Republic of the Philippines

CENTRAL MINDANAO UNIVERSITY

COLLEGE OF NURSING
University Town, Musuan, Maramag, Bukidnon
E-mail: nursing@cmu.edu.ph

NCM74
Care of Clients with Problems in Nutrition and Gastrointestinal,
Metabolism, and Endocrine, Perception and
Coordination, Acute and Chronic

Gastroesophageal Reflux Diseases– Manuscript

Submitted by:
AMBAL, KISHA LONE G.

Submitted to:
Ms. Neda Joy L. Espina MAN, RN
Clinical Instructor

February 24, 2022

GERD

Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows
back into the tube connecting your mouth and stomach (esophagus). This backwash
(acid reflux) can irritate the lining of your esophagus.

Precipitating factors

 Obese- People who are obese or overweight seem to have an increased risk of
GERD. While the reasons for this are not well understood, it is thought to be related
to increased pressure in the abdomen.
 Hiatal hernia- This is a condition in which part of the upper stomach pushes up
through the diaphragm (the large, flat muscle at the base of the lungs). The
diaphragm has an opening for the esophagus to pass through before it joins with the
stomach (called the "diaphragmatic hiatus"); in people with a hiatal hernia, part of
the stomach also squeezes up through this hole.
 Pregnant- Many women experience acid reflux during pregnancy. This usually
resolves after delivery, and complications are rare.

Predisposing factors

 Smoking- The nicotine from tobacco relaxes the valve between the esophagus and
stomach (lower esophageal sphincter). This can allow stomach acid and juices, the
chemicals that break down food in the stomach, to back up (reflux) into the
esophagus, which causes heartburn.
 Alcohol- alcohol can relax the lower part of the esophagus, making it easier for your
stomach acid to back up.
 Medication- medication that irritates your esophagus like ibuprofen, aspirin etc.
 Eating large meals- Large meals make your stomach expand. This increases
upward pressure against the lower esophageal sphincter (LES). The LES is the
valve between your esophagus and stomach

Etiology
The presence of reflux implies lower esophageal sphincter (LES) incompetence, which
may result from a generalized loss of intrinsic sphincter tone or from recurrent
inappropriate transient relaxations. Transient LES relaxations are triggered by gastric
distention or sub threshold pharyngeal stimulation. TLESR) is defined as lower
esophageal sphincter relaxation that is induced spontaneously without swallowing.
TLESR is a physiological mechanism that enables venting of gas from the stomach.
Pathophysiology

Lower esophageal sphincter (LES) is weak and allows the stomach to reflux up into the
esophagus Gastroparesis contributes acidic stomach contents irritate the esophageal
epithelium Hiatal hernia interferes with the closure of the LES and results in reflux gastric

acid erodes the protective mucosal epithelial layer of the esophagus .

Signs and Symptom

 Heartburn- burning pain in your chest

 Epigastric pain- discomfort right below your ribs in the area of your upper
abdomen.
 Refurgitation- sour taste in mouth
 Dry cough- acid or other content in your stomach flows back up into your esophagus.
This irritates the lining of your esophagus, causing a dry cough
 Nausea- food or fluids travels from the stomach up into the esophagus
 Hypersalivation- when your body makes too much saliva, causing it to mix with your
stomach acid and back up into your throat.

Diagnostic and Evaluation tools

 Clinical diagnosis- assess for signs and symptoms, physical exam and health
history to determine GERD.
 Endoscopy- detects the inflammation of the esophagus or other complication.
 24- Hour pH monitoring- performed to measure the pH or amount of acid that flows
into the esophagus from the stomach during a 24-hour period.

Prognosis

If left untreated can lead to:

 Esophagitis- inflammation that damages the lining of esophagus.

  Peptic esophageal ulcer- painful sore located in the lining of the lower part of the
esophagus.
 Esophageal stricture- abnormal tightening of the esophagus.
 Barrett esophagus- change in your cells lining your esophagus. Common in
GERD but can develop without the presence of acid reflux.
 Esophageal adenocarcinoma- cancer in the esophagus.

GERD is treated it lower the risk for long term damage of esophagus

Nursing Dx

Risk for aspiration r/t impaired swallowing risk for intragastric pressure

• Assess for pulmonary symptoms resulting from reflux of gastric content

• Assess for nocturnal regurgitation.

• Assess patient’s ability to swallow and the presence of gag reflex. Have the
patient swallow a sip of water.

• Avoid placing patient in supine position, have the patient sit upright after meals.

• Instruct patient to avoid highly seasoned food, acidic juices, alcoholic drinks,
bedtime snacks, and foods high in fat

• Elevate HOB while in bed

• Avoid nasogastric intubation for more than five (5) days

• Instruct the patient to chew food thoroughly and eat slowly

• If the patient has dysphagia, put the patient on NPO and notify physician

If medication is not effective, surgical is recommended:

• Fundoplication Surgery

Acute pain r/t gastroesophageal reflux

• Administers antacids to alleviate heartburn/ chest pain

• Assess the patient vital sign and characteristics at least 30 minutes after
administration of medication

• Elevate the head of the bed

 • Encourage patient to follow appropriate meal times and meal portion.

Imbalanced nutrition: less than body requirements reduced food intake

secondary to GERD as evidenced by nausea and vomiting

• Explore the patient daily nutritional intake and food habits

• Create daily weight chart and a food and fluid chart.

• Discuss patient the long term and short term goals.

• Help the patient to select appropriate dietary choices to follow a low fat diet with
minimal fried foods, alcohol and caffeine.

• Refer patient to the dietitian.

References

Lee, KL. (2020).Gatroesphageal reflux diseases (GERD). Retrieved from

https://www.msdmanuals.com/professional/gastrointestinal-disorders/esophageal-and-
swallowing-disorders/gastroesophageal-reflux-disease-gerd

Vera, M. (2020). 7 Gastroesophageal Reflux Disease (GERD) Nursing Care Plans.

Retrieved https://nurseslabs.com/gastroesophageal-reflux-disease-gerd-nursing-care-
plans/

Mayo Clinic. (2020). Gastroesophageal Reflux (GERD). Retrieved from

https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-
20361940#:~:text=Gastroesophageal%20reflux%20disease%20(GERD)
%20occurs,reflux%20from%20time%20to%20time.