Gerd Edapt Notes PDF

Pharmacological Differences Beta blockers Calcium channel blockers H2 histamine blockers Proton pump inhibitors block one of the first stimuli for acid production in the stomach. Beta blockers Calcium channel blockers H2 histamine blockers Proton pump inhibitors block the final step in the pathway o...

Pharmacological Differences Beta blockers Calcium channel blockers H2 histamine blockers Proton pump inhibitors block one of the first stimuli for acid production in the stomach. Beta blockers Calcium channel blockers H2 histamine blockers Proton pump inhibitors block the final step in the pathway of acid secretion in the stomach. Clinical Manifestations What are the common manifestations of gastroesophageal reflux disease? Select all that apply. Pyrosis Vomiting Dyspepsia Hypertension Urinary retention Drug Therapy Which prescription is commonly administered for gastroesophageal reflux disease (GERD)? Famotidine Oxycodone Mesalamine Carvedilol What Causes Gastroesophageal Reflux Disease? Gastric contents, including hydrochloric acid (HCl) and pepsin (a gastric enzyme), backflow into the esophagus and mouth, causing irritation and inflammation to the mucosa and lining. Normally, our lower esophageal sphincter (LES) is a one-way valve, keeping the gastric contents from coming up into the esophagus. However, when the LES becomes weak or incompetent, the acidic contents can reflux. Recognizing Cues Pyrosis, or heartburn, is the most common symptom of gastroesophageal reflux disease (GERD). This is a burning tightness that is felt in the chest and can extend up to the jaw or throat. It may be so severe that it wakes clients up in the middle of the night and does not allow them to rest lying down. Doing a complete and thorough history and physical assessment can reveal the extent of the pyrosis: Does the client sleep upright in a chair? Do they have this manifestation after eating certain foods? How often do they experience pyrosis? Other common manifestations of GERD are dyspepsia, or discomfort in the upper midline abdomen from the gastric mucosa inflammation and regurgitation. Regurgitation is the feeling of acid or gastric contents backing up, or regurgitating into the throat or mouth. Clients may describe regurgitation as a sour or bitter taste in the mouth, often accompanying pyrosis and dyspepsia. A common manifestation in older adult clients suffering from GERD is chest pain. This can be a frightening occurrence as most people associate chest pain with myocardial infarction. Unlike angina-related chest pain, GERD chest discomfort will decrease with the use of antacids because the pain is not related to poor perfusion, but acid. Atypical Cues Gastroesophageal reflux disease (GERD) can also be classified as a syndrome. A syndrome is a grouping of symptoms that might not have a definitive cause. Some clients do not report pyrosis and have atypical symptoms, such as: • pain in the chest • hoarseness in the throat • difficulty swallowing Clients may feel like they have food stuck in their throat, experience a choking sensation, or state that their throat feels “tight.” GERD can also cause a dry cough and bad breath. Nursing Considerations Obesity, smoking, and hiatal hernias are risk factors associated with the development of gastroesophageal reflux disease (GERD). Obesity slows gastric emptying, which allows food to sit in the stomach for longer. Smoking increases gastric acidity. Hiatal hernias occur when the diaphragm muscle is too weak and causes some of the esophagus to protrude through the hiatus. The diaphragm has a small opening (hiatus) through which the esophagus passes before connecting to the stomach. Traditionally, hiatal hernias are divided into two types: • Sliding hernia occurs when the stomach and a portion of the esophagus that joins the stomach slide in and out into the chest through the hiatus. This is the more common type of hiatal hernia. • Paraoesophageal (or rolling) hernia occurs when the esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. Clients who are at risk for hiatal hernias are those who lift heavy objects on a regular basis, clients who are obese, and clients who are pregnant as they have increased intraabdominal pressure. Lifestyle Changes With lifestyle modifications and changing daily habits, many clients can manage their gastroesophageal reflux disease (GERD) successfully. The client needs to remember that the main cause of GERD is the weakening of the lower esophageal sphincter (LES), so making smart diet selections to not impact the LES any further is key. Food choices cause symptoms of GERD. Foods including fried or processed items (potato chips, pizza), spicy items involving chili powders or pepper, tomato-based sauces, citrus, carbonated beverages, and cheese should be eaten in moderation. It is difficult to tell clients that these items need to be completely eliminated from their diets; it is better for compliance if we teach the concept of moderation. There are foods that can lower the risk of GERD symptoms. Green, leafy vegetables, whole grains, and watery foods like watermelon or celery help the client feel full (therefore, less likely to overeat, which can contribute to heartburn) and dilute the strength of stomach acid. Small, frequent meals are usually beneficial, as the amount of stomach acid produced by these smaller meals allows for food to be digested sooner. The client should also be instructed to stop smoking. Providing good community resources or support groups may be helpful for this task. Managing stress can also help reduce symptoms of GERD. Risk Factors What are some risk factors commonly associated with the development of gastroesophageal reflux disease (GERD)? Select all that apply. Diabetes mellitus Smoking Heart disease Obesity Hiatal hernias Analyzing Cues A healthcare provider may diagnose a client with gastroesophageal reflux disease (GERD) based on clinical manifestations or response to a prescribed medication. If treatment is not working or lifestyle changes are not modified, and symptoms progress, an endoscopy may be prescribed to confirm a diagnosis or to rule out other medical conditions. Diagnostics: Endoscopy An endoscopy procedure utilizes a small camera with a light (endoscope) that enters the client’s mouth and travels down the esophagus into the stomach, allowing healthcare providers to get a clear picture of the gastrointestinal tract. It can also take samples of tissue, gastric acid or lavage, or flush stomach contents if necessary. During an endoscopy, the client is sedated and the back of the throat is numbed for the scope to enter the esophagus more comfortably. Making sure that the client’s gag reflex has returned before eating will decrease the risk of aspiration. Gastroesophogeal Reflux Disease Drug Therapy Review the drug therapy of gastroesophageal reflux disease (GERD) in these slides. Goals for drug therapy related to GERD center around decreasing the amount of reflux, the acidity of gastric contents, and improving lower esophageal sphincter (LES) function. Utilizing proton pump inhibitors (PPI) and histamine (H2) receptor blockers, the most common prescriptions for GERD, clients can achieve effective symptomatic treatment. Proton Pump Inhibitors (PPI) Mechanism of Action Decrease hydrochloric acid (HCl) levels by inhibiting the proton pump, thereby reducing acid reflux Histamine (H2) Receptor Blockers Decreases in secretion of HCl occur by inhibiting the histamine-2 receptor in gastric mucosal cells that stimulates the production of gastric acid More effective in treating esophageal inflammation In over-the-counter (OTC) (esophagitis) compared to and prescription formulas H2 receptor blockers Slower onset of relief (2.5 In over-the-counter (OTC) hours), but lasting effects and prescription formulas of 8–10 hours Most effective if taken 30 minutes prior to meals Examples ADVERSE REACTIONS: Long-term usage increases risks of fractures; increased risk for clostridium difficile infection ADVERSE REACTIONS: Side effects are rare but may include headache esomeprazole (Nexium), omeprazole (Prilosec), pantoprazole (Protonix) famotidine (Pepcid), cimetidine (Tagamet) Gastroesophogeal Reflux Disease Drug Therapy Review the drug therapy of gastroesophageal reflux disease (GERD) in these slides. Other types of medication commonly associated with GERD drug therapy are antacids. Acid neutralizers, such as antacids, are beneficial in neutralizing the acidity of gastric contents (like HCl). To be most beneficial, antacids (including aluminum hydroxide and calcium carbonate) should be taken approximately 1–3 hours after meals and at bedtime. Clients need to watch how often they are taking antacids, however, as side effects include constipation and electrolyte imbalances (especially calcium, magnesium, and phosphorous). Meet Rebecca Recognizing Cues Rebecca (pronouns: she/her/hers), a 58-year-old adult with a history of hypertension and arthritis, has arrived at the emergency department (ED) for symptoms of chest pain. She was finishing dinner with her husband, Ron, when the symptoms started. Rebecca took a calcium carbonate tablet while en route to the emergency department (ED) and took her hypertensive medication this morning as prescribed. Which question would best alert the nurse to the possible cause of Rebecca’s chest pain? “What did you have at dinner?” “Do you have a family history of heart disease?” “Is your chest pain better since taking the calcium carbonate?” “Have you been recently ill?” Meet Rebecca Take Action Rebecca (pronouns: she/her/hers) has just returned from an endoscopy procedure to evaluate for gastroesophageal reflux disease (GERD). She is asking for a glass of water stating, “My mouth is so dry.” Which assessment finding is the nurse's priority? Return of the client’s gag reflex Last time the client had something to eat Assessing the client’s blood pressure Monitoring laboratory values for signs of dehydration Surgical Options While most clients can successfully manage their gastroesophageal reflux disease (GERD) symptoms with lifestyle changes and medications, some may require surgical interventions due to complications, including medication ineffectiveness/intolerance, Barrett’s esophagus, or strictures. Barrett’s esophagus is a precancerous lesion caused by the cells of the esophagus changing shape due to an abnormal stimulus, like repetitive inflammation seen with GERD. The development of Barrett’s esophagus puts the client at increased risk of developing esophageal cancer, so surgical intervention is sometimes warranted. Most surgical procedures for GERD are performed laparoscopically, or through several small incisions, and with cameras. A Nissen fundoplication is a common laparoscopically performed antireflux surgery. During a Nissen fundoplication, the top portion of the stomach (the fundus) is wrapped around the esophagus, strengthening the lower esophageal sphincter (LES). This fundal collar tightens the LES, decreasing the chance of acid being able to regurgitate or reflux back into the esophagus. With the procedures performed laparoscopically, the risk of complications is decreased. Clients are still at risk for the development of respiratory complications, including pneumonia and atelectasis, as well as hemorrhage, esophageal or gastric injury, or infection. Post-operatively, the symptoms of the client’s GERD should decline. Meet Rebecca Client Teaching Rebecca (pronouns: she/her/hers) has been diagnosed with gastroesophageal reflux disease (GERD). She is concerned about adopting new lifestyle changes to help manage symptoms. What recommendations would be most beneficial for this client? Involve Rebecca’s family in the client education. Ask the healthcare provider to change Rebecca’s prescriptions to options that don’t need to be taken daily . Inform Rebecca that she will need surgery if she does not modify her lifestyle choices. Remind Rebecca that she has technology that can help her, like reminders set or alarms on her personal cell phone or devices. Meet Jeff Analyze Cues Jeff (pronouns: he/him/his) is a 64-year-old retired contractor who was admitted to the hospital for an exacerbation of gastroesophageal reflux disease (GERD). He has smoked 1.5 packs of cigarettes a day for 30 years. He drinks “one or two glasses of whiskey at night,” loves tomato soup, and has a body mass index (BMI) of 39. What lifestyle changes can Jeff make to decrease the clinical manifestations of GERD? Select all that apply. Increase calories to gain weight Decrease daily fluid intake Cease smoking Eat small, frequent meals Avoid foods that cause reflux Meet Jeff Generate Solutions Jeff (pronouns: he/him/his) is a 64-year-old retired contractor who was admitted to the hospital for an exacerbation of gastroesophageal reflux disease (GERD). He has smoked 1.5 packs of cigarettes a day for 30 years. He drinks “one or two glasses of whiskey at night,” loves tomato soup, and has a body mass index (BMI) of 39. Jeff just had a meal tray delivered to his room. Which food choices would the nurse see as an opportunity for client teaching? A leafy, green salad with apples Whole wheat avocado toast Watermelon salad with cucumbers Bowl of tomato soup and grilled cheese sandwich Meet Jeff Taking Priority Action Jeff (pronouns: he/him/his) has returned to the nursing unit after a Nissen fundoplication. He has an indwelling urinary catheter, a nasogastric (NG) tube for low continuous suction, and two intravenous (IV) catheters. Jeff is alert and oriented with a 4/10 pain score on the 0-10 scale. The nurse notes bright red blood in the NG tube. What action should the nurse take first? Take a full set of vital signs. Reassess the drainage in 60 minutes. Document the findings in the chart. Notify the surgeon immediately. Meet Trevor Generate Solutions Trevor (pronouns: he/him/his) presents to his follow-up appointment after recently being diagnosed with gastroesophageal reflux disease (GERD). He is unable to sleep due to pyrosis and dyspepsia and asks the nurse, “How can I sleep better at night?” Which teaching recommendation should the nurse provide? Trevor needs to lie down after eating to help his heartburn. Trevor should drink a glass of wine before bed. Trevor should use extra pillows to sleep on. Trevor should have his favorite nighttime snack right before bed. Meet Trevor Client Teaching Trevor (pronouns: he/him/his) is questioning the nurse about why the healthcare provider prescribed pantoprazole for gastroesophageal reflux disease (GERD). What explanation by the nurse is most appropriate? Pantoprazole can be taken as needed (PRN). Pantoprazole coats and protects the lining of the stomach from hydrochloric acid. Pantoprazole reduces the reflux of gastric acid by increasing the rate of gastric emptying. Pantoprazole decreases stomach acid secretion. Dietary Teaching Which food options should the nurse teach clients with gastroesophageal reflux disease (GERD) to eat in moderation? Select all that apply. Carbonated beverages Oranges Cheese Brussels sprouts Spaghetti sauce Oatmeal Drag and drop the correct risk factor for the cause associated with the development of gastroesophageal reflux disease (GERD). Obesity slows gastric emptying, which allows food to sit in the stomach longer. Smoking increases gastric acidity. Hiatal hernia occurs when the diaphragm muscle is too weak and causes some of the esophagus to protrude through the muscle.