Presentations text content in Gastroesophageal
Slide1
Gastroesophageal Reflux Disease(GERD)
Slide2OBJECTIVES
Understand the basic pathophysiology of GERD
Identify the symptoms of GERD
Understand proper medical and nursing interventions
Slide3PATHOPHISIOLOGY
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)
Slide4SYMPTOMOLOGY
Heartburn
Regurgitation
Sleep disturbances
Cough
Hoarseness
Asthma
Dental erosions
(
Nowkediuko
, 2012)
Slide5PREVALANCE
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)
Slide6RISK FACTORS
Genetic factor
Obesity
Alcohol abuse
Smoking
(
Nowkediuko
, 2012)
Slide7
MEDICAL INTERVENTIONS
Acid Suppressive Therapy
Histamine 2 receptor antagonists (H2RAs)
Proton pump inhibitors (PPI)
Antacids
Surgery
Transoral
incisionless
fundoplication
Nissen’s
fundoplication
(
Nowkediuko
, 2012)
Slide8NURSING 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)
Slide9PATIENT 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)
Slide10PATIENT 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.
Slide11PATIENT MEDICATIONS
LovenoxInsulinDilaudidPhenol topical (chloraseptic spray)Patient was not taking any acid suppressive therapy medication or antacids to relieve symptoms
http://www.adultmeducation.com/images/Overview.jpg
Slide12LABS 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
Slide13PATIENT SCENARIO- INTERVENTIONS
Medical
Transoral
incisionless
fundoplication
Nursing
Pain control with medication
Increasing comfort of patient by adjusting bed to comfortable position
Slide14NURSING 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
Slide15NCLEX 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
Slide16
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
Slide17NCLEX 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/
Slide18NCLEX 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
Slide19NCLEX 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
Slide20REFERENCES
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
Gastroesophageal
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