File
Gastroesophageal
Reflux Disease
(GERD)
OBJECTIVES
Understand the basic pathophysiology of
GERD
Identify the symptoms of GERD
Understand proper medical and nursing interventions
PATHOPHISIOLOGY
Caused by the relaxation of the lower esophageal sphincter (LES)
Gastric juices move back through the LES into the esophagus
Can cause erosion of the esophageal mucosal layer http://www.youtube.com/watch?v=o8iShP84HP
4
(Nowkediuko, 2012)
SYMPTOMOLOGY
Heartburn
Regurgitation
Sleep disturbances
Cough
Hoarseness
Asthma
Dental erosions
(Nowkediuko, 2012)
PREVALANCE
Most common upper gastrointestinal disease in western countries
10%-20% of people in western countries experience symptoms
8.9 million people diagnosed (Perry, 2012)
Seen mostly in older Caucasian males
(Nowkediuko, 2012)
RISK FACTORS
Genetic factor
Obesity
Alcohol abuse
Smoking
(Nowkediuko, 2012)
MEDICAL INTERVENTIONS
Acid Suppressive Therapy
Histamine 2 receptor antagonists (H2RAs)
Proton pump inhibitors (PPI)
Antacids
Surgery
Transoral incisionless fundoplication
Nissen’s fundoplication
(Nowkediuko, 2012)
NURSING INTERVENTIONS
Pain management
Assess pain level frequently
Administer medications
Risk for aspiration
Monitor respiratory rate, depth, and effort
When eating look for signs of aspiration including coughing, choking, and spitting food
(Ackley, 2010)
PATIENT TEACHING
For patients that are obese encourage weight loss.
Avoid alcohol, chocolate, citrus juice, tomato-based products, peppermint, coffee, and onion.
Smaller sized meals more frequently throughout the day.
(Nowkediuko, 2012)
PATIENT SCENARIO- HPI
The patient is a 58 year-old white female who complains of gastroesophegeal reflux. She states that the esophageal reflux began approximately 10 years ago and had nissen fundoplication surgery to fix the problem.
Esophageal reflux pain began again 8 months ago in the stomach, esophagus, and back.
Patient reports pain as constant, burning, and an 8/10 on 0/10 scale. Tried 4-5 different medications, none made her symptoms better. Symptoms worsened after eating.
PATIENT MEDICATIONS
Lovenox
Insulin
Dilaudid
Phenol topical
(chloraseptic spray)
Patient was not taking any acid suppressive therapy medication or antacids to relieve symptoms http://www.adultmeducation.com/images/O verview.jpg
LABS AFTER SURGERY
Glucose 155 (higher than normal range)
After surgery glucagon can be released from the pancreas with decreased production of insulin
HGB 10.8, HCT 34.0 (lower than normal range)
Hemoglobin and hematocrit values are commonly low after surgery
WBC 7.4, PLT 217 (within normal range)
Indicates no infection
PATIENT SCENARIO-
INTERVENTIONS
Medical
Transoral incisionless fundoplication
Nursing
Pain control with medication
Increasing comfort of patient by adjusting bed to comfortable position
NURSING DIAGNOSIS
Pain r/t recent surgery a.e.b patient complaints of pain 5/10 and grimacing
Impaired swallowing r/t pain from recent surgery a.e.b grimacing while swallowing
Risk for imbalanced nutrition r/t difficulty swallowing and lack of desire to eat
NCLEX QUESTIONS 1
Gastroesophageal reflux disease (GERD) weakens the lower esophageal sphincter, predisposing older persons to risk for impaired swallowing. In managing the symptoms associated with
GERD, the nurse should assign the highest priority to which of the following interventions?
A. Decrease daily intake of vegetables and water, and ambulate frequently
B. .Drink coffee diluted with milk at each meal, and remain in an upright position for 30 minutes.
C. Eat small, frequent meals, and remain in an upright position for at least 30 minutes after eating.
D. Avoid over-the-counter drugs that have antacids in them.
Tabloski, P. B. (2010). NCLEX review questions. Retrieved from http:// wps.prenhall.com/chet_tabloski_gerontolog_1/40/10305/2638168.cw/ content/index.html
NCLEX QUESTION 2
Which of the following foods should be avoided by clients who are prone to develop heartburn as a result of gastroesophgeal reflux disease
(GERD)? A. Lettuce B. Eggs C. Choc olate D. Butterscotch
Basic care and comfort nclex practice test. (2010, July 22). Retrieved from http://nclexreviewers.com/nclex-sample-questions/basic-care-andcomfort/basic-care-and-comfort-nclex-practice-test.html
NCLEX QUESTION 3
The client with GERD complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions?
A. Development of laryngeal cancer
B. Irritation of the esophagus
C.Esophageal scar tissue formation
D. Aspiration of gastric contents
Student nursing study blog [Web log message] . (2010). Retrieved from http:// amy47.com/nclex-style-practice-questions/gastro/gastro-3/
NCLEX QUESTION 4
The surgical procedure of choice for older patients with GERD and Barrett's esophagus that is not reversible with medical management is:
Esophagectomy.
Nissen’s fundoplication
Tota laryngectomy.
Labyrinthectomy.
Tabloski, P. B. (2010). NCLEX review questions. Retrieved from http:// wps.prenhall.com/chet_tabloski_gerontolog_1/40/10305/2638168.cw/ content/index.html
NCLEX QUESTION 5
The RN has finished teaching a patient about treatment of GERD. The RN knows the patient has understood the teaching if
she states: A. “I should eat a small bedtime snack each night.” B. “I should lie flat in bed.” C. “I can have red wine with dinner.” D. “I should eat six small meals daily.”
Physiological adaptation nclex RN practice test. (2010, August 23). Retrieved from http://nclexreviewers.com/nclex-sample-questions/physiologicaladaptation/physiological-adaptation-nclex-rn-practice-test.html
REFERENCES
Ackley, B. J., Ladwig, G. B. (2011). Nursing diagnosis handbook. St. Louis, MO:
Mosby Elsevier
Basic care and comfort nclex practice test. (2010, July 22). Retrieved from http://nclexreviewers.com/nclex-sample-questions/basic-care-andcomfort/basic-care-and-comfort-nclex-practice-test.html
Nowkediuko, S. C., (2012, July 11). Current trends in the management of gastroesophageal reflux: a review. ISRN Gastroenterol, 2012. doi:
10.5402/2012/391631
Peery, A.F., & Dellon, E. S. (2012, November). Burden of gastrointestinal disease in the
United States: 2012 update. Gastroenterology, 143(5): 1179-1187. doi:
10.1053/j.gastro.2012.08.002.
from Physiological adaptation nclex RN practice test. (2010, August 23). Retrieved http://nclexreviewers.com/nclex-sample-questions/physiologicaladaptation/physiological-adaptation-nclex-rn-practice-test.html
Student nursing study blog [Web log message] . (2010). Retrieved from http:// amy47.com/nclex-style-practice-questions/gastro/gastro-3/
Tabloski, P. B. (2010). NCLEX review questions. Retrieved from http:// wps.prenhall.com/chet_tabloski_gerontolog_1/40/10305/2638168.cw/ content/index.html
