Textbook of chronic gastritis

Nursing of patients with chronic gastritis

Chronic gastritis is a cause of gastric mucosa inflammation caused by a variety of causes, which is closely related to HELICobacter pylori infection. China is a country with high infection rate of Helicobacter pylori, so the incidence of chronic gastritis ranks first among all kinds of gastric diseases. This disease is more male than female, and the incidence increases with age. If the inflammatory cell infiltration of chronic gastritis is only in the surface layer of mucosal lamina propria and the gland is not damaged, it is called chronic superficial gastritis. If the glands involved in the stomach atrophy and disappear, the gastric mucosa becomes thinner, known as chronic atrophic gastritis; If the adenocarcinoma cells of the stomach occur intestinal adenocarcinoma or pseudopyloric adenocarcinoma, hyperplasia, hyperplasia of the epithelium and intestinal epithelium abnormal development, the formation of moderate or more atypical hyperplasia, known as precancerous lesions.

[Nursing assessment]
 Health history
1. Helicobacter pylori infection is the main cause of chronic gastritis.
2. Autoimmune response is dominated by atrophy of the gastric body and fundus mucosa rich in parietal cells.
3. Physical and chemical factors such as smoking, strong tea, liquor, coffee, too cold, overheat, coarse food, medicine and so on.
4. Other factors include diet, environment, age and so on.

helicobacter pylori infection Helicobacter pylori is a unipolar, multi-flagellated, terminal blunt round, spirally curved bacteria, gram negative, dynamic. Studies have shown that Helicobacter pylori has a strong motor ability in a sticky environment, and strong dynamic performance is an important factor in its pathogenesis. After helicobacter pylori in the stomach, with the aid of bacteria on the side of the flagellum is powered through the mucus layer, reach the surface of the epithelium, with epithelial cells by adhesion factor firmly together, avoid with food by gastric emptying, secretion and superoxide dismutase (SOD) and catalase, to protect it from damage effect of neutrophils. Helicobacter pylori is rich in urease, which hydrolyzes urea to produce ammonia, forming an "ammonia cloud" protective layer around the bacteria to resist the killing effect of gastric acid. Helicobacter pylori infection is a major risk factor for chronic gastritis, peptic ulcer, gastric mucosa-associated lymphoid tissue lymphoma and gastric cancer.

Clinical manifestations
The course of chronic gastritis is prolonged and progresses slowly. Most patients have no symptoms or varying degrees of dyspepsia, which is manifested as abdominal fullness and discomfort, irregular abdominal pain, loss of appetite, acid reflux, belching, etc. Autoimmune gastritis patients can accompany pernicious anemia, glossitis.
  Laboratory and other examinations
1. Gastroscopy is the most reliable method of diagnosis.
(1) Chronic superficial gastritis: erythema, rough and uneven mucosa, bleeding spots, mucosal edema, exudation and other manifestations can be seen.
(2) Chronic atrophic gastritis: the mucosa is red and white, the blood vessels are exposed, the color is dark, the folds are small, or the mucosa is granular or nodular.
2. Other tests for Helicobacter pylori and autoimmune gastritis are helpful for diagnosis.

 Psycho-social status
Chronic gastritis symptoms are not typical, repeated, long course of disease, easy to make patients anxious, emotional instability, and even fear.
  Main points of treatment
Helicobacter pylori eradication, removal of other possible pathogenic factors, symptomatic treatment.

[Common Nursing Diagnosis/Questions]
1. Malnourishment: lower than the body's requirements and loss of appetite, indigestion and absorption.
2. Lack of knowledge: lack of knowledge about the etiology and prevention of this disease.
[Nursing measures]
  malnutrition: lower than the body's requirements
1. Rest and activity In acute episodes, rest in bed. Recovery period, life should be regular, appropriate exercise, promote appetite, enhance physical fitness, avoid overwork.
2. diet
(1) During the acute episode, the patient should be given a slag free, semi-liquid warm diet. If the patient has a small amount of bleeding, milk and rice soup can be given to neutralize gastric acid, which is conducive to mucosal repair.
(2) When severe vomiting and hematemesis, fasting and intravenous nutrition should be carried out.
(3) Give high calorie, high protein, high vitamin, easy to digest diet during the recovery period, avoid eating harsh, too cold, too hot, too salty, too sweet, spicy and other irritating food. Regular meals, a small number of meals, eat slowly, avoid overeating, smoking cessation and alcohol.
(4) When gastric acid is lacking, thick broth, chicken soup, hawthorn and vinegar are given to stimulate gastric acid secretion. To gastric acid much patient should avoid acid, adipose food.

1. Assess the nutritional status of the patient, observe and record the number, amount and type of meals every day, and know whether the daily nutrition intake can meet the needs of the body. Measure your weight regularly and monitor the changes of your nutritional indicators.

Health education
1. Etiological knowledge guidance helps patients find and avoid etiological factors.
(1) To avoid helicobacter pylori infection: people are the only source of infection of Helicobacter pylori, mainly through the oral-oral or faecal-oral way of transmission, to help patients develop good health habits.
(2) Avoid rough, irritating diet and drugs that damage gastric mucosa. For those who are addicted to tobacco and alcohol, they should be advised to abstain.
2. Psychological counseling comfort patients, informed of the cause of the disease, disease process and outcome, that after regular treatment can be improved, even if it is atypical hyperplasia, through close follow-up can also be found early cancer, early surgery. Make the patient relaxed, emotional stability, eliminate fear.
3. Take medicine as directed
(1) Let the patient understand the purpose of treatment, medication method, drug effect, so as to actively cooperate with the treatment.
(2) Chronic gastritis caused by Helicobacter pylori infection should be treated with sterilization as advised by the doctor. Commonly used triple therapy, drug usage and nursing measures refer to the fourth section of this chapter "nursing of patients with peptic ulcer" related content.
(3) According to the cause of the disease according to the doctor's advice to give corresponding treatment. ① The patients with bile reflux were adsorbed with aluminum hydroxide gel and treated with gastric mucosa protector. ② Because of taking drugs or other stimulating diet caused, should stop immediately, if necessary, with gastric acid inhibition drugs and gastric mucosa protection drugs. ③ When there is dyspepsia, domperidone or cisapride and other gastrointestinal motility drugs can be used to accelerate gastric empelling. Gastrointestinal motility drugs should be taken before meals and should not be combined with atropine and other spasmolysis drugs.
(4) Patients with pernicious anemia may be injected with vitamin B12 as advised by the doctor.
(5) When abdominal pain, local hot compress, massage, acupuncture or analgesic drugs should be given to relieve the pain according to the doctor's advice.
4. Observe the patient to observe abdominal pain and other digestive tract symptoms, pay attention to whether there is hematemesis, black stool and other conditions.

reflection question

The patient, male, 45 years old, had recurrent epigastric distension, acid reflux and belching, loss of appetite, etc., in the past two years. He was addicted to alcohol and coffee. The above symptoms were aggravated two days ago. The examination showed no abnormal vital signs, emaciation, fecal occult blood test (+), gastric mucosal blood vessels revealed by gastroscopy, dark color, tiny folds, positive helicobacter pylori test. Preliminary diagnosis is: chronic superficial gastritis.
1. What is the cause of the patient's gastritis? How to avoid it?

2. How to guide him on diet?
3. How can he be treated and cared for as prescribed by the doctor?