Management of Patients With Gastric and Duodenal Disorders

Chapter 46
Management of Patients With

Gastric and Duodenal Disorders
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Gastritis
• Inflammation of the stomach

• A common GI problem
• Acute: rapid onset of symptoms usually caused by
dietary indiscretion. Other causes include medications,
alcohol, bile reflux, and radiation therapy. Ingestion of
strong acid or alkali may cause serious complications
• Chronic: prolonged inflammation due to benign or
malignant ulcers of the stomach or by Helicobacter
pylori. May also be associated with some autoimmune
diseases, dietary factors, medications, alcohol, smoking,
or chronic reflux of pancreatic secretions or bile
Copyright © 2018 Wolters Kluwer · All Rights Reserved

Erosive Gastritis

Nursing Process: The Care of the Patient
With Gastritis—Assessment
• History including presenting signs and symptoms

• Dietary history and dietary associations with symptoms
• 72-hour diet; diary may be helpful
• Abdominal assessment

Manifestations of Gastritis
• Acute: abdominal discomfort, headache, lassitude,

nausea, vomiting, hiccupping
• Chronic: epigastric discomfort, anorexia, heartburn after
eating, belching, sour taste in the mouth, nausea and
vomiting, intolerance of some foods. May have vitamin
deficiency due to malabsorption of B12
• May be associated with achlorhydria, hypochlorhydria, or
hyperchlorhydria
• Diagnosis is usually by UGI x-ray or endoscopy and
biopsy

With Gastritis—Diagnoses
• Anxiety
• Imbalanced nutrition
• Risk for fluid volume imbalance
• Deficient knowledge
• Acute pain

With Gastritis—Planning
• Major goals may include reduced anxiety, avoidance of

irritating foods, adequate intake of nutrients,
maintenance of fluid balance, increased awareness of
dietary management, and relief of pain

Medical Management of Gastritis
• Acute
– Refrain from alcohol and food until symptoms subside
– If due to strong acid or alkali treatment to neutralize
the agent, avoid emetics and lavage due to danger of
perforation and damage to esophagus
– Supportive therapy
• Chronic
– Modify diet, promote rest, reduce stress, avoid alcohol
and NSAIDs
– Pharmacologic therapy

Interventions
• Reduce anxiety; use calm approach and explain all

procedures and treatments
• Promote optimal nutrition; for acute gastritis, the patient
should take no food or fluids by mouth. Introduce clear
liquids and solid foods as prescribed. Evaluate and report
symptoms. Discourage caffeinated beverages, alcohol,
cigarette smoking. Refer for alcohol counseling and
smoking cessation
• Promote fluid balance; monitor I&O, for signs of
dehydration, electrolyte imbalance, and hemorrhage
• Measures to relieve pain: diet and medications

Peptic Ulcer
• Erosion of a mucous membrane forms an excavation in

the stomach, pylorus, duodenum, or esophagus
• Associated with infection of H. pylori
• Risk factors include excessive secretion of stomach acid,
dietary factors, chronic use of NSAIDs, alcohol, smoking,
and familial tendency
• Manifestations include a dull gnawing pain or burning in
the midepigastrium; heartburn and vomiting may occur
• Treatment includes medications, lifestyle changes, and
occasionally surgery

Deep Peptic Ulcer

Question
Is the following statement true or false?
The most common site for peptic ulcer formation is the

pylorus

Answer
False
The most common site for peptic ulcer formation is not the
pylorus. The most common site for peptic ulcer formation
is the duodenum

With Peptic Ulcer—Assessment
• Assess pain and methods used to relieve pain

• Dietary intake and 72 hour diet diary
• Lifestyle and habits such as cigarette and alcohol use
• Medications; include use of NSAIDs
• Sign and symptoms of anemia or bleeding

With Peptic Ulcer—Diagnoses
• Acute pain
• Anxiety

Collaborative Problems and Potential
Complications
• Hemorrhage
• Perforation
• Penetration
• Pyloric obstruction (gastric outlet obstruction)

With Peptic Ulcer—Planning
• Major goals for the patient may include relief of pain,

reduced anxiety, maintenance of nutritional
requirements, knowledge about the management and
prevention of ulcer recurrence, and absence of
complications

Relieve Pain
• Treat with prescription medications

• Avoid aspirin, NSAIDs, and alcohol

Anxiety
• Assess anxiety
• Calm manner
• Explain all procedures and treatments
• Help identify stressors
• Explain various coping and relaxation methods such as
biofeedback, hypnosis, and behavior modification

Patient Education
• Medication education
• Dietary restrictions
• Lifestyle changes

Management of Potential Complications
• Management of hemorrhage
– Assess for evidence of bleeding, hematemesis or melena,
and symptoms of shock/impending shock and anemia
– Treatment includes IV fluids, NG, and saline or water
lavage; oxygen, treatment of potential shock including
monitoring of VS and UO; may require endoscopic
coagulation or surgical intervention
• Pyloric obstruction
– Symptoms include nausea and vomiting, constipation,
epigastric fullness, anorexia, and (later) weight loss
– Insert NG tube to decompress the stomach, provide IV
fluids and electrolytes. Balloon dilation or surgery may be
required
Management of Potential Complications
• Management of perforation or penetration

– Signs include severe upper abdominal pain that may
be referred to the shoulder, vomiting and collapse,
tender board-like abdomen, and symptoms of shock
or impending shock
– Patient requires immediate surgery

Question
What is the best time to teach a client to take proton pump

inhibitors?
A. 30 minutes before a meal
B. With a meal
C. Immediately after the meal
D. One to three hours after a meal

Answer
A. 30 minutes before a meal
The best time for a client to take a proton pump inhibitor is

before a meal. It is a delayed-release medication that is
to be swallowed whole and taken before a meal

Obesity
• Obesity is body mass indices (BMI) above 30 mg/m2

• 66% of all adults are overweight or obese
• Obesity-related mortality rates are 30% greater for every
gain of 5 kg/m2 of body mass beyond a BMI of 25 kg/m2
• Increased risk for disease, disorders, low self-esteem,
impaired body image, depression, and diminished quality
of life

Obesity Management
• Lifestyle modifications
• Pharmacotherapy
• Bariatric surgery

Bariatric Surgery
• Morbid obesity: persons more than two times IBW, BMI

exceeds 30 kg/m2, or more than 100 pounds greater
than IBW; high risk for health complications
• Surgery is preformed only after nonsurgical methods
have failed
• Selection factors include body weight, patient history,
failure to lose weight using other means, absence of
endocrine disorders, and psychological stability

Surgical Procedures for Morbid Obesity—
Roux-en-Y Gastric Bypass

Gastric Banding

Vertical-Banded Gastroplasty

Sleeve Gastrectomy

Biliopancreatic Diversion With Duodenal Switch

Nursing Care of the Patient Undergoing
Bariatric Surgery
• Preoperative care; evaluation and counseling

• Postoperative care is similar to gastric resection, but the
patient is at greater risk for complications because of
obesity
• Postoperative diet: six small feedings totaling 600 to 800
calories per day
• Patients require psychosocial interventions to modify their
eating behaviors
• Follow-up care
• Education regarding long-term effects

Complications
• Hemorrhage
• Bile reflux
• Dumping syndrome
• Dysphagia
• Bowel or gastric outlet obstruction

Question
Is the following statement true or false?
The average weight loss after bariatric surgery is 60% of

previous body weight

Answer
False
The average weight loss after bariatric surgery is 25% to

35% of previous body weight

Gastric Cancer
• Incidence is deceasing, but accounts for more than 10,000

deaths in the United States annually
• Increased incidence in men, Native Americans, Hispanic
Americans, and African Americans
• Risk factors include diet, chronic inflammation of the stomach,
H. pylori infection, pernicious anemia, smoking, achlorhydria,
gastric ulcers, previous subtotal gastrectomy, and genetics
• Manifestations include pain relieved by antacids, dyspepsia,
early satiety, weight loss, abdominal pain, loss or decrease in
appetite, bloating after meals, nausea, and vomiting. Diagnosis
of the disease is often late
• Treatment is surgical removal of the tumor if possible, and
palliative care if the tumor is unresectable or metastasized

With Gastric Cancer—Assessment
• Dietary history and nutritional status

• Risk factors and smoking and alcohol history
• Social support, individual and family coping
• Resources
• Physical assessment, including assessment of the
abdomen

With Gastric Cancer—Diagnoses
• Anxiety
• Pain
• Anticipatory grieving

With Gastric Cancer—Planning
• Major goals include reduced anxiety, optimal nutrition,

relief of pain, adjustment to the diagnosis, and
anticipated lifestyle changes

Anxiety
• Provide a relaxed, nonthreatening atmosphere

• Allow patient to express fears and concerns
• Provide support and encourage family support
• Promote positive coping measures
• Explain treatments and procedures
• Referral to support persons such as social worker or
clergy

Promote Optimal Nutrition
• Encourage small, frequent meals of nonirritating foods

• Provide foods high in calories and vitamins A and C and
iron
• Provide diet and education for potential dumping
syndrome after gastric resection
• Six small feedings low in carbohydrates and sugar, with
fluids between, not with, meals
• Assessment includes I&O, daily weights, assessment for
signs of dehydration, and nutritional status

Other Interventions
• Pain
– Administer analgesic as prescribed
– Nonpharmacologic pain relief measures
• Psychosocial support
– Allow patient to express fears concern and grief
– Allow patient to participate in decisions
– Include family members and significant others
– Referral or involvement of other support persons as
needed
• Patient education
With Gastric Surgery—Assessment
• Patient and family knowledge

• Nutritional status
• Postoperatively assess for potential complications

With Gastric Surgery—Diagnoses
• Anxiety
• Pain

Complications
• Hemorrhage
• Dietary deficiencies
• Bile reflux

With Gastric Surgery—Planning
• Major goals include reduced anxiety, increased

knowledge, optimal nutrition, management of
complications that can interfere with nutrition, relief of
pain, avoidance of hemorrhage and steatorrhea, and
enhanced self-care skills at home

Interventions
• Provide interventions to reduce anxiety

• Pain
– Administer analgesics as prescribed so patient may
perform pulmonary care, leg exercises, and
ambulation activities
– Position in Fowler position
– Maintain function of NG tube
• Patient education
• Individualized nutritional care and support

Care and Prevention of Complications
• Gastric retention
– May require reinstatement of NPO and NG suction;
use low-pressure suction
• Bile reflux
– Agents that bind with bile acid: cholestyramine
• Malabsorption of vitamins and minerals
– Supplementation of iron and other nutrients
– Parenteral administration of vitamin B12 because of a
lack of intrinsic factor

Care and Prevention of Complications
– Caused by rapid passage of food into the jejunum
and drawing of fluid into the jejunum caused by
hypertonic intestinal contents
– Causes vasomotor and GI symptoms with reactive
hypoglycemia
– Avoid fluid with meals
– Avoid high carbohydrate and sugar intake
• Steatorrhea
– Reduce fat intake and administer loperamide

Dietary Self-Management
• To delay stomach emptying and dumping syndrome,

assume low Fowler position after meals; lie down for 20
to 30 minutes
• Take antispasmodics as prescribed
• Avoid fluid with meals
• Meals should contain more dry items than liquid items
• Eat fat as tolerated but keep carbohydrate intake low and
avoid concentrated carbohydrates
• Eat small, frequent meals
• Take dietary supplements as prescribed; vitamins,
medium-chain triglycerides, and B12 injections
Tumors of the Small Intestine
• 64% malignant
• Higher rates of cancer among older adults, African
Americans, and men
• May be asymptomatic or present with pain, occult
bleeding, weight loss, nausea, vomiting, and intestinal
obstruction
• Assessment includes CBC, bilirubin, carcinoembryonic
antigen (CEA)
• Diagnose by upper GI radiograph or abdominal CT
• Treat with surgery and chemotherapy

Management of Patients With Gastric and Duodenal Disorders

Transféré par

Informations du document

Titre original

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Management of Patients With Gastric and Duodenal Disorders

Transféré par

Droits d'auteur :

Formats disponibles

Chapter 46

Management of Patients With

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

• Inflammation of the stomach

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

• History including presenting signs and symptoms

Copyright © 2018 Wolters Kluwer · All Rights Reserved

• Acute: abdominal discomfort, headache, lassitude,

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

• Major goals may include reduced anxiety, avoidance of

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

• Reduce anxiety; use calm approach and explain all

Copyright © 2018 Wolters Kluwer · All Rights Reserved

• Erosion of a mucous membrane forms an excavation in

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Is the following statement true or false?

The most common site for peptic ulcer formation is the

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

• Assess pain and methods used to relieve pain

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

• Major goals for the patient may include relief of pain,

Copyright © 2018 Wolters Kluwer · All Rights Reserved

• Treat with prescription medications

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

• Management of perforation or penetration

Copyright © 2018 Wolters Kluwer · All Rights Reserved

What is the best time to teach a client to take proton pump

Copyright © 2018 Wolters Kluwer · All Rights Reserved

A. 30 minutes before a meal

The best time for a client to take a proton pump inhibitor is

Copyright © 2018 Wolters Kluwer · All Rights Reserved

• Obesity is body mass indices (BMI) above 30 mg/m2

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

• Morbid obesity: persons more than two times IBW, BMI

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

• Preoperative care; evaluation and counseling

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Is the following statement true or false?

The average weight loss after bariatric surgery is 60% of

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The average weight loss after bariatric surgery is 25% to

Copyright © 2018 Wolters Kluwer · All Rights Reserved

• Incidence is deceasing, but accounts for more than 10,000

Copyright © 2018 Wolters Kluwer · All Rights Reserved

• Dietary history and nutritional status

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Copyright © 2018 Wolters Kluwer · All Rights Reserved