Assessment and Possible Nursing Diagnosis for Gastritis

Nursing care Plamn for Gastritis

Assessment

1. Activity / Rest
Symptoms : weakness, fatigue.
Signs : tachycardia, tachypnea / hyperventilation (in response to activity)

2. Circulation
Symptoms : hypotension, tachycardia, dysrhythmias (hypovolemia / hypoxemia), weakness / weak peripheral pulse, capillary refill underlayer / slowly (vasoconstriction), color : pale, cyanosis (depending on the amount of blood loss), weakness of skin / mucous membranes = sweating.

3. Ego integrity
Symptoms : acute or chronic stress factors, feeling helpless.
Sign : a sign of anxiety.

4. Elimination
Symptoms : history of previous hospitalization due to bleeding gastroenteritis (GI) or problems related to GI, eg peptic ulcer, gastritis, gastric surgery, gastric irradiation area. Altered bowel habit / characteristic feces.
Signs : abdominal tenderness, distention.
Bowel sounds : often hyperactive during bleeding, hypoactive after hemorrhage. Characteristics of stool : diarrhea, blood dark, brownish or sometimes bright red, frothy, foul odor (steatorrhoea). Constipation can occur (changes in diet, use of antacids).
Urine output : decreased, concentrated.

5. Food / Fluid
Symptoms : Anorexia, nausea, vomiting (throwing up that extends beyond the suspected pyloric obstruction in connection with duodenal injury).
Swallowing problems : hiccups
Heartburn, belching sour smell, nausea / vomiting
Signs : vomiting : coffee color dark or bright red, with or without blood clots.
Dry mucous membranes, decreased mucous production, poor skin turgor (chronic bleeding).

6. Neuro sensory
Symptoms : a sense of throbbing, dizziness / light headaches, weakness.
Mental status : the level of consciousness may be impaired, range from somewhat inclined to sleep, disorientation / confusion, fainting and coma until (depending on the volume of circulation / oxygenation).

7. Pain / Leisure
Symptoms : pain, described as sharp, shallow, burning, tingling, sudden severe pain can be accompanied by perforation. Sense of discomfort / distress faint after eating a lot
and lost by eating (acute gastritis). Epigastric pain left until the middle / back or spreading to occur 1-2 hours after eating and relieved by antacids (gastric ulus). Pain epigastrum left until / or spreads to the back occur approximately 4 hours after eating when the stomach is empty and relieved by food or antacids (duodenal ulcer). There was no pain (esofegeal varices or gastritis).
Precipitating factors : food, cigarettes, alcohol, use of certain drugs (salicylates, reserpine, antibiotics, ibuprofen), psychological stressors.
Signs : wrinkled face, be careful in the area of pain, pallor, sweating, narrowed attention.

8 Security
Symptoms : allergies to medications / sensitive eg : ASA
Signs : an increase in temperature, spider angioma, palmar erythema (indicating cirrhosis / portal hypertension).

9 Guidance / Learning
Symptoms : the use of prescription drugs / OTC containing ASA , alcohol , steroids . NSAIDs cause GI bleeding. Complaints can be accepted at this time because (eg anemia) or diagnoses unrelated (eg, head trauma), intestinal flu, or episodes of severe vomiting. Long health problems eg cirrhosis, alcoholism, hepatitis, eating disorders (Doengoes, 1999, p : 455).


Possible Nursing Diagnosis for Gastritis

1. Risk for Fluid and Electrolyte Imbalance related to inadequate intake, vomiting.

2. Imbalanced Nutrition Less than Body Requirements related to inadequate intake, anorexia.

3. Pain ( acute / chronic ) related to inflammation of the gastric mucosa.

4. Activity Intolerance related to physical weakness.

5. Knowledge Deficit : about diseases related to lack of information.