GERD

GERD

1. Pathophysiology

   • No Single cause
   • reflux of acidic gastric contents into the esophagus overwhelms the esophageal defenses.
   • Gastric HCl acid and pepsin cause esophageal irritation and inflammation

2. Clinical Manifestations

   • Vary per person
   • Heartburn- most common
   • dyspepsia or regurgitation
   • Respiratory symptoms-
     • wheezing
     • coughing
     • dyspnea
   • hoarseness
   • sore throat
   • globus sensation
   • hypersalivation
   • choking
   • chest pain that mimics angina
     • burning
     • squeezing
     • radiating to the back, neck, jaw or arms

3. Diagnostic Studies

   • diagnosed based on symptoms
   • diagnosed based on response to behavioral and drug therapies
   • Endoscopy
   • Biopsy and cytologic specimen
   • manometric studies
   • ambulatory pH monitoring
   • Radionuclide test

4. Interprofessional Care

   • Lifestyle modifications
     • Avoid Triggers
     • Encourage weight reduction
     • Encourage smoking cessation
     • Discuss ways to reduce stress.
     • small frequent meals
   • Drug Therapy
     • Proton pump inhibitors
     • histamine (h2) receptor blockers
     • Cholinergic drugs
     • Prokinetic Drugs
     • Antacids
   • Surgery when other therapies fail

5. Nursing Diagnosis

   • Risk for aspiration related to barriers to swallow, decreased reflux larynx and glottis to liquid reflux
   • Imbalanced Nutrition: less than body requirements related to anorexia, nausea, vomiting
   • Acute pain related to inflammation of the esophagus lining.
   • Ineffective airway clearance related to reflux of fluid into the larynx and throat.
   • Impaired Swallowing related to narrowing / stricture of the esophagus due to gastroesophageal reflux disease
   • Anxiety related to the disease process

6. Nursing Interventions

   • Encourage following the necessary regimen
   • Head of bed elevated
   • Take PPI before the first meal of the day.
   • Educate on medication side effects