ACUTE

GASTRITIS

MATRIX NUMBER 1869

 LEARNING OBJECTIVES :-

• At the end of the case study, I’ll be able to:-

• 1. Define of Acute gastritis.

• 2. Explain the anatomy & physiology of
digestive system.
• 3. State the etiology of Acute gastritis.
• 4. Explain the pathophysiology of Acute
gastritis.
• 5. State the clinical manisfestation of
Acute gastritis.
6.List down the complication of Acute
gastritis.
7.List down investigation for Acute gastritis.
8.Explain the management for patient with
Acute gastritis.
9.Carry out of the care for patient with Acute
gastritis using nursing process
10.Appreciate the significant of health
education to the patient in home care plan.
 Introduction
Mrs. C, a 36 year old Indian lady came to
ISH on June 15, 2008 at 10.50 pm with a
complain of epigastric pain & vomiting for past x
5/7. She was admitted under Doctor S. She has
one year medical history of epigastric pain and
relieved by medication that she bought from G/P.
On that same day she complained of severe pain
at the epigastric region. She was admitted for
investigation and further treatment that evening.
 Patient details
• Name :Mrs. C
• MRN No :422xxx
• Age :36 years old
• Sex :Female
• Race :Indian
• Religion :Hindu
• Language spoken : Tamil, Malay, English
• Occupation : Housewife
• Date/time of admission :15/6/08@10.50pm
• Consultant : Dr. S
• Reason for admission : c/o epigastric
pain & vomiting
x 5/7
• Medical history : epigastric pain
since last year.
• Surgical history : Nil
• Family medical history : Nil
• Current medication : Nil
• Allergies : Nil
• Diagnosis : Acute gastritis
 Vital sign of admission

During the admission time in the ward, her vital

sign has been taken and the result is as
follow :-
Temperature : 36.0 celcius
Pulse : 80 beats/min
Respiration : 20 breaths/min
Blood pressure : 120/80 mmHg
Weight : 67kg
Height : 162 cm
 Cont..

• Mode of admission : Wheelchair

• Level of consciousness : Conscious
• Mental status : Orientated
• Emotional status : Calm
Activity daily living
 Activities daily living
BREATHING : No difficulty in breathing.
COUGH : No cough.
SMOKE : She didn’t smoke
EATING AND DRINKING: normal,but
lately she
verbalized pain
with food.
ELIMINATIONS : No problem.
BLADDER : No problem.
SLEEPING : No problem
MOBILITY : Ambulant
PERSONAL HYGIENE : Self
SAFE ENVIRONMENT : Side rails
COMMUNICATIONS : Normal
HEARING : Normal
VISION : Normal
NO ABNORMALITY DETECTED IN MRS C

Pain

IVD

Anterior Posterior
THE DIGESTIVE SYSTEM
 Organ of the digestive
system
Alimentary tract @ Gastrointestinal (GI) tract
- along tube through which food passes. It commences
at the mouth and terminates at the anus.
- The parts of the alimentary tracts are :
• mouth
• pharynx
• oesophagus
• stomach
• small intestines
• large intestines
• rectum and anal canal
 Digestive system
Is a collective named used to describe alimentary canal,
some accessory organs and a variety of digestive
processes which take place at different levels to prepare
food eaten in diet for absorption.
- The alimentary canal begins at the mouth, passes through
the thorax, abdomen and pelvis and ends at the anus.
- The activities in digestive system is group under 5 main
headings :-
-Ingestion : the process of taking food into
alimentary tract.
-Propulsion : moves the contents along
alimentary tract.
- Digestion : mechanical breakdown of food e.g :
mastication chemical digestion of food by
enzymes present
in secretions produced by glands and
accessory organs of digestive system.
- Absorption : digested food substances pass
through the walls of some
organs of alimentary canal into
the
blood and lymph capillaries
for circulation round the body.
- Elimination : food substances that cannot be
digested and absorbed are
excreted by bowel as faeces.
 Accessory organ
Various secretions are poured into the
alimentary tract, some by glands in the lining
membrane of the organs, e.g : gastric juice
secreted in the lining of the stomach.
- The latter are the accessory organs of
digestion and their secretions pass through
ducts to enter the tract.
- They consists of:
- 3 pairs of salivary glands
- Pancreas
- Liver and the biliary tract
 Basic structure of the alimentary
canal
- The layers of the wall of alimentary canal
follow a consistent pattern from the oesophagus
onwards, it doesn’t apply obviously to the mouth
and pharynx.
- The walls of the alimentary tract are formed by
4 layers of tissue :
-Adventitia
-Muscle layer
-Submucosa layer
-Mucosa lining
The normal stomach
Fundus
Body

Antrum
 Digestive system
Functions of mouth, pharynx and oesophagus :-
• Formation of a bolus
• Deglutition or swallowing

The Stomach (Gaster)

- a J-shaped dilated portion of the alimentary
tract situated in the epigastric, umbilical and
left hypochondriac regions of the abdominal
cavity.
- It is continuous with the oesophagus at the
cardiac sphincter and with the duodenum at
the pyloric sphincter.
It has 2 curvature..
- The lesser curvature is short, lies on the
posterior surface of the stomach. It curves
upwards to complete the J shape.
- The oesophagus joins the stomach the
anterior region angles acutely upwards,
curves downwards forming the greater
curvature then slightly upwards towards the
pyloric sphincter.
- The stomach is divided into 3 regions :
-Fundus
-Body
-Antrum
- The pyloric sphincter guards the opening
between the stomach and the duodenum.
- When it is inactive the pyloric sphincter is
relaxed and open, and when the stomach
contains food the sphincter is closed.
- The muscle layer of the stomach consists of 3
layers of smooth muscle fibres which makes
the stomach different from other organs of the
alimentary tract :
– An outer layer of longitudinal fibres
– A middle layer of circular fibers
– An inner layer of oblique fibers
- This arrangement allows for the churning
motion characteristic of gastric activity as well
as peristaltic movement.
- Circular muscle is strongest in the pyloric
antrum and sphincter.
Mucosa

- When the stomach is empty the mucous

membrane lining is thrown into
longitudinal folds or rugae, and when full the
rugae are ironed out and the surface has a
velvety appearance.
- Numerous gastric glands are situated below
the surface in the mucous membrane.
- They consist of specialized cells that secrete
gastric juice into the stomach.
Gastric juice and the functions of the
stomach

- Stomach size varies with the volume of food it

contains, which may be 1.5 litres or more in an
adult.
- When a meal has been eaten the food
accumulates in the stomach in layers, the last
part of the meal remaining in the fundus for
some time.
- Mixing with the gastric juices takes place
gradually and it may be sometime
before the food is sufficiently acidified to stop
the action of salivary amylase.
- The muscle contraction churns the food,
breaks down the bolus and mixes it with the
gastric juice and peristaltic waves propel the
stomach contents towards the pylorus.

- When the stomach is active the pyloric

sphincter closes. Strong contractions of the
pyloric antrum force gastric contents, after
they are liquefied, through the pylorus into the
duodenum is small spurts.
Gastric Juices
- About 2 litres are secreted daily by special
secretory glands in the mucosa. It
consists of :
– Water and mineral salts secreted by gastric
glands
– Mucus secreted goblet cells in the glands
and on the stomach surface
– Hydrochloride acid and intrinsic factor
secreted by parietal cells in the gastric
glands.
– Inactive enzyme precursors pepsinogen
secreted by chief cells in the glands.
Functions of gastric juice:-
- Water further liquefies the food swallowed
- Hydrochloride acid : acidifies the food and
stops the action of salivary amylase, kills
ingested microbes, provides the acid
environment needed for effective digestion by
pepsins.
- Pepsinogens are activated to pepsins by
hydrochloride acid and by pepsins already
present in the stomach. They begin the
digestion of proteins, breaking them into
smaller molecules. Pepsin acts most
effectively at pH 1.5 to 3.5.
- Intrinsic factor (a protein) is necessary for the
absorption of vitamin B12 from the ileum.
- Mucus prevents mechanical injury to the
stomach wall by lubricating the contents.
- It prevents chemical injury by corrosive
gastric juice. Hydrochloride acid is present in
potentially damaging concentration and
pepsins digest protein.
Functions of the stomach:-
- Temporary storage allowing time for digestive
enzymes pepsins to act.
- Chemical digestion pepsins convert proteins
to polypeptides.
- Mechanical breakdown the 3 layers of
smooth muscle enable the stomach to act as
a churn, gastric juice is added and the
contents are liquefied to chyme.
- Limited absorption of water, alcohol and
some lipid-soluble drugs.
- Non-specific defence against microbes
provided by hydrochloride acid. Vomiting is a
response of ingestion of gastric irritants e.g.
microbes and chemicals.
- Preparation of iron for absorption. The acid
environment of the stomach solubilises iron
salts, which is required before iron can be
absorbed.
- Production of intrinsic factor needed for
absorption of vitamin B12 in the terminal
ileum.
- Regulation of the passage of gastric contents
into the duodenum. When the chyme is
sufficiently acidified and liquefied, the pyloric
antrum forces small jets of gastric contents
through the pyloric sphincter into the
duodenum.
• Ac. gastritis is sudden inflammation of the
lining of the stomach.

Http/www.emedicinehealth.com/gastritis/article_em.htm

• Gastritis in which vomiting occurs, caused

by ingesting excess alcohol or other
irritating or corrosive substances.
Dictionary of nursing, Malaysian edition.page 192
 Total of statistic between gender at
ISH that having Acute gastritis from
Mac – June 2008
Total of patient
30

25

20
MALE
15
FEMALE
10

0
MAC APR MEI JUN Month
 Helicobactor pylori infection

Destruction of mucus bicabonate layer

Superficial erosion

Ulceration

Acute Gastritis
• Long term medication (NSAIDS)
• Bacteria infection (H.pylori)
• Smoking
• Excess gastric acid secretion
• Stress
• Ingestion of large quantity of alcohol
• Trauma ( from examination ,radiation
treatment)
• Abdominal pain
• Loss of appetite
• Nausea
• Vomiting
• Hiccup
• Heartburn after eating
• Belching or bloating
• Ingestion (Dyspepsia)
• Severe blood loss (Bleeding)
• Perforated
• MEDICAL TREATMENT

• SURGICAL TREATMENT
 LAB. INVESTIGATION

• FBC

• SGOT

• SGPT

• Amylase
 FULL BLOOD COUNT (GP IA)-
15 June 2008 at 2213 hours

Examination Result Reference

Range
Haemoglobin 13.3 11.5-16.0 g/dL
g/dL
Red Cell Count 4.5 4.0-5.2 1012/L
1012/L
Haematocrit(PCV) 37% 36-46 %
MCV 83fl 76-103 fl
 Continue…
MCH 29 pg 26-34 pg
MCHC 35g/dL 31-36 g/dL
**RDW 15% 8.6-14.6 %
Platelet 332 103/uL 150-450
Count 103/uL
WBC Count 10.5 103/uL 4.3-10.5
103/uL
MPV 9.1fl 6.5-12.0
103/uL
 WBC Differential Count
(15 June 2008) at 2213 hours

Examination Result Reference Range

Neutrophil 61.5% 40.75%

Lymphocyte 30.3% 20 – 45 %
Eosinophil 0.4% 0–6%
Monocyte 6.6% 1 – 11 %
Basophil 0.7% 0–2%
 Continue…

SGOT / AST 13 u/L 7 - 44

SGPT / ALT 18 u/L 7 - 48

Alpha - Amylase 32 u/L < 100

 DIAGNOSTIC IMAGING
Ultrasound abdomen and pelvis
- 15/6/08

- The liver, GB, pancreas, both kidney

and urinary bladder show no
abnormality. But the uterus is bulky
suggestive of adenomyosis.
DIAGNOSTIC PROCEDURE

OGDS (OESOPHAGO GASTRO

DUODENO SCOPY)

-16/6/08
-mild to moderate duodenitis and
pangastritis
-Helicobector pylori +ve
DEFINITION :-
OGDS (OESOPHAGO GASTRO
DUODENAL SCOPY)
- Endoscope examination of esophagus,
stomach and the small portion of the
small intestine for the purpose of
diagnosis and treatment of disorder
the upper GIT.
OGDS PROCEDURE
Divided in 2 types :-
• MEDICAL management

• SURGICAL management
Drugs & Group Indica- Route / Date Date
Generic tion Dosage/ on off
name frequency

NEXIUM ANTACID Treatment & IV 40mg 15.6.08 15.6.08

Esomeprazole ANTIUL- prevention of STAT
CERANTS H pylori- Oral 40mg 16.6.08 18.6.08
associated BD
ulcers
ZOFRAN ANTI- Prevention & IV 4mg/2ml 15.6.08 15.6.08
Ondansetron EMETICS Treatment of STAT
HCI dihydrate Nausea & BD 16.6.08 17.6.08
vomiting
SYRUP ANTACID Heartburn,in- Oral 16.6.08 18.6.08
GAVISCON ANTIUL- digestion,hi- 10ml
ADVANCE CERANTS atus hernia,
Reflux-
Na alginate TDS
oesophagitis
K bicabonate
Drugs & Group Indica- Route / Date Date
Generic tion Dosage/ on off
name frequency

GANATON ANTACID GI symptom Oral 16.6.08 18.6.08

Itopride HCI ANTIUL- of functional, 50 mg
CERANTS Non-dyspep- TDS
sia(Chronic
gasritis)
DYNASTAT NSAIDS Management IV 15.6.08 15.6.08
Parecoxib Na of post-op 40 mg
pain
STAT

PETHIDINE ANALGE- Short term IM 15.6.08 15.6.08

Pethidine HCI SIC & (24-36 50 mg
ANTIPY- hours)
PRN
RETICS relief of
moderate
to severe
pain
1. Alteration in comfort :abdominal pain
related to irritated stomach mucosa
2. Alteration in oral intake related to
vomiting
3. Alteration in comfort: vomiting related
to epigastric pain.
4. Alteration in emotional status : anxiety
related to diagnostic procedure
(OGDS)
5. Knowledge deficit related to dietary
management and her disease .
Date: 15th June 2008
Time: 11.00 pm

Diagnosis: Alteration in comfort: pain related to

abdominal pain.

Supporting data: 1. Patient’s facial expressions

shows she’s in pain.
2. Patient’s complain of pain at
epigastric site.

Goal: Patient’s pain will be reduce 1-2 hours after

nursing interventions carried out and
during hospitalization.
1. Assess patient’s general conditions such as
severity of pain, characteristic of pain.
® As a baseline data and to plan appropriate
nursing care.
I: I assess patient’s general condition by asking
how severe and the characteristics of pain.

2. Position patient in a comfortable position

such as semi Fowler’s.
® To reduce pain and make pt comfortable
I: I prop up patient’s bed in semi Fowler’s
position.

3. Monitor patient’s vital signs especially blood

pressure and pulse every 4 hourly.
® Increased blood pressure and pulse may
indicate patient is having pain.
I: I monitor patient’s blood pressure every 4
hourly.

4. Administer medication, IM Pethidine 50 mg

as ordered by doctor.
® To relieve pain.
I: I administer IM Pethidine 50mg as ordered by
doctor under the staff nurse’s supervision.

5. Advise patient to rest in bed.

® Excessive movement may increase the pain.
I: I advise patient to rest in bed.
6. Provide conducive environment for patient
such as switch on the air cond & quiet
environment.
® To enable patient to rest and comfortable.
I: I provide a conducive environment for patient
such as switch on the air cond and quiet
environment.

7. Inform doctor if patient’s pain still persist.

® For further management .
I: I not informed the doctor because patient’s
pain had reduced
Evaluation : Patient had minimal pain after 2
hours nursing interventions given.
Date : 15 June 2008
Time : 12.00 am

Supporting data : - Patient verbalized that she

had minimal pain.

Re-evaluation : Patient had no pain during

hospitalization.
Date : 17 June 2008
Time : 10.00 am

Supporting data : - Patient verbalized that she

had no pain.
Poor
intak
e
Date: 15th June 2008
Time: 11.00 pm

Diagnosis : Alteration in oral intake related

to vomiting
Supporting data: 1. Patient’s facial expression
look pale.
2. Patient complain that she
had poor intake for past
x 5/7

Goal: Patient’s intake will be increase in 1@ 2

days after nursing intervention given and
during hospitalization.
Nursing intervention :
1.Assess patient’s general condition e.g
lethargic and diet intake
® to act as baseline data and plan appropriate
nursing care
I: Observation, interview and assessment have
done to my patient

2.Encourage patient to take small amount of

food but frequently as tolerated
® to maintain body requirement and give
energy
I: I encourage patient to take small amount of
food but frequently
3. Explain to patient the importance of taking a
balance diet (e.g carbohydrate)
® to make patient understand that the of taking
balance diet and increase patient appetite
I: I advise the patient the importance of
carbohydrate which that can give patient energy.

4.Encourage patient’s family members to bring

patient’s favourite food from home.
® to increase patient’s intake
I: I encourage patient’s family members to bring
patient’s favourite food from home
5.Administer IV therapy e.g Dextrose saline
® to replace patient’s fluid and electrolyte
I: I’ve change the IV drip after the infusion empty.

6.Administer medication as prescribed by doctor.

e.g IV Zofran
® to stop patient’s vomiting,so that patient can eat.
I: I’ve help staff nurse to administer the medication
to patient

7.Inform doctor if patient’s intake still poor

® for further management
I: I’m not inform doctor because patient intake is
increased
Evaluation : Patient’s intake had improved after
nursing intervention given and
during hospitalization.

Date : 17 June 2008

Time : 9.00 am

Supporting data : i) Patient verbalized that her

appetite is increased.
ii) Patient able to complete 1
bowl of porridge.
Date: 15th June 2008
Time: 11 pm
Diagnosis : Alteration in comfort: vomiting related
to epigastric pain.

Supporting data: 1. Patient’s verbalized that she

had vomiting for x 5/7
2. Patient look weak and pale.

Goal: Patient’s vomiting will be reduces after 1-2

hours after nursing intervention and during
hospitalization.
Nursing intervention.
1. Assess patient’s general conditions such as
type, frequent and amount of vomiting.
® As a baseline data and to plan appropriate
nursing care.
I: I assess patient’s general condition by asking
the type,frequent and amount of vomiting.

2. Position patient in her desire position such as

semi Fowler’s.
® To make pt comfortable and easy if want to
vomit.
I: I prop up patient’s bed in semi Fowler’s
position.
3. Provide a vomit bowl to the patient.
® easy for patient to vomiting and no need go
to the toilet to vomit.
I: I gave a vomit bowl to the patient.

4. Advise patient to rest in bed

® To make pt rest and minimize movement
I: I advise patient to rest in bed

5. Provide conducive environment such as

switch on the air cond and free from bad
odor.
® to reduce patient from felt vomiting
I: I switch on the air cond and make sure room
free from bad odor.
6. Administer the medication as prescribed by
doctor (IV Zofran)
® to reduce patient from vomiting
I: I help the staff nurse to prepare and observe
staff nurse give medication to the patient.

7. Advise patient to increase fluid intake(H2o)

atleast 1-3L/day.
® to prevent dehydration
I: I inform patient to drink a lot of fluid of
water(H2o) atleast 1-3L/day.

8. Inform doctor if patient’s vomiting is still

persist.
® To plan further management and treatment.
I: I didn’t inform doctor because her vomiting is
reduced.
Evaluation : Patient’s vomiting is reduce after
nursing intervention given.
Date : 15 June 2008 Time : 1.00 am

Supporting data : - Patient verbalized that her

vomiting is reduced.

Re-evaluation : Patient had no vomiting after

nursing intervention given and
during hospitalization.
Date : 17 June 2008 Time : 10.00 am

Supporting data : - Patient verbalized that she no

vomiting
Date: 16th June 2008
Time: 8.00 am

Diagnosis : Alteration in emotional status: Anxiety

related to before going for diagnostic
procedure (OGDS).

Supporting data: 1. Patient’s facial expression

look anxious
2. Patient ask a lot of question
about procedure

Goal: Patient’s anxiety will be reduces after

nursing intervention given and before going for
diagnostic procedure.
Nursing intervention :
1.Assess patient’s general condition such as
level of anxiety and facial expression.
® to act as baseline data and plan appropriate
nursing care
I:I assess patient’s general condition such as
level of anxiety and facial expression.

2.Reinforce doctor’s explanation regarding

the procedure
® for better understanding
I: I reinforce doctor explanation regarding the
procedure
3.Monitor pt’s vital sign esp. BP and Pulse every
4 hourly
® high BP and Pulse indicates pt’s have anxiety
I: I monitor pt’s vital sign every 4 hourly and
before going for diagnostic procedure.

4.Explain to the pt regarding the procedure such

as pre and post procedure by using simple
word.
® to ensure pt is clear with the procedure
I: I gave explanation to the pt by using simple
word.
5.Encourage pt’s family member to stay with her
® for give moral support and to allay anxiety
I: I ask and encourage pt’s family member to stay
with her

6.Provide divertional therapy to the patient such as

switch on the television.
® to divert pt’s mind
I:I switch on the television

7.Encourage patient to ask question regarding the

procedure.
® to clear patient’s doubt
I:I encourage patient to ask question

8.Inform doctor if pt’s anxiety still persist

® for further management.
I:I didn’t inform doctor because pt’s anxiety is
reduced.
Evaluation : Patient’s anxiety is reduced
after nursing intervention given and
before going for procedure.
Date : 16 June 2008
Time : 9.00 am

Supporting data : i) Patient verbalize her

anxiety is reduced.
ii) Patient look more calm.
Date: 18th June 2008
Time: 9.00 am

Diagnosis :Knowledge deficit related to dietary

management and her disease.

Supporting data: 1. Patient verbalized that she

does not understand well
regarding about dietary
management and her disease.

2. Patient ask more question.

Goal: Patient’s knowledge will be increase after

explanation given and before discharged.
1. Assess patient and family members’ level of
knowledge.
® To assess the level of understanding of patient
and to plan how to give explanations to patient
and her family members.
I: I ask patient’s and family member’s about their
doubt.

2. Explain the causes, pathophysiology, clinical

manifestation and the complication to patient
and family members.
® So that patient understand more about the
disease.
I: I explain the causes, pathophysiology, clinical
manifestation and the complication to patient
and family members.
3. Explain to patient by using simple words and
language.
® So that easy for patient to understand.
I: I explain to patient by using simple words and
language.

4. Explain the importance of taking the medications

and the side effects to patient.
® So that patient will take her medications on time.
I: I explain the importance of taking the medications
and the side effects to patient.
5. Advise patient to avoid any food that cause
irritating the stomach e.g fatty and spicy food.
® To prevent from recurrence disease.
I: I advise patient to avoid any food that cause
irritating the stomach

6. Instruct patient report to doctor immediately if

got any recurrence of disease.
® To prevent any complication.
I: I instruct patient report to doctor immediately if
got recurrence of disease.
7.Advise patient to take meal regularly at frequent
intervals of about 3 hours.
® To maintain the buffering action of food in the
stomach.
I: I advise patient to take meal regularly at
frequent intervals of about 3 hours.

8. Emphasis the importance of follow up.

® To monitor patient’s well being.
I: I emphasis the importance of follow up to
patient.
9. Encourage patient and family members to ask
questions.
® So that every query will be clarified.
I: I encourage patient and family members to ask
questions

10. Encourage patient and family members to

explain about the information
® To evaluate their understanding and to
ensure that they understand.
I: I encourage patient and family members to
explain about the information given.
Evaluation : Patient’s knowledge is increased
before her discharged.
Date : 18 June 2008
Time : 12.30 pm

Supporting data : i) Patient’s able to re-explain

what I had told to her.
ii) Patient verbalize that
knowledge she got is
important for her to carry
out her life after discharge.
• Diet

• Medication

• Lifestyle

• Exercise

• Follow up
Diet
-I encourage patient to drink 6-8 glasses or 1.5-3
liters/day.
-I advise patient to take balance diet such as eat high
fiber food to promote healing process of ulcer (fruit &
vegetable) it also to reduce of amount of
inflammation in lining of the stomach.
-I advise patient to avoid any food that cause irritating
(spicy,acidic,fried and fatty)
Medication
-I advise patient to take medication as prescribed by
doctor on time.
- I also explained to the patient about the purpose and
side effect of medication.
Lifestyle
-I advise patient to change the lifestyle to avoiding the
long-term use of irritants (aspirin, anti-inflammatory
drugs, coffee, and alcohol) will go a long way to
preventing gastritis and its complications like an
ulcer.
- Besides that I also advise patient to take regular meals
to avoid recurrence of the disease. I advised her to
avoid taking food that contains caffeine and spicy
food. These food will stimulate the secretion of acid.
Exercise
- I advise patient do regular exercise at least 3
times/week such as stress reduction through
relaxation techniques including yoga, tai chi, and
meditation that can also be quite helpful.
Follow up
- I emphasis to her the importance of follow up. I also
remind her the date to come to hospital for follow up
and also come to see the doctor when she is having
gastric pain.
My patient Mrs. C was discharged by Dr S on
18th,June 2008, she looked well and cheerful
because the pain was tolerable.
She went home accompanied by her parents
with TTA :-

- Tab. Nexium 40 mg bd
- Tab. Ganaton 50mg tds
- Syrup Gaviscon Advance 10ml tds

Mrs. C was given medical certificate for her

leave and appointment card written date for
follow up on 27 June 2008 at Dr S clinics.
 Mrs. C come to follow up at Dr S clinic
accompany by her parents on 27 June 2008
@ 1500 hours. She looked more healthy and
cheerful. Dr was done do the ultrasound
abdomen on her and said everything normal.
Lastly, Dr S was prescribed some medication
to her :-
• Tab Klacid 500mg bd
• Tab Ammoxicillin 1000mg bd
• Tab Nexium 40mg bd
Mrs. C was advised to come again when if
necessary.
 Mrs C was admitted to ISH on the 15th June 2008
at 10.50pm.During her admission, she was accompanied
by her family members and the nurse from A&E
department .
After he was examined by Dr. S, she was diagnosed as
Acute gastritis. Dr. S had ordered the blood investigation
FBC, Amylase, SGOT,SGPT. Dr. S also ordered the
diagnostic procedure (OGDS) for my patient
on 16th June 2008. Dr. S had also prescribed some
medications for the patient.
 My patient was discharged on 18th June
2008 with TTA as ordered by doctor. Before
she left, I’ve given her health educations
regarding her disease, medications and how to
take good care of herself to prevent recurrence.
Before she left, she also thanked all the staffs
who had take good care of her.
• Mike Walsh,(2002) Watson’s Clinical Nursing and Related
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• Suzanne C.Smeltzer, Brenda G.Bare,Janice L. hinkle & et al
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• Elizabeth A.Martin MA,(2005) Dictionary of
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