gastroesophageal reflux disease (gerd). objectives understand the basic pathophysiology of gerd ...

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=o8iShP84HP4

(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/

Overview.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.    LettuceB.    EggsC.    ChocolateD.    Butterscotch

Basic care and comfort nclex practice test. (2010, July 22). Retrieved from http://nclexreviewers.com/nclex-sample-questions/basic-care-

and- comfort/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/physiological- adaptation/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-and- comfort/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. Physiological adaptation nclex RN practice test. (2010, August 23). Retrieved

from http://nclexreviewers.com/nclex-sample-questions/physiological-adaptation/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