GERD Algorithm

Review definition and pathophysiology

Assess for the presence of risk factors
Obesity Gastric outlet Obstruction
Hiatal hernia Delayed stomach emptying
Pregnancy Connective tissue disorders
Asthma Zollinger-Ellison syndrome
Gastroparesis Gastric outlet Obstruction

Source: http://www.mayoclinic.com/health/gerd/DS00967/DSECTION=risk-factors

YES NO
Are Risk
Factors
Present?
Monitor for key indicators of GERD: Initiate client education for
 Dyspepsia or Heartburn Health Seeking Behaviors
 Regurgitation into pharynx to identify:
 Non cardiac chest pain  risk factors
 Hoarseness  Signs and symptoms for early
 Nighttime wheezing detection of disease

NO

Are positive Are alarm

findings symptoms
present? NO present?
present (See Figure 1)

YES
YES
Are acute signs and symptoms of GERD
present? Refer client for physician evaluation & follow
plan of care for a client requiring endoscopy and
plan care for complications
YES NO
Follow plan of care for Risk for ineffective
Follow plan of care for potential therapeutic regimen management: GERD meds,
complications procedures and lifestyle modifications

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 Figure 1
ALARM SYMPTOMS (Malignancy)
Age > 55
new-onset dyspepsia, family hx of upper GI cancer, unintended weight loss, GI
bleeding, progressive dysphagia, odynophagia, unexplained iron-deficiency
anemia, persistent vomiting, palpable mass or lymphadenopathy, and jaundice.

Risk

Risk for Ineffective

therapeutic regimen management (RITRM)

Newly Diagnosed?
Previously
Ready to learn?
diagnosed?
Absence of barriers to
learning?

Teach medication therapy Evaluate client’s ability to integrate

Surgical options
Lifestyle modification
Monitoring protocol
S/S of potential complications
therapeutic regimen,
if unable,
Follow plan of care for Ineffective
therapeutic regimen management
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Initiate the plan of care for a Risk for Ineffective Therapeutic Regimen
management:
 Disease process
 How to take GERD medications
 Lifestyle modifications
 Weight reduction
 Avoidance of triggers and factors that exacerbate GERD (smoking/ETOH,
increased intra-abdominal pressure)
 Use of GERD pillow
 Potential complications:
o Reflux induced asthma, aspiration, Bleeding, esophageal stricture,
Barrett’s esophagus, alarm symptoms
 Diagnostic testing and Periodic assessment
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 PC: reflux-induced PC: GI Bleeding
PC: PNU
asthma

LUQ pain & tenderness ,

night time coffee ground emesis,
symptoms cough, malaise, fever,
present dark tarry stool
Dyspnea, CP
associated with adventitious breath Systemic Signs/symptoms
cough & wheezing sounds of bleeding

Follow plan of care for Hemorrhage: NIC shock management

Follow plan of care for
tracheobronchial constriction
Add nighttime PPI med
Use of GERD pillow
Possible Antireflux surgery
Follow plan of care for
PNU/Sepsis/hypoxia
Continue PPI med
Ensure swallow eval
Use GERD pillow
FOBT & Hgb/Hct
Keep NPO
Hold meds that contribute to bleeding &Continue PPI med
Transfuse PRBCs as ordered
Prepare for Endoscopy with
1
24
hemostatic measures

Acute Pain PC: esophageal stricture PC: Barrett’s esophagus

monitor for dyspepsia

GERD accompanied by
exacerbated by triggers
difficulty swallowing
“getting food down” Alarm symptoms
Respiratory distress Age > 55
when feeding
Exclude other causes: GI Bleeding, Myocardial ischemia
Administer H2 Antagonists, PPI, and antacids as prescribed
and monitor effect
Mon Upper GI Series results
Offer non -pharmacological relief: Prepare for Endoscopy with
Place on aspiration precautions
HOB elevated Biopsy
Loosen tight fitting clothing Speech Pathology Consult
Follow plan of care for
Prepare client for endoscopic
Removal of triggers client with cancer
dilatation
Instruct in lifestyle modifications (Chart 58-2) 26
25

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