Gastroesophageal Reflux

Disease
(GERD)
Ch.42 pp. 931-935

GERD

Reflux of stomach acid into

esophagus
Causes mucosal damage

Possible causes

Incompetent LES
Obesity
Cigarette and cigar smoking
Hiatal hernia

GERD

What clinical manifestations may the pt.

with GERD exhibit?

GERD
Complications

Esophagitis
Can lead to strictures, scar tissue, and
dysphagia

Esophageal ulcerations
Barretts esophagus

Precancerous lesion

Respiratory complications
Dental erosion

GERD
Diagnostic Studies
History and Physical
Upper GI endoscopy with biopsy
Esophagram (barium swallow)
Motility Studies
pH monitoring
Radionuclide studies

GERD
Collaborative Care
Lifestyle modification
Nutritional Therapy
Drug therapy
Surgery

GERD
Collaborative Care

Lifestyle modification

Avoid triggers
Weight reduction
Smoking cessation
Manage stress

GERD
Collaborative Care

Nutritional Therapy
Avoid foods /items that decrease LES pressure (Table 427)

Alcohol
Anticholinergics
Chocolate
Fatty foods
Nicotine
Peppermint

Avoid milk
Small frequent meals
Increase saliva production
Avoid late evening meals
Fluid between rather than with meals
Avoid foods that irritate esophagus
Positioning

GERD
Collaborative Care

Drug Therapy
Goals of drug therapy

Decrease volume and acidity of reflux

Improve LES function
Increase esophageal clearance
Protect esophageal mucosa

GERD
Collaborative Care

Drug Therapy
Proton Pump Inhibitors (eg. Prevacid, Prilosec, Protonix,
Nexium)

Histamine (H2)- Receptor Blockers (eg. Tagamet, Pepcid,

Zantac)

Prokinetic Agents (eg. Reglan)

Antiulcer, Protectants (eg. Carafate)
Cholinergics (eg. Urecholine)
Antacids (eg. Amphojel, Tums, Alka-Seltzer, Maalox, Mylanta)
Prostaglandins (eg. Cytotec)

GERD
Collaborative Care

Surgical Therapy

Nissen and Toupet fundoplications

Fundus of stomach wrapped around lower portion
of esophagus

LINX reflux management system

Titanium beads with magnetic core implanted into

LES

Endoscopic Therapy

Endoscopic mucosal resection

Photodynamic therapy
Cryotherapy
Radiofrequency ablation

GERD
Nursing Management

Pt Teaching

Elevation of head of bed 30 degrees

Not lying down for 23 hours after eating
Avoidance of late-night eating
Evaluating effectiveness of medications
Observing for side effects of medications
Avoidance of factors that cause reflux
Stop smoking
Avoid alcohol and caffeine
Avoid acidic foods

Stress reduction techniques

Weight reduction, if appropriate
Small, frequent meals

GERD
Nursing Management

Postop Care

Prevent respiratory complications

Maintain F & E balance
Prevent infection
Respiratory assessment
Deep breathing
Pain management
Meds to prevent N & V
Fluids (peristalsis present) then gradually
progress to solids
Avoid gas producing foods

Ch.43 pp.973-974

 Most

common cause of RLQ pain

Opening

of the appendix is obstructed or

blocked
Initial

obstruction associated with:

Fecaliths (most common cause)

 Perforation
Peritonitis

Elevation in temperature
Increased pulse

Diagnostics

History and Physical

Laboratory findings

CBC including WBC with

diff.
Serum electrolytes
Abdominal paracentesis
and culture of fluid

Imaging Diagnostics

Abdominal X-ray
Ultrasound
CT scan

Collaborative Care

Appendectomy

Antibiotics
Fluid replacement

 Hospitalized

and examined by HCP

Keep pt NPO

DO NOT..
Give laxative or enema
Post-op

management

Early ambulation
Advance diet as tolerated

Ch.43 pp.974-975

Life threatening

Bacterial contamination of peritoneum

Massive fluid shifts

What clinical manifestations may the pt. with

peritonitis exhibit?

DIAGNOSTIC STUDIES

COLLABORATIVE CARE

CBC
WBC
Peritoneal aspiration
Abdominal X-ray
Ultrasound
CT scans

Antibiotics
NG suction
Analgesics
IV fluids
Surgery

What findings should the nurse assess for in the

pt. with suspected peritonitis?

Nursing Diagnosis
Acute pain
Risk for deficient fluid volume

Anxiety

Planning: Pt. goals

Resolve inflammation
Relieve abdominal pain

No complications
Normal nutritional status

Nursing Implementation
IV access
Fluid replacement
Antibiotics

Pain management
Pt. may be positioned with knees flexed
Decrease anxiety
Monitor I & O
Monitor VS
Antiemetics
NPO
NG tube
Oxygen therapy
Post-op care for laparotomy