Comprehensive Presentation: Gastroesophageal Reflux Disease (GERD)

1. Gastro-esophageal Reflux Disease (GERD)

2. overview

4. GERD Commonly known as heartburn Backflow of gastric and/or duodenal contents into the esophagus and past the lower esophageal sphincter (LES), without associated belching or vomiting Reflux may cause symptoms or pathologic changes

9. Pathophysiology and Etiology

11. Normally, gastric contents don't back up into the esophagus because the LES creates enough pressure around the lower end of the esophagus to close it Reflux occurs when LES pressure is deficient or pressure in the stomach exceeds LES pressure When this happens, the LES relaxes, allowing gastric contents to regurgitate into the esophagus

15. Alcohol

16. Cigarettes

17. Anticholinergics

18. Atropine

19. Belladonna

20. propantheline

21. Other drugs

22. Morphine

23. Diazepam

24. calcium channel blockers

28. Clinical manifestations

30. typically occurring 30-60 min after meals and with reclining positions

31. complaints of spontaneous reflux (regurgitation) of sour or bitter gastric contents into the mouthOther typical symptoms: Globus (sensation of something in throat) Mild epigastric pain Dyspepsia Nausea and/or vomiting

34. Hoarseness

35. Recurrent sore throat

36. Frequent throat clearing

37. Chronic cough

38. Dental enamel loss

39. Bronchospasm (asthma/wheezing)

41. Dysphagia rule out

42. Odynophagia cancer

43. GI bleeding or

44. shortness of breath esophageal

50. Lifestyle Modifications

52. Pharmacologic treatment

54. Use on an as-needed basis

56. Provide symptomatic relief

57. May require lifelong therapy

58. ranitidine (Zantac)

59. cimetidine (Tagamet)

60. famotidine (Pepcid)

63. blocks gastric acid secretion

64. omeprazole (Prilosec)

65. esomeprazole (Nexium)

66. pantoprazole (Protonix)

67. rabeprazole (Aciphex)

68. lansoprazole (Prevacid)PPIs are more effective than H2-receptor antagonists in achieving faster healing rates for erosive esophagitis

69. Drug maintenance therapy may be needed depending on the severity of disease and recurrence of symptoms after initial drug therapy is stopped Use the lowest effective drug dose of H2-receptor blocker or proton pump inhibitor

70. Antireflux Surgery

72. Can be performed laparoscopically

73. Combined with vagotomy-pyloroplasty if associated with gastroduodenal ulcer

75. ENDOSCOPIC TREATMENTS

77. prevents reflux of gastric acid into the throat

79. Nursing Diagnoses

80. Acute pain Anxiety Deficient knowledge (diagnosis and treatment) Imbalanced nutrition: Less than body requirements Risk for aspiration

81. Key outcomes

82. The patient will: express feelings of comfort identify strategies to reduce anxiety express an understanding of the disorder and treatment regimen achieve adequate caloric and nutritional intake The patient won't show signs of aspiration

83. Nursing Interventions

85. Avoid lying down for 3 hours after meals and eating late-night snacksAfter surgery, provide post-laparotomy care. Pay particular attention to the patient's respiratory status because the surgical procedure is performed close to the diaphragm.

86. Administer prescribed analgesics, oxygen, and I.V. fluids Monitor intake and output Check vital signs If surgery was performed using a thoracic approach, watch and record chest tube drainage If needed, provide chest physiotherapy

87. Patient teaching

89. Eat small, frequent meals

91. Coughing

92. Vigorous exercise

93. Obesity

94. Constipation