Pandes, Sophia Mae O.

BSN-3A

CONCEPT MAP

Medical Diagnosis

Gastroesophageal reflux disease

Defined as:

A disorder marked by backflow of

gastric or duodenal contents into the
esophagus that causes troublesome
symptoms and/or mucosal injury to
the esophagus.

Caused by: Contributed by risk factors:

Usually due to incompetent • Old age
lower esophageal sphincter, • Patients with irritable bowel
pyloric stenosis or motility syndrome
disorder • Patients with obstructive
airway disorders, ulcer
disease, and angina
• Tobacco use
• Coffee drinking
• Alcohol consumption
• Gastric infection with H.
Pylori
• Less physical activity at work
• Eating habits

Pathophysiology

GERD is a result of gastric juices overcoming the lower

esophageal sphincter (LES) pressure and re-entering the
esophagus. Other factors include delayed gastric
emptying, decreased salivation, sliding and para-
esophageal hiatal hernia, increase or decrease of intra-
abdominal pressure.
 Assessment

As manifested by signs and symptoms
• Pyrosis (heartburn, specifically
more commonly described as a
burning sensation in the
esophagus)
• Dyspepsia
• Regurgitation
• Dysphagia
• Hypersalivation
• Esophagitis
• Dental erosion
• Ulcerations in the pharynx and
esophagus
• Laryngeal damage
• Esophageal strictures
• Adenocarcinoma
• Pulmonary complications
• Appetite? Decrease
• Pain? Yes, mid epigastric
burning sensation in chest
• Dry cough
• Occasional regurgitation
• Does change in position
affect the discomfort? Yes,
pain worsens when lying flat
and after eating. Pain is
relived when in a sitting
position and taking OTC
medications.
• postprandial fullness and
early satiety
• Waking up from pain and
burning, with a sore throat
and hoarse voice.
• The patient reports
associated mid-thoracic,
bilateral back pain that
occurs during the episodes.

Diagnostic test:

• Endoscopy
• Barium swallow
• Gastric ambulatory pH analysis
• Bilirubin monitoring
Nursing Diagnosis
• Imbalanced nutrition: less
than body requirements
reduced food intake
secondary to GERD
• Risk for aspiration related to
difficulty swallowing.
• Acute pain related to
irritated esophageal
mucosa.
• Anxiety related to deficient
knowledge about the
esophageal disorder.
Medical Management Surgical Pharmacologic Nursing Management
Management Management
• Lifestyle changes Promotive/Preventive
such as weight • Antireflux Antacids/Acid
• Encouraging
loss. Avoidance of surgery neutralizing agent:
adequate
carbonated,
• calcium nutritional intake
caffeine intake,
and alcoholic carbonate by asking patient
beverages. • aluminum to eat slowly and
hydroxide to chew all food
Avoiding spicy
thoroughly so that
and citrus foods.
Histamine 2 receptor it can pass easily
Maintaining low
analgesics in the stomach.
fat diet, elevating
the head of the • pepcide • Decreasing risk of
bed, and avoid • ranitidine aspiration by
keeping patient in
eating several • cimetidine
hours before a semi fowler
going to bed. Prokinetic agents position.
• • Providing patient
Administering • Metodopramide
medications for education to
severe symptoms Protein Pump Inhibitors ensure patient is
or persistent prepared
• Omeprazole physically and
symptoms. • Nexium psychologically for
Reflux inhibitors all tests and
treatments.
• urecholine
Curative/Restorative

• Relieving pain by
encouraging to
small, frequent
feedings.
• Advice patient to
avoid any
activities that
increase pain and
to remain upright
for 1 to 4 hours
after each meal