NURSING DIAGNOSIS: Altered comfort: dyspepsia

related to:
  1. impaired fat digestion associated with bile flow obstruction;
  2. reflux of gastric contents associated with increased intra-abdominal pressure resulting from ascites;
  3. impaired gastrointestinal functioning associated with venous congestion in the gastrointestinal tract (portal hypertensive gastropathy) resulting from portal hypertension;
  4. esophagitis/gastritis associated with the irritant effect of chronic alcohol ingestion on the esophageal and gastric mucosa.
Desired Outcome
The client will verbalize relief of dyspepsia.
Nursing Actions and Selected Purposes/Rationales
  1. Assess client for signs and symptoms of dyspepsia (e.g. reports of epigastric discomfort, heartburn, nausea, or feeling of fullness or bloating; frequent eructation).
  2. Determine if particular foods/fluids contribute to dyspepsia.
  3. Implement measures to reduce dyspepsia:
    1. perform actions to reduce gastroesophageal reflux:
      1. keep head of bed elevated for 2-3 hours after meals
      2. provide small, frequent meals rather than large ones
    2. perform actions to restore fluid balance (see Diagnosis 2) in order to promote the resolution of ascites and subsequently reduce abdominal pressure and the associated gastroesophageal reflux and feeling of fullness and bloating
    3. instruct client to ingest foods and fluids slowly
    4. encourage client not to smoke
    5. encourage client to avoid the following foods/fluids:
      1. those high in fat (e.g. fried foods, gravies, butter, cream, ice cream)
      2. carbonated beverages
      3. gas-producing foods (e.g. beans, onions, cabbage)
      4. those that may cause gastric irritation (e.g. spicy foods; caffeine-containing beverages such as coffee, tea, and colas; alcohol)
    6. administer the following medications if ordered:
      1. antacids, histamine2 receptor antagonists (e.g. famotidine, nizatidine, ranitidine), or proton-pump inhibitors (e.g. omeprazole, lansoprazole, rabeprazole) to reduce acidity of gastric contents and subsequently also reduce esophageal irritation if reflux occurs
      2. cytoprotective agents (e.g. sucralfate, misoprostol) to protect the gastric mucosa
      3. antiflatulents (e.g. simethicone)
      4. antiemetics (phenothiazines should be used cautiously).
  4. Consult appropriate health care provider (e.g. clinical nurse specialist, physician) if above measures fail to control dyspepsia.