Gastro-esophageal reflux - PowerPoint Presentation

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Gastro-esophageal reflux

disease

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GERD

, is a common condition

characterized by prolonged reflux of hydrochloric acid, pepsin, and bile salts in esophagus, oral cavity, or respiratory system leading to esophagitis.

Causes are related to the weakness or inappropriate prolonged / frequent transient relaxation of the LES, or delayed gastric emptying.The chief symptom of GERD is frequent and prolonged retrosternal heartburn (dyspepsia) and regurgitation (acid reflux) in relationship to eating or activities.

Key points

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Other symptoms can

include:

chronic cough, dysphagia, belching (eructation), flatulence (gas), atypical chest pain,

and

asthma exacerbationsIf untreated; GERD leads to inflammation, breakdown, and long-term complications.The primary treatment of GERD is diet and lifestyle changes, advancing into medication use (antacids, H2 antagonists, and proton pump inhibitors).

Key points

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Any

factor that relaxes the

LES (smoking

, caffeine, alcohol, or drugs).Any factor that increases the abdominal pressure (obesity, tight clothing at the waist, ascites, or pregnancy.Older age and/or a debilitating condition that weakens the LES tone.Contributing factorsDiet: Excessive ingestion of foods that relax the LES include:

Fatty and fried foods.

Chocolate.Caffeinated beverages such as coffee.Peppermint.Spicy foods.Tomatoes.Citrus fruits.Alcohol.Etilogy

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Distended abdomen from overeating or delayed emptying

Increased abdominal pressure (

obesity

, pregnancy, bending at the waist, ascites or tight clothing at the waist)Drugs that relax the LES, such as theophylline, nitrates, calcium channel blockers, anticholinergics, and diazepam (Valium)Drugs, such as NSAIDs, or events (stress) that increase gastric acidDebilitation or age-related conditions resulting in weakened LES toneHiatal hernia (LES displacement into the thorax with delayed

esophageal clearance

)Lying flatEtiology

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History

: Symptoms 4 to 5 times per week on a consistent

basis

Improvement after a 6-week course of proton pump inhibitors (PPI)Diagnostic interventions taken to differentiate GERD from gastritis and from gastric/peptic ulcer (ulceration of gastric mucosa)Barium meal: pre & post Nsg responsibilities

Endoscopy is used while the client is under conscious sedation to observe

for tissue damage (Nsg responsibilities).Esophageal manometry

is used to measure muscle tone of LES and

pH monitoring

.

Diagnostic Procedures and Nursing Interventions

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Surgery

(fundoplication) may be indicated for clients who fail to respond.The surgeon wraps the fundus of the stomach around and behind the

esophagus through

laparoscopy to create a physical barrier.New option: Stretta procedure uses radiofrequency energy, applied by laparoscopy, to the LES muscle. This causes the tissue to contract and tighten.Therapeutic Procedures and Nursing Interventions

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Classic

symptoms: Dyspepsia, especially after eating an offending

food/ fluid,

and regurgitation.Other symptoms: Symptoms from throat irritation (chronic cough, laryngitis), hypersalivation, eructation, flatulence, or atypical chest pain from esophageal spasm. Chronic GERD can lead to dysphagia (difficulty swallowing).Assessments

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Assess the client’s:

Dietary intake patterns, paying particular attention to foods

containing caffeine

and fat.Smoking history.Alcohol use.Weight.Assessments

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Acute pain

Deficient knowledge

NANDA Nursing Diagnoses

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Educate

the client regarding:DietAvoid offending foods.

Avoid large meals.

Remain upright after eating.LifestyleAvoid tight-fitting clothing around the middle.Lose weight, if applicable.Elevate the head of the bed 15.2 to 20.3 cm (6 to 8 in) with blocks. The use of pillows is not recommended, as this rounds the back, bringing the stomach contents up closer to the chest.Nursing Interventions

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Medications

Encourage consistent appropriate use of prescribed medications:

Antacids,

should be administered when the acid secretion is highest (1 to 3 hr after eating and at bedtime). Antacids should be separated from other medications by at least 1 hr.Histamine2 receptor antagonists (ranitidine

(Zantac

), famotidine (Pepcid), nizatidine (Axid), and cimetidine (Tagamet), reduce the secretion of acid. The onset is longer than antacids, but the effect has a longer duration.

Proton pump inhibitors (PPI), omeprazole

(Prilosec

)

reduce gastric acid by inhibiting the cellular

pump necessary

to secrete it. Studies show that PPI are more effective than

H2 antagonists

.

Medications such as metoclopramide hydrochloride (Reglan),

increase the

motility of the esophagus and stomach

.

Prokinetic;

promote gastric emptying

Nursing Interventions

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Pain Management

N&V management

Nutritional needs management

Assess for bleedingNursing Interventions

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Risks

associated with aspiration include:

Asthma exacerbations from inhaled aerosolized acid.

Frequent upper respiratory, sinus, or ear infections.Aspiration pneumonia.Formation of esophageal strictures (scarring).Erosive esophagitis, ulceration, and hemorrhage.Barrett’s epithelium (premalignant) and esophageal adenocarcinoma.Complications and Nursing Implications

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