Chronic gastritis in children nursing care. Present and potential problems in chronic gastritis. Principles of treatment. Care. The complex of rehabilitation measures includes

Content
Introduction………………………………………………………………………..3
1. Etiology and pathogenesis……………………………………………………...4
2. Types of gastritis……………………………………………………………...5
3. Clinical picture……………………………………………………….6
4. Treatment of chronic gastritis………………………………………………7
5. The role of the nurse in the rehabilitation of patients……………………………...10
6. Algorithm for the actions of a nurse when collecting urine according to Zimnitsky………13
Conclusion…………………………………………………………………….15
Literature………………………………………………………………………..16

Introduction
Chronic gastritis (CG) is a chronic inflammation of the gastric mucosa, with a restructuring of its structure and progressive atrophy, characterized by a disorder of secretion, motility and food evacuation.
50% of the population suffers from chronic gastritis and only 10-15% go to the doctor. The disease is not harmless, because. as a result, malabsorption of a number of nutrients required by the body develops.
Anemia often develops because the stomach stops producing a factor involved in hematopoiesis. In addition, against the background of atrophic gastritis, tumors of the stomach can develop.
Classification of chronic gastritis.
Adopted by the International Congress in Sydney in 1990.
Distinguish gastritis:
by etiology - associated with Helicobacter pylori, autoimmune;
by localization - pangastritis (common), antral (pyloroduodenal), fundal (stomach body);
according to morphological data (endoscopically) - erythematous, atrophic, hyperplastic, hemorrhagic, etc.;
by the nature of juice secretion - with preserved or increased secretion, with secretory insufficiency.
Chronic gastritis is a gradually progressive disease.

The pathogenetic essence of chronic gastritis is: damage to the gastric mucosa by Helicobacter pylori or another etiological factor, dysregulation of its regeneration processes, changes in the regulation of gastric secretion, microcirculation disorder, motor function, immunological disorders (characteristic of atrophic and autoimmune gastritis).

2. Types of gastritis
Type A gastritis (endogenous, autoimmune gastritis). Endogenous gastritis occurs due to the production of autoantibodies to the lining cells of the stomach. This variant of gastritis is characterized by primary atrophic changes localized in the bottom and body of the stomach, a decrease in gastric secretion, an increase in the content of gastrin in the blood.
Type B gastritis. HP - associated gastritis. It has been proven that the pathogenesis of type B chronic gastritis is based on persistent HP infection, which is confirmed by the fact that this microorganism is found in the pyloric region in the vast majority of patients. The route of infection is oral with food or during endoscopic manipulations, probing.
Type C gastritis (reactive, chemical gastritis, reflux gastritis). A decisive role in the pathogenesis of gastritis C is played by duodenogastric reflux with the reflux of bile acids that disrupt the coolant and damage the epithelium (reflux gastritis). Among other causes of this variant of gastritis, NSAIDs (acetylsalicylic acid, etc.) occupy a leading position. Due to the antiprostaglandin effect of NSAIDs, the production of bicarbonates and mucus is blocked by the subsequent formation of erosions, impaired microcirculation

3. Clinical picture
For any form of gastritis, the main syndromes are characteristic.
Pain syndrome - occurs in 80-90% of patients with chronic gastritis. Usually the pain is localized in the epigastric region.
Gastric dyspepsia is a constant gastritis syndrome. Symptoms: appetite disorders, belching, heartburn, nausea, sometimes vomiting, discomfort in the abdomen after eating.
Violations of the general condition - weight loss, hypovitaminosis, changes in the liver, gallbladder, pancreas.
Each type of gastritis has different symptoms.
Antral gastritis. It is mainly associated with pyloric Helicobacter pylori, accompanied by hypertrophy of the mucous membrane and increased (or normal) gastric secretion. More common in young people. Complaints of heartburn after sour food, belching sour, constipation, sometimes vomiting. Pain appears 1-1.5 hours after eating, "hungry" - night pains that subside after eating are possible. Appetite decreases only during an exacerbation, without an exacerbation it is normal or increased. The general condition and body weight are disturbed. The tongue is coated, palpation of the epigastric region is painful. The study of gastric secretion reveals increased acidity (especially stimulated).
X-ray reveals thickening of the folds of the gastric mucosa and signs of hypersecretion.
Fundal (autoimmune) gastritis. It occurs more often in people of mature and elderly age, characterized by primary atrophy of the mucous membrane and secretory insufficiency.
Complaints of dull arching pains in the epigastric region immediately after eating, rapid satiety, sharply reduced appetite, unpleasant taste in the mouth. Belching in patients with the smell of rotten eggs after protein food, heartburn - after eating carbohydrate foods. Frequent symptoms: rumbling and bloating, diarrhea. Coated tongue. Poor tolerance to milk. Body weight is reduced, the skin is dry, pale (B]_2-deficiency anemia develops). There are symptoms of hepatitis, cholecystitis, colitis, pancreatitis. OAK - signs of anemia.
In the study of gastric secretion - anacid or hypoacid state. On x-ray, the mucosal folds are thinned.

4. Treatment of chronic gastritis
Treatment for chronic gastritis should be complex and differentiated. Treatment begins with the normalization of the mode of work and life. Therapeutic measures, individual for each patient, are determined by the attending physician.
Principles of treatment of type A gastritis.
Substitution therapy is carried out, aimed at restoring the conditions of the functioning of the stomach close to normal, compensation of atrophic processes in the gastric mucosa.
In autoimmune gastritis with anemia, intramuscular administration of oxycobalamin (vit. B12) is prescribed for a long time according to the scheme. Replacement therapy is carried out with acidin-pepsin, enzyme preparations (festal, digestal), plantaglucid, vitamins C, PP, Wb.
With high acidity of gastric juice, gastrocepin, antacids (maaloke, gastal, remagel, phosphalugel, etc.)
The main method of therapy is clinical nutrition. In the acute phase, diet No. 1a is prescribed, which provides functional, mechanical, thermal and chemical restrictions and 5-6 meals a day. Dishes that irritate the coolant (pickles, smoked meats, rich soups, marinade, spicy seasonings, fried meat and fish) are excluded from the diet.
In the presence of pain and dyspeptic syndromes, a good effect is achieved with internal administration or intramuscular injections of metoclopramide, sulpiride, no-shpa, butylscopolamine bromide (buscopan).
Enveloping and astringent herbal remedies are widely prescribed: an infusion of plantain leaves, plantaglucid granules, yarrow, chamomile, mint, St. John's wort, valerian root. Herbal infusions are taken orally 1/3 1/2 cup 4-5 times a day before meals for 2-4 weeks. In order to stimulate the secretory function of the stomach, you can use herbal combination preparations that stimulate secretion: herbogastrin, herbion gastric drops, plantain and its preparations (plantaglucid).
Principles of treatment of type B gastritis.
Considering that the predominant number of cases of type B gastritis is caused by HP, the treatment of this form of gastritis is based on the eradication of Helicobacter pylori infection.
Seven-day courses of treatment are prescribed: ranitidine + clarithromycin + metronidazole or omerazol + clarithromycin + trichopolum, or famotidine + de-nol + tetracycline, etc.
During the period of exacerbation, with a significant severity of the pain syndrome, antispasmodics can be additionally prescribed - drotaverine (drotaverine-KMP, no-shpa), papaverine. In some cases, anticholinergics atropine, buscopan are effective.
At high levels of gastric acidity, antisecretory drugs from the group of selective M-anticholinergics - pirenzepine (gastrocepin) are prescribed for up to 4 weeks.
In order to improve the trophism of the coolant, sea buckthorn oil, multivitamin preparations for a period of 3-4 weeks can be used. In complex therapy, appointments for 2-3 weeks of tranquilizers - diazepam (seduxen, sibazon), tazepam, etc. - are justified. Herbal sedative preparations - valerian extract, persen - are effective.
Principles of treatment of type C gastritis
In the treatment of type C gastritis (reflux gastritis) occurring with dysmotility, duodenogastric and gastroesophageal refluxes, the appointment of metoclopramide (raglan, cerucal) is indicated, which normalizes the closing function of the cardia.
Normalizes gastric motility domperidone (motilium). This drug is milder than cerucal, rarely gives side effects. With gastroesophageal reflux, the use of the selective cholinomimetic cisapride is promising (use with caution in violations of the conduction system of the heart).
In order to neutralize the aggressive action of bile on the coolant, phosphalugel is prescribed, which, in addition to the antacid action, adsorbs bile acids and has an enveloping effect. Sucralfate (ankrusal, venter, ulgastran, sucrase) has a good cytoprotective effect. The mechanism of action of the drug in reflux gastritis is the formation of complex compounds with tissue proteins in the area of the damaged mucosa. Sucralfate adsorbs pepsin and bile acids, increases the resistance of the mucous membrane to the acid-peptic factor. Cytoprotective action has diosmectite (smecta).
In some cases, gastritis is prescribed mud therapy, diathermy, electro- and hydrotherapy.
Complications of chronic gastritis.
1. Gastric bleeding (associated with HP, hemorrhagic gastritis).
2. Peptic ulcer of the stomach and duodenum (associated with HP gastritis).
3. Gastric cancer (associated with HP and autoimmune).
4. B12-deficiency anemia (autoimmune).

5. The role of the nurse in the rehabilitation of patients
Problems of patients suffering from gastritis:
gastric discomfort, epigastric pain, changes in appetite, belching, heartburn, nausea, vomiting, weight loss, etc.
Potential problems: stomach bleeding, fear of complications (cancer, peptic ulcer).
The nurse must: monitor the strict implementation of the established dietary regimen; explain to the patient the importance of adherence to dietary nutrition and the intake of mineral water; explain to relatives about the need to bring packages in accordance with the diet; control physiological functions; to administer medications for pain relief as prescribed by the doctor. Tell the patient about preventive measures, the effectiveness of which also depends on the efforts of the patient.
Of great importance in complex therapy is therapeutic nutrition. The patient should take food in small portions at relatively short intervals (5-6 times a day) at the same hours. Physical and mental stress should be avoided. In the period of remission of gastritis, the patient is treated on an outpatient basis.
The dietary menu for a patient with chronic gastritis provides for all the components of nutrition necessary for the life of the body: proteins, fats, carbohydrates, mineral salts.
It is not recommended to drink coffee, cocoa, as these drinks contain substances that irritate the gastric mucosa. Pepper, mustard, horseradish, vinegar are excluded from the diet. In case of violation of the secretion of digestive juice, food is poorly digested, therefore, abundant food is contraindicated. Alcohol, beer, carbonated drinks are strictly contraindicated.
During chronic gastritis, a remission phase and an exacerbation phase are distinguished. During an exacerbation, a more rigid diet should be followed; during remission, the diet can be significantly expanded if individual tolerance allows.
During an exacerbation, food is cooked in a semi-liquid form or in the form of jelly, fried foods are excluded. The number of main food components is slightly reduced, the diet contains 80 g of protein, 80-100 g of fat, 200-300 g of carbohydrates, energy value is 2200 kcal. Semolina, rice porridge, fruit and berry jelly, milk or mucous soups, soft-boiled eggs, omelettes, mashed vegetables, mashed cottage cheese, butter, rosehip broth are allowed.
As acute symptoms disappear (usually after 2-3 days), the diet is gradually expanded. The number of main food components corresponds to the usual: 100 g of protein, 100 g of fat, 400 g of carbohydrates, energy value 2600-2800 kcal.
During this period, soups made from potatoes, carrots, milk soups with vermicelli, vegetable soup are recommended; fresh cottage cheese, non-sour curdled milk, kefir, unsalted butter; soft-boiled eggs, omelettes; lean meat (beef, veal, chicken, rabbit) boiled or in the form of steam cutlets, meatballs; lean ham, doctor's sausage; any cereals; puddings, well-boiled, chopped vegetables; sweet mashed, boiled or baked fruits; jelly, weak tea; dried white bread, dry biscuits, drying.
Control over the timely and full intake of drugs prescribed by the attending physician, which are intended to correct the acidity of gastric juice, as well as normalize the motility of the gastrointestinal tract.
Patients with chronic gastritis with reduced secretion of gastric juice (especially with the absence of hydrochloric acid in gastric juice) are put on dispensary records. Once a year, such patients undergo a gastroscopy or x-ray examination of the stomach, as they are at risk for developing stomach cancer.
The complex of therapeutic measures includes physiotherapeutic procedures (mud therapy, diathermy, electro- and hydrotherapy). Vitamin therapy is recommended, especially the intake of nicotinic and ascorbic acids, vitamins B6, B12.
Creating conditions for deep and full sleep. Sleep duration should be at least 8 hours. Creating a favorable environment at home and at work. The patient should not worry and be annoyed. Physical education and sports. It is necessary to carry out the rehabilitation of the oral cavity, treatment and prosthetics of teeth in a timely manner.
No less important is sanatorium treatment (after exacerbation) - Essentuki, Zheleznovodsk, Kislovodsk, etc. Mineral water is used during outpatient and inpatient treatment during exacerbation, the greatest effect is given by mineral waters - carbonic or alkaline. In chronic gastritis, they improve the function of the digestive glands, normalize the secretory and motor activity of the stomach and contribute to the dissolution and removal of mucus accumulated in the stomach. For gastritis with increased secretion and acidity of the gastric contents, Borjomi is prescribed, and for low secretion, Essentuki No. 17.
Prevention. Patients with chronic gastritis are subject to clinical examination. There is a concept of primary and secondary prevention. Prevention of chronic gastritis is primary, and prevention of exacerbations of chronic gastritis is secondary. If therapeutic measures have succeeded in stopping the pathological process and achieving a practical restoration of normal stomach functions, then the stage of remission (persistent improvement) begins.

6. Algorithm of actions of a nurse when collecting urine according to Zimnitsky
Purpose: determination of the concentration and excretory functions of the kidneys.
Indications: doctor's prescription. There are no contraindications.
Patient preparation:
1. Explain to the patient that the drinking, food and motor regimes should remain the same.
2. It is necessary to collect urine for a day, for every 3 hours.
3. The doctor cancels diuretics the day before the study. Patient sequence:
(or nurses if the patient is on bed rest)
1. Give the patient 8 numbered containers with the time and the 9th - spare. At 6 am, the patient urinates into the toilet.
2. Then, every 3 hours, the patient urinates into an appropriate container until 6 a.m. the next day, the morning portion is included in the study.
3. Received containers must be tightly closed with lids with glued labels, on which are written: - Full name. the patient; - branch number; - room number; - time interval (6-9; 9-12; 12-15; 15-18; 18-21; 21-24; 24-3; 3-6).
4. Ensure the delivery of urine to the laboratory.
5. Treat used gloves, funnel, diuretic, vessel (urinal) in a disinfectant, solution, then soak in it.
Additional Information.
The nurse must remember that every three hours at night she must wake the patient.
Urine collected at 6 a.m. the day before is not examined, as it is excreted from the previous day.
If the patient has polyuria and does not have enough volume of one container, the nurse gives him an additional container, which indicates the appropriate period of time. If the patient does not have urine at some time interval, this container should remain empty.
Evaluation of the results of the study.
The nurse should know that daily portions are collected from 6.00 to 18.00 hours. Daily diuresis is 2/3-4/5 daily. The density of urine is normal 1010-1025. Normal daily diuresis is 1.5-2 liters and depends on many factors.
When evaluating the results, the nurse should determine:
- daily diuresis; - sum of all sample volumes; - separately the first 4 (day) and last 4 (night) volumes; - the ratio between nocturnal and daytime diuresis; - urometer density of urine in each portion.
- Pouring urine from the container into a measuring cylinder and lowering the urometer into it so that it reaches the bottom, and then determine what division the urine level is on the lower meniscus
- Record the result in the direction.
Normally, daily portions of urine have a lower relative density than night ones, but not lower than 1010. A decrease in urine density below 1010 indicates a decrease in the concentration function of the kidneys.
If it is not enough to determine the density of urine, then its density is determined as follows: the resulting sample is diluted 2 times with water, measured with a urometer and the result is multiplied by 2.
If the volume of urine is very small, you can dilute 3 times or more, and, accordingly, multiply the result by this value. Record the data obtained in the form in the appropriate column.

Conclusion
Treatment of patients is carried out in the clinic, and with a strong pain syndrome in the hospital, since acute symptoms require a fairly quick intervention.
Caring for patients with chronic gastritis requires a nurse to have a good knowledge of the basics of therapeutic nutrition. It is necessary to remind him to eat at strictly defined hours (to develop the so-called digestive reflex).
To prevent chronic gastritis, it is necessary to carefully and timely treat various both acute and chronic inflammatory diseases of the abdominal organs: colitis (inflammation of the large intestine), cholecystitis (inflammation of the gallbladder), appendicitis (inflammation of the worm-like process).
Dishes that have a strong irritant effect on the mucous membrane are excluded from the diet (pickles, smoked meats, rich soups, marinades, hot spices, fried meat and fish, canned foods), poorly tolerated foods (milk, grape juice, foods), it is necessary to limit salt intake , strong tea, coffee, carbohydrates (sugar, jam, pastry products) exclude alcoholic beverages (including beer). All of these products contain extractives that increase juice secretion and may also irritate the gastric mucosa.
The fight against smoking is a necessary element in the prevention of chronic gastritis, since under the influence of smoking, the gastric mucosa initially thickens significantly, and then atrophies.
It is necessary to monitor the condition of the oral cavity, treat other diseases in a timely manner, eliminate occupational hazards and helminthic-protozoal invasions.

Literature

1. Zakharov V.B. Dietary nutrition in chronic gastritis. - M.: Enlightenment, 2000. - 78 p.
2. Madan A.I., Borodaeva N.V. Algorithms for the professional activity of nurses (textbook for students of medical schools). - Krasnoyarsk, 2003. - 86 p.
3. Smoleva E.V. Nursing in therapy. - Rostov n / a: Phoenix, 2007 - 278s.
4. Directory of nurses. – M.: Eksmo Publishing House, 2002. -324s.
5. Directory of a general practitioner. In 2 volumes. / Ed. Vorobieva N.S. –M.: Eksmo Publishing House, 2005.- 312s.

Chronic gastritis (CG)- chronic inflammation of the gastric mucosa, accompanied by its cellular infiltration, impaired physiological regeneration (recovery) and subsequent atrophic changes, disorders of the secretory, motor (motor) and endocrine functions of the stomach. CG is the most common stomach disease, widespread among the world's population.

CG often occurs without distinct clinical symptoms, it is difficult to suspect and diagnose. Its characteristic clinical manifestations are nonspecific and may occur in syndromes

functional dyspepsia, caused by motor (motor-evacuation) disorders of the stomach and duodenum, and organic dyspepsia that develops in a number of diseases (gastric and duodenal ulcer, gastric cancer, gastroesophageal reflux disease, chronic cholecystitis, pancreatitis, etc.).

The term "dyspepsia" comes from the Greek dys(violation) and peptien(digest). dyspepsia syndrome are defined as sensations of rapidly advancing saturation, fullness (overflow) of the stomach after eating, as well as burning and pain in the epigastric region. Often, these symptoms alone or in combination determine the clinical picture of chronic hepatitis.

If dyspepsia syndrome is detected, the nurse refers the patient for a consultation with a doctor. He plays the main role in carrying out diagnostic measures using physical, laboratory and instrumental (endoscopic, x-ray, ultrasound, etc.) methods, identifying the functional or organic nature of dyspepsia and verifying chronic hepatitis. The latter is achieved with the help of a histological (cytological) study of biopsy specimens of the gastric mucosa and the identification of its morphological changes.

Etiopathogenesis

The main causes of HCG are autoimmune and infectious (Helicobacter pylori infection) factors. A lesser role in the development of chronic hepatitis is played by an unfavorable (damaging) effect on the gastric mucosa of duodenogastric reflux (reflux of the contents of the duodenum and bile into the stomach); long-term use of certain drugs (corticosteroid hormones, non-steroidal anti-inflammatory drugs - NSAIDs, cardiac glycosides, etc.), violation of the quality and diet (long intervals between meals, abuse of monotonous, spicy, cold or hot food, etc.); bad habits (smoking, abuse of alcohol and strong coffee), occupational hazards (heavy metals, acids, alkalis, etc.).

The listed etiological factors contribute to the violation of the physiological balance between protective and damaging processes in the gastric mucosa with a predominance of the latter. The regeneration of the epithelium is disturbed, an inflammatory process develops with cellular infiltration of the mucous membrane and its subsequent atrophic changes. As a result, the secretory, acid-forming, enzyme-forming and motor (contractile) functions of the stomach suffer.

Taking into account the causes and mechanisms of the development of CG, morphological (histological), endoscopic changes and features of the course of the disease, there are The 2 most clinically significant forms of chronic hepatitis: autoimmune (fundal) and Helicobacter pylori (antral).

Autoimmune hCG- a disease of unknown etiology, occurring mainly in the elderly and old people. Its essence is the formation of autoantibodies to the parietal cells of the mucous membrane of the bottom and body of the stomach, which produce hydrochloric acid and an internal factor (promotes the absorption of vitamin B 12 in the intestine). A pronounced atrophy of the mucous membrane of the upper 2/3 of the stomach develops, the production of hydrochloric acid (achlorhydria) stops, and B 12 deficiency anemia occurs.

Much more common Helicobacter hCG. H. pylory first cause an inflammatory process in the antral (output) section of the stomach, followed by its spread to the overlying sections (body and fundus). The source of infection is a sick person and animals. The inflammatory process caused by the production H. pylory toxic substances (cytotoxins), is the "initiator" of atrophic changes in the antrum, and then other parts of the stomach. This form of CG is characterized by the development of superficial defects (erosions) of the mucous membrane, frequent combination with duodenal ulcer, a tendency to malignancy (the occurrence of malignant tumors of the stomach).

Clinic and diagnostics

CG for a long time may not be clinically manifested. Patients seek medical help, as a rule, with an exacerbation of the disease, accompanied by the occurrence of a number of nonspecific symptoms, the nature of which depends on the form of CG and the peculiarities of the secretory and motor functions of the stomach caused by it.

Autoimmune hCG, characterized by atrophic changes in the bottom and body of the stomach, a pronounced decrease in its acid-forming function, characterized by syndromes of gastric and intestinal dyspepsia. Patients are concerned about early dull pain, a feeling of heaviness and fullness after eating in the enclosed area. Often there is a decrease in appetite, belching food and air, nausea, an unpleasant taste in the mouth, bloating and rumbling in the abdomen, a tendency to unstable stools and diarrhea.

An objective examination reveals weight loss, tongue coating with a whitish-yellow coating, dystrophic changes in the skin, brittle nails and hair are possible. There is pain on palpation in the epigastric region.

The presented clinical picture allows the nurse to suspect hCG. Its autoimmune form is identified by a doctor using instrumental research methods. The most valuable of them is endoscopy (esophagogastroduodenoscopy) with a biopsy of the gastric mucosa; at the same time, thinning and smoothness are found, sometimes - pallor of the mucous membrane, and during its histological examination - atrophy with the disappearance of specialized glands.

Less significant in the diagnostic plan is an x-ray examination, indicating a decrease in the severity of the folds of the gastric mucosa, and an analysis of the secretion of gastric juice using probe methods, which reveals a decrease, sometimes a lack of production of hydrochloric acid (achlordria).

It is possible to develop B12-deficiency anemia, characterized by an increase in the color index, a decrease in the number of leukocytes and platelets, the appearance of large erythrocytes (macrocytes) and polysegmented neutrophilic leukocytes in the peripheral blood.

Helicobacter pylori hCG less pronounced atrophic changes (often of a focal nature) of the mucous membrane of the antral and higher located sections of the stomach are characteristic, more often - its increased, less often - normal acid-forming function. The clinical picture is dominated by early dull, less often late (1.5-2 hours after eating) cramping pain in the epigastric region. Patients are concerned about heartburn, sour belching, nausea, an unpleasant taste in the mouth, and a tendency to constipation.

As the disease progresses with the development of atrophy of the mucous membrane of all parts of the stomach, the nature of clinical manifestations changes. Often there is a feeling of heaviness and fullness in the epigastric region after eating, rumbling and bloating, a tendency to diarrhea. Appetite worsens.

On examination, the tongue is coated with a whitish-yellow coating, and on palpation of the abdomen - pain in the epigastric region.

Endoscopy with a biopsy of the gastric mucosa helps to identify more often inflammatory, less often - atrophic changes in the mucous membrane and erosion, mainly in the antrum (output) section of the stomach. An important diagnostic tool is the detection H. pylory using biochemical, morphological, serological methods and a breath test.

A fairly characteristic sign of Helicobacter pylori chronic hepatitis, especially in the initial stage, is an increase, less often, the preservation of acid-forming and enzyme-forming functions of the stomach.

Patients with CG may experience asthenoneurotic syndrome, characterized by weakness, irritability, chilliness of the extremities, as well as dumping syndrome that occurs after eating and is manifested by sudden weakness, drowsiness, pallor and sweating.

The course of chronic hepatitis is characterized by alternating periods of exacerbation and remission. Exacerbation - the appearance of pain and dyspeptic syndromes - is often facilitated by the use of coarse, spicy, smoked, fried foods, alcoholic beverages, the use of certain drugs (NIIVP, etc.).

nursing care

Reasonably (purposefully) collected anamnesis with subsequent objective research allows the nurse to formulate the patient's problems and plan nursing care correctly. It is important to specify the patient's complaints regarding pain and dyspeptic syndromes, and find out when the symptoms of the disease first appeared and whether they are associated with food intake. It is necessary to assess the localization, intensity and nature of pain (early, late, hungry). The nurse should ask the patient about the peculiarities of his diet and professional activities, bad habits, and the use of medicines.

Nursing diagnoses (patient problems)XI"can be represented as follows:

pain in the epigastric region;
feeling of heaviness and fullness in the epigastric region after eating;
dyspeptic disorders (belching, nausea, heartburn);
bloating (flatulence);
insufficient awareness of the patient about the causes of the disease, how to prevent and treat it.

In a patient diagnosed with chronic hepatitis C, the causes of the exacerbation of the disease, their possible connection with violations of the diet and the regimen of drug treatment, are ascertained.

The scope of the nurse's duties includes assessing the level of knowledge of the patient and his family members about the disease and the features of care for it, organizing psychological, physical, economic and social assistance to the patient, and measures to change his lifestyle. She explains the feasibility and diagnostic capabilities of laboratory tests, the list of which is as follows: a clinical blood test with counting platelets and reticulocytes (young red blood cells); determination of the levels of total protein, protein fractions, blood sugar, blood type and Rh factor, serum iron; general urine analysis; analysis of feces for occult blood; urease test (to detect infection of the stomach H. pylori)-, esophagogastroduodenoscopy with targeted biopsy and subsequent histological examination of the biopsy; Ultrasound of the liver, biliary tract and pancreas. Conducting additional studies and consultations of specialists depends on the clinical manifestations of the underlying and suspected concomitant diseases.

The nurse observes the patient's behavior, notes changes in his well-being and general condition, teaches self-care methods, monitors the implementation of general hygiene measures, including those related to oral hygiene, tells the patient and his relatives about the basics of oral care. If the tongue is dry, brushing it with a soft toothbrush using a soda solution 2-3 times a day is indicated. You can often and in small portions give the patient pieces of ice, mineral water. Lips smeared with Vaseline. In the absence of teeth in an elderly person, he is fed pureed food.

With the development of stomatitis, a consultation with a dentist is indicated. Infection of the oral cavity can worsen the patient's well-being, interfere with the normal intake of food and medicines. In such cases, spicy and acidic foods are excluded from the diet; teeth, gums and tongue are wiped with a weak solution of boric acid, baking soda, decoctions of chamomile and oak bark. The mucous membrane of the oral cavity is lubricated with rosehip or sea buckthorn oil.

With exacerbation of CG, outpatient (home) treatment is more often used, less often - with severe pain and dyspeptic syndromes - inpatient treatment. The tactics of treatment depends on the form and characteristics of the clinical course of the disease, the nature of disorders of the secretory and motor functions of the stomach. Treatment is individual, complex and is aimed at eliminating and preventing exacerbations of chronic hepatitis. use non-drug(medical nutrition, herbal medicine, exercise therapy) and medicinal methods. In accordance with the appointments of the attending physician, the nurse cooperates with specialists in dietetics, physiotherapy, psychotherapy, physiotherapy, etc., conducts conversations with the patient and his relatives about the normalization of work and rest, nutrition, elimination of insomnia, conflict situations, bad habits.

An important condition for the effectiveness of the complex treatment of CG is diet therapy, directed during the period of exacerbation of the disease to thermal, chemical and mechanical sparing of the stomach.

Foods and dishes that have a strong irritating effect on the gastric mucosa are excluded from the diet: pickles, smoked meats, rich soups, marinades, spicy seasonings, fried meat and fish. Limit the use of salt, strong tea and coffee, exclude alcoholic beverages. They recommend slimy soups from cereals, milk soups with grated cereals, mashed boiled vegetables, soft-boiled eggs or in the form of omelettes, calcined cottage cheese, jelly, weak tea with milk, boiled meat and fish, wheat bread baked yesterday.

Mechanical sparing involves reducing the volume of food at each meal, grinding or rubbing it to a mushy consistency, limiting the fiber content, as well as heat treatment, carried out only by steaming or by cooking food. The patient should be fed in small portions 4-5 times a day.

As the signs of exacerbation of chronic hepatitis C are eliminated and the transition to good nutrition in case of secretory insufficiency, fatty, fried, smoked foods, canned food, black bread, fresh dough products, concentrated cream and sour cream are excluded from the diet; in the case of normal and increased secretory function, the use of rough, spicy, salty and juice foods is prohibited.

Medical treatment of autoimmune chronic hepatitis It is aimed at replacing disturbed (reduced) secretory and motor functions of the stomach, compensation for B 12 deficiency anemia and trophic disorders. For this purpose, the following drugs are used:

replacement therapy with a decrease or absence of hydrochloric acid production (hydrochloric acid, acidin-pepsin, pepsidil, sugast-2, etc.);
stimulants of the motor-evacuation function of the stomach - prokinetics: domperidone (motilium), metoclopramide (cerucal); enzyme preparations: festal, mezim-forte, panzinorm forte, creon, etc.;
immunomodulators: imunofan, taktivin, etc.;
stimulants of regenerative (restorative) processes in the mucous membrane: methyluracil, retabolil, nerobol, etc.;
vitamins B, B 2 , B J2 P, PP, folic acid, complexes of vitamins and microelements - "Oligovit", etc.;
sedatives (valerian, motherwort, etc.).

The basis of drug therapy for Helicobacter pylori is the eradication (destruction) of bacteria in the gastric mucosa, as well as the use of agents that reduce the formation of hydrochloric acid and weaken its damaging effect on the mucous membrane.

Treatment of this form of HCG:

antibacterial agents: tetracycline, tinidazole, clarithromycin, amoxicillin, etc.;
antisecretory drugs: H2-receptor blockers (ranitidine, famotidine, etc.); proton pump inhibitors (omeprazole, lansoprazole, esomeprazole, etc.);
a combination of antibacterial, antisecretory agents and bismuth preparations: triple therapy - 1st line therapy (omeprazole, clarithromycin, amoxicillin), quadritherapy - 2nd line therapy (omeprazole, clarithromycin, tinidazole, de-nol), etc. ;
gastroprotectors with enveloping and astringent properties: de-nol, sucralfate, sea buckthorn oil, etc.;
antacids: almagel, phosphalugel, maalox, etc.;
sedatives (valerian, motherwort, etc.);
vitamins B, B 6, ascorbic acid.

The main role in solving the patient's problems - in the relief of pain and dyspeptic syndromes - belongs to dietary and drug treatment. The nurse monitors the patient's compliance with these therapeutic measures, detects dietary violations and the negative effects of drugs and informs the doctor about this. A certain place in the complex treatment of CG is occupied by the use of mineral waters (with secretory insufficiency - chloride and sodium, with preserved and increased secretory function of the stomach - hydrocarbonate), as well as herbal medicine, physiotherapy and exercise therapy.

Prevention

Prevention of CG and the prevention of its progression include the observance of proper (rational) nutrition, general hygiene measures, the exclusion of bad habits, occupational hazards, the use of certain anti-inflammatory drugs. Preventive measures include sanitation of the oral cavity, treatment of chronic foci of infection.

Patients with chronic hepatitis, especially with its diffuse atrophic forms, are subject to medical examination, which provides for a comprehensive examination, including endoscopic, and anti-relapse treatment 1-2 times during the year.

Chronic gastritis is a pathological condition that develops as a result of inflammation of the gastric mucosa. In chronic gastritis, along with inflammatory changes in the mucous membrane, its dystrophic changes are observed. In advanced cases, atrophic changes in the mucous membrane are noted, with damage to the gastric glands, which leads to a sharp decrease in the secretory function of the stomach.

Risk Factors for the Development of Chronic Gastritis

Violation of the quality of nutrition (the use of poor-quality and indigestible food);
Lack of protein, iron, vitamins in food;
alcohol abuse;
Smoking;
Prolonged violation of the rhythm of nutrition - the presence of large intervals between meals;
Diseases accompanied by a violation of metabolic processes in the body (pulmonary insufficiency, diabetes mellitus, impaired renal function, obesity, blood diseases);
Allergy to food products;
Irritant effect of certain medicinal substances (aspirin, antibiotics, sulfonamides, etc.);
Occupational hazards (lead, bismuth, coal or metal dust, etc.);
Untreated acute gastritis.

The symptomatology of the disease is determined by the state of the secretory function of the stomach.

Dyspeptic disorders in the form of decreased appetite, unpleasant taste in the mouth, nausea;
Pain in the epigastric region that occurs shortly after eating, but their intensity is low and does not require the use of painkillers;
Irregular bowel action is also noted: a tendency to loose stools;
The general condition of patients changes only with pronounced symptoms of gastritis with the addition of intestinal dysfunction;
There is a decrease in body weight;
In the gastric juice, a decrease in the content of hydrochloric acid is detected (up to the absence after stimulation of gastric secretion by subcutaneous administration of a histamine solution);
The content of the enzyme pepsin in gastric juice is also reduced.

In chronic gastritis with reduced secretion, the following symptoms predominate:

Heartburn.
Belching sour.
Feeling of burning and fullness in the epigastric region.
Pain, as in patients with duodenal ulcer: pain occurs on an empty stomach and disappears after eating; pain also occurs 3-4 hours after eating, repeated eating relieves pain.

Rules for the care of patients with chronic gastritis

Treatment of patients is carried out in the clinic, since acute symptoms require fairly rapid intervention.
Patients with chronic gastritis are usually not hospitalized, as they are quite able to work.
Smoking and drinking alcohol are strictly prohibited.
Compliance with the correct diet and appropriate diet. The diet is prescribed in accordance with the results of the study of gastric juice. However, regardless of the results of the study of gastric juice, the patient should not eat "heavy" food (fatty meat, canned foods, spicy dishes, rich pies, etc.). With increased secretion of gastric juice, you can not eat anything "spicy" (spices, sauces, salty dishes), as these foods increase the secretion of gastric juice. If the patient has high acidity, black bread, sauerkraut, sour fruits are not recommended. With gastritis with a reduced secretory function of the stomach, some spices and seasonings are acceptable, which can increase the acidity of gastric juice, but food is given in a well-chopped form ("mechanical sparing"). With increased acidity, the table should be mechanically and chemically sparing (diet No. 1), and with low acidity, mechanically sparing (diet No. 2) (see the section "Diets for diseases of the digestive system"). Mineral waters have a good effect.
Control over the timely and full intake of drugs prescribed by the attending physician, which are intended to correct the acidity of gastric juice, as well as normalize the motility of the gastrointestinal tract. If the processes of intestinal digestion are disturbed (with gastritis with reduced secretory function), which is manifested by diarrhea, then enzyme preparations (panzinorm, festal) are prescribed at the same time, which should be taken with meals.
Patients with chronic gastritis with reduced secretion of gastric juice (especially with the absence of hydrochloric acid in gastric juice) are put on dispensary records. Once a year, such patients undergo a gastroscopy or x-ray examination of the stomach, as they are at risk for developing stomach cancer.
The complex of therapeutic measures includes physiotherapeutic procedures (mud therapy, diathermy, electro- and hydrotherapy).
Vitamin therapy is recommended, especially the intake of nicotinic and ascorbic acids, vitamins B6, B12.
Creating conditions for deep and full sleep. Sleep duration should be at least 8 hours.
Creating a favorable environment at home and at work.
The patient should not worry and be annoyed.
Physical education and sports.
Hardening of the body.
It is necessary to carry out the rehabilitation of the oral cavity, treatment and prosthetics of teeth in a timely manner.
Treatment of patients with chronic gastritis can be carried out in gastroenterological sanatoriums. It should be remembered that with a reduced secretory function of the stomach, thermal procedures are not prescribed due to the risk of developing stomach cancer.
To prevent exacerbations of the disease.
Even with the onset of remission, you should follow the diet and diet.

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Patient A., aged 26, is being treated in the gastroenterology department with a diagnosis of chronic gastritis type B, exacerbation. Nursing examination revealed complaints of heartburn, sour belching, cutting pains in the epigastric region after eating, especially after spicy, salty, coarse food; tendency to constipation, weight loss, loss of appetite. Sick for about 5 years. The deterioration of the condition is associated with errors in the diet. Smokes, drinks alcohol moderately. Heredity is not burdened. Objectively: the general condition is satisfactory. Body temperature 36.5°C. Skin and mucous membranes are pale. Vesicular breathing in the lungs. NPV 16 per minute. Heart sounds are clear, clear, rhythmic. Pulse 72 per minute, BP 120/70 mm Hg. Art. Tongue wet, lined with white coating. Belly of the correct form. On palpation, pain in the epigastrium is noted. The liver and spleen are not palpable. Chair 1 time per day or two, decorated.

Tasks: 1. Determine the needs, the satisfaction of which is impaired, formulate the patient's problems. 2. Set goals and plan nursing interventions with motivation.

Sample response:

1. Satisfaction of needs is disturbed: eat, be healthy. The problems are real: heartburn, sour belching, dull aching pain in the epigastric region after eating, especially spicy, salty, coarse food; constipation, weight loss, loss of appetite .

Potential issue: risk of developing stomach ulcers.

Priority issue: pain in the epigastric region.

2. Short-term goal: the patient will notice a decrease in pain after eating after 3 days of treatment. Long term goal: the patient will note the absence of pain in the epigastric region after eating by the time of discharge.

Nursing Interventions	Motivation
1. Ensure adherence to the prescribed diet and motor regimen	For maximum stomach sparing
2. Recommend avoiding foods that cause heartburn and pain	Prevent heartburn, stomach pain
3. If heartburn and pain occur, provide the patient with an antacid (1 tsp. Almagel)	Relieve heartburn and pain
4. Conduct a conversation with relatives about the nature of the programs, taking into account the prescribed diet	Avoid foods that can cause pain
5. Observe the appearance and condition of the patient (control of blood pressure, respiratory rate, pulse)	For status monitoring
6. Recommend, with the permission of the doctor, walks before meals	whet your appetite
7. Timely and correctly fulfill medical appointments	For effective treatment
8. Provide preparation for additional research	For the correct execution of research

Evaluation of the effectiveness of nursing interventions: the patient notes the absence of epigastric pain after eating. The goal has been reached.

Prevention.Primary: identification and correction of exogenous and endogenous risk factors, rational nutrition, exclusion of bad habits. Secondary: adherence to the regime and diet, the exclusion of bad habits, a healthy lifestyle; carrying out anti-relapse treatment twice a year in spring and autumn, taking into account the acid-forming function of the stomach. Patients with chronic gastritis with secretory insufficiency are under dispensary registration for the risk of developing stomach cancer. Once a year, they undergo FGDS or X-ray examination of the stomach, in spring and autumn, replacement and restorative therapy is carried out.

Chronic gastritis is a disease of the stomach that occurs with damage to the mucous membrane of the digestive organ. To get rid of the disease, complex treatment is required, as well as a special diet. But sometimes the patient cannot follow the doctor's recommendations on their own. In this case, the main assistant in a hospital setting is a nurse. Her task is to supervise treatment, care, and provide recommendations for a speedy recovery. This is the basis of the nursing process in chronic gastritis.

The nursing process for chronic gastritis consists of the following steps:

Survey- anamnesis is collected, the results of the analyzes are studied.
Problem definition- it is presumably established what disease the patient suffers from, what it threatens him with in the future, the data is transmitted to the attending physician.
Determination of goals How long does it take for a nurse to fully heal a patient?
Realization of goals- the actions of the nurse, which will help the patient to become healthy.
Evaluation of performance- whether the patient received assistance and how good it is.

The overall result depends on the correct actions carried out at each stage.

Stage 1: examination

The task of the nurse is to determine the nature of the patient's complaints. It should be established what pains bother him when they appear, how quickly the feeling of fullness sets in, whether nausea, vomiting and other characteristic symptoms are present. As for pain, with this disease, they can appear immediately after eating, after 20 minutes or 2 hours.

Objective methods of examination are as follows:

visual inspection- detection of bruises under the eyes, white plaque on the tongue, pain on palpation in the abdomen;
study of instrumental and laboratory diagnostic methods- examination of feces, general analysis of urine and blood, biopsy, etc.

Stage 2: identifying problems

In people suffering from this disease, the physiological needs associated with eating, sleeping and other things are violated. This means that nursing care for chronic gastritis involves solving these problems.

Based on the symptoms, it is presumably established what disease the patient has. Problems associated with inflammatory processes occurring on the mucous membrane are being investigated. In this regard, there are pains in the stomach and abdomen, a feeling of heaviness. In addition, there are problems that have arisen due to indigestion. These include bloating, nausea and vomiting, belching, heartburn, complete or partial lack of appetite.

If all these problems are determined, the patient must be hospitalized for a complete diagnosis and accurate diagnosis.

Steps 3-4: setting goals and implementing them

Nursing care for chronic gastritis has the main goal, which is to create all the conditions for the complete recovery of the patient and the successful completion of the tasks.

Be sure to provide information about the disease and possible consequences, explain the need for complex treatment, compliance with all doctor's recommendations. During the period of exacerbation, it is desirable to provide bed rest for several days.

Control over compliance with the treatment regimen is as follows:

timely intake of drugs in certain dosages and according to the established regimen;
protection of the central nervous system from external stimuli;
organization of sparing nutrition, developed individually;
providing comfortable conditions and the correct daily routine.

The result of the correct organization of the treatment regimen is a decrease in the intensity of clinical signs and an improvement in the general condition.

The nurse is obliged to ensure that comfortable conditions are created in the ward that contribute to the recovery of the patient. Necessary timely wet cleaning, regular change of bed linen, silence. Patients should be fully tuned in to treatment and not be exposed to stress and other negative external factors. Their relatives should be informed about what is allowed to be transferred from food.

The task of the nurse is also to assist with eating and hygiene activities. In this regard, it is necessary to have a conversation about personal hygiene. In addition, it is important to explain and then monitor the patient's compliance with a diet designed personally for him. It is necessary that mineral water be included in his diet.

Step 5: Performance Evaluation

If nursing care is organized correctly, the patient will fully recover within a certain period of time and can be discharged from the hospital, having instructed on further actions during the rehabilitation period. The patient himself must be aware of how necessary it is for him to follow a diet and take certain medications at home. If symptoms appear that indicate an exacerbation of the disease, it is necessary to go to the hospital in a timely manner, without self-medication.

The role of the nurse during the rehabilitation period

At the stage of remission, the patient continues treatment, but already on an outpatient basis. The nurse should inform the patient about what diet he needs to follow during the rehabilitation period, notify him of the need for fractional nutrition. It is advisable to eat at the same time. Portions should be small. Starvation is unacceptable. The diet should contain all the necessary nutrients in certain quantities.

The nurse should explain to the patient, as well as his relatives, about the prohibitions on certain foods. In particular, you can not drink cocoa and coffee, because these drinks irritate the stomach lining. Spicy and fried foods, spices are also excluded. As for alcohol and carbonated drinks, they are strictly contraindicated.

People with this disease, which develops against a background of low acidity, should be registered with a dispensary. They should undergo gastroscopy once a year even in the absence of signs of an exacerbation of the disease. The fact is that they are at risk for the transition of the disease to stomach cancer.

Not the last place in the rehabilitation period is occupied by sanitary-resort treatment. The task of the nurse is to notify the patient about how useful it is for him to go to Essentuki, Kislovodsk and other resort areas with healing mineral water. It improves the function of digestion in chronic gastritis, restores gastric motility, dissolves accumulated mucus and generally has a beneficial effect on health.

The role of the nurse in the treatment of chronic gastritis should not be underestimated. The result of therapy, the speed of recovery and the possibility of further complications depend on its timely and correct actions. The correct approach in the course of treatment gives the chances for a quick and successful recovery.