GERD Gastroesphageal Reflux Disease Nursing Diagnosis Care Plan NCLEX Review
Nursing Study Guide: Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease (GERD) is a medical condition that involves the stomach acid’s tendency to flow back into the esophagus, the tube that connects the mouth and the stomach.
Also known as acid reflux, GERD results to the irritation and possible damage to the esophageal lining. GERD can happen anytime from once a week up until several times a week.
Mild GERD is usually treated with over-the-counter medications and dietary changes. However, moderate to severe GERD may require prescription medications or even surgical interventions.
Signs and Symptoms of GERD
- Heart burn – a burning sensation in the chest that usually happens after eating and may be worse at night
- Regurgitation of food or sour liquid (stomach acid)
- Nausea and vomiting
- Chest pain
- Difficulty swallowing
- Sensation of a lump in the throat
- Weight loss
When GERD occurs at night, the patient may also experience chronic cough, laryngitis, disrupted sleep, or new or worsening asthma.
Causes and Risk Factors of GERD
The lower esophageal sphincter is a band of muscle below the esophagus that, when relaxed, allows food to enter the stomach.
This sphincter normally closed when the food and liquid have passed it. A weakened lower esophageal sphincter results to the regurgitation or the flowing back of the stomach acid but up to the esophagus.
The continuous acid reflux may damage the esophageal lining and may eventually cause inflammation.
People who are at a higher risk for GERD include those who have obesity, connective tissue disorders (e.g. scleroderma), hiatal hernia, delayed stomach emptying.
Pregnancy may also contribute to the development of GERD.
Some lifestyle related factors that may trigger an acid reflux include smoking, alcohol, coffee, fatty or fried foods, certain medications (e.g. aspirin), and eating late at night or eating large meals.
Complications of GERD
- Esophageal stricture. The stomach acid can damage the lower esophagus, which may result to scar tissue formation. The scar tissue takes up some space in the food pathway, causing the esophagus to become narrowed. Problems with swallowing and nutrition may occur due to esophageal stricture.
- Esophageal ulcer. An open sore or ulcer can form as the stomach acid continues to damage the lining of the esophagus. Esophageal ulcers are painful and may increase the difficulty of swallowing (dysphagia). Ulcers are also at high risk for bleeding.
- Barrett’s esophagus. The lower esophagus’ lining may have cellular changes due chronic inflammation. It can eventually lead to precancerous changes, known as Barrett’s esophagus.
Diagnosis of GERD
- Physical examination and history taking –to check for any signs and symptoms of GERD and to identify the triggers of GERD
- Endoscopy – to visualize the esophagus and stomach by means of inserting an endoscope, a thin and flexible tube that comes with a camera and light. Endoscopy can also be used to perform a biopsy, collecting a sample of esophageal tissue.
- Ambulatory acid (pH) probe test – to check for the frequency and duration of acid reflux by means of inserting a thin catheter from the nose down to the esophagus
- GI X-ray – to visualize the upper gastrointestinal system by means of asking a patient to swallow a liquid that will coat the digestive tract, making it easier to visualize. Barium pill may also be given to check for any narrowing of the esophagus that causes difficulty of swallowing.
- Esophageal manometry – to measure the esophagus’ rhythmic muscle contractions when the patient swallows
- X-ray of your upper digestive system. X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. The coating allows your doctor to see a silhouette of your esophagus, stomach and upper intestine. You may also be asked to swallow a barium pill that can help diagnose a narrowing of the esophagus that may interfere with swallowing.
Treatment of GERD
- Antacids are helpful in neutralizing stomach acid. These include Tums, Rolaids, and Mylanta. Side effects of antacids include kidney disorders and diarrhea.
- H2-receptor blockers. These medications reduce the production of stomach acid. H2-receptor blockers include famotidine, cimetidine, and nizatidine. Compared to the quick relief provided by antacids, H2-receptor blockers take time to act but provides long-term relief, reducing the production of acid for a maximum of 12 hours.
- Proton-pump inhibitors. These medications work by reducing the amount of stomach acid. They include omeprazole and lansoprazole.
- Baclofen. This medication can help GERD patients by strengthening the lower esophageal sphincter.
- Surgical Intervention. The lower esophageal sphincter can be tightened by the surgeon in a procedure called fundoplication. Another option is through the use of the LINX device, which is a ring composed of small magnetic beads that wrap the area between the stomach and esophagus, preventing reflux while allowing food to enter the stomach.
- Lifestyle changes. Obesity is one of the risk factors for GERD, so it is imperative to help the patient maintain a weight that is within his/her normal BMI range. Smoking cessation and reduced alcohol intake can help prevent acid reflux.
Nursing Care Plans for GERD
- Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements reduced food intake secondary to GERD, as evidenced by weight loss, nausea and vomiting, loss of appetite, dysphagia, heartburn, and muscle mass loss
Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.
|Explore the patient’s daily nutritional intake and food habits (e.g. meal times, duration of each meal session, snacking, etc.)||To create a baseline of the patient’s nutritional status and preferences.|
|Create a daily weight chart and a food and fluid chart. Discuss with the patient the short term and long-term weight goals related to GERD.||To effectively monitory the patient’s daily nutritional intake and progress in weight goals.|
|Help the patient to select appropriate dietary choices to follow a low fat diet with minimal fried foods, alcohol and caffeine.||Low fat foods are ideal for GERD patients. Fried foods, alcohol, and caffeine put the patient at high risk for acid reflux.|
|Refer the patient to the dietitian.||To provide a more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed GERD.|
- Nursing Diagnosis: Acute Pain related to acid reflux secondary to GERD, as evidenced by pain score of 10 out of 10, verbalization of chest pain after eating, guarding sign on the chest, blood pressure level of 180/90, respiratory rate of 29 cpm, and restlessness
Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.
|Administer prescribed medications that alleviate the symptoms of heart burn/ chest pain.||Antacids are helpful in neutralizing stomach acid. H2-receptor blockers reduce the production of stomach acid. Proton-pump inhibitors work by reducing the amount of stomach acid. Baclofen can help GERD patients by strengthening the lower esophageal sphincter.|
|Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.||To monitor effectiveness of medical treatment for the relief of heartburn. The time of monitoring of vital signs may depend on the peak time of the drug administered.|
|Elevate the head of the bed.||To reduce the backwash of acid from the stomach to the esophagus.|
|Encourage the patient to follow appropriate meal times and meal portions.||To ensure that the patient does not eat a huge meal, or that he/she does not eat late at night/ before bedtime as both of these contribute to GERD.|
Nursing Diagnosis: Impaired tissue integrity related to esophageal exposure to gastric acid.
Patient is able to verbalize knowledge of necessity lifestyle changes with 24 hours of discharge from the hospital.
|Teach patient to avoid foods that cause pain and or can increase acid secretions.||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.|
Nursing Diagnosis: Risk for aspiration related to esophageal disease affecting the lower esophageal sphincter.
Within 8 hours of interventions, the patient will have no episodes of aspiration.
|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.|
Other Nursing Diagnoses for GERD:
- Deficient Knowledge
- Risk for Aspiration
- Sleep Deprivation
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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