THEORETICAL BACKGROUND

OF ACUTE GASTRITIS

IN KASUARI’S WARD IDAMAN BANJARBARU HOSPITAL

By

MUTIA ADELINE

1614401110053

UNIVERSITY OF MUHAMMADIYAH BANJARMASIN

INTERNATIONAL CLASS OF NURSING DIPLOMA PROGRAM

ACADEMIC YEAR 2017/2018

 ADVISOR’S APROVAL

Name : Mutia Adeline

SRN : 1614401110053

Ward/Hospital : Kasuari/Idaman Hospital Banjarbaru

Theoretical Background’s Title : Theoretical Background of Acute Gastritis

Nursing Care Report’s Title : Nursing Care Report on Ms. B with Acute Gastritis
Medical Diagnose in Kasuari Ward Idaman Hospital
Banjarbaru

Has completed all reports of basic nursing stages in this ward

Banjarmasin, February , 2018

Student

(Mutia Adeline)

Known By

Advisor CI Advisor CT

(Agustina R.A, S.Kep) (Zaqyyah Huzaifah, M.Kep, Ns)

NIP: 198708032010012009 NIK: 01.24121984.059.002.011

 THEORETICAL BACKGROUND

OF ACUTE GASTRITIS

A. CONCEPT OF DISEASE
1. Anatomy and Physiology Overview

The stomatch is located at the top left of the abdomen just below the diaphragm. In the
empty state of the J-shaped hull, and when full, it is shaped like a giant avocado. Anatomically
the stomach is divided into fundus, body and antrum pyloric or pylorus. The upper right side
of the stomach is a small curvature curve, and the lower left portion of the stomach is a major
curvatura (Figure 1).

The normal capacity of the stomach is 1 to 2 L (Lewis, 2000). The volume of the
stomach will increase at mealtime, and decreases as the stomach fluid enters the small
intestine. When the stomach is relaxed (empty), the mucosa enters the crease called rugae
(Figure 1). Rugae is a temporary place of gastric enlargement. When the stomach is filled the
rugae narrows and when the stomach is full the rugae disappears (Simon, 2003).

Figure 1. Stomatch structure

The digestive and motor function of the hull is summarized in Table 1. The motor
function consists of storage, mixing, and discharging of the stomach fluid (kimus / food mixed
with gastric secretions) to the duodanum.
 TABLE 1. STOMATCH PHYSIOLOGICAL SUMMARY
MOTOR FUNCTION
Reservoir Store food until the food is
function gradually digested and
moves in the gastrointestinal
tract.
Adjust the volume increase
without increasing pressure
with smooth muscle
receptive relaxation;
mediated by the vagus nerve
and stimulated by gastrin.
Mixing Break food into small
function particles and mix it with
gastric juices through
muscle contractions that
surround the stomach. The
peristaltic contraction is
governed by a basic
intrinsic electrical rhythm.
Gastric It is regulated by the
emptying opening of the pyloric
function sphincter affected by
viscosity, volume, acidity,
osmotic activity, physical
state, as well as by
emotions, drugs, and work.
Gastric emptying is
governed by nerve and
hormonal factors.
2. Definition
Acute gastritis is an acute inflammation of the gastric mucosal surface with erosive
damage to the superficial. Many factors can cause acute gastritis, including some drugs,
alcohol, bacteria, viruses, fungi, acute stress, radiation, allergies or intoxication from food and
beverages, bile salts, ischemia and direct trauma.
DIGESTIVE FUNCTION
Protein The digestion of
digestion proteins by pepsin and
secretion and HCI
begins here; digestion
of carbohydrates and
fats by amylase and
small gastric deformity
lipase role
Synthesis Synthesis and release
and of gastrin is influenced
release of by edible proteins,
gastrin antrum stretching,
alkaline alkalinization,
and vagal stimulation.
Secretion Intrinsic factor
of secretion allows the
intrinsic absorption of vitamin
factors B2 from the distal
intestine.
Secretion Mucus secretions form
of mucus a shell that protects the
stomach and serves as
a lubricant so that food
is more easily
transported.
 Drugs, such as NSAIDs / Non-steroidal anti-inflammatory drugs (indomethacin,
ibuprofen, salicylic acid), sulfonamides, steroids, cocaine, chemotherapy agents
(mitomycin, 5-fluoro-2-deoxyuridine), salicylates and digitalis, are also involved in
irritating the gastric mucosa (Gelfand, 1999).
 Alcoholic beverages, such as whiskey, vodka, and gin (Kang, 1995).
 Bacterial infections, such as: H pylori (most frequent), H heilmanii, Streptococci,
Staphylococci, Proteus species, Clostridium species, E coli, Tuberculosis,
Secondary syphilis (Andersen, 2007).
 Viral infections by cytomegalovirus (Giannakis, 2008).
 Fungal infections, such as: Candidiasis, Histoplasmosis, and Phycomycosis
(Feldman, 1999).
 Physical stress caused by burns, sepsis, trauma, surgery, respiratory failure, renal
failure, central nervous system damage, gastrointestinal reflux (Lewis, 2000).
 Irritant food and drinks. Seasoned food and beverages with caffeine and alcohol
content, are the causes of irritant gastric mucosa (Price, 1996).
 Bile salts occur in bile salt reflux conditions (an important component of alkali for
the activation of gastrointestinal enzymes) from the small intestine to the gastric
mucosa thus causing a mucosal inflammatory response (Mukherjee, 2009).
 Ischemia, this is associated with a decrease in blood flow to the stomach (Wehbi,
2009).
 Direct trauma to the stomach, associated with an aggressive balance and defense
mechanisms to maintain mucosal integrity give rise to a combat response to the
gastric mucosa (Wehbi, 2009).
3. Pathway

4. Supporting Investigation/Diagnostic
 Endoscopy: will appear multi erosion that some are usually bloody and scattered.
 Examination of Hispatology: will appear mucosal damage because the erosion
never passes through the muscular mucosa.
 Radiology examination.
 Laboratory examination.
 Gaster analysis: to determine the level of HCL secretion, HCL secretion decreases
in the client with chronic gastritis.
 Levels of vitamin B12 serum: Normal value 200-1000 Pg / ml, low vitamin B12
levels is megalostatic anemia.
 Levels of hemagiobi, hematocrit, platelets, leukocytes and albumin.
  Gastroscopy. To know the mucosal surface (change) identify the area of bleeding
and take tissue for biopsy.
 EGD (Esofago Gastriduo Denoscopy): Key diagnostic test for upper GI bleeding,
done to see bleeding / degree of tissue ulcers / injury.
 Angiography: GI vascularization can be seen if the endoscope can not be inferred
or can not be performed. Shows the circulation of the cholesterol and possible
contents of the bleeding.
 Serum amylase: increased with duodenal ulcer, low grade suspected gastritis
(Doengoes, 1999, p. 456).

5. Medical Management

Acute gastritis usually resolves when the causative agents are removed. Medical
interventions made when the complaint is not lost by avoiding the causative agent are by
pharmacological therapy including fluid therapy and drug therapy (Wehbi, 2008).

a. Liquid therapy. This is given in the acute phase for excessive post-vomiting
hydration.
b. Drug therapy.

Prinsive therapy, including:

 There is no specific cure for cure except for Helicobacter pylori infection
(Santacroce, 2008).
 Provision of therapy in accordance with known factors, such as tuberculosis
then get OAT (Anti-Tuberculosis drug) which is adjusted with the protocol of
administration from the MOH RI.
 Provision of pharmacological drugs tailored to the conditions and tolerance of
clients.

Pharmacological drugs, including:

 Antacids. Used for group profiles in general. Antacids contain aluminum and
magnesium that can help decrease gastritis complaints by neutralizing stomach
acid.
 H2 Inhibitor. This agent has a mechanism as it inhibits histamine receptors.
Histamine is believed to have an important role in gastric acid secretion. H2
inhibitors will effectively suppress stomach acid expenditure and stimulate the
release of acid by food from the nervous system. Some agents of this agent
include cimetidine, ranitidine, famotidine and nizatidine. Cimetidine is very
 effective when administered intravenously while ranitidine is more effective
when used orally on an empty stomach with the effect of decreasing the
secretion of acid production, accelerating gastric emptying and balancing
hydrogen concentration.
 Proton pump inhibitors. This agent inhibits proton pumps such as enzymes,
H +, K + -ATPase, which are located within the apical membrane scretory of
gastric acid (parietal cell) stomach cells. This agent has the ability to inhibit
acid production with long duration. These agents include omeprazole (Kee,
1996).
 Antibiotics. This agent is used in gastritis of bacterial infections, such as
Helicobacter pylori. Some antibiotic agents are recommended such as oral
amoxicillin, oral tetracycline, oral metronidazole.

B. NURSING CARE PLAN

1. Assessment
a. Nursing history
 Main complaint
Usually clients come with pain complaints on epigastrium, nausea,
vomiting, anorexia and dizziness.
 History of current disease
In acute gastritis is usually accompanied by a history of food poisoning
drinks. Decreased awareness level, vomiting, weak pulse tachycardia, rapid
breathing and severe pain in the entire abdomen, pain in the esophagus,
tongue burns. There may also be an increase in intestinal peristalsis,
diarrhea or melena.
 History of previous disease
Includes disease-related diseases now, hospital history, and history of drug
use.
b. Physichal examination
 General situation: Looking painful on physical examination there is
tenderness in the epigastric quadrant.
 B1 (breath): Thakipnea
 B2 (blood): Tachycardia, hypotension, dysrhythmias, weak peripheral
pulse, slow peripheral fill, pale skin color.
 B3 (brain): Headache, weakness, level of consciousness can be disturbed,
disorientation, pain epi gastrum.
 B4 (bladder): Oliguria, fluid balance disorder.
  B5 (bowel): Anemia, anorexia, nausea, vomiting, heartburn, intolerant
spicy food.
 B6 (bone): Weakness, fatigue.
c. Supporting Investigation/Diagnostic
 Endoscopy: will appear multi erosion that some are usually bloody and
scattered.
 Examination of Hispatology: will appear mucosal damage because the
erosion never passes through the muscular mucosa.
 Radiology examination.
 Laboratory examination.
 Gaster analysis: to determine the level of HCL secretion, HCL secretion
decreases in the client with chronic gastritis.
 Levels of vitamin B12 serum: Normal value 200-1000 Pg / ml, low vitamin
B12 levels is megalostatic anemia.
 Levels of hemagiobi, hematocrit, platelets, leukocytes and albumin.
 Gastroscopy. To know the mucosal surface (change) identify the area of
bleeding and take tissue for biopsy.
 EGD (Esofago Gastriduo Denoscopy): Key diagnostic test for upper GI
bleeding, done to see bleeding / degree of tissue ulcers / injury.
 Angiography: GI vascularization can be seen if the endoscope can not be
inferred or can not be performed. Shows the circulation of the cholesterol
and possible contents of the bleeding.
 Serum amylase: increased with duodenal ulcer, low grade suspected
gastritis (Doengoes, 1999, p. 456).

2. Nursing Diagnosis

Diagnosis 1: Deficient fluid volume related to active fluid volume loss.

Diagnosis 2: Imbalance nutrition: less than body requirtments related to anorexia, nausea and
vomiting.

Diagnosis 3: Impaired comfort related to epigastric pain.

3. Nursing Intervention

Diagnosis 1: Deficient fluid volume related to active fluid volume loss.

Goals: After getting treatment for 3 days the fluid and electrolyte client balance will balance
again

After being given nursing care for 3x24 expected fluid and electrolyte client balance with
result’s criteria:

NOC Label>> Fluid Balance

 Turgor elastic skin (scale 5)

 Intake and balanced fluid output (scale 5)
 Moist mucus membrane (scale 5)

NOC label >> Vital sign

Vital signs of clients in normal range (BP: 120/80 mmHg, RR: 15-20 x/minutes, HR: 60-100
x/minutes, client temperature 36.5-37,5o C)

INTERVENTION
NIC Label >> Electrolyte Monitoring
1. Identify possible causes of electrolyte
imbalance
2. Monitor for fluid and electrolyte loss
3. Monitor the presence of nausea,
vomiting and diarrhea
NIC Label >> Fluid Management
1. Monitor hydration status (mucous
membrane, orthostatic pressure, pulse
strength)
2. Monitor the accuracy of intake and
fluid output
3. Monitor vital signs
4. Monitor IV therapy
NIC Label >> Vital Signs Monitoring
Monitor client’s vital sign
RATIONALE
1. Know the cause to determine the
settlement intervention
2. Know the general state of the client
3. Reduce the risk of voume fluid
deficiency is increasing
1. Know the progress of rehydration
2. Evaluation of interventions
3. Know the general state of the client
4. Optimal rehydration
To know the client’s vital sign

Diagnosis 2: Imbalance nutrition: less than body requirtments related to anorexia, nausea and
vomiting.

Goals: After getting treatment for 3 days the nutrition will balance again.
After done nursing care for 3 × 24 hours expected fulfillment of client requirement fulfilled
with result’s criteria:
NOC Label >> Nutritionl status
 Sufficient nutrition intake.
 Adequate food and fluid intake
NOC Labels >> Nausea and vomiting severity
 Decreased intensity of nausea vomiting
 Decreased frequency of nausea and vomiting.
NOC Labels >> Weight: Body mass
Clients experience weight loss

INTERVENTION RATIONAL
NOC Label >> Nutritionl status 1. An important assessment is conducted
1. Determine client’s nutritional status to determine the nutritional status of
and ability to meet nutrition needs the client so as to determine the
2. Instruct client about nutritional needs intervention given.
(i.e., discuss dietary guidelines and 2. To help meet the nutritional needs of
food pyramids) the client.
3. Assist client in determining guidelines 3. The information provided can
or food pyramids (e.g, vegetarian food motivate the client to improve the
pyramid, food guide pyramid, and nutritional intake.
food pyramid for seniors over 70)
most suited in meeting nutritional
needs and preferences

NOC Labels >> Nausea and vomiting 1. It is important to know the

severity characteristics of nausea and the
1. Perform complete assessment of factors that cause nausea. If the
nausea, including frequency, duration, characteristics of nausea and causing
severity, and precipitating factors, factors of nausea are known then it
using such tools as self-care journal, can determine the intervention given.
visual analog scales, duke descriptive 2. Eating little by little can increase the
scales, and rhodes index of nausea nutritional intake.
and vomiting (INV) form 2
2. Encourage eating small amounts of
food that are appealing to the
nauseated person
NOC Labels >> Weight: Body mass 1. Helps to choose an adequate nutrition
1. Discuss with individual the fulfillment option.
 relationship between food intake, 2. Weighing can monitor the
exercise, weight gain and weight loss improvement and nutritional status.
2. Encourage individual to chart weekly
weights, as appropriate

Diagnosis 3: Impaired comfort related to epigastric pain.

Goals: After getting treatment for 3 days the problem of pain relief pain is overcome

After getting treatment for 3x24 hours, pain relief problem can be overcome with result’s
criteria:

NOC Label >> Pain Level

 The frequency of client pain decreases

 The client does not seem to wince

NOC Tags >> Comfor Status: Physical

 Client can control the symptoms

 Relaxation of the client muscle
INTERVENTION RATIONAL
NIC label: Pain Management 1. Reduce the scale of pain felt by the client
1. Ensure that clients get the analgesic 2. Prevent client pain getting worse
appropriately 3. Provide techniques to deal with pain in the
2. Exploring factors that can aggravate client
clients' pain
3. Teach the principles in managing pain
NIC label: Environmental Management 1. Provide a comfortable temperature for the
Comfort client more relaxed
1. Set the room temperature at a comfortable 2. Prevent the emergence or worsen the bad
temperature for the client feeling of discomfort to the client
2. Reduce the things that can interfere with
the client's convenience
 REFERENCE

Corwin, Elizabeth J. 2009. Buku Saku Patofisiologi Edisi 3. Jakarta : EGC

Broker. 2009. Ensiklopedia Keperawatan. Jakarta :EGC.
Mansjoer, Arief . 2010. Kapita Selekta Kedokteran Edisi 4. Jakarta : Media.

Muttaqin, Arif & Kumala Sari. 2009. Gangguan Gastrointestinal: Aplikasi Asuhan

Keperawatan Medikal Bedah. Jakarta: Salemba Medika.

Robbins. 2009. Manajemen kesehatan. Jakarta: Gramedia.

Suratun, Lusniah. 2010. Asuhan Keperawatan Klien Dengan Diagnosa Ganguan Sistem
Gastritis. Jakarta: Trans Info Media.

Advisor CT Advisor CI

(Zaqyyah Huzaifah, M.Kep, Ns) (Agustina R.A., S.Kep)