Gastritis Flashcards
1
Q
what is cyclooxygenase?
A
enzyme that produces mucosal PGs, decreases gastric acid, inc secretion of bicarb and cytoprotective mucus, and provides maintenance of submucosal blood flow to protect gastric mucosa
2
Q
what is gastritis? what are the 4 types?
A
- Gastritis: inflammation of the lining of the stomach, either erosive or nonerosive, and can be acute or chronic
- Nonerosive gastritis: acute or chronic
- Most often caused by H. pylori infection
- Erosive gastritis: likely caused by NSAIDs, alcohol use disorder, or recent radiation tx
- Extensive gastric mucosal wall damage can cause erosive gastritis (ulcers) and can inc the risk of stomach cancer
- Acute gastritis: sudden onset, short duration, and can result in gastric eating if severe
- Severe form caused by ingestion of an irritant, such as a strong acid or alkali
- Can result in development of gangrenous tissue or perforation
- Scarring can result leading to pyloric stenosis
- Chronic gastritis: can be related to an autoimmune dz, such as pernicious anemia, and H. pylori
- Nonerosive gastritis: acute or chronic
3
Q
gastritis: health promotion and dz prevention
A
- Assist in reduction of anxiety related to gastritis
- Follow prescribed diet
- Dec or eliminate alcohol use
- Client who has pernicious anemia will need vitamin B12 injections due to dec in intrinsic factor by stomach parietal cells
- Watch for indications of GI bleed
- Follow medication regimen
- Eat small, frequent meals
- Avoid foods/beverages that cause irritation
- Report constipation, n/v, or bloody stools
- Stop smoking
4
Q
gastritis: risk factors
A
- Family member w/ H. pylori
- Family hx of gastritis
- Prolonged use of NSAIDs, corticosteroids (stops PGs synthesis)
- Excessive alcohol use
- Bile reflux dz
- Advanced age
- Radiation therapy
- Smoking
- Caffeine
- Excessive stress
- Exposure to contaminated food/water
- Bacterial infection: H. pylori, Salmonella, Streptococci, Staphylcocci, E. coli
- Autoimmune diseases: systemic lupus rheumatoid arthritis, pernicious anemia
5
Q
gastritis: expected findings
A
- Dyspepsia, general abdominal discomfort, indigestion
- HA
- Hiccupping that can least for a few hours to several days
- Upper abdominal pain or burning can inc or dec after eating
- n/v
- Reduced appetite and weight loss
- Abdominal bloating or distention
- Hematemesis (bloody emesis) and stools that can test positive for occult blood
6
Q
erosive gastritis: expected findings
A
- Black tarry stools
- Coffee ground emesis
- Acute abdominal pain
7
Q
gastritis: lab tests
A
- CBC: check for anemia
- Women: Hgb <12; RBC <4.2
- Men: Hgb <14; RBC <4.7
- Serum & Stool Antibody/Antigen Test: for presence of H. pylori
- C13 urea breath test: used to measure H. pylori
8
Q
gastritis: upper endoscopy
A
- type of therapeutic procedure
- small flexible scope is inserted thru the mouth into the esophagus, stomach, and duodenum to visualize the upper digestive tract
- Allows for a biopsy, cauterization, removal or polyps, dilation, or diagnosis
- Client edu:
- Instruct client to maintain NPO 6-8 hr prior to procedure
- Advise client to a have a ride home after procedure
- Inform client that a local anesthetic will be sprayed onto back of throat, but throat may be sore after procedure
- Monitor for indications of perforation: chest or abdominal pain, fever, n/v, abdominal distention
- Have emergency contact numbers available
9
Q
gastritis: nursing care
A
- Monitor fluid intake and urine output
- Administer IV fluids
- Monitor electrolytes
- Diarrhea and vomiting can deplete electrolytes and cause dehydration
- Assist client in identifying foods that are triggers
- Provide small, frequent meals & encourage client to eat slowly
- Advise client to avoid alcohol, caffeine, foods that cause irritation
- Assist the client in identifying ways to reduce stress
- Monitor for indications of gastric bleeding: coffee ground emesis, black tarry stools
- Monitor for findings of anemia: tachycardia, hypoTN, fatigue, shortness of breath, pallor, lightheadedness, dizziness, chest pain
10
Q
gastritis: list the classes of medications
A
- H2 receptor antagonists
- antacids
- PPIs
- prostaglandins
- anti-ulcer/mucosal barriers
- abxs
11
Q
gastritis: H2 receptor antagonists
A
- nizatidine, famotidine, ranitidine, cimetidine
- Decreases gastric acid output by blocking gastric H2 receptors
- Nursing interventions:
- Allow 1 hr before or after to administer an antacid
- Antacids can dec effectiveness of H2 receptor antagonists
- Monitor for neutropenia and hypoTN
- Dilute and administer slowly when given IV
- Rapid administration can cause bradycardia & hypoTN
- Client edu:
- Do not smoke or drink alcohol
- Take oral dose with meals
- Take famotidine 1 hr before meals to dec heartburn, acid indigestion, and sour stomach
- Advise client to wait 1 hour prior to or following H2 receptor antagonist to take an antacid
- Advise clients to monitor for indications of GI bleeding: black stools, coffee ground emesis
12
Q
gastritis: antacids
A
- aluminum hydroxide, magnesium hydroxide w/ aluminum hydroxide
- Inc gastric pH and neutralizes pepsin
- Improves mucosal protection
- Nursing Interventions:
- Do not give to clients with acute kidney injury or chronic kidney failure
- Monitor aluminum antacids for aluminum toxicity and constipation
- Monitor magnesium antacids for diarrhea or hypermagnesemia
- Client edu:
- Advise clients to take on an empty stomach
- Advise clients to wait 1 hour to take other medications
13
Q
gastritis: PPIs
A
- omeprazole, lansoprazole, rabeprazole, pantoprazole, esomeprazole
- Reduces gastric acid by stopping the hydrogen/potassium ATPase enzyme system in parietal cells, blocking acid production
- Nursing Interventions:
- Can cause n/v, abdominal pain
- Use filter for IV admin of pantoprazole and lansoprazole
- Client edu:
- Advise client to allow 60 min before eating when taking esomeprazole
- Do not crush or chew if EC or SR
- It can take up to 4 days to see effects
- Take w/ or w/o food according to instructions
14
Q
gastritis: prostaglandins
A
- misoprostol
- Replacement for endogenous PGs that stimulates mucosal protection
- Reduces gastric acid secretion
- Nursing interventions:
- May be given w/ NSAIDs to prevent gastric mucosal damage
- Can cause abdominal pain and diarrhea
- Client Edu:
- Use contraceptives
- Do not take if chance of becoming pregnant
- Take w/ food to avoid gastric effects
15
Q
gastritis: anti ulcer/mucosal barriers
A
- sucralfate
- Inhibits acid and forms protective coating over mucosa
- Nursing interventions:
- Allow 30 min before or after giving antacid
- Client edu:
- Take on empty stomach
- Do not smoke or drink alcohol
- Take even if manifestations subside
