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Gastroesophageal Reflux Disease (GERD) - NCLEX Study

Terms in this set (12)

GERD Overview
-Gerd is a common condition characterized by gastric content and enzyme leakage into the esophagus.

-These corrosive fluids irritate the esophageal tissue and limit its ability to clear the esophagus.
Health Promotion and Prevention of GERD
-Maintain BMI below 30

-Stop smoking.

-Drink alcohol in moderation.
Risk Factors for GERD
-Obesity

-Older age

-Sleep apnea
Contributing Factors
•Excessive
ingestion of foods that relax lower
esophageal
sphincter (LES)
-Fatty
and fried
foods
-Chocolate
-Caffeinated beverages
-Alcohol

•Increased abdominal pressure due to obesity, pregnancy, bending at the
waist,
ascites,
or tight clothing

•Drugs that relax the
LES.
-Theophylline, nitrates
-Calcium
channel
blockers
-Anticholinergics, diazepam

• Medications (NSAIDs) or events (stress) that increase gastric acid

•Hiatal hernia

•Lying flat

•Smoking
Manifestations of GERD
•Frequent and
prolonged
-Substernal
heartburn (dyspepsia)
Regurgitation
(acid reflux)

•Throat
irritation
-Chronic cough
-Laryngitis

•Hypersalivation

•Eructation

•Flatulence

•Bitter
taste in
mouth

•Atypical
chest pain from esophageal
spasm

•Chronic GERD
can lead to
dysphagia.

•GERD may mimic a heart attack due to the substernal pain that can
radiate to the jaw and back.
Diagnostic Procedures: Esophagogastroduodenoscopy (EGD)
•Allows
visualization of the
esophagus.

•May
reveal esophagitis or Barrett's epithelium (premalignant cells).

•Done
using moderate sedation to observe for tissue damage (in 60% of
clients
who have GERD) and possibly to dilate structures.

•Verify gag response has returned prior to providing oral fluids or food
following the procedure.
Diagnostic Procedures
•24-hr
ambulatory esophageal pH
monitoring
-A small catheter is placed through the client's nose and into the distal
esophagus where pH readings are taken in relation to food, position,
and activity.

•Esophageal
manometry
-Records
lower esophageal sphincter pressure.

•Barium
swallow
-Can
identify a hiatal hernia, which would contribute to or cause
GERD.
Medications to Treat GERD
•Antacids neutralize
excess acid.
-Aluminum hydroxide (Mylanta)

•Instruct
the client to take antacids when acid secretion is the highest (1 to 3 hr after eating and at bedtime), and to separate from other
medications by at least 1 hr.
Medications to Treat GERD cont.
•Histamine2 receptor antagonists reduce
the secretion of acid.
-Ranitidine (Zantac)
-Famotidine (Pepcid)
-Nizatidine (Axid)

•Proton
pump inhibitors
(PPIs)
reduce
gastric acid by inhibiting the
cellular pump necessary for secretion.
-Pantoprazole (Protonix)
-Esomeprazole (Nexium)
-Lansoprazole (Prevacid)

•Prokinetics
increase
the motility of the esophagus and stomach.
-Metoclopramide
hydrochloride
(Reglan)

•Monitor client for extrapyramidal side effects.
Therapeutic Procedures
•Stretta
procedure
-Uses
radiofrequency energy, applied by an endoscope, to the LES
muscle.
-This
causes the tissue to contract and tighten.

•Fundoplication
-Surgical
option that may be indicated for clients who fail to respond
to other
treatments.
-The
fundus of the stomach is wrapped around and behind the
esophagus to create a physical barrier.
Client Education
•Avoid offending foods.

•Avoid large meals.

•Remain upright after eating.

•Avoid eating before bed.

•Avoid tight
-fitting clothing around the
middle.

•Lose weight, if applicable.

•Elevate the head of the bed 6 to 8
inches with blocks.

•Sleep on the right side.
Complications of GERD
•Aspiration of gastric
secretion
-Reflux
of gastric fluids into the esophagus can be aspirated into the
trachea

•Risks associated with
aspiration
-Asthma exacerbations
-Frequent
upper respiratory, sinus, or ear
infections
-Aspiration pneumonia
-Barrett's
epithelium (premalignant) and esophageal
adenocarcinoma
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