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Gastroesophageal Reflux Disease (Gerd) : By: Therese Jane Timbalopez

The document provides information about gastroesophageal reflux disease (GERD). It describes GERD as a disorder where the lower esophageal sphincter allows stomach contents to flow back up into the esophagus. Symptoms include heartburn and acid reflux. The document also discusses risk factors like hiatal hernias and lists nursing care goals such as managing nutrition, pain, risk of aspiration, and increasing patient knowledge.

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joyrena ochondra
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461 views14 pages

Gastroesophageal Reflux Disease (Gerd) : By: Therese Jane Timbalopez

The document provides information about gastroesophageal reflux disease (GERD). It describes GERD as a disorder where the lower esophageal sphincter allows stomach contents to flow back up into the esophagus. Symptoms include heartburn and acid reflux. The document also discusses risk factors like hiatal hernias and lists nursing care goals such as managing nutrition, pain, risk of aspiration, and increasing patient knowledge.

Uploaded by

joyrena ochondra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Gastroesophageal Reflux

Disease
(GERD )

By: Therese Jane


Gastroesophageal reflux disease, or GERD, is a digestive
disorder that affects the lower esophageal sphincter (LES), the
ring of muscle between the esophagus and stomach.
Gastroesophageal refers to the stomach and esophagus.
Reflux means to flow back or return.

Therefore, gastroesophageal reflux is the return of the


stomach's contents back up into the esophagus.
In normal digestion, the lower esophageal sphincter
(LES) opens to allow food to pass into the stomach
and closes to prevent food and acidic stomach juices
from flowing back into the esophagus.

Gastroesophageal reflux occurs when the LES is


weak or relaxes inappropriately, allowing the
stomach's contents to flow up into the esophagus.
Some doctors believe a hiatal hernia may weaken the LES and
increase the risk for gastroesophageal reflux. Hiatal hernia
occurs when the upper part of the stomach moves up into the
chest through a small opening in the diaphragm (diaphragmatic
hiatus). The diaphragm is the muscle separating the abdomen
from the chest.

Recent studies show that the opening in the diaphragm helps


support the lower end of the esophagus. Many people with a
hiatal hernia will not have problems with heartburn or reflux.
But having a hiatal hernia may allow stomach contents to
reflux more easily into the esophagus.
Many people experience acid reflux from time to time. GERD
is mild acid reflux that occurs at least twice a week, or moderate
to severe acid reflux that occurs at least once a week.

Most people can manage the discomfort of GERD with lifestyle


changes and over-the-counter medications. But some people
with GERD may need stronger medications or surgery to ease
symptoms.
Nursing Care Plans

Nursing care planning goals of gastroesophageal reflux


disease (GERD) involves teaching the patient to avoid situations
that decrease lower esophageal sphincter pressure or cause
esophageal irritation.

Imbalanced Nutrition: Less Than Body Requirements


Acute Pain
Imbalanced Nutrition: More Than Body Requirements
Risk for Aspiration
Deficient Knowledge
mbalanced Nutrition: Less Than Body Requirements
Imbalanced Nutrition: Less Than Body Requirements: 
The state in which an individual who is not on NPO,
experiences or is at risk for inadequate intake or metabolism of nutrients for metabolic
needs with or without weight loss.
May be related to
•inability to intake enough food because of reflux
•increased metabolism caused by disease process
•early satiety
•heartburn

Nursing Interventions Rationale


Accurately measure the patient’s weight and For baseline data.
height.
Determining the feeding habits of the client can
Obtain a nutritional history. provide a basis for establishing a nutritional plan.

Encourage small frequent meals of high calories


Small and frequent meals are easier to digest.
and high protein foods.

Instruct to remain in upright position at least 2


Helps control reflux and causes less irritation from
hours after meals; avoiding eating 3 hours before reflux action into esophagus.
bedtime.
Instruct patient to eat slowly and masticate foods
well. Helps prevent reflux.
Acute Pain: 
The state in which an individual experiences and reports the presence of
severe discomfort or an uncomfortable sensation lasting from 1 seconds to <6
months.
May be related to
gastroesophageal reflux
coughing
aspiration
irritated esophageal mucosa
irritated oral cavity from reflux

Nursing Interventions Rationale


Heartburn is the most common
feature of GERD. This becomes
Assess for heartburn. more severe with
vigorous exercise, bending, or
lying down.

Pain of esophageal spasm


Carefully assess pain location resulting from reflux esophagitis
and discern pain from GERD tends to be chronic and may
and angina pectoris. mimic angina pectoris: radiating
to the neck, jaws, and arms.
Imbalanced Nutrition: More Than Body Requirements: 
The state in which an individual experiences or is at risk of experiencing weight gain
related to an intake in excess of metabolic requirements.
May be related to
decreased physical activity
GERD
eating to try to assuage pain
decreased metabolic rate
Nursing Interventions Rationale

Provides information regarding factors


Assess patient for dietary history intake, eating associated with being overweight or obesity
patterns, the importance of eating, and problems and assists in establishing a plan of
potentials for where dietary exercises can be care for weight reduction. Note: Elderly tend to
limited. gain weight faster and easily because of
decreased activity and a lower metabolic rate.

Establish a dietary plan for weekly goals of Prevents frustration from lack of achieving
weight loss of one pound. Encourage patient to goals. A reduction of approximately 500 calories
make gradual changes in dietary habits. per day will achieve the prescribed goal.

Utilize calories and provides diversion from


Provide activities for the patient that do not eating; being overweight increases abdominal
center around or are associated with meals or pressure, which can then push stomach
snacks.
contents up into the esophagus.
Risk for Aspiration: 
The state in which a person is at risk for entry of secretions, solids, or fluids into the
tracheobronchial passages.
May be related to
esophageal compromise affecting the lower esophageal sphincter impaired swallowing

Nursing Interventions Rationale


These include subsequent aspiration, chronic pulmonary
Assess for pulmonary symptoms resulting from reflux of
gastric content. disease, or nocturnal wheezing, bronchitis, asthma,
morning hoarseness, and cough.

Assess for nocturnal regurgitation. This is a rare condition wherein the patient awakens with
coughing, choking, and and a mouthful of saliva.
Assess patient’s ability to swallow and the presence of gag
Loss of the gag reflex increases the risk of aspiration.
reflex. Have the patient swallow a sip of water.
Avoid placing patient in supine position, have the patient Supine position after meals can increase regurgitation of
sit upright after meals. acid.
Instruct patient to avoid highly seasoned food, acidic juices, These can reduce the lower esophageal sphincter pressure.
alcoholic drinks, bedtime snacks, and foods high in fat.
To prevent aspiration by preventing the gastric acid to flow
Elevate HOB while in bed. back in the esophagus.
The tube interferes with sphincter integrity and allows
Avoid nasogastric intubation for more than five (5) days.
reflux, especially when the patient lies flat.
Instruct the patient to chew food thoroughly and eat Well-masticated food is easier to swallow. Food should be
slowly. cut into small pieces.
If the patient has dysphagia, put the patient on NPO and Patient at high risk for aspiration should be kept NPO until
notify physician. swallowing study has been completed.
Deficient Knowledge: 
The state in which an individual or group experiences a deficiency in cognitive
knowledge or psychomotor skills concerning the condition or treatment plan.
May be related to
lack of information regarding condition/disease process.

Nursing Interventions Rationale


Assess patient for information
needed and ability to perform Provides a basis for teaching.
actions independently.
Assist with the reduction in Overweight increases
caloric intake. intraabdominal pressure.
Provide patient with information
regarding disease
Provides knowledge and
process, health practices that
facilitates compliance.
can be changed, and
medications to be utilized.

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