Transcript Upper GI: Gastroesophageal Reflux Disease (GERD)

UPPER GI:
GERD
Group 5:
Brooke Bevins, Lindsey Gamrat, Briana
McKenney, Emily Mendel, Latifah Gray,
Hannah Crist
PATIENT HISTORY
 Joe is a 47 YO male who came in c/o intense burning sensation in his chest
accompanied by nausea. He reports that he has also been belching frequently
which gives him the sensation of regurgitation in his throat.
 Joe smokes ½ a pack of cigarettes per day and consumes moderate
amounts of alcohol
 Dx with asthma at 14 YO
 Recently dx with hiatal hernia
 NKA to food
 Reports that he frequently get a burning sensation in chest after dinner
 Late dinner then watches TV in chair and goes to bed
 Symptoms worsen when he lays down
 Takes antacids occasionally which helps
PHYSICAL AND DIAGNOSTICS
Nurse calculates BMI as 31.2
A BMI over 30 indicates a patient is obese
A stool occult blood test is positive
Indicative of bleeding somewhere in the
GI tract
Never had an endoscopy or acid probe test
PREVALENCE
Occurs in both men and women
Most common in those that are overweight
RISK FACTORS
 Obesity
 Hiatal hernia
 Pregnancy
 Smoking
 Dry mouth
 Asthma
 Diabetes
 Delayed stomach emptying
PATHOPHYSIOLOGY
 GERD- Gastroesophageal reflux disease (aka acid-reflux disease) is
caused by excessive reflux occurring, either in frequency or volume, or
if the esophagus fails to contract in response to stomach contents
 Common cause is a hiatal hernia
 Effective diets relax the lower esophageal sphincter and don’t stimulate
gastric secretions
http://www.youtube.com/w
atch?v=TdK0jRFpWPQ
SYMPTOMS AND RISKS
 Heart burn with pain occurring behind the sternum
 Pain can sometimes radiate to the neck and the back of
the throat
 Those at risk include pregnant women and obese people
 In women, BMI may be associated with the symptoms of
GERD for those who are normal or overweight.
 Moderate weight gain may aggravate the symptoms
 Smoking increases the risk of GERD
DIAGNOSIS
 X-ray of esophagus
 Chalky liquid that coats the GI tract and allows physician to see inside of tract and
determine damage that has been done.
 Endoscopy
 Physician passes a flexible tube with a light and camera down the esophagus to view
the stomach and esophagus
DIETARY INTERVENTIONS
 Loose weight if it is needed
 Avoid lying down for three hours after eating
 Eat frequent and smaller portioned meals
 Do not eat close to bed time
 Stay away from food that may worsen GERD symptoms:
 Citrus fruits, chocolate, caffeine, alcohol, fatty/fried foods, garlic, onions, spicy foods,
tomato-based foods
NURSING INTERVENTIONS
 Educate client and family on importance of a healthy diet.
 Educate client about risks attached to smoking and how it perpetuates
his condition.
 Promote regular exercise.
 Educate client foods that are harmful to his condition.
 *see dietary interventions
 Assist in obtaining resources to help track nutrient/calorie intake
 ChooseMyPlate.gov/SuperTracker
 https://www.choosemyplate.gov/SuperTracker/default.aspx
MEDICATIONS
 OTC: Antacids/any medicine that slows acid production and
heals the esophagus
 Alka-Seltzer
 Prescription Strength:
 H-2 receptor Blockers (Pepcid, Zantac)
 Proton Pump Inhibitors (Prevacid, Prilosec)
 Surgery is a last resort treatment that occurs if the
medications do not help in controlling GERD
ALTERNATIVE MEDICATIONS
 Not proven to treat or reverse damage, but are proven to
provide some relief
 Acupuncture
 Relaxation Therapy
 Guided Imagery
 Progressive Muscle Relaxation
 Herbal remedies *
 Licorice, Slippery Elm, Chamomile,
Marshmallow
*May interfere with
some medications
PATIENT GOALS
 Maintains a healthy weight
 Excess weight creates pressure on abdomen and acid will build up in
the esophagus.
 Patient avoids food and drinks causing heartburn
 Fried foods, fast foods, soda, tomato sauce, onion, garlic, spicy foods,
etc.
 Eats smaller meals
 Obese clients should work towards loosing weight and maintaining
a healthier food diet.
 Doesn’t lie down after eating
 Wait at least three hours to lie down.
OUTCOMES
Weight loss for obese clients
Healthier food diet
Engage in weekly physical activities
Smaller meal portions
Stop/reduce smoking habits
LONG-TERM IMPLICATIONS
Narrowing of the esophagus
(esophageal stricture)
An open sore in the esophagus
(esophageal ulcer)
Precancerous changes to the esophagus
(Barrett’s esophagus)
QUESTIONS?
REFERENCES
 Fennerty, Brian. (2007, May). Heartburn, gastroesophageal reflux (ger), and
gastroesophageal reflux disease (gerd). Retrieved from
http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/
 Longstreth, G. F. (2011, August 11). Gastroesophageal reflux disease. Retrieved
from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001311/
 Center for Disease Control and Prevention. (2011, September 13). About
bmi for adults. Retrieved from
http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html
 Mayo Foundation for Medical Education and Research (MFMER). (19982012). Retrieved from
http://www.mayoclinic.com/health/gerd/DS00967/DSECTION=lifestyle-andhome-remedies
REFERENCES
 Lutz, Carroll & Przytulski, Karen. (2011). Nutrition and Diet Therapy.
Philadelphia, PA: F.A. Davis Company
 Mayo Clinic Foundation for Medical Education and Research. (2011).
GERD. Mayo Clinic. Retrieved from
http://www.mayoclinic.com/health/gerd/DS00967