April 8, 2017
Gastroesophageal reflux disease (GERD) nursing NCLEX lecture on the symptoms, GERD diet, nursing interventions, and treatment. GERD is a chronic condition where stomach contents is flowing back up into the esophagus.
What causes gastroesophageal reflux disease? GERD is mainly due to a weak or damaged lower esophageal sphincter. The LES is a collection of circular muscles at the end of the esophagus that closes and prevent toxic acids and GI contents from flowing back into the esophagus once it enters the stomach.
What causes the LES to become weak? Many things such as pressure on the LES from pregnancy, obesity, hiatal hernia, or overeating along with medications such as antihistamines, calcium channel blockers, sedatives, and even smoking. In addition, GERD can be caused by delayed gastric emptying or impaired motility of the esophagus.
Signs and symptoms of GERD include: heartburn, regurgitation (bitter taste in the mouth), dry chronic cough especially at night, upper GI pain, voice changes, nausea, problems swallowing etc.
Complications of gastroesophageal reflux disease include: narrowing of the esophagus (strictures), Barret's esophagus, bleeding, increased risk of esophageal cancer, aspiration, lungs infections, and ear infections.
What is the treatment for GERD? It is treated with lifestyle changes (smoking cessation, weight loss, diet changes etc.), medications, and in the worst cases surgery (fundoplication).
How is gastroesophageal reflux disease diagnosed? An endoscopy is performed to assess the esophagus for changes such as erosion or strictures etc. Esophageal manometry assesses the function of the esophagus' ability to squeeze food down into the stomach and how the lower esophageal sphincter closes. PH monitoring measures the acid amounts in the esophagus for a 24 hour period as the patient perform activities of daily living (a small tube stays in the esophagus to help measure the acid amounts).
Medications used to treat GERD include: Antacids, histamine receptor blockers, proton-pump inhibitors, and prokinetics. Nursing interventions for GERD include: diet teaching (avoids foods that relax the lower esophageal spincter: peppermint/spearmint, alcohol, coffee, fatty/greasy foods), smoking cessation, limiting acids foods such as citrus and tomatoes, avoid eating right before bed, sitting up an hour after a meal, and eating small meals rather than large ones. Monitor the patient for complications, assessing quality/frequency of pain, medication history, and administering medications per MD order.
