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UPPER GI:GERDGroup 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/watch?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). (1998-2012). Retrieved from http://www.mayoclinic.com/health/gerd/DS00967/DSECTION=lifestyle-and-home-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