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Gastroesophageal Reflux Disease (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)

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Gastroesophageal Reflux Disease (GERD)

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  1. Gastroesophageal Reflux Disease(GERD)

  2. OBJECTIVES • Understand the basic pathophysiology of GERD • Identify the symptoms of GERD • Understand proper medical and nursing interventions

  3. 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)

  4. SYMPTOMOLOGY • Heartburn • Regurgitation • Sleep disturbances • Cough • Hoarseness • Asthma • Dental erosions (Nowkediuko, 2012)

  5. 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)

  6. RISK FACTORS • Genetic factor • Obesity • Alcohol abuse • Smoking (Nowkediuko, 2012)

  7. MEDICAL INTERVENTIONS • Acid Suppressive Therapy • Histamine 2 receptor antagonists (H2RAs) • Proton pump inhibitors (PPI) • Antacids • Surgery • Transoralincisionless fundoplication • Nissen’s fundoplication (Nowkediuko, 2012)

  8. 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)

  9. 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)

  10. 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.

  11. 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

  12. 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

  13. PATIENT SCENARIO- INTERVENTIONS • Medical • Transoralincisionless fundoplication • Nursing • Pain control with medication • Increasing comfort of patient by adjusting bed to comfortable position

  14. 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

  15. 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

  16. 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.    Chocolate
D.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

  17. 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.Esophagealscar 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/

  18. 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 • Totalaryngectomy. • 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

  19. 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

  20. 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

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