Gastroesophageal Refux

Disease
(GERD)
OBJECTIVES

Unerstan the !asi" pathoph#siolog#

o$ GERD

Ienti$# the s#%pto%s o$ GERD

Unerstan proper %ei"al an nursing

inter&entions
'(T)O')ISIO*OG+

Cause !# the relaxation o$ the lo,er

esophageal sphin"ter (*ES)

Gastri" -ui"es %o&e !a". through the *ES into

the esophagus

Can "ause erosion o$ the esophageal %u"osal la#er

http/00,,,1#outu!e1"o%0,at"h2&3o4iSh'45)'5
(6o,.eiu.o7 89:8)
S+;'TO;O*OG+

)eart!urn

Regurgitation

Sleep istur!an"es

Cough

)oarseness

(sth%a

Dental erosions
(6o,.eiu.o7 89:8)
'REV(*(6CE

;ost "o%%on upper gastrointestinal

isease in ,estern "ountries

:9<=89< o$ people in ,estern "ountries

experien"e s#%pto%s

41> %illion people iagnose ('err#7

89:8)

Seen %ostl# in oler Cau"asian %ales

(6o,.eiu.o7 89:8)
RIS? @(CTORS

Geneti" $a"tor

O!esit#

(l"ohol a!use

S%o.ing
(6o,.eiu.o7 89:8)

;EDIC(* I6TERVE6TIO6S

("i Suppressi&e Therap#

)ista%ine 8 re"eptor antagonists ()8R(s)

'roton pu%p inhi!itors (''I)

(nta"is

Surger#

Transoral in"isionless $unopli"ation

6issenAs $unopli"ation
(6o,.eiu.o7 89:8)
6URSI6G I6TERVE6TIO6S

'ain %anage%ent

(ssess pain le&el $reBuentl#

(%inister %ei"ations

Ris. $or aspiration

;onitor respirator# rate7 epth7 an eCort

Dhen eating loo. $or signs o$ aspiration

in"luing "oughing7 "ho.ing7 an spitting
$oo
((".le#7 89:9)
'(TIE6T TE(C)I6G

@or patients that are o!ese en"ourage

,eight loss1

(&oi al"ohol7 "ho"olate7 "itrus -ui"e7

to%ato=!ase prou"ts7 pepper%int7
"oCee7 an onion1

S%aller siEe %eals %ore $reBuentl#

throughout the a#1
(6o,.eiu.o7 89:8)
'(TIE6T SCE6(RIO= )'I

The patient is a F4 #ear=ol ,hite $e%ale ,ho

"o%plains o$ gastroesophegeal refux1 She states
that the esophageal refux !egan approxi%atel#
:9 #ears ago an ha nissen $unopli"ation
surger# to Gx the pro!le%1 Esophageal refux
pain !egan again 4 %onths ago in the sto%a"h7
esophagus7 an !a".1 'atient reports pain as
"onstant7 !urning7 an an 40:9 on 90:9 s"ale1
Trie 5=F iCerent %ei"ations7 none %ae her
s#%pto%s !etter1 S#%pto%s ,orsene a$ter
eating1
'(TIE6T ;EDIC(TIO6S

*o&enox

Insulin

Dilaui

'henol topi"al
("hlorasepti" spra#)

'atient ,as not ta.ing

an# a"i suppressi&e
therap# %ei"ation or
anta"is to relie&e
s#%pto%s
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*(BS (@TER SURGER+

Glu"ose :FF (higher than nor%al range)

($ter surger# glu"agon "an !e release $ro%

the pan"reas ,ith e"rease prou"tion o$
insulin

)GB :9147 )CT H519 (lo,er than nor%al

range)

)e%oglo!in an he%ato"rit &alues are

"o%%onl# lo, a$ter surger#

DBC I157 '*T 8:I (,ithin nor%al range)

Ini"ates no in$e"tion
'(TIE6T SCE6(RIO=
I6TERVE6TIO6S

;ei"al

Transoral in"isionless $unopli"ation

6ursing

'ain "ontrol ,ith %ei"ation

In"reasing "o%$ort o$ patient !# a-usting

!e to "o%$orta!le position
6URSI6G DI(G6OSIS

'ain r0t re"ent surger# a1e1! patient

"o%plaints o$ pain F0:9 an gri%a"ing

I%paire s,allo,ing r0t pain $ro% re"ent

surger# a1e1! gri%a"ing ,hile
s,allo,ing

Ris. $or i%!alan"e nutrition r0t

iJ"ult# s,allo,ing an la". o$ esire
to eat
6C*EK LUESTIO6S :

Gastroesophageal refux disease (GERD) weakens the lower

esophageal sphincter, predisposing older persons to risk for
impaired swallowing. In managing the smptoms associated with
GERD, the nurse should assign the highest priorit to which of
the following inter!entions"

(1 De"rease ail# inta.e o$ &egeta!les an ,ater7 an a%!ulate

$reBuentl#

B1 1Drin. "oCee ilute ,ith %il. at ea"h %eal7 an re%ain in an upright

position $or H9 %inutes1

C1 Eat s%all7 $reBuent %eals7 an re%ain in an upright position $or at least

H9 %inutes a$ter eating1

D1 (&oi o&er=the="ounter rugs that ha&e anta"is in the%1

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6C*EK LUESTIO6 8

#hich of the following foods should

$e a!oided $ clients who are
prone to de!elop heart$urn as a
result of gastroesophgeal refux
disease (GERD)"(1 *ettu"eB1 Eggs
C1 Cho"olateD1 Butters"ot"h

Basi" "are an "o%$ort n"lex pra"ti"e test1 (89:97 Jul# 88)1 Retrie&e $ro%
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"o%$ort0!asi"="are=an="o%$ort=n"lex=pra"ti"e=test1ht%l
6C*EK LUESTIO6 H

%he client with GERD complains of a

chronic cough. %he nurse understands
that in a client with GERD this
smptom ma $e indicati!e of which
of the following conditions"

(1 De&elop%ent o$ lar#ngeal "an"er

B1 Irritation o$ the esophagus

C1Esophageal s"ar tissue $or%ation

D1 (spiration o$ gastri" "ontents

Stuent nursing stu# !log PDe! log %essageQ 1 (89:9)1 Retrie&e $ro% http/00
a%#5I1"o%0n"lex=st#le=pra"ti"e=Buestions0gastro0gastro=H0
6C*EK LUESTIO6 5

The surgical procedure of choice for

older patients with GERD and Barrett's
esophagus that is not reversible with
medical management is:

Esophagectomy.

Nissens fundoplication

Tota laryngectomy.

Labyrinthectomy.
Ta!los.i7 '1 B1 (89:9)1 6C*EK re&ie, Buestions1 Retrie&e $ro% http/00
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6C*EK LUESTIO6 F

%he R& has 'nished teaching a

patient a$out treatment of GERD. %he
R& knows the patient has understood
the teaching if she states((1 RI
shoul eat a s%all !eti%e sna". ea"h
night1SB1 RI shoul lie fat in !e1SC1 RI
"an ha&e re ,ine ,ith inner1SD1 RI
shoul eat six s%all %eals ail#1S

'h#siologi"al aaptation n"lex R6 pra"ti"e test1 (89:97 (ugust 8H)1 Retrie&e

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RE@ERE6CES

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Else&ier

Basi" "are an "o%$ort n"lex pra"ti"e test1 (89:97 Jul# 88)1 Retrie&e $ro%
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"are=an="o%$ort=n"lex=pra"ti"e=test1ht%l

6o,.eiu.o7 S1 C17 (89:87 Jul# ::)1 Current trens in the %anage%ent o$

gastroesophageal refux/ a re&ie,1 ISRN Gastroenterol, !"1 oi/:91F598089:80H>:OH:

'eer#7 (1@17 T Dellon7 E1 S1 (89:87 6o&e%!er)1 Buren o$ gastrointestinal isease in

the Unite States/ 89:8 upate1 Gastroenterology7 :5H(F)/ ::I>=::4I1 oi/
:91:9FH0-1gastro189:819419981

'h#siologi"al aaptation n"lex R6 pra"ti"e test1 (89:97 (ugust 8H)1 Retrie&e $ro%
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aaptation0ph#siologi"al=aaptation=n"lex=rn=pra"ti"e=test1ht%l

Stuent nursing stu# !log PDe! log %essageQ 1 (89:9)1 Retrie&e $ro% http/00
a%#5I1"o%0n"lex=st#le=pra"ti"e=Buestions0gastro0gastro=H0

Ta!los.i7 '1 B1 (89:9)1 6C*EK re&ie, Buestions1 Retrie&e $ro% http/00

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"ontent0inex1ht%l