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Scenario:Wang, a 40-yr-old male immigrant from Vietnam, has a 1-yr history of epigastric distress

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Scenario:Wang, a 40-yr-old male immigrant from Vietnam, has a 1-yr history of epigastric

distress. Increasingly, it is not relieved by over-the-counter antacids and cimetidine

(Tagamet). He is scheduled for an upper endoscopy this morning. He reports increasing

 

substernal pain, especially 2 to 3 hour after eating, he currently avoids alcohol and is taking

antacids and over-the-counter H2-receptor blocker, has smoking history of 1 pack of

cigarettes per day for 20 year, complains of increasing fatigue with exercise, reports

occasional black bowel movement, takes Chinese medicine for frequent back pain upon

physical examination, height 5'5" tall and weight 140 lbs. His diagnostic studies are the

following:

• Endoscopy reveals gastritis

• Hgb 10.2 g/dL; Hct 30%

• Histology of biopsied tissue reveals Helicobacter pylori infection

The doctor's prescription are the following:

• omeprazole 20 mg bid × 10 days

• clarithromycin 500 mg bid × 10 days

• amoxicillin 1 g bid × 10 days

1. Explain the pathophysiology of gastritis.

2. What are the risk factors for gastritis? Which of these did Wang have?

3. What is the role of H. pylori in gastritis? How do it contribute in gastritis development?

4. What lifestyle changes would you recommend for Wang?

5. Priority Decision: What are the priority nursing interventions for Wang?

6. Delegation Decision: For the interventions that you identified in question 5, which of

the following personnel could be responsible for implementing them: registered nurse

(RN), licensed practical nurse (LPN), unlicensed assistive personnel (UAP)?

7. Priority Decision: Based on the assessment data provided, what are the priority

nursing diagnoses? Are there any collaborative problems?

8. Evidence-Based Decision: Wang asks you if the treatment will work and this will be

the end of his problems. How will you respond?

Activity

 

1. Present the medical management of Gastritis by highlighting:

a. Nutritional therapy

b. Surgical therapy

c. Pharmacological therapy in MNEMONIC form