Nursing Interventions
REDUCING ANXIETY
If the patient has ingested acids or alkalis, emergency measures may be needed. The nurse offers supportive therapy to the patient and family during treatment and after the ingested acid or alkali has been neutralized or diluted. In some cases, the nurse may need to prepare the patient for additional diagnostic studies (endoscopy) or surgery. The patient usually feels anxious about the pain and the treatment modalities. The nurse uses a calm approach to assess the patient and to answer all questions as completely as possible. It is important to explain all procedures and treatments according to the patient’s level of understanding.
PROMOTING OPTIMAL NUTRITION
For acute gastritis, the nurse provides physical and emotional support and helps the patient manage the symptoms, which may include nausea, vomiting, heartburn, and fatigue. The patient should take no foods or fluids by mouth—possibly for days—until the acute symptoms subside, thus allowing the gastric mucosa to heal. If IV therapy is necessary, the nurse monitors it regularly, along with serum electrolyte values. After the symptoms subside, the nurse can offer the patient ice chips followed by clear liquids. Introducing solid food as soon as possible will provide oral nutrition, decrease the need for IV therapy, and minimize irritation to the gastric mucosa. As food is introduced, the nurse evaluates and reports any symptoms that suggest a repeat episode of gastritis. secretion. It also is important to discourage alcohol use. Discouraging cigarette smoking is important because nicotine reduces the secretion of pancreatic bicarbonate and thus inhibits the neutralization of gastric acid in the duodenum (Eastwood, 1997). When appropriate, the nurse refers the patient for alcohol counseling and smoking cessation programs.
PROMOTING FLUID BALANCE
Daily fluid intake and output are monitored to detect early signs of dehydration (minimal urine output of 30 mL/hour, minimal intake of 1.5 L/day). If food and fluids are withheld, IV fluids (3 L/day) usually are prescribed and a record of fluid intake plus caloric value (1 L of 5% dextrose in water 170 calories of carbohydrate) needs to be maintained. Electrolyte values (sodium, potassium, chloride) are assessed every 24 hours to detect imbalance. The nurse must always be alert for any indicators of hemorrhagic gastritis, which include hematemesis (vomiting of blood), tachycardia, and hypotension. If these occur, the physician is notified and the patient’s vital signs are monitored as the patient’s condition warrants.
RELIEVING PAIN
Measures to help relieve pain include instructing the patient to avoid foods and beverages that may be irritating to the gastric mucosa (described earlier) and instructing the patient about using medications to relieve chronic gastritis. To follow up, the nurse assesses the patient’s level of pain and the extent of comfort attained from the use of medications and avoidance of irritating substances.
PROMOTING HOME AND COMMUNITY-BASED CARE
Teaching Patients Self-Care
The nurse evaluates the patient’s knowledge about gastritis and develops an individualized teaching plan that includes information about stress management, diet, and medications. Dietary instructions take into account the patient’s daily caloric needs, food preferences, and pattern of eating. The nurse and patient review foods and other substances to be avoided (eg, spicy, irritating, or highly seasoned foods; caffeine; nicotine; alcohol). Consultation with a dietitian may be recommended. Providing information about prescribed antibiotics, bismuth salts, medications to decrease gastric secretion, and medications to protect mucosal cells from gastric secretions can help the patient recover and prevent recurrence. Patients with pernicious anemia need information about long-term vitamin B12 injections; the nurse may instruct a family member about administering these injections or make arrangements for the patient to receive the injections from a health care provider. Finally, the nurse emphasizes the importance of keeping follow-up appointments with health care providers.
Evaluation
EXPECTED PATIENT OUTCOMES
Expected patient outcomes may include the following:
1. Exhibits less anxiety
2. Avoids eating irritating foods or drinking caffeinated beverages or alcohol
3. Maintains fluid balance
a. Has intake of at least 1.5 L daily
b. Drinks six to eight glasses of water daily c. Has a urinary output of about 1 L daily
d. Displays adequate skin turgor
4. Adheres to medical regimen
a. Selects nonirritating foods and beverages
b. Takes medications as prescribed
5. Maintains appropriate weight
6. Reports less pain