Gastroesphageal Reflux Disease GERD Nursing Care Plans Diagnosis and Interventions
Gastroesophageal Reflux Disease GERD NCLEX Review and Nursing Care Plans
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.
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 Diagnosis for GERD
Gerd Nursing Care Plan 1
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.
|GERD Nursing Interventions||Rationale|
|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.|
Gerd Nursing Care Plan 2
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.
|GERD Nursing Interventions||Rationale|
|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.|
Gerd Nursing Care Plan 3
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.
|GERD Nursing Interventions||Rationale|
|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.|
Gerd Nursing Care Plan 4
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.
|GERD Nursing Interventions||Rationale|
|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.|
Gerd Nursing Care Plan 5
Nursing Diagnosis: Anxiety related to a change in the health status of the infant secondary to severe Gastroesophageal Reflux Disease (GERD) as possibly evidenced by increased fear that the disease will worsen and that surgery will be required and expressed concern and worry about the upcoming surgery, pre and post-operative care, gastrostomy and therapies while in the hospital, and complications after surgery.
Desired Outcome: The parent will report a reduction in anxiety level to none or mild.
|GERD Nursing Interventions||Rationale|
|Examine the source of anxiety and how it manifests: there is a need for information that will help to alleviate anxiety. Clients should be asked to rank their anxiety on a scale of one to ten, with ten being the most severe. Levels of anxiety include moderate, severe, and panic.||This provides information on the severity of anxiety and the necessity for anxiety-relieving methods; sources for parents include dread and uncertainty about treatment and recovery, as well as guilt for the illness’s existence.|
|Allow parents to express their concerns and ask questions about the condition, treatment, surgery, and recuperation.||This allows them to express their feelings and anxieties while also securing knowledge to help them feel less anxious.|
|Parents should be encouraged to stay with their children and assist in providing care for the patient.||This allows parents to reclaim their parental role by providing assistance and care for their children.|
|Communicate with parents on a regular basis and provide simple, genuine answers to their queries; use images, drawings, and models to explain things.||This encourages a calm, helpful, and trusting environment.|
|As far as possible, involve parents in decisions about care and routines.||This makes more control over the situation possible.|
|Ensure that the infant receives consistent care from a familiar caregiver.||This encourages trust and reduces anxiety.|
|Parents should be informed about the disease’s progression, its symptoms, as well as the physical repercussions of the condition.||Provides information to help the parents feel less anxious by letting them know what to expect.|
|Explain why each pre and postoperative treatment or type of therapy, diagnostic exam, surgical technique, and rationales, such as intravenous therapy, nasogastric tube, bandages, and gastrostomy tube, are being performed.||Thorough explanation to the parents eases anxiety by reducing fear of the unknown.|
|When postoperative ileus is resolved and the gastrostomy tube is withdrawn 2 or more weeks following surgery, inform parents about the removal of the nasogastric tube.||Reduces anxiety associated with tube implantation and care.|
|Explain postoperative issues such as delayed gastric emptying, inability to vomit, and gas bloating, as well as how to care for and feed through a gastrostomy tube.||Anxiety will be reduced if you know what to expect.|
|Teach the parents proper feeding procedures, including allowing the newborn to feed slowly and reporting any feeding issues.||Parents are made aware of changes in feeding patterns in order to avoid choking and aspiration issues.|
|Instruct the patient’s guardian/companion to report any signs of infection on their wounds (redness, swelling, increasing pain, bleeding, or discharge).||Allows for quick treatment when an infectious procedure is present.|
|Demonstrate and instruct on wound care and dressing changes; allow for a follow-up demonstration, and let them know the importance of protecting the dressing from a diaper.||This ensures wound healing without the risk of infection or infection recurrence.|
Gerd Nursing Care Plan 6
Nursing Diagnosis: Nausea related to irritation of gastric mucosa secondary to Gastroesophageal Reflux Disease (GERD) as possibly evidenced by gagging sensation, aversion toward food, and verbal report of nausea.
- The patient will be free of nausea.
- The patient will manage nausea as evidenced by an acceptable level of dietary intake.
- The patient will maintain weight, as appropriate.
|GERD Nursing Interventions||Rationale|
|Place an emesis basin near the patient’s bedside. Vomiting and nausea are intimately linked.||If the nausea is psychological in origin, keep the emesis basin hidden but reachable for the patient.|
|Encourage or provide regular oral hygiene.||Prevents mucosal dryness, increases comfort, and lowers sour taste.|
|Remove strong odors from the environment such as perfumes, dressings, and emesis. Avoid foods that are too sweet, greasy, or spicy.||Strong and unpleasant odors can contribute to nausea and can trigger vomiting.|
|Encourage the customer to consume a high-calorie, nutrient-dense diet with plenty of water. Encourage the usage of supplements as well as smaller, more frequent meals dispersed throughout the day.||In addition to fluids, metabolic tissue demands are raised in order to get rid of waste products. Supplements might help you stay on track with your caloric and protein requirements.|
|Maintain fluid balance in high-risk patients.||In these instances, adequate hydration before surgery or chemotherapy has been demonstrated to lower the risk of nausea.|
|Allow the patient to use nonpharmaceutical nausea management methods including relaxation, guided visualization, music therapy, distraction, or deep breathing exercises.||These techniques have helped patients relieve the condition, but they must be used before it develops.|
|Apply acupressure or acustimulation bands as directed.||People can use acupressure to treat nausea caused by a variety of factors. In some cases, stimulation of the Neiguan P6 acupuncture point on the ventral surface of the wrist has been shown to reduce nausea. This has been proved to be beneficial for those who suffer from motion sickness. Another pressure point thought to reduce nausea is the Youmen pressure point. This is located immediately below the breastbone on either side of the upper stomach. Manipulation of this location, according to practitioners, may help to minimize nausea and vomiting during pregnancy. Because of the position of this point, caution must be observed and a skilled acupressure practitioner may be required to apply pressure on it.|
|Before and after treatment, include clear, cool liquids, light or bland foods, candied ginger, dry crackers, toast, and carbonated beverages in your diet. Give 1 hour before or after meals, drink liquids.||Dietary changes in the treatment of post-therapy nausea are highly personalized. To identify the optimum option or mix, clients must experiment. When you don’t drink anything throughout your meal, you’re less likely to get “full” too quickly.|
|If tolerated and acceptable to the patient’s diet, introduce cold water, ice chips, ginger items, and room temperature broth or bouillon.||These help with hydration. Ginger, whether in the form of ginger ale, ginger tea, or candied ginger, helps to reduce nausea. Fluids that are excessively cold or too hot might be uncomfortable to drink.|
|Give the patient little amounts of meals that he or she likes on a regular basis.||This approach will help in maintaining the patient’s nutritional status. An empty stomach can aggravate nausea in certain patients.|
|Maintain the patient in an upright position while eating and 1 to 2 hours after eating.||This can aid in risk reduction. It’s a good idea to keep your head up when eating and avoid lying down for at least two hours thereafter. After a meal, get up and move about to assist stomach juices to flow in the appropriate way.|
|Administer antiemetics as prescribed or as required.||The majority of antiemetics function by raising the stimulation threshold of the chemoreceptor trigger zone.|
|Ensure that rooms are well ventilated. If possible, assist the patient in getting some fresh air.||Breathing becomes easier in a well-ventilated area or with a fan nearby.|
|Educate the patient or caregiver about nausea-relieving fluid and food options.||By noting dietary factors to consider while nauseated, patients and caregivers can support proper hydration and nutritional status.|
|Educate the patient on the importance of taking prescribed drugs as directed.||Taking drugs according to the doctor’s prescribed schedule helps to prevent nausea.|
|Educate the patient on the significance of slowly and calmly changing positions.||Movements that are too fast or too big can aggravate the problem.|
|Nonpharmacological nausea management measures, such as relaxation, guided imagery, music therapy, distraction, or deep breathing exercises, should be taught to the patient or caregiver.||The sense of personal efficacy in controlling nausea is increased when the patient and caregiver are taught strategies to control nausea.|
|Assess the patient’s response to antiemetics or other treatments for the disease.||This method is useful for assessing the efficacy of such interventions.|
|If vomiting develops or lasts longer than 24 hours, tell the patient or caregiver to seek medical help.||Dehydration, electrolyte imbalance, and dietary deficits can all occur as a result of persistent vomiting.|
|Educate the patient or caregiver on how to use acupressure or accustimulation bands.||If the intervention was proven to be useful and effective, patients and caregivers may wish to continue with it.|
Gerd Nursing Care Plan 7
Nursing Diagnosis: Deficient Knowledge related to the scarcity of information about the disease/ disease process, lack of information or recall, unfamiliarity with information resources, and information misinterpretation secondary to Gastroesophageal Reflux Disease (GERD) possibly evidenced by the presence of preventable complications, verbalization of problems, request for information, and inaccurate follow-through of instructions.
- The patient will have a better understanding of how to reduce acid reflux.
- The patient will express knowledge of therapeutic needs.
- The patient will correctly perform necessary procedures to relieve symptoms and explain the significance of these interventions.
- The patient will demonstrate essential changes in lifestyle.
|GERD Nursing Interventions||Rationale|
|Examine the patient for necessary knowledge and his or her ability to operate autonomously.||This can serve as a groundwork for teaching.|
|Assist in the caloric intake decrease.||An increase in weight can elevate the intraabdominal pressure.|
|Provide information to the patient on the disease process, healthy habits that can be improved, and drugs that should be used.||Compliance with medication and adherence to healthy habits can be more achieved when the patient is provided with adequate knowledge about the disease process. Encourage the patient to consume modest amounts of bland food and drink an adequate amount of water.|
|Instruct patient to stay upright for at least 1–2 hours after meals and not to eat within 2–4 hours of going to bed.||Gravity aids in the control of reflux and reduces the discomfort caused by reflux into the esophagus.|
|Instruct the patient to avoid behaviors that cause reflux, such as bending over, coughing, straining at defecations, and other similar activities.||Lowers intra-abdominal pressure, which reduces stomach reflux, resulting in increased comfort..|
|Instruct patients to chew their food thoroughly, eat slowly, and stick to a high-protein, low-fat diet.||This can help prevent acid reflux.|
|Instruct the patient to avoid foods that are too hot or too cold, spicy meals, citrus, and gas-forming foods.||These foods can increase acid production in the stomach, which can eventually lead to acid reflux.|
|Instruct the patient about the dangers of drinking alcohol, smoking, and drinking caffeinated beverages.||Possible side effects are increased acid production and esophageal spasms.|
|Before eating, instruct the patient to lift both arms fully extended towards the ceiling.||Relieves cramps and makes eating more comfortable.|
|Instruct the patient about the medications, their effects, and adverse effects, as well as how to contact their doctor if symptoms persist despite medication treatment.||This not just only promote understanding, but also makes it easier to follow the treatment plan. It aids in the early detection of the need for drug modifications to avoid difficulties.|
|Administer medications as prescribed.|
|Antacids and H2 receptor antagonists||As a result of their ability to neutralize stomach acid, antacids aid in the relief of pain.|
|Proton pump inhibitors (PPIs)||PPIs reduce the amount of stomach acid released.|
|Prokinetic agents||Prokinetic agents help to speed up the emptying of the stomach.|
|Sucralfate||Sucralfate aids in healing by establishing a protective barrier on the ulcer’s surface.|
|Prostaglandin E1 analogues||Reduces basal stomach acid secretion and enhances gastric mucus and bicarbonate production; replaces gastric prostaglandins that have been reduced by the use of NSAIDs.|
|Instruct the patient on how to prepare for diagnostic tests properly.||Do not intake food 6 to 8 hours prior to endoscopy or barium swallow.|
|Advise the patient to avoid smoking.||Nicotine from smoking relaxes the esophageal sphincter and increases acid production in the stomach. Smoking can make the esophagus more vulnerable to acid reflux injury by inducing inflammation. It can also affect gastric motility by prolonging gastric emptying, thereby affecting digestion.|
|Instruct the patient to abstain from consuming alcohol.||Alcohol increases stomach acid production and at the same time lowers the esophageal sphincter. This leads to the regurgitation of stomach acids into the esophagus.|
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