Chapter 47

Management of Patients With

Gastric and Duodenal Disorders

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Gastritis

• Inflammation of the stomach

• A common GI problem
• Acute versus Chronic

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Erosive Gastritis

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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

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Nursing Process: The Care of the Patient
With Gastritis—Diagnoses
• Anxiety
• Imbalanced nutrition
• Risk for fluid volume imbalance
• Deficient knowledge
• Acute pain

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Nursing Process: The Care of the Patient
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

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Medical Management of Gastritis
• Acute
– Refrain form 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
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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
• Manifestations

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Nursing Process: The Care of the Patient
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
• Abdominal assessment

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Nursing Process: The Care of the Patient
With Peptic Ulcer—Diagnoses
• Acute pain
• Anxiety
• Imbalanced nutrition
• Deficient knowledge

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

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Nursing Process: The Care of the Patient
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

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Patient Education

• Medication education
• Dietary restrictions
• Lifestyle changes

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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

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Obesity Management

• Lifestyle modifications
• Pharmacotherapy
• Bariatric surgery

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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

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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
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Collaborative Problems and Potential
Complications
• Hemorrhage
• Bile reflux
• Dumping syndrome
• Dysphagia
• Bowel or gastric outlet obstruction

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Gastric Cancer
• Incidence is deceasing, but accounts for more than 10,000
deaths in U.S. annually
• Risk factors
• Manifestations
• Treatment is surgical removal of the tumor if possible, and
palliative care if the tumor is unresectable or metastasized

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Nursing Process: The Care of the Patient
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

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Nursing Process: The Care of the Patient
With Gastric Cancer—Diagnoses
• Anxiety
• Imbalanced nutrition
• Pain
• Anticipatory grieving
• Deficient knowledge

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Nursing Process: The Care of the Patient
With Gastric Cancer—Planning

• Major goals include reduced anxiety, optimal nutrition,

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

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Nursing Process: The Care of the Patient
With Gastric Surgery—Assessment
• Patient and family knowledge
• Nutritional status
• Abdominal assessment
• Postoperatively assess for potential complications

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Nursing Process: The Care of the Patient
With Gastric Surgery—Diagnoses

• Anxiety
• Pain
• Deficient knowledge
• Imbalanced nutrition

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Collaborative Problems and Potential
Complications
• Hemorrhage
• Dietary deficiencies
• Bile reflux
• Dumping syndrome

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Nursing Process: The Care of the Patient
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

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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’s position
– Maintain function of NG tube
• Patient education
• Individualized nutritional care and support

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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
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Care and Prevention of Complications
• Dumping syndrome
– 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

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Dietary Self-Management
• To delay stomach emptying and dumping syndrome,
assume low Fowler’s 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
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