the study it should be rinsed with a thick probe to clean water. The nurse should explain to the patient the need for examination and reassure him. At night, for the purpose of a hypnotic effect, the doctor prescribes phenobarbital 0.03 orally.
Stage 5. Nursing Process Assessment.
The patient is prepared for examination and treatment. He has sufficient knowledge about his disease and its possible complications. The patient thought about his bad habits. During the treatment process, the stomach pain subsided and heartburn decreased. A chair appeared. The patient is prescribed sanatorium treatment and diet.
Conclusion: nursing process allows you to significantly improve the quality of patient care, ensure active cooperation between the nurse and the patient, and restore impaired basic needs as much as possible.
Test tasks
1. The main cause of chronic gastritis type B
a) poisoning
b) autoimmune disorders
c) poor nutrition
d) Helicobacter pylori infection
2. Cereal products are included in the diet because they contain
a) B vitamins
b) vegetable fiber
c) carbohydrates
d) microelements
3. Chronic gastritis is characterized by syndromes
a) dyspeptic
b) hypertensive
c) intoxicating
d) hepatolienal
4. Symptom of chronic gastritis with preserved secretion
a) diarrhea
b) bitterness in the mouth
c) fever
d) pain in the epigastric region
5. The main symptom of chronic gastritis with secretory insufficiency
a) increased appetite
b) belching sour
c) burping rotten
d) constipation
6. In chronic gastritis it is determined
a) pain in the epigastric region
b) Ortner's sign
V) positive symptom Pasternatsky
d) positive Shchetkin-Blumberg symptom
7. When preparing a patient for gastric intubation, a cleansing enema
c) placed in the evening and morning
d) not put
8. Complication of chronic gastritis with increased secretory activity
a) stomach cancer
b) cholecystitis
c) cirrhosis of the liver
d) peptic ulcer
9. Crucial in the diagnosis of chronic gastritis is
a) X-ray of the stomach
b) gastric intubation
c) laparoscopy
d) fibrogastroscopy
10. Complication of chronic gastritis with sharply reduced secretory activity
a) stomach cancer
b) cholecystitis
c) cirrhosis of the liver
d) peptic ulcer
11. Information about the secretory function of the stomach can be obtained
a) general stool analysis
b) gastric intubation
c) X-ray examination
d) duodenal intubation
12. Preparing the patient for gastric intubation
d) in the morning – siphon enema
13. Preparing the patient for endoscopic examination of the esophagus, stomach and duodenum
a) in the evening - a light dinner, in the morning - on an empty stomach
b) in the evening – cleansing enema
c) in the evening and in the morning – cleansing enema
d) in the morning – siphon enema
14. Endoscopic examination of the esophagus, stomach and duodenum
a) irrigoscopy
b) colonoscopy
c) sigmoidoscopy
d) esophagogastroduodenoscopy
15. When preparing a patient for endoscopic examination of the esophagus, stomach and duodenum, a cleansing enema
a) placed the evening before the test
b) placed in the morning on the day of the study
c) placed in the evening and morning
d) not put
16. To stimulate gastric secretion, the nurse uses
a) pentagastrin
c) barium sulfate
d) magnesium sulfate
17. The most effective stimulant of gastric secretion
a) cabbage broth
b) meat broth
c) trial breakfast
d) histamine
18. Parenteral irritant of gastric secretion m/s introduces
a) through a probe
b) intravenously
c) intramuscularly
d) subcutaneously
19. In case of chronic gastritis, exclude from the diet
a) fatty, fried
b) dairy products
c) porridge
d) vegetables and fruits
20. Diet No. 1 involves
a) increased calcium content
b) thorough grinding of food
c) exclusion of dairy products
d) exclusion of cereal dishes
21. Highest value for the prevention of exacerbations of chronic gastritis has
a) normalization of body weight
b) elimination of physical inactivity
c) hardening
d) rational nutrition
22. For chronic gastritis with secretory insufficiency, it is used as replacement therapy.
a) almagel
b) atropine
c) pepsidil
d) Maalox
23. Tubeless study of gastric secretory function
a) acid test
b) glucotest
c) radiography
d) laparoscopy
24. Early pain in the epigastric region occurs after eating for
a) 30 minutes after eating
b) 2 hours after eating
c) 3 hours before meals
d) 4 hours before meals
25. Preparing the patient for x-ray of the stomach
a) in the evening - a light dinner, in the morning - on an empty stomach
b) evening and morning – cleansing enema
c) in the morning – siphon enema
d) 3 days before the test, exclude iron-containing foods
26. Pathognomonic signs of gastric bleeding
a) pallor, weakness
b) headache, dizziness
c) vomiting “coffee grounds”, tarry stools
d) tachycardia, decreased blood pressure
27. Character of feces in acute stomach bleeding
a) bloody
b) tarry
c) discolored
d) fat
28. In the treatment of chronic gastritis, they are used enzyme preparations
a) atropine, gastrocepin
b) vikalin, cimetidine
c) vikaline, platifillin
d) panzinorm, festal
29. In the first 2 days after gastrointestinal bleeding, the nurse monitors diet compliance.
a) hungry
b) 2
at 4
d) 6
30. When preparing a patient for a stool occult blood test, medications should be discontinued.
a) iron
b) magnesium
c) potassium
d) calcium
STANDARD ANSWERS
1 g, 2 a, 3 a, 4 g, 5 c, 6 a, 7 g, 8 g, 9 g, 10 a, 11 b, 12 a, 13 a, 14 g, 15 g, 16 a, 17 g ,
18 g, 19 a, 20 b, 21 g, 22 c, 23 a, 24 a, 25 a, 26 c, 27 b, 28 g, 29 a, 30 a.
Answer questions for self-control:
1. What infectious factor most often causes chronic gastritis?
2. What non-infectious causes development of chronic gastritis Do you know?
3. What does eating disorder include?
4. What endogenous factors can cause the development of chronic gastritis?
5. Long-term use of what medications can cause the development of chronic gastritis?
6. Indicate the role of Helicobacter pyloricus in the occurrence of chronic gastritis.
7. How is chronic gastritis classified according to the state of the acid-forming function of the stomach?
8. List the main problems of the patient with chronic gastritis with secretory insufficiency.
9. Name the reason for the development of iron deficiency anemia in patients with chronic gastritis with reduced secretory function.
10. Name the reason for the development of B12-deficiency anemia in patients with chronic gastritis with reduced secretory function.
11. List the complications of chronic gastritis with decreased secretory function.
12. List the main problems of the patient with chronic gastritis with increased secretion.
13. List the main data instrumental methods examinations for chronic gastritis with preserved and increased secretory function.
14. List the data of the main instrumental examination methods for chronic gastritis with reduced secretory function.
15. What is the difference between diet therapy for chronic gastritis with secretory insufficiency and diet for chronic gastritis with increased secretion?
16. Pharmacotherapy of chronic gastritis with increased secretion.
17. Pharmacotherapy of chronic gastritis with secretory insufficiency.
18. What replacement therapy is used for gastritis with secretory insufficiency?
19. Herbal medicine for chronic gastritis.
20. Features of taking mineral waters when various types gastritis.
Criteria for assessing the solution to a situational problem:
5 "excellent"– comprehensive assessment of the proposed situation; knowledge of theoretical material taking into account interdisciplinary connections, right choice action tactics; consistent, confident execution of practical manipulations; rendering emergency care in accordance with action algorithms;
4 "good"– a comprehensive assessment of the proposed situation, minor difficulties in answering theoretical questions, incomplete disclosure of interdisciplinary connections; correct choice of action tactics; logical justification of theoretical questions with additional comments from the teacher; consistent, confident execution of practical manipulations; provision of emergency care in accordance with action algorithms;
3 "satisfactory"– difficulties with a comprehensive assessment of the proposed situation; incomplete answer requiring leading questions from the teacher; the choice of tactics of action in accordance with the situation is possible with leading questions from the teacher, correct sequential, but uncertain execution of manipulations; provision of emergency care in accordance with action algorithms;
2 "unsatisfactory"– incorrect assessment of the situation; incorrectly chosen tactics of action, leading to a worsening of the situation and a violation of patient safety; incorrect performance of practical manipulations carried out in violation of the safety of the patient and medical staff; inability to provide emergency assistance.
Criteria for assessing the test task:
91-100% of correct answers - “excellent”;
81-90% of correct answers are “good”;
71-80% of correct answers - “satisfactory”;
70% or less correct answers - “unsatisfactory” .
LIST OF REFERENCES USED
Dietetics. 4th ed. / Ed. A. Yu. Baranovsky. - St. Petersburg: Peter, 2012. - pp. 42-92
Makolkin S.I. Internal illnesses: textbook. - 6th ed., revised. and additional / V. I. Makolkin, S. I. Ovcharenko, V. A. Sulimov. - M.: GEOTAR-Media, 2012. -768 p. : ill.
Ruban E.D. Therapy: treatment of a therapeutic patient/ E.D. Ruban. – Rostov n/d: Phoenix, 2011. – P.316 - 341
Smoleva E.V. Nursing in therapy with a primary course medical care/ E. V. Smoleva; edited by Ph.D. B.V. Kabarukhina. - Ed. 13th. - Rostov n/d: Phoenix, 2012. - pp. 175-183. (Secondary vocational education).
Shchukin Yu. V. Patient research methods. - Rostov n/d: Phoenix, 2014. - 287 p.: ill. - (Medicine)
State budgetary professional
educational institution
Stavropol Territory
"Kislovodsk Medical College»
Review
FOR METHODOLOGICAL DEVELOPMENT
according to MDK 02.01 “Nursing care for various diseases and conditions”
for specialty02/34/01 Nursing
teacher clinical disciplines
Akulshina Anna Sergeevna
"Nursing care for chronic gastritis"
Reviewer Elena Tikhonovna Ivanova, teacher of clinical disciplines, highly qualified
Methodological development on the topic: “Nursing care for chronic gastritis” PM 02 Participation in the treatment, diagnostic and rehabilitation processes MDK 02.01 “Nursing care for various diseases and conditions” is compiled in accordance with the requirements of the Federal State Educational Standard for Secondary Professional Education of the new generation and corresponds to the minimum content and level of training of the graduate specialty 34.02.01 Nursing. Methodological development is designed for 4 hours of preclinical practice.
IN methodological development the content, goals, knowledge, skills of students are clearly formulated, the results of mastering professional and general competencies, the time and place of the lesson, the form of training, the type and type of lesson, logistics, intermodule and intramodule connections, a list of basic and additional literature, the Internet are indicated – resources.
Methodological development on the topic: “Nursing care for chronic gastritis” contains an assignment for monitoring the initial level of knowledge, materials for explaining the topic to the teacher, assignments for students’ independent work and consolidation of the studied material. Assessment criteria are given that allow maximum control over the level of mastery of acquired knowledge.
The methodological development is devoted to the current problem of the occurrence and development of gastritis, the role of the nurse in caring for patients with this pathology. The author points out the problem of the relevance of the topic of methodological development also in connection with the low quality of life of patients with gastritis.
Akulshina A.S. chose a very relevant topic for the current state of the world and in particular Russian healthcare. which lies in the search for new organizational approaches in nursing care, the need to implement effective forms and methods of treatment and preventive care for patients with gastritis.
The methodological development correctly presents theoretical and practical material that reveals the topic of nursing care for patients, and technical literacy is observed.
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(signature) (full name clearly)
Gastritis is an inflammation of the gastric mucosa, which can be acute or chronic. Acute gastritis is the most common reason changes in the mucous membrane such as hyperemia, edema and the appearance of erosions.
Chronic gastritis is more common in older people and in people with pernicious anemia (B-12 deficiency anemia). Morphologically, this is manifested by atrophic gastritis, in which all layers of the mucous membrane are inflamed, and the number of parietal cells is reduced. Both acute and chronic gastritis can occur at any age.
Causes of gastritis:
- Eating junk food, spicy foods, alcohol.
- Medicines such as: aspirin, non-steroidal anti-inflammatory drugs, cytotoxic drugs, caffeine, corticosteroids, antimetabolites, phenylbutazone, indomethacin.
- Toxic substances such as: insecticides, ammonia, mercury, carbon tetrachloride, corrosives.
- Bacterial endotoxins (staphylococcus, Escherichia, salmonella).
Complications of gastritis:
- Bleeding.
- Perforation.
- Penitration.
Signs and symptoms of gastritis:
Patients with acute gastritis often complain of epigastric discomfort, dyspepsia, colic, loss of appetite, nausea, and vomiting blood. Symptoms may last from several hours to several days. With chronic gastritis, the symptoms may be similar, but their intensity will be less, or only mild pain in the epigastrium may be present.
With chronic atrophic gastritis, patients most often have no symptoms.
On clinical examination, the patient may appear completely healthy or show signs of fatigue, anxiety, or pain, depending on the severity of the disease. With gastric bleeding, the patient looks pale, tachycardia and decreased blood pressure are detected. Upon examination and palpation, you can determine bloating and tenderness of the abdomen, muscle tension. Auscultation may reveal increased bowel sounds.
Nursing diagnosis of gastritis:
- Acute pain.
- Lack of anamnestic knowledge (diagnosis, treatment).
- Unbalanced diet, insufficient nutrition.
- Risk of dehydration.
Expected treatment results:
- Patients feel comfortable.
- Patients understand their disease and are familiar with the treatment regimen.
- Patients maintain normal weight.
- Patients are not concerned about current conditions.
- Patients maintain normal fluid volumes.
Nursing care for gastritis:
- Provide physical and moral support.
- If necessary, give the patient antiemetics, maintain and monitor fluid volume.
- Provide proper nutrition patient.
- Encourage the patient to eat small, frequent meals to reduce the secretion of gastric acid that causes pain.
Gastritis is one of the the most unpleasant diseases stomach. It is expressed by inflammation of the mucous membrane of the organ. Gastritis can be acute or chronic and is accompanied by the appearance of erosions or swelling. What is the nursing process for gastritis?
Causes
There are not many causes of gastritis, but you can always distinguish it from other diseases.
- The first and most main reason is the use harmful products food and drinks. This is fast food, spicy and fatty foods, alcohol. Of course, if you treat yourself to tasty but unhealthy food only on holidays and special occasions, you will not necessarily become a victim of gastritis. However, note that it most often develops in older people with weak stomachs.
- No one can rule out an overdose of various medications either. These include drugs based on aspirin, caffeine, indomethacin, phenylbutazone and various non-steroidal anti-inflammatory drugs.
- Certain toxic substances also provoke gastritis: mercury, insecticides, corrosive substances.
- Many bacteria contribute to the occurrence of this disease. These include staphylococcus, salmonella and Escherichia.
To understand whether you need medical care or you can handle it yourself, you should pay attention to the symptoms.
Signs of gastritis
With chronic gastritis, there may often be no symptoms or only mild pain. With acute gastritis, everything is much more serious. Symptoms of this disease include:
- discomfort in the epigastric area;
- colic;
- nausea and vomiting blood;
- acute pain in the stomach;
- general weakness.
If any symptoms are present, a person needs medical attention, since any physical activity can cause additional pain.
Actions of a nurse for chronic gastritis
What is the nursing process for gastritis?
- Conducting surveys, collecting information.
- Establishing a diagnosis.
- Setting process goals, i.e. what result is planned to be achieved.
- Implementation of treatment.
- Assessing the effectiveness of a medical worker’s work.
In addition to the nursing process for gastritis, the nurse has responsibilities that must be strictly fulfilled in case of a chronic disease:
- monitor patient compliance with a strict diet;
- conduct conversations about the importance of maintaining proper nutrition;
- Explain to relatives what foods can be brought to the patient;
- give the patient suffering from gastritis the necessary medications;
- realize preventive measures and teach the patient, as far as possible, to independently carry out preventive measures for his body.
In fact, the nursing process for gastritis is quite simple. The main thing is to control all the patient’s actions.
Nursing process for acute gastritis
The situation is different in a situation where a person suffers from an acute form of gastritis. In this case, the nursing process for gastritis includes the following actions:
- Provide the patient with complete peace - both moral and physical.
- Give antispasmodics.
- Lay the patient on his side and ask him to pull his knees towards his stomach. This action will help relax the stomach muscles, which will reduce the pain. The patient must remain in this position for 15 minutes until symptoms are completely eliminated.
- If after an hour of rest the symptoms do not go away, the patient should be given a bottle of cold water on the stomach.
The nursing process for acute gastritis must be extremely precise and fast, since most often the attack begins suddenly. The patient is physically unable to care for himself. An attack can last from half an hour to several hours. It is necessary to follow a strict diet during and after an attack. It is advisable to limit yourself to porridges and lean soups for the next few days. For drinks, you can drink either fruit juice or very weak tea. It is better to give preference to plain water on the first day.
Nursing care for gastritis is not an easy and very painstaking task. The most important thing in this matter is to treat the patient with attention and patience, and then all your actions will definitely be beneficial. In addition, gastritis can be triggered by a nervous surge. Peace and a friendly attitude for a patient in such a situation are the most necessary for recovery.
