GASTROESOPHAGEAL REFLUX DISEASE (GERD) Risk Factors for Developing GERD- Obesity - Hiatal Hernia - Pregnancy - Diet- Smoking - Dry Mouth - Diabetes - Chest Trauma- Delayed Stomach Emptying - Connective Tissue Disorders - Zollinger-Ellison Syndrome - Cancer- Pyloric Surgery - Nasogastric Intubation for 4 days - Medicine (Anticholinergics) - Reduce LES pressure- Intraabdominal Pressure - Alcoholic - Peptic Ulcer Disease -Lying down after mealsNursing Interventions:1. Offer emotional and psychological Nursing Diagnosis: support to help the patient to cope 1. Anxiety with pain and discomfort.2. Avoid situation or activities that 2. Imbalanced nutrition: less body increase intra-abdominal pressure like requirements coughing, bending, constipation Impaired Esophageal Defense 3. Risk for aspiration related to promotes acid reflux. Mechanism3. Avoid lying down for 3 hours after incompetent LES meals and eating late night snacks 4. Fluid volume deficit promotes acid reflux. 5. Acute pain and chronic pain4. Surgically, assess the respiratory status related to physical injury to the of the patient because the surgical procedure is performed closely to LES the diaphragm. 6. Altered elimination5. Teach the patient to reduce intake of 7. Impaired swallowing related to fatty foods, caffeinated beverages, Poor Esophageal Clearance inflammation of the Esophagus chocolate, nicotine, alcohol, and peppermint. Reducing the intake of 8. Ineffective breathing pattern spicy and acidic foods lets 9. Impaired gas exchange esophageal healing occur during 10.Ineffective Tissue Perfusion times of acute inflammation.
Nursing Interventions: 6. Encourage the patient to eat five to six small meals during the day rather than large meals. Ingestion of large amounts of food increases gastric pressure and Esophageal Clearance fails to thereby increases esophageal neutralized acid reflux via LES reflux. 7. Position the patient by elevating the head of the bed during sleep. May lessen symptoms.Aspiration of Gastric Exposure of the Esophagus from the content in the Esophageal Ulcer gastric acids of the stomachtracheobronchial tree Anemia, Nausea, Coughing, DOB Voniting Damaging the Lower Esophageal Wheezing, Chest Sphincter Pain
Nursing Interventions: Dysfunctional Lower Esophageal8. Encourage the patient to avoid Sphincter restrictive clothing, lifting heavy objects, straining, working in a bent-over position, and stooping. Worsens the condition of the patient.9. Encourage the patient to avoid food for 3 hours before going to sleep.10. Place 6-inch blocks under the Permanent or Transient Relaxation of head of the bed or place a wedge the Lower Esophageal Sphincter under the mattress. to enhance nocturnal clearance. Compensatory Mechanism Decreases Intraluminal PressureAcid Irritates the Vocal produced by the LES Chords Excessive Production of Saliva to Neutralize pH in the EsophagusHoarseness, Dysphagia Acid Irritates the Mucosa
Diagnostic Assessment:Surgical Management: 1. 24hr Ambulatory pH monitoring 2. Esophageal Manometry /1. Nissen fundoplication, a Motility Testsurgical wrapping of the Increases Abdominal Pressure 3. Esophagogastroduodenoscopystomach around the esophagus (EGD)using a laporoscopic procedure 4. Endoscopystitched with silk sutures. 5. Auscultation Medical Management: Promoting More Acid Reflux 1. Proton pump inhibitors (reducing gastric acid secretion) 2. Gastric H2 receptor blockers (reduce gastric secretion of acid) 3. Antacids (can reduce gastric acidity) 4. Alginic acid (increase pH and decrease reflux) 5. Prokinetics (strengthen the LES and speed up gastric emptying.) 6. Sucralfate (heals and prevent esophageal Gastroesophageal Reflux Disease damage) 7. Baclofen (decreases transient LES relaxations)
CONCEPT MAP in GASTROINTESTINAL SYSTEMGROUP MEMBERS: 1. Alejandro, Wyeth Paul 2. Custodio, Adrian 3. Penarubia, Theresa 4. Penaranda, Mark Francis 5. Alcantara,Frank 6. Blanca, Anthony Laurence 7. Lansangan, Fatima 8. Laguitan, April