Gastroesophageal reflux disease – GERD Pathophysiology, Podcast and Nursing care plan

GERD

Gastroesophageal reflux – GER

Ger occurs when the gastric contents in the stomach back up into the esophagus. It is not uncommon for a person the have GER as it is fairly common. However, when GER occurs more 2x per week, a diagnosis of Gastroesophageal reflux disease may be made.

Gastroesophageal reflux disease – GERD

GERD occurs when there is frequent backflow of gastric contents from the stomach or bile contents from the small intestine back into the esophagus.

Normally, when a patient eats food, the lower esophageal sphincter (LES), located at the bottom of the esophagus relaxes and allows food to travel down to the stomach. This sphincter will then close to keep food products in the stomach for digestion.

But, when the sphincter does not function normally, stomach acid is able to back flow into the esophagus. With the continuous back flow of gastric acid, the lining of the esophagus will become inflamed and irritated. This condition is called esophagitis. As esophagitis continues, the esophageal lining is worn away causing esophageal narrowing, bleeding, or even a precancerous condition called Barrett’s esophagus.

Sign and Symptoms

The signs and symptoms of GERD include:

  • Heartburn (major symptom): a burning sensation in the chest. This can spread to the throat and even cause a sour taste in mouth.
  • Dysphagia: difficulty swallowing
  • Chest pain
  • Dyspepsia: indigestion
  • Sore throat or hoarseness
  • Acid reflux (regurgitation of flood or soar liquid)
  • Feeling like something is in throat
  • Dry cough

Gastrointestinal

Risk Factors

Certain patients are at risk for GERD. They include those who are/have:

  • Obese
  • Pregnant
  • Smokers
  • Dry mouth
  • Asthma
  • Hiatal hernias (top of stomach goes up into the diaphragm).
  • Connective tissue disorders
  • Diabetes
  • Delayed gastric emptying

 

Complications

The chronic inflammation of GERD can lead to the following complications:

  •  Esophageal Stricture: scar tissue is formed from the acid that has backed up into the esophagus. This scar tissue narrows the esophagus and can also cause difficulty in swallowing.
  • Esophageal Ulcer: the gastric acid that backs up from the esophagus, can cause an open sore to form in the esophagus. The ulcer that is formed can not only bleed, but cause pain and difficulty in swallowing.
  • Barrett’s Esophagus: this is a precancerous condition which intestinal tissue replaces tissue that lines the esophagus. This condition may develop into a cancer that is rare called esophageal adencarcinoma.

Diagnosis

Usually a detailed history will help the physician to diagnose the disease:

  • Patient presentation of symptoms
  • Endoscopy to visualize esophagus and stomach.
  • Ph testing for 24 hours for patients with symptoms of GERD but with normal endoscopy.
  • Upper GI series or Barium Swallow

Treatment and Interventions

Patients tend to use over the counter medications in the beginning of GER or GERD to help with the discomfort.  If the symptoms do not get better, the physician may order the following:

  • Head of bed elevated
  • Avoidance of coffee, alcohol, smoking, peppermint, chocolate, fried fatty foods, and carbonated beverages.
  • Proton pump inhibitors and antacids may be prescribed.
  • Low fat, high fiber diet and avoid eating 2 hours before bedtime.
  • Avoid anticholinergics as they may delay gastric emptying.
  • Avoid NSAIDS and other medications that contain acetylsalicylic acid as they can increase the frequency of ulcers and upper GI bleeding.
  • Surgery may be needed in extreme cases such as a fundoplication which is wrapping some of the gastric fundus around the sphincter area of the esophagus.

 

Nursing Care Plan

Nursing Diagnosis

1. Impaired tissue integrity related to esophageal exposure to gastric acid.

Desired Outcome:

Patient is able to verbalize knowledge of necessity lifestyle changes with 24 hours of discharge from the hospital.

InterventionsRationals
InterventionsRationals
Teach patient to avoid foods that cause pain and or can increase acid secretion.Foods that can cause pain or increase acid secretion can worsen esophageal erosion.
If indicated, recommend strategies for smoking cessation. Smoking impairs tissue healing and is associated with a higher incidence of complications that may necessitate surgery.
Teach the patient to avoid NSAIDS, ASA, chocolate, coffee, and alcohol.These medicines and foods have been associated with increased GI erosions and acidity.
Administer acid suppression therapy as prescribed.To decrease the amount of acid that is produced and can cause mucosal erosion.

2. Risk for aspiration related to esophageal disease affecting the lower esophageal sphincter.

Desired Outcome:

Within 8 hours of interventions, the patient will have no episodes of aspiration.

InterventionsRationals
InterventionsRationals
Assess the patients ability to swallow and presence of gag reflex.this will help to determine presence and or effectiveness of protective mechanisms.
Avoid placing patient in supine position.Supine positioning has been indicated for increasing the risk of aspiration.
Elevate the HOB while in bed.This position will prevent aspiration as it is more difficult for gastric acid to backflow back into the esophagus.

 

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

Facebooktwittergoogle_plusredditpinterestmail

Anna C. RN-BC, BSN, PHN, CMSRN Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process. She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

One comment

Leave a Reply

Your email address will not be published. Required fields are marked *