A Nursing Case Study on

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

In Partial Fulfillment of the

Requirements on NCM 218-RLE

PRIMARY NURSING ROTATION

Submitted to:

Edric Joy A. Ebero, RN, RM, MAN

Clinical Instructor

Farisa Jane G. Bango, StN

Angel Shane P. Bangonon, StN
Practicing Clinical Instructors

Submitted by:
Kharyl Roisse C. Castillano, StN
Doreen Mae P. Cavalida, StN
Charisse S. Caydan, StN
Jonji Dominic C. Coronel, StN
Dale Jade M. Cuta, StN
Aira Mae D. Espanola, StN
Alyssa Beatrice Caryl F. Espineli, StN
BSN-4L, Group 1, Subgroup 2

September 28, 2022

 TABLE OF CONTENTS

I. INTRODUCTION………………………………………………………………… 1
II. GOALS AND OBJECTIVES…………………………………………………… 3
III. CASE SCENARIO ASSESSMENT ………………………………………… 4
a. Biographical Data…………………………………………………………….4
b. Clinical Data………………………….……………………………………….4
c. Family Health History………….……………………………………….…….4
d. Past Health History…………………………………………………………..5
e. History of Present Illness……………………………………………………5
f. Developmental Tasks……………………………………………………….6
IV. PHYSICAL/NEUROLOGICAL ASSESSMENT……………………………… 9
V. DEFINITION OF DIAGNOSIS…………………………………………………. 23
VI. ANATOMY AND PHYSIOLOGY………………………………………………. 25
VII. PATHOPHYSIOLOGY……………………………………………………………28
a. Etiology…………………………………………………………………………28
i. Causative Factor………………………………………………………28
ii. Mode of Transmission………………………………………………..29
iii. Predisposing Factors…………………………………………………29
iv. Precipitating Factors………………………………………………….30
b. Symptomatology………………………………………………………………32
c. Schematic Tracing…………………………………………………………….39
d. Narrative……………………………………………………………………….41
VIII. MEDICAL MANAGEMENT………………………………………………………43
a. Actual Laboratory Examinations…………………………………………….43
b. Diagnostic Exams…………………………………………………………….101
c. Therapeutics………………………………………………………………….121
i. Drug Studies………………………………………………………….122
IX. SURGICAL MANAGEMENT……………………………………………….….146
a. Possible Surgical Interventions……………………………………………146
X. NURSING MANAGEMENT……………………………………………………152
 a. Nursing Theory………………………………………………………………152
b. Nursing Care Plans…………………………………………………………156
c. Review of Related Literature……………………………………………...179
d. Discharge Planning…………………………………………………………183
XI. PROGNOSIS……………………………………………………………………187
XII. REFERENCES………………………………………………………………….188
 I. INTRODUCTION

Primary nursing is also known as relationship-based nursing. In primary

nursing, the primary nurse assumes 24-hour responsibility for planning the care of
one or more patients from admission or the start of treatment to discharge or the
treatment's end. During work hours, the primary nurse provides total direct care for
that patient. In this rotation, primary nursing, the student nurses will be able to
understand better the flow of authority and organizational flow of the hospital and
give high-quality care to the patients.

The prevalence of Gastroesophageal Reflux Disease (GERD) is rising

globally. It is characterized as a condition brought on by a continuous retrograde
movement of stomach contents into the esophagus, oral cavity, or lungs.
Dysfunction of the lower esophageal sphincter, pyloric stenosis, or a motility issue
can contribute to excessive reflux. With age, reflux seems to occur more frequently.
The esophagus, lower esophageal sphincter (LES), and stomach can be
considered a straightforward plumbing circuit. Any system component may be to
blame for the anomalies that cause GERD. GERD frequently results in bothersome
symptoms or side effects such as acid regurgitation, heartburn, and a persistent
cough. Even though GERD is considered a non-life-threatening condition, its
symptoms can negatively affect a person's quality of life in terms of their health.

One of the most widespread gastrointestinal conditions is GERD, affecting

20% of adults in western societies. According to El-Serag et al.'s review, GERD
prevalence in the US ranges from 18.1% to 27.8%. GERD is now the most often
diagnosed condition in gastrointestinal practices. According to a 2014 study,
GERD is more common (10–20%) in Europe and the US but less common in Asia.
According to epidemiological data, the prevalence of symptomatic GERD has been
increasing throughout the Asia Pacific Region. In Eastern Asia, the frequency of
GERD was between 2.5–4.8% in 2005 and rose to 5.2–8.5% by 2010. According
to published time trend research, erosive esophagitis (EE), a common
consequence of GERD, has increased more than twofold in the Philippines during
the past 20 years. Similar findings have been reported from the Philippines, where

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esophagitis prevalence increased noticeably over six years, rising from 2.9% to
6.3%. In this case study, a 47-year-old male presented episodes of mid-epigastric
pain for almost a month. The pain worsened after meals or when he was changing
positions. Regurgitation, dysphagia, and heartburn were present as well. Due to
these symptoms, he had difficulty eating and continuing his daily activities.

This case study is advantageous for nursing education because it can assist
nurse educators in promoting active learning and enhancing critical thinking skills,
which are essential for nurses and other healthcare professionals. Better preparing
future medical professionals for cases involving gastroesophageal reflux disease
will also help them acquire more knowledge. In nursing practice, this case study
allows nurses to practice nursing by educating them on GERD and the proper
interventions. It offers a perspective to help patients get better care and shines a
light on the holistic component of the nursing job. Lastly, this study can further
improve the pathophysiology of gastroesophageal reflux disease for nursing
research, adding to its value. Researchers can use this work to incorporate more
GERD prevention strategies and possibly a more all-encompassing treatment plan.

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 II. OBJECTIVES
A. GENERAL OBJECTIVES

Within the four (4) weeks of Primary Nursing Rotation, the Group 1
Subgroup 1 of BSN 4L student nurses will develop a comprehensive Nursing Case
Study regarding Gastroesophageal Reflux Disease (GERD) with reliable sources
that will improve their understanding and sharpen their skills about the case, for
them to apply the principles and concepts of Primary Nursing Rotation in the
hospital setting.

B. SPECIFIC OBJECTIVES

a. The student nurses specifically aim to:

b. define Primary Nursing Rotation;
c. provide an overview of Gastroesophageal Reflux Disease;
d. discuss available data on the global and national situation of
Gastroesophageal Reflux Disease;
e. describe its implication to nursing education, nursing practice, and nursing
research;
f. formulate objectives that are specific, measurable, attainable, realistic, and
time-bounded;
g. discuss who is at risk and its risk factors;
h. distinguish the signs and symptoms of Gastroesophageal Reflux Disease;
i. elaborate Gastroesophageal Reflux Disease's disease process;
j. determine the complications brought by Gastroesophageal Reflux Disease;
k. discuss the medical, surgical, and nursing management of
Gastroesophageal Reflux Disease;
l. create three nursing care plans for patients with Gastroesophageal Reflux
Disease;
m. discuss the prognosis of Gastroesophageal Reflux Disease;
n. relate the case to three nursing theories;
o. compare recent related studies on Gastroesophageal Reflux Disease; and
p. cite the sources in formulating the manuscript following the APA format.

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III. CASE SCENARIO ASSESSMENT
A. BIOGRAPHICAL DATA

Name XYZ
Age 47 years old
Gender Male
Birthdate December 25, 1965
Address Davao City
Nationality Filipino
Marital Status Married
Occupation Medical Representative Head Supervisor at a
Pharmaceutical Company

B. CLINICAL DATA
Chief Complaint Mid-epigastric pain
Date of Admission September 8, 2022
Attending Physician Dr. Sabido
Admitting Diagnosis Gastroesophageal Reflux Disease

C. FAMILY HISTORY
I. Genogram

4
 II. Narrative

Client XYZ is the eldest child of three siblings. The middle child, ABC was
born on November 10, 1970, male. ABC suffered from hypertension and died at
45 years old in his sleep. The youngest child, DEF, female, was born on August
26, 1977, is alive and is diagnosed with hypertension.

For the paternal side, XYZ’s father, 72 years old, XY suffered from coronary
artery disease and died due to cardiac arrest. His grandmother, BH, suffered from
coronary artery disease and died in her sleep at 77 years old. His grandfather, PO,
died from gastric cancer. Aunt 1 named LV, 66 years old, suffers from diabetes
mellitus type 1, while Aunt 2, named CC, 69 years old, suffers from hypertension

For maternal side, his mother, XX, is 70 years old and is diagnosed with
type 1 diabetes mellitus. His grandmother named HK, suffered from hypertension,
and died due to stroke at 69 years old. His grandfather, OA, suffered from
pneumonia and died in his sleep at the age of 72. Uncle 1, YT, is 80 years old and
suffers from lung cancer, while uncle 2 NM, is 66 years old and suffers from
hypertension

The client’s wife named, GH, is 43 years old and suffers from Hypertension.
Their children IJ, 20 years old, female, and KL, 18 years old, male, both have no
medical conditions.

D. PAST HEALTH HISTORY

The client does not have any significant medical history, such as past
admissions and surgeries. He does not smoke and is a social drinker. He does not
use any medication other than the occasional over the counter (OTC) medications
such as Mylanta and Zantac.

E. HISTORY OF PRESENT ILLNESS

Patient XYZ has been experiencing episodes of mid-epigastric pain for a

month now and has a feeling of an acid moving back into the esophagus with acidic

5
taste in the mouth. He takes medications such Mylanta and Zantac to relieve the
symptoms.
The client sought medical attention due to mid-epigastric pain or a “burning”
sensation in his chest on September 8, 2022, at 8 am and was placed under the
care of Dr. Sabido. The patient is experiencing a pain rate of 8/10. Zantac doesn’t
give some relief with his current condition. Upon admission, he appears with facial
grimacing and guarding behavior. Regurgitation, dysphagia, and heartburn were
present.
F. DEVELOPMENT TASK

ERIK ERIKSON PSYCHOSOCIAL THEORY OF DEVELOPMENT

Erik Erikson’s 8 stages of Psychosocial Development asserts that a

person's progress through the stages of development is influenced by how they
handle social challenges throughout their lives. The 7th stage is called the
Generativity vs Stagnation refers to Adulthood ages from 26-64 years old.

Age Crisis Met / Unmet Justification

Adulthood Generativity Met Adults at this stage strive to
(26-64 years) vs. Stagnation create or nurture things,
generally through parenting,
community service, or some
other beneficial change.
However, stagnation
happens when a person is
unable to find a way to
achieve good change. The
patient is a hard-working
person and would do
anything for the sake of his
family. He was able to live a
happily with his family and
contribute positive change to

6
 the community. But because
of his current situation he
becomes stagnant, as he
was not able to fulfill his
duties.

ROBERT HAVIGHURST’S DEVELOPMENTAL TASK

Havighurst's developmental task is the staged development of a person's

entire lifespan. A person advances from one stage to the next by successfully
resolving issues or completing specified developmental tasks. For the patient, he
belongs to the Middle Age.

Age Task Met / Unmet Justification

Middle Age (36- Establishing Met The patient has been
60 years old) and maintaining working as a Medical
a standard of Representative Head
living Supervisor in a big
pharmaceutical
company for 10 years.
He was able to establish
a good relationship with
the company as he was
able to work for a long
time.
Achieving civic Met Since the patient has
and social been working in the
responsibilities same company for a
long time, he was able
to help shaped the
company in a positive
way through the means

7
 of sharing his ideas in
improving the quality of
the product they are
selling.
Maintain a Met The patient is happily
relationship with married for 20 years
spouse and has 2 children. He
tries to spend some
quality time with the wife
whenever he has some
free time after work or
during his day offs.
Adjust to Met The patient is aware of
physiological the physiological
changes changes that is
happening to his body
such decrease muscle
strength, reaction time,
sensory abilities, and
cardiac output. He was
able to understand that
as he grows older, the
physiological changes
will continue to decline.
Assisting Met The patient has two
teenage children who are 20 and
children to 18 years old. Both him
become and the mother
responsible and continues to guide their
happy adults children in becoming
adults and being

8
 responsible with their
lives. He was able to
teach their children
about ways to become a
responsible and better
adult.

IV. PHYSICAL ASSESSMENT / NEUROLOGICAL ASSESSMENT

A. CEPHALOCAUDAL

General Survey
Upon assessment, the patient is well-dressed and well-groomed. Even
though the patient had an overall tired or fatigued look, the patient displayed that
she is awake responsive to minimum stimulation. He also displayed an appropriate
deportment and mood throughout the interview because he was cooperative,
expressive about his concerns and raised clarifications, and had good eye contact.
He is an endomorph due to the fat deposition surrounding mostly her torso. His
weight is 86 kg. The patient’s weight was evenly distributed as he is able to stand
on her heels and toes straight ahead and equal on both sides. Her arm movements
are coordinated and rhythmic, where it strides in opposition appropriately. Hence,
the patient is ambulatory. However, the patient was noted to have abdominal
guarding and was hunching over due to chest pain. There is no sign that the patient
is in cardiac or respiratory distress. Upon admission, his vital signs are as follows:

Vital Signs Normal Range Result Remarks

Blood Pressure 110/70 - 130/90 mmHg 140/90 mmHg Hypertensive

Temperature 35.6 - 36.7 °C 37.5 °C Febrile

Pulse Rate Male: 70 - 80 bpm 105 bpm Tachycardia

Women: 80-90 bpm

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 Respiratory Rate 16 - 20 cpm 23 cpm Tachypnea

Skin
The general color of the client’s skin was uniform, and its texture was
smooth. The skin turgor was good, his skin’s temperature was warm, and the skin's
moisture was dry. There is hyperpigmentation present mainly on his forehead and
the buccal area. It is noted that the patient has several hyperpigmentation. This
hyperpigmentation are macules as they are small, flat, nonpalpable and the size
is up to 1 cm. Despite the several lesions, nothing grossly wrong was noted. There
were no edema and ulceration noted. His nails were also well-trimmed.

Head
The client’s head and skull were normocephalic and symmetrical. He
fontanelles were also closed. His hair is smooth and distributed normally
throughout her scalp. His scalp has dandruff. There are no lacerations, swelling,
tenderness, or lice noted during the assessment. Yet, two lesions were found on
her hairline at the back of her neck area. The lesions assessed are palpable with
fluid within its cavities and filled with pus. The lesions are at 1 cm at most. The size
of the cranium is normal as both are symmetrical and smooth. The patient’s face
is symmetrical, and no involuntary movements are noted as the patient is capable
of performing facial expressions freely without any swelling and tenderness. His
muscle jaw is normal as well.

Eyes
The eyebrows of the patient are symmetrical in alignment, yet the
distribution is sparse, especially on the left eyebrow. Both the upper eyelid
symmetrically covers only the top region of the iris. Hence, no ptosis and retraction
were noted. His lashes are curled outward. The lacrimal duct openings are evident
at nasal ends and no edema and tenderness are noted as well as discharges. The
eyeballs sit to their socket normally as there is no bulging noted. The delicate
periorbital area appears discolored because there are shadows underneath. The
conjunctivae appeared pale, yet there is no sign of edema, lesions, or discharges

10
noted. Furthermore, the sclera of the patient appeared anicteric and surrounds the
iris and the pupil. When assessed, the pupils are isocoric as both briskly constrict
with light bilaterally. The eyes also converge as the patient is focused on the pen
thus, the patient’s eyes can accommodate. In assessing the eyes’ extraocular
muscles, the eyes were able to complete the 6 cardinal gaze test without any
restrictions, and the movement of the eyes is conjugated except when converging
on an object moving closer. The client has also been assessed for eyes with pupils
equally round and reactive to light. Visual acuity and visual fields are grossly
normal, and were able to complete her functional vision without any anomalies
noted.

Ears
The pinna of the client is normoset. His external canal was patented and his
ears were also checked with clear tympanic membranes, and the canals are clear
bilaterally. Furthermore, the patient was able to repeat the words using a normal
tone and was able to hear the ticking of the watch. During the whisper test, the
patient misheard 2 words out of 10 words given.

Nose
The patient’s nasolabial fold has a uniform color and is symmetrical
because the nasal septum is intact and straight and not perforated or deviated.
The nose is also patent as the air moves freely as the client breathes. The patient
is also able to smell the aroma of the coffee. Abnormal secretions aren’t found as
the mucosa is pink. There are also no signs of growth of tenderness, lesions, and
blood points as well. The paranasal sinuses, such as the maxillary and frontal
sinuses, don’t have any tenderness as there is no pain within touch.

Mouth
During the assessment, the patient had chapped, dry, and pallor lips. His
lips appeared to have pigmentation as it is darker on the edges as if to outline the
lips. There are no fissures, lesions, or ulcers noted on the lips. The tongue of the
patient is fitted comfortably in the midline of the mouth, tip against lower incisors.
No anomalies were noted. The patient has 24 permanent teeth in total and four

11
missing teeth. His missing teeth are his right and left 1st premolars on his upper
jaw, right 1st molar of the lower jaw, and left 2nd molar of his lower jaw. The right
and left canine on the lower jaw has dental carries on them. Lesions and lingual
erosion of teeth were noted as his incisors and canines had these symptoms. All
of the teeth appeared to be yellowish, and some were slanted. The patient has an
overbite as well. his gums were pinkish; thus, normal. The buccal mucosa of the
patient has an entire pinkish oral cavity however, the presence of some erythema
was observed. His palate is pinkish; thus, normal.

Pharynx
The uvula is on the center and mobile as well. The pharyngeal wall has
smooth and pink homogenous surface prominences. No swelling and ulceration
was noted. The tonsils are inflamed and enlarged. Also, the patient had a gag
reflex.

Neck
The neck fits symmetrically in the center however, the neck is slightly
leaning forward. Upon palpation, the lymph nodes are palpable thus, swelling and
enlarged. The thyroid is in normal size. The movement of the patient is
coordinated and smooth. Jugular vein distention is not observed. The muscle
strengths of the patient are of equal strength and power.

Thorax
The thorax’s shape of the patient is symmetrical and his spinal alignment is
also normal. Thise were no anomalies noted. Her breathing pattern was effortless
and his chest turgor was also normal. Her respiratory excursion is also normal,
thorax’s tactile fremitus was symmetrical, and resonance upon percussion. The
patient had vesicular breath sounds in all areas of auscultation thus no adventitious
sounds noted. Lungs are clear to bilateral auscultation, with no rales, no ronchi
and no wheezing.

Heart

12
 The precordium of the patient’s heart is normodynamic. There were no extra
sounds recorded upon auscultation. Upon palpation, all of the eight pulse sites had
strong pulsation. There was no calf tenderness recorded for both of the extremities.
There was no irregular rhythm, no murmurs, or even no gallops noted.

Breast
The patient’s breasts were equal and flat and there were no masses,
dimpling, redness, or edema noted. The breast was not tender as there's pain upon
touch. The color of his nipples and areola is brownish black, and there were no
anomalies recorded.

Abdomen
The patient’s lower abdomen has striae present and his abdomen was
observed to be distended and bloated with stomach gurgling noises heard upon
auscultation performed. No abnormalities were noted. His bowel movement was
normoactive and there was no bruit heard during auscultation. There’s an absence
of friction rub and upon percussion, it is tympanic. His bladder was nonpalpable
and there were no ascites however there is muscle guarding present.

Genito-Urinary
The patient’s penis was normal. There were no lesions or tenderness noted.
No discharges were recorded and the meatus is in the midline. His scrotum is
symmetrical and there were no hernia or hydrocele noted. As for his water intake,
it was estimated between 500 ml to 800 ml a day. His urine output was less than
30 ml per hour. He was constipated as he was only able to defecate every three
to four days.

Musculoskeletal
On both sides of his body, the patient has muscles of comparable size
supporting his interphalangeal joints, metacarpophalangeal joints, wrists, elbows,
shoulders, metatarsophalangeal joints, ankles, knees, and hip joints. No evidence
of contractures, atrophy, hypertrophy, tremors, or spasticity was found when the
muscle and tendons were examined. A rating of five (5) indicates that the patient's

13
sternocleidomastoid, trapezius, biceps, triceps, and fingers/wrist can move actively
against full resistance. However, when flexed or extended, the patient's hamstrings,
quadriceps, and ankles/feet have a limited range of motion. Rating of five (5)
indicates that the patient's sternocleidomastoid, trapezius, biceps, triceps, and
fingers/wrist can move actively against full resistance. The patient's bones are
symmetrical and free of abnormalities and painful spots. The patient has equal-
sized joints with no lumps and no visible edema. The patient's sternocleidomastoid,
trapezius, biceps, triceps, and fingers/wrist are given a rating of five (5), which is
regarded as an active movement against full resistance for muscle strength. There
were no visible indications of skeletal deformities, anomalies, redness, crepitation,
warmth, swelling, or soreness.

Neurological Assessment
Upon interview, the patient was able to enunciate words freely and he was
able to express himself. There were no abnormalities in his speech and language.
He was also able to tell the time, date, and place thus, oriented. He was able to
answer the questions and his statements during the interview are concise and
coherent, thus oriented in orderly and appropriate words. Even though he was
aware and responsive throughout the interview, he seldom forgets minimal details
throughout his day, when asked. However, he answered questions from his
childhood with ease. Also, he was able to concentrate and focus entirely during
the interview.

B. CRANIAL NERVE TEST

CRANIAL FUNCTIONS METHODS OF RESULTS

NERVE ASSESSMENT

I. Olfactory Olfacory nerve is a Odor identification The patient

sensory nerve, was used to assess could identify
whose major the olfactory cranial all the odors
nerve. The patient he presented

14
 function is the sense was asked to close bilaterally,
of smell. their eyes and such as
identify the odor coffee and
presented in front of alcohol.
each nostril while
the other nostril was
covered.

II. Optic Optic Nerve is a Visual acuity was Upon

sensory nerve, tested through the assessment,
whose major Snellen chart in the patient
function is vision. assessing the optic had trouble
nerve. Using the seeing from
Snellen chart, the both eyes as
patient will be 10 he could read
feet away from the the letters
chart. Since the until 20/30.
patient is not
wearing corrective
lenses, he would not
be wearing any
during the
assessment. He will
close one eye at a
time and read the
most familiar, and
readable letters. He
will continue to
voice out the letters
until he cannot
distinguish them.

15
Then, this would be
repeated in the
other eye.

As for the patient's

visual fields, this
would be assessed
Upon
through a
assessment,
confrontation visual
the patient
field test. Firstly, the
correctly
patient will remove
identifies all of
their hat or anything
the numbers
that could interfere
of fingers held
with their peripheral
up in all of the
vision. Sit
visual
approximately three
quadrant of
to four feet away
both eyes.
and directly in front
of the patient. If
possible, adjust the
seat height to the
patient's eye level.
Then, ask the
patient to gently
cover their left eye
with their left hand
and instruct the
patient to fix their
gaze directly on
their left eye

16
throughout the test.
While the patient
focuses on the
nurse’s eye, close
the nurse’s right eye
and maintain
fixation on the
patient's open eye.
The nurse will raise
their hand to the
inferior temporal
edge of your
peripheral vision
halfway between
the nurse and the
patient while holding
up 1, 2, or 5 fingers.
Using only 1, 2, and
5 fingers helps to
make the number
more easily
distinguished by the
patient. Ask the
patient how many
fingers are seen.
This will be
repeated to all four
visual quadrants
and to the other eye.

17
III. Oculomotor Oculomotor is a Using a penlight, the In all four
IV. Trochlear motor nerve whose nurse should hold it visual
VI. Abducens function is eye at least 12 inches quadrants,
movement such as away from the including the
the pupillary patient's nose when midline, the
constriction and evaluating patient could
accommodation, and nystagmus. Instruct follow the
the muscle of the the patient to follow penlight.
upper eyelid. the penlight in all
four visual
Trochlear nerve is a quadrants as it
motor nerve whose advances across
function is the eye the midline and
movements toward the tip of the
especially the nose using only
intorsion and their eyes and not
downward gaze. their heads.

Abducens nerve is a Allowing the patient

motor nerve whose to look at a faraway
Both of the
function is eye item that can
patient's
movements enlarge their pupils
pupils were
specifically will help you
able to
abduction or lateral evaluate the
contract
movements of the patient's pupil
rapidly in
eye. structure in a dimly
response to
illuminated space.
light.
Cast a light with a
penlight to close the

18
 pupils at the outer
corners of each eye.

In assessing the
accommodation,
instruct the patient
When the
to focus their eyes
index finger
and allow them to
was brought
follow the tip of the
closer to the
index finger as it
patient’s
gently slide it
nose, the
towards the tip of
patient’s
the patient’s nose.
pupils
As your index finger
constricted as
approaches the
his eyes
patient’s nose and
closed
eyes are crossed,
the patient’s pupils
should constrict

V. Trigeminal Trigeminal nerve is In order to assess The patient

both sensory and the patient's was able to
motor nerve, whose trigeminal motor clamp his
major function is the function, the teeth and was
somatic sensation masseter muscles able to open
from the face, mouth, are felt while the his mouth
cornea and the patient clenches against
muscles of their teeth, and the resistance
mastication. patient is asked to
open their mouth
against resistance.

19
 When the mouth is
opened, the jaw
shifts to one side if a
pterygoid muscle is
weak.

VII. Facial Facial nerve is both Ask the patient to The patient
sensory and motor tightly close both could close
nerve whose eyes and open them both eyes
function is to control when signaled to tightly, grin,
the muscles of facial test the facial nerve. and blow out
expression, taste After that, request his cheeks.
from anterior tongue, from the patient a No facial
lacrimal and slavary smile, a frown, and a spasms,
glands. cheek blow. weakness, or
drooping were
noted.

VIII. Vestibulocochlear Using the whisper The pateint

Vestibulocochlear nerve is a sensory test, cranial nerve 8 can hear from
nerve whose was evaluated. With both ears.
function is for your hand, cover
hearing and sense of one of the patient's
balance. ears while speaking
into the other. The
patient ought to be
able to understand
the murmured
words. On the
opposite side of the

20
 ear, repeat the
procedure.

IX. Glossopharyngeal To evaluate the The uvula of

Glossopharyngeal nerve is both uvula, ask the the patient
sensory and motor patient to open their was able to
nerve whose major mouth and say move upward
function is the “Ahh.” It is normal to when he
sensation from anticipate the uvula opened his
posterior tongue and moving upward. mouth.
pharynx, taste from
posterior tongue, In assessing the
The gag reflex
carotid gag reflex, ask the
is present
baroreceptors and patient to open their
chemoreceptors and mouth and use a
salivary glands tongue depressor to
press on the throat
gently.

X. Vagus Vagus nerve is a To check for voice No

sensory and motor hoarseness, ask the hoarseness of
nerve whose patient to talk voice was
function is the noted.
autonomic functions To check the
of the gut, cardiac patien’s ability to
The patient
inhibition, sensation swallow, ask the
was able to
from larynx and patient to swallow
swallow
pharynx; muscles of
without any
vocal cords and
discomfort or
swallowing.
pain.

21
XI. Accessory Accessory nerve is a In assessing the The patient
motor nerve whose head’s range of was able to
function is for the motion, the patient move his
shoulder and neck should be instructed head and
muscles. to move their head shrug against
side-to-side, up- resistance
and-down, and
shrug against
resistance

XII. Hypoglossal Hypoglossal nerve is Instruct the patient The patient

a motor nerve whose to stick out their was able to
function is the tongue and move it stick out his
movements of the from side-to-side to tongue and
tongue. assess for tongue move it from
movement. side to side
without
discomfort.

C. REFLEXES

REFLEX RESULT

Biceps reflex Contraction upon tapping is present, and flexion of the

forearm is noted with a brisk response. Graded as 2+
(normal).

Triceps reflex Extension upon tapping the tendon with the reflex hammer
is present with brisk reaction. Graded as 2+ (normal).

Brachioradialis Brisk flexion and supination of the forearm were noted upon
reflex tapping with a reflex hammer. Graded 2+ (normal).

22
 Patellar reflex There is a a quick, although mild, contraction of the
quadriceps muscles, resulting in a small kicking motion.
Knee reflex jerks graded as 2+ (normal).

Achilles reflex There is normal reflex response as there is flexion of the

great toe. Graded 2+ (normal).

D. SENSORY EXAM

SENSATION RESULT

Position The patient was able to identify all of the position sense and
Sense there was no observed abnormality noted.

Vibration The patient was able to feel vibrations on both ankles when tunic
fork was placed on his ankles.

V. DEFINITION OF DIAGNOSIS

Gastroesophageal reflux disease (GERD) is a widespread digestive disorder

worldwide. It is a condition of troublesome symptoms and complications that result
from the reflux of stomach contents into the esophagus. Hence, diagnosis of
GERD is typically based on classic symptoms and response to acid suppression
after an empiric trial (Clarrett, D. & Hachem, C., 2018). On the other hand,
Gastroesophageal reflux (GER) is a process in which stomach acid flows back up
into the esophagus. However, if an individual experiences persistent acid reflux
that occurs more than twice a week, a doctor may now diagnose GERD.
To put it simply, GERD is the regular, persistent, and long-term occurrence of
GER (MacGill, M., 2022).
In addition, this condition was identified to interfere with daily living, since
troublesome symptoms such as chest pain, regurgitation of stomach's contents,
difficulty swallowing, bad breath, nausea and vomiting, sore throat, or even an

23
irritated feeling in esophagus but most people can get relief from it through lifestyle
changes, home remedies, and medical treatment (Welch, A., 2021).
The severity of reflux into the esophagus determines the illness stage. There
are four (4) phases of GERD, each with its own set of symptoms ranging from
minor heartburn to severe chest pain mimicking a heart attack, and treatment
options differ in each stage. Stage one (1), Mild GERD, an individual may have
infrequent heartburn and regurgitation (less than once a week) or a lump in the
back of the throat, although this stage is normally addressed with lifestyle changes
and OTC acid suppression drugs only if needed. Stage two (2), Moderate GERD,
is characterized by more typical symptoms such as heartburn and regurgitation
that occur a few times per week and necessitate daily prescription acid
suppression drugs.
In stage three (3), Severe GERD, an individual's symptoms are poorly
controlled on prescription drugs, and they are likely to develop erosive esophageal
inflammation. It is usually treated with antisecretory treatment daily to twice daily
and should be monitored by a GERD expert. Furthermore, at this time, a person is
a candidate for anti-reflux operations that may help restore the integrity of their
lower esophageal sphincter. Finally, stage four (4), reflux-induced precancerous
lesions or esophageal cancer, is caused by years of untreated severe reflux.
Individuals may experience all symptoms of the three stages, including hoarse
voice, persistent cough, and dysphagia, and usually develop a precancerous
condition known as Barrett's esophagus, which can progress to cancer if not
treated. Furthermore, all treatments and diagnostic tests for suspected GERD are
performed at this time. GERD is often diagnosed based on classic symptoms and
an empiric trial's response to acid suppression. If GERD is clinically suspected and
endoscopy is not indicated, empiric therapy ranging from lifestyle changes to a
short trial with PPis should be undertaken. As a result, GERD is anticipated in
individuals who react to this therapy regimen. On the other hand, treatment of
GERD symptoms has been linked to considerable improvements in quality of life,
including lower physical pain, greater vigor, physical and social function, and
mental well-being.

24
VI. ANATOMY AND PHYSIOLOGY

A muscular tube known as the esophagus connects the pharynx to the stomach.
The mucosa, a pink, wet tissue, lines the esophagus that measures approximately
8 inches long. The esophagus is located in front of the spine, behind the trachea
and heart. The esophagus travels through the diaphragm before entering the
stomach. At the top of the esophagus, there is a group of muscles known as the
upper esophageal sphincter. The upper esophageal sphincter muscles are utilized
for breathing, eating, belching, and vomiting, which are controlled by the nervous
system. They prevent fluids and food from entering the trachea. A group of
muscles known as the lower esophageal sphincter is located where the esophagus
enters the stomach at the lower end. Acid and stomach contents cannot pass
backward from the stomach when the lower esophageal sphincter is closed. The
lower esophageal sphincter muscles are not controlled voluntarily.

25
 In the top region of the abdomen is the muscular, J-shaped stomach. It
stores and digests food as part of the digestive system. The size of each person's
stomach is different depending on the number of meals they eat and the structure.
The esophagus and the top of the stomach are connected and the
gastroesophageal junction is the region where the esophagus and stomach
converge. The bottom of the stomach connects to the duodenum. There are 5
sections in the stomach. The first section of the stomach that connects to the
esophagus is called the cardia. It has the cardiac sphincter, a little muscular ring
that aids in preventing reflux of stomach contents into the esophagus. The
upper, rounded region to the left of the cardia is known as the fundus. The
stomach's largest and most important component is its body. Here, food is
combined and begins to break down. The stomach's lowest third is known as
the antrum. Until the meal is prepared to enter the small intestine, it stores the
broken-down food. The portion of the stomach that joins the small intestine is
known as the pylorus. It contains the pyloric sphincter, a muscular ring that
serves as a valve to regulate the emptying of the contents of the stomach into

26
the duodenum. The pyloric sphincter also stops the duodenum's contents from
returning to the stomach.
The mucosa, which is the stomach's inner lining, is one of the several layers
of tissue that make up the stomach. Its glands and specialized cells produce
enzymes, hydrochloric acid, and mucus. When the stomach is empty, the mucosa
is ridged. As the stomach is full from eating, the ridges flatten out. A layer of
connective tissue called the submucosa encircles the mucosa. It has bigger nerve
cells, lymphatic and blood arteries, and fibers. The submucosa is covered by the
muscularis propria, which is the following layer. It has two layers of muscle and is
the primary muscle of the stomach. The fibrous membrane that covers the exterior
of the stomach is known as the serosa. The visceral peritoneum is another name
for the stomach's serosa. Your stomach receives instructions from the central
nervous system (CNS) to produce gastric juice, which is a mixture of acids,
enzymes, and mucus used for digestion. The hormone gastrin is released into the
blood by endocrine cells in the stomach to help regulate stomach activity. Food
and liquids pass through the esophagus and into the stomach after being
swallowed. As the muscles in the stomach wall contract and relax, food is
combined with enzymes and acids. The stomach lining is shielded from acids by
mucus. Food and liquids are digested into chyme, a viscous, acidic soup-like
substance. The pyloric sphincter relaxes as chyme forms. In order to transfer the
chyme into the duodenum, where digestion occurs and many nutrients are
absorbed, the stomach muscles contract and then relax. The stomach doesn't play
a significant part in food absorption. Only water, alcohol, and some narcotics are
absorbed by it.

27
VII. PATHOPHYSIOLOGY
A. ETIOLOGY
I. Causative Factor

Gastroesophageal reflux disease, also known as chronic acid reflux, is a

disorder in which the esophagus, the tube that connects your neck to your stomach,
frequently becomes infected with acid-containing stomach contents. The lower
esophageal sphincter (LES), at the end of the food pipe, can become relaxed, thus
allowing food back into the esophagus. In most cases, this occurs postprandially.
GERD occurs when LES fails to close such that the stomach content or acid flows
back into the esophagus. The reflux disturbs the lining of your esophagus and as
a result causing GERD. Generally, damage to the esophagus is likely to arise when
reflux is very acidic, frequent, or if the esophagus cannot clear acid as quickly as
it should. In such instances, a person would feel heartburn.

II. Mode of Transmission

Gastroesophageal reflux disease (GERD) is not contagious. This disease

is caused by internal factors in the body. Even though a majority of people assume
that GERD is caused by certain food, lifestyle habits, or stressful situations,
scientist suspect that it is caused by both genetic and environmental factors. With
this in mind, one's genes can play a role in causing structural problems in the
esophagus which in turn causes GERD. Another causative agent is H. pylori
strains that may colonize the esophageal mucosa, aggravate the inflammation of
the lower esophagus, and induce intestinal metaplasia or even adenocarcinoma.

III. Predisposing Factors

FACTOR PRESENT/ABSENT MECHANISM/RATIONALE

Gender (Female) Absent GERD is more prevalent in
females and their frequency
increased by increase in age.
Such findings may be due to

28
 female hormones and hiatal
hernia (Yaseri, 2017).
Age Present Anyone can develop GERD at
any age but a person is more
likely to develop it as it gets
older due to lifestyle (Ratini,
2021).

IV. Precipitating Factors

FACTOR PRESENT MECHANISM/RATIONALE

Obesity Absent Obesity is a risk factor for
GERD, although the specific
mechanism remains to be
determined. In an obese
person the
intraabdominal pressure is
increased, which can
exacerbate
GERD. (Harding, 2020).
Diet Present Foods may stimulate the
production of stomach acid,
making GERD symptoms more
severe. Others may relax the
muscle that separates the
esophagus and stomach,
allowing acidic stomach
contents to flow back up into
the esophagus. This flow can
cause symptoms such as

29
 lower chest burning and pain.
(Walker, 2018).
Hiatal Hernia Absent A hernia of this nature is
characterized by the stomach
being pulled into the chest,
which is higher than where it
normally sits. As the stomach
gets trapped into a higher
position than where it normally
sits, it becomes easier for
stomach acid to flow back up
into the esophagus and cause
acid reflux. (The Surgical
Clinic, n.d.)
Continuous intake of Absent Nonsteroidal anti-inflammatory
NSAIDS drugs (NSAIDs), such as
aspirin and ibuprofen, break
down the protective barrier in
your stomach. This allows acid
to irritate the lining of your
stomach and worsen
symptoms of GERD. (Walker,
2018).
Pregnancy N/A Pregnancy hormones can
make the valve at the entrance
to the stomach relax so that it
doesn't close as it should. This
lets acidic stomach contents
move up into the esophagus.
(Joseph, n.d.)

30
 Smoking Absent One of the effects of nicotine
on the body is that it acts as a
relaxant to smooth muscle.
Since the lower esophageal
sphincter is composed of
smooth muscle, the intake of
nicotine during smoking can
cause the muscle to relax and
function improperly. In these
circumstances (especially if
combined with any other
gastroesophageal problems),
stomach acid can leak through
and cause heartburn
(CaryGastro, 2021).

B. SYMPTOMATOLOGY
SIGN/SYMPTO PRESENT MECHANISM/RATIONAL NURSING
M / E REPONSIBILITIES
ABSENT
Heartburn Present It occurs when the 1. Avoid certain
sphincter muscle at the foods that can
lower end of your cause
esophagus relaxes at heartburn
the wrong time, allowing such as mint,
stomach acid to back up fatty foods,
into your esophagus spicy foods,
(MayoClinic, 2022). tomatoes,
onions, garlic,
Chest Pain Present It's a painful burning coffee, tea,
sensation in the middle

31
of your chest caused by chocolate,
irritation to the lining of and alcohol.
the esophagus caused 2. Do not drink
by stomach acid. This carbonated
burning can come on beverages
anytime but is often R: They make
worse after eating. For you burp,
many people heartburn which sends
worsens when they acid into the
recline or lie in bed, esophagus.
which makes it hard to 3. Stay up after
get a good night's sleep. eating
Chest pain due to GERD R: When
is relieved by antacids you're
(Cleveland Clinic, 2019). standing, or
even sitting,
gravity alone
helps keeps
acid in the
stomach,
where it
belongs.
Finish eating
three hours
before you go
to bed. This
means no
naps after
lunch, and no
late suppers

32
 or midnight
snacks.
Dyspepsia Present Patients may also 1. Encourage
complain of dyspepsia. small frequent
Dyspepsia is pain or meals of high
discomfort centered in calories and
the upper abdomen high protein
(mainly in or around the foods.
midline as opposed to R: Small and
the right or left frequent
hypochondrium). meals are
Stomach ulcers or acid easier to
reflux can cause digest.
dyspepsia. If there is 2. Instruct to
reflux, stomach acid remain in
backs up into the upright
esophagus (Lewis, position at
2020). least 2 hours
after meals;
avoiding
eating 3 hours
before
bedtime.
3. Instruct
patient to eat
slowly and
masticate
foods well.
R: Helps
prevent reflux.

33
Regurgitation Present Regurgitation is usually 1. Instruct to
described as a sour taste remain in
in the mouth or a sense upright
of fluid moving up and position at
down in the chest. It least 2 hours
happens when a mixture after meals;
of gastric juices, and avoiding
sometimes undigested eating 3 hours
food, rises back up the before
esophagus and into the bedtime.
mouth (Sethi, S., 2019). 2. Stay up after
eating
R: When
When you have GERD, you're
Coughing Present acid from your stomach standing, or
backs up into your even sitting,
esophagus. If the acid is gravity alone
brought back in, it can helps keeps
make a person cough acid in the
(Gillson, 2022). stomach,
where it
belongs.
Finish eating
three hours
before you go
to bed. This
means no
naps after
lunch, and no
late suppers

34
 or midnight
snacks.
Water Brash Absent People with 1. Avoid certain
gastroesophageal reflux foods that
disease may experience can trigger
a symptom called water water brash
brash. Water brash such as
occurs when a person chocolate,
produces an excessive alcohol, and
amount of saliva that fatty foods
mixes with stomach 2. Instruct client
acids that have risen to to increase
the throat (Brennan, daily activity
2021). and lose
weight.
3. Administer
antacids and
or proton
pump
inhibitors as
ordered.
Wheezing Absent The refluxed gastric acid 1. Assess the
irritates the nerve patient’s VS
endings in the and
esophagus generating characteristic
signals to the brain. s of
Subsequently, the brain respirations at
responds with impulses least every 4
to the lungs that hours.
stimulate the muscle and R: To obtain
baseline data

35
 mucus production in the 2. Encourage
airways (Gillson, 2022). coughing.
Suction
secretions as
needed.
R: To help
clear
remnants that
the patient
may not be
able to
expectorate
3. Administer
supplemental
oxygen as
prescribed
R: To
increase
oxygen level.
Globus Absent According to Selleslagh 1. Instruct client to
Sensation et.al. (2013), globus Drinking plenty
may be attributed to of fluids. Avoid
reflux going past throat clearing as
esophagus into this tends to
hypopharynx causing exacerbate the
irritation and globus
inflammation to symptoms.
laryngeal tissue 2. Teach client to
(laryngopharyngeal have gentle
reflux) throat massage
and rolling neck

36
 to release tight
muscles or any
tight sensations.
Odynophagia Present The acidity of the 1. Check for
stomach's contents can coughing or
cause irritation in the choking
esophagus, which during eating
cause pain when and drinking.
swallowing (Biggers, 2. Check for
2021). residual food
in mouth after
eating.
3. Check for
food or fluid
regurgitation
through the
nares.
Sore Throat Present Short-term sore throat 1. Get adequate
from acid reflux is rest and get
caused by the digestive plenty of
fluids burning your sleep
tissues. Long-term sore R: So that the
throat can indicate voice can
GERD with coughing, relax, too.
which adds to the
inflammation, swelling, 2. Drink plenty of
and throat pain (Pugle, fluids and
2022). avoid
caffeinated
drinks.

37
 R: Water
keeps the
throat moist
and prevents
dehydration.
Caffeinated
drinks may
trigger other
GERD
symptoms
and can also
cause
dehydration.
3. Gargle with
saltwater
R: A saltwater
gargle of 1/4
to 1/2
teaspoon
(1250 to 2500
milligrams) of
table salt to 4
to 8 ounces
(120 to 240
milliliters) of
warm water
can help
soothe a sore
throat.

38
 C. SCHEMATIC TRACING OF GERD

Precipitating Factors:
• Obesity
Predisposing • Diet
Factors: • Hiatal Hernia
- Age • Continuous taking of
- Gender NSAIDs
• Pregnancy
• Smoking

Esophageal Tissue exposed to

stomach acid

Pro-inflammatory Cells &

cytokines recruited to the area

Excessive or Prolonged
Transient Lower Esophageal
Sphincter Relaxation

Regurgitation, Hydrochloric Acid is pushed up Heartburn, Chest Metoclop

Coughing due to increased intra- Pain, Water Brash ramide
abdominal pressure.

Omepra
Refluxate contains proteolytic Dyspepsia
zole
enzymes (trypsin) and bile

Squamous
Pharyngeal
Esophageal
Lining and
Epithelium
Airway Damage
Damage

Cough Sensory Increased

Nerve Endings inflammation of
are Stimulated; cells; may
airway becomes undergo
irritated metaplasia

39
 GASTROESOPHAGEAL REFLUX DISEASE

Primary Secondary
Gastroesophageal Gastroesophageal
Reflux Disease Reflux Disease

IF NOT
TREATED TREATED

Metoclopramide Esophagitis

Omeprazole

Atorvastatin Laryngitis (A/C)

Ranitidine Hiatal Hernia

Nissen
Fundoplication

Laparoscopic
Fundoplication

Instructing
Failure to follow
Client to follow
treatment
treatment
regimen
regimen

GOOD FAIR TO POOR

PROGNOSIS PROGNOSIS

Legend:
Medications Signs and Symptoms
Nursing Intervention Disease Process
Surgical Intervention Diagnosis
Complications Subclass of Diagnosis
Possible Laboratory Prognosis
Examinations
Laboratory Examination Predisposing | Precipitating
Taken Factors

40
Narrative:

The predisposing factors of G.E.R.D. are (1) Age and (2) Gender. The
precipitating factors are (1) Obesity, (2) Diet, (3) Hiatal Hernia History, (4)
Continuous taking of NSAIDs, (5) Pregnancy, and (6) Smoking/Exposure to
Smoking.

The Esophageal Tissue is exposed to stomach acid, causing pro-

inflammatory cells and cytokines to proceed to the are where there is a stomach
acid exposure. And this mechanism can be divided into two- primary and
secondary. If the case is primary, it can be caused by Diet, NSAIDs, Obesity, and
Pregnancy. Diet and NSAIDs are due to incompetent Lower Esophageal
Sphincter. And in obesity and pregnancy, there is Hiatal Hernia, which is also
considered as a complication of GERD. If the case is otherwise, it can be caused
by scleroderma (an autoimmune disease), large amounts of meal, and delayed
gastric emptying. Scleroderma makes GERD worse because the stomach remains
filled with noxious materials for a longer time after eating, thus decreasing
peristalsis. As per delayed gastric emptying and large consumption of meal, the
CN XI stimulates the Lower Esophageal Sphincter. Now, there is an excessive of
prolonged transient lower esophageal sphincter relaxation and due to that
relaxation, HCl Acid is pushed up due to increased intra-abdominal pressure. And
because of that, the refluxate contain proteolytic enzymes and bile. Continuously
exposed to that, it can lead to (a) Pharyngeal Lining and Airway Damage and (b)
Squamous Esophageal Epithelium Damage.

If there is damage in pharyngeal lining, the cough sensory nerve endings

are stimulated, airway becomes irritated, and fibroblasts proliferate and deposit
granulation tissue in airway. If Cough Sensory Nerve Endings are stimulated, the
vagal reflex is activated, causing activation of cough center. If the airway, on the
other hand, is irritated, it causes increased bronchial reactivity, thus causing
increased vagal tone. There would be bronchoconstriction that can be manifested
by wheezing, globus sensation, and or odynophagia that eventually ends in

41
asthma or chronic cough. If the granulation tissue in airway is deposit causing
fibroblasts to proliferate, it can lead to a certain complication called Chronic
Laryngitis in which it is the narrowing of laryngeal space that can further ascend to
Laryngeal or Tracheal Stenosis.

For Squamous Esophageal Epithelium Damage, increased inflammation of

cells is present causing esophagitis. And that esophagitis forms ulcers in
esophagus and collagen is deposited where ulcers heal. As the time goes by, the
collage fibers will contract, leading to Esophageal Stricture Disease. Another
damage that may cause is that it would undergo metaplasia to become columnar
epithelium, causing Barrett’s Esophagus, thus having premalignant changes, that
would eventually end in esophageal adenocarcinoma if not diagnosed early.

If the client has no bleeding, and adheres to treatment regiment (antacids,

antibiotic therapy if H. pylori is the causative agent, taking prescribed drugs, and
lifestyle modification), it would lead to good prognosis. Non-compliance to
treatments and manifestations of different complications such as esophagitis,
Barrett’s Esophagus, Ulcerations and Narrowing of Esophagus, then, it could be
under fair or poor prognosis.

42
 VIII. MEDICAL MANAGEMENT
A. ACTUAL LABORATORY TESTS

Complete Blood Count

A complete blood count (CBC) is a blood test used to evaluate your overall
health and detect a wide range of disorders, including anemia, infection, and
leukemia. It measures the quantity of all the different types of cells in the blood. A
complete blood count test measures several components and features of your
blood, including red blood cells, which carry oxygen. One of the most routinely
requested blood tests is the complete blood count (CBC).

COMPO NORMAL RATIONALE RESULT INTERPRETATI NURSING

NENT RANGE AND ON AND RESPONSIBILITI
DEFINITION SIGNIFICANCE ES

WBC 4.0 - 10.5 A white blood Septemb Normal Before

x10E3 count is most often er 8,
The patient’s ● Encourage to
used to help 2022 @
/uL white blood cell is avoid stress if
diagnose 9:00 AM
within the normal possible
White blood disorders related
range. because
cells are part of to having a high
altered
the body's white blood cell 5.7
physiologic
immune count or low white x10E3
status
system. They blood cell count.
/uL influences and
help the body Disorders related
changes
fight infection to having a high
normal
and other white blood count
hematologic
diseases. include:
values
Autoimmune and
● Explain that
inflammatory
fasting is not
diseases,

43
 conditions that necessary.
cause the immune However, fatty
system to attack meals may
healthy tissues. alter some test
results as a
RBC 4.10 - 5.60 The results of an Septemb Normal result of
x10E3 RBC count can be er 8, lipidemia.
The patient’s red
used to help 2022 @ ● Explain test
/uL blood cells are
diagnose blood- 9:00 AM procedure.
within the normal
Red blood cells related conditions,
Explain that
range.
that carry such as iron slight
oxygen from deficiency anemia 5.27
discomfort may
the lungs to the (where there are
x10E3 be felt when the
rest of the fewer red blood
skin is
body. Then cells than normal). /uL
punctured.
they make the A low RBC count
return trip, could also indicate
During
taking carbon a vitamin B6, B12
dioxide back to or folate ● Apply manual
the lungs to be deficiency. pressure and
exhaled. dressings over
the puncture
Hemoglo 12.5 - 17.0 A hemoglobin test Septemb Normal site on removal
bin (Hgb) g/dL measures er 8, of needle.
The patient’s
2022 @
Hemoglobin is the levels of hemoglobin is
9:00 AM
a protein in red hemoglobin in the within the normal After
blood cells that blood. If the range.
● Monitor the
carries oxygen hemoglobin
15.4 puncture site
throughout the
levels are for oozing or
body. g/dL
abnormal, it may

44
 be a sign of a hematoma
blood disorder. formation
● Instruct to
A test is often
resume normal
used to check for activities and
anemia, a diet.
condition in which
your body has
fewer red blood
cells than normal.

Hematocr 36.0 - 50.0 % A lower than Septemb Normal

it (HCT) normal hematocrit er 8,
Hematocrit is The patient’s
can indicate: An 2022 @
the percentage hematocrit is
insufficient supply 9:00 AM
by volume of within the normal
of healthy red
red cells in your range.
blood cells
blood.
(anemia) A large 44.1 %

number of white
blood cells due to
long-term illness,
infection or a white
blood cell disorder
such as leukemia
or lymphoma. High
hematocrit levels
could indicate
underlying medical
conditions like
dehydration.

45
MCV 80-98 fL The MCV test can Septemb Normal
help to identify if er 8,
Mean The patient’s
red blood cells are 2022 @
corpuscular mean
too big 9:00 AM
volume (MCV) corpuscular
measures the or too small. volume is within
average size of Changes in red the normal range.
84 fL
red blood cells
blood cell volume
in a blood
can affect
sample. An
MCV is how oxygen
test is

part of a panel distributed

of tests called throughout the
the red blood body and
cell indices,
may be a sign of a
which evaluate
blood
certain features
of how red disorder or other
blood cells health
function.
conditions.

MCH 27.0 - 34.0 pg MCH is a useful Septemb Normal

measurement for er 8,
Mean The patient’s
2022 @
corpuscular understanding how mean
9:00 AM
corpuscular
hemoglobin effectively oxygen
hemoglobin is
(MCH) is a is being distributed
within the normal
throughout the 29.2 pg
measurement range.
of the average body. Changes in
MCH or other RBC
amount of

46
 hemoglobin in indices may be a
sign of a blood
each red blood
disorder
cell.
called anemia.

MCHC 32 - 36 g/dL The MCHC test is Septemb Normal

one of a panel er 8,
Mean The patient’s
2022 @
corpuscular of tests called the Mean
9:00 AM
red blood cell corpuscular
hemoglobin
indices, which help hemoglobin
concentration
to define the concentration is
34.9
(MCHC) is a different physical within the normal
g/dL
measurement range.
characteristics of
of the average red blood cells. As
amount of an assessment of

hemoglobin in the blood’s ability

a single red to carry oxygen,

blood cell the MCHC test

(RBC) as it along with the
relates other RBC indices
to the volume can be used to
of the cell. diagnose and
classify disorders
that affect the

blood, like anemia

RDW 11.7-15 % An RDW blood test Septemb Normal

measures your red er 8,

47
 A red cell blood cells’ 2022 @ The patient’s red
distribution variation in size 9:00 AM cell distribution
width (RDW) and volume. An width is within the
test measures RDW blood test normal range.
the differences can help your 13.7 %

in the volume healthcare

and size of your provider diagnose
red blood cells. anemia and other
related conditions,
along with other
tests that provide
information about
your red blood
cells.

Platelets 140-415 The platelet count Septemb Normal

test is a laboratory er 8,
x10E3 The patient’s
procedure that 2022 @
platelets are
/uL counts the 9:00 AM
within the normal
Platelets, or platelets in your range.
thrombocytes, blood. When
268
are small, platelet counts are
x10E3
colorless cell abnormally low or
fragments in excessively high, a /uL
our blood that platelet count test
form clots and might reveal this.
stop or prevent Low platelet

bleeding. counts can lead to

Platelets are excessive

made in our bleeding because

48
 bone marrow, they make it harder
the sponge-like for the body to
tissue inside form blood clots.
our bones. Too much clotting
Bone marrow can result from
contains stem high platelet
cells that counts. Serious
develop into medical disorders
red blood cells, may develop from
white blood blood clots in the
cells, and blood veins
platelets. becoming stuck in
the heart, brain,
lungs, or
intestines.

Neutrophi 40-74 % An absolute Septemb Normal

ls neutrophil count er 8,
Neutrophils are The patient’s
may check for 2022 @
a type of white neutrophils are
infection, 9:00 AM
blood cell within the normal
inflammation,
(leukocytes) range.
that act as your leukemia, and
47%
immune other conditions.
system's first The lower a
line of defense. person's absolute
neutrophil count is,
the higher the risk
of getting an
infection.

49
Lymphs 14-46 % Such tests are Septemb Normal
used to assist in er 8,
Lymphocytes The patient’s
detecting, 2022 @
are a type of lymphocytes is
diagnosing, and 9:00 AM
immune cell within the normal
monitoring various
that is made in range. However,
the bone medical the result is
46%
marrow and is conditions. borderline of the
found in the normal range. H.
Lymphocyte
blood and pylori attracts
counts that are
lymph tissue. neutrophils and
below the
The two main lymphocytes with
reference range,
types of several
which varies for
lymphocytes chemotactic
adults and
are B proteins released
children, and may
lymphocytes in the stomach.
indicate
and T Some
lymphocytes. B lymphocytopenia. substances
lymphocytes In contrast, those secreted by
make above it are a sign mononuclear
antibodies, and of cells and
T lymphocytes neutrophils
lymphocytosis
help kill tumor induce mucosal
cells and help inflammation and
control immune thus cause
responses. A gastritis.
lymphocyte is a
type of white
blood cell.

Monocyte 4-13 % An absolute Septemb Normal

50
 s Monocytes are monocyte count er 8, The patient’s
a type of white identifies how 2022 @ monocytes are
blood cell in many monocytes 9:00 AM within the normal
your immune are present in a range.
system. sample of your
Monocytes turn blood. The 6%

into calculation for an

macrophages absolute monocyte
or dendritic count multiplies
cells when an the percentage of
invading germ monocytes from a
or bacteria complete blood
enters your count by the total
body. The cells number of white
either kill the blood cells from
invader or alert the same count.
other blood The results from
cells to help this test identify
destroy it and whether or not
prevent your monocyte
infection. count is normal,
too high or too low.

Eosinophi 0-7% An absolute Septemb Normal

ls eosinophil count is er 8,
The eosinophil The patient’s
a blood test that 2022 @
is a specialized eosinophils are
measures the 9:00 AM
cell of the within the normal
number of one
immune range.
type of white blood
system. This
cells called 1%
proinflammator

51
y white blood eosinophils.
cell generally Eosinophils
has a nucleus become active
with two lobes when you have
(bilobed) and a certain allergic
cytoplasm filled diseases,
with infections, and
approximately other medical
200 large conditions.
granules Eosinophilia is a
containing higher than normal
enzymes and level of
proteins with eosinophils.
different Eosinophils are a
(known and type of disease-
unknown) fighting white
functions. The blood cell. This is
functions of the the condition most
eosinophil are often indicates a
varied, some of parasitic infection,
which are very an allergic
similar to other reaction, or
white blood cancer.
cells. They are
implicated in
numerous
inflammatory
processes,
especially
allergic

52
 disorders.

Basophils 0-3 % An absolute Septemb Normal

basophil count er 8,
Basophils are a The patient’s
identifies how 2022 @
type of white basophils are
many basophils 9:00 AM
blood cell that within the normal
are present in a
works closely range.
sample of your
with your
blood. The 0%
immune
calculation for an
system to
absolute basophil
defend the
count multiplies
body from
the percentage of
allergens,
basophils from a
pathogens and
complete blood
parasites.
count by the total
Basophils
number of white
release
blood cells from
enzymes to
the same count.
improve blood
The results from
flow and
this test identify
prevent blood
whether or not
clots.
your basophil
count is too high,
normal or too low.

Neutrophi 1.8 - 7.8 An absolute Septemb Normal

ls neutrophil count er 8,
x10E3 The patient’s
Absolute may check for 2022 @
neutrophils
/uL infection, 9:00 AM
(absolute) are

53
 Neutrophils are inflammation, within the normal
a type of white range.
leukemia, and 2.6
blood cell
other conditions. x10E3
(leukocytes)
The lower a
that act as your /uL
person's absolute
immune
neutrophil count is,
system's first
the higher the risk
line of defense.
of getting an
infection.

Lymphs 0.7 - 4.5 Such tests are Septemb Normal

Absolute used to assist in er 8,
x10E3 The patient’s
detecting, 2022 @
lymphocytes
/uL diagnosing, and 9:00 AM
(absolute) are
Lymphocytes monitoring various
within the normal
are a type of medical range.
2.6
immune cell conditions.
that is made in x10E3
Lymphocyte
the bone
counts that are /uL
marrow and is
below the
found in the
reference range,
blood and
which varies for
lymph tissue.
adults and
The two main
children, and may
types of
indicate
lymphocytes
are B lymphocytopenia.
lymphocytes
In contrast, those
and T
above it are a sign
lymphocytes.

54
 B lymphocytes of
make
lymphocytosis
antibodies, and
T lymphocytes
help kill tumor
cells and help
control immune
responses. A
lymphocyte is a
type of white
blood cell.

Monocyte 0.1 - 1.0 x10E3 An absolute Septemb Normal

s monocyte count er 8,
/uL The patient’s
Absolute identifies how 2022 @
monocytes
Monocytes are many monocytes 9:00 AM
(absolute) are
a type of white are present in a
within the normal
blood cellin sample of your
range.
your immune blood. The 0.4
system. calculation for an x10E3
Monocytes turn absolute monocyte
/uL
into count multiplies
macrophages the percentage of
or dendritic monocytes from a
cells when an complete blood
invading germ count by the total
or bacteria number of white
enters your blood cells from
body. The cells the same count.
either kill the The results from
invader or alert

55
 other blood this test identify
cells to help whether or not
destroy it and your monocyte
prevent count is normal,
too high or too low.

Eosinophi 0.0 - 0.4 x10E3 Absolute Septemb Normal

ls eosinophil count is er 8,
/uL The patient’s
Absolute a blood test that 2022 @
eosinophils
The eosinophil measures the 9:00 AM
(absolute) are
is a specialized number of one
within the normal
cell of the type of white blood
range.
immune cells called 0.1
system. This eosinophils.
x10E3
proinflammator Eosinophils
y white blood become /uL
active
cell generally when you have
has a nucleus certain allergic
with two lobes diseases,
(bilobed) and a infections, and
cytoplasm filled other medical
with conditions.
approximately Eosinophilia is a
200 large higher than normal
granules level of
containing eosinophils.
enzymes and Eosinophils are a
proteins with type of disease-
different fighting white
(known and blood cell. This is
unknown)

56
 functions. The the condition most
functions of the often indicates a
eosinophil are parasitic infection,
varied, some of an allergic
which are very reaction, or
similar to other cancer.
white blood
cells. They are
implicated in
numerous
inflammatory
processes,
especially
allergic
reactions

Basophils 0.0 - 0.2 x10E3 An absolute Septemb Normal

Absolute basophil count er 8,
/uL The patient’s
identifies how 2022 @
basophils
Basophils are a many basophils 9:00 AM
(absolute) are
type of white are present in a
within the normal
blood cell that sample of your
range.
works closely blood. The 0.0
with your calculation for an x10E3
immune absolute basophil /uL
system to count multiplies
defend the the percentage of
body from basophils from a
allergens, complete blood
pathogens and count by the total
parasites.

57
 Basophils number of white
release blood cells from
enzymes to the same count.
improve blood The results from
flow and this test identify
prevent blood whether or not
clots. your basophil
count is too high,
normal or too low.

Immature 0-1 % If immature Septemb Normal

Granuloc granulocytes are er 8,
Immature The patient’s
ytes found in your 2022 @
granulocytes immature
bloodstream, it 9:00 AM
(includes granulocytes are
could mean that
promyelocytes, within the normal
there's a problem
myelocytes, range.
with your bone 0%
metamyelocyte
marrow. The
s) are
presence of
premature
immature
granulocytes
granulocytes in
that are
peripheral blood
released from
indicates
bone morrow
leukopoiesis and
during infection
may represent the
and
earliest indicator of
inflammatory
bone marrow
conditions.
stimulation by
infection,
inflammation, or

58
 any other stimuli.

Immature 0.0 - 0.1 x10E3 If immature Septemb Normal

Grans granulocytes are er 8,
/uL The patient’s
Absolute found in your 2022 @
immature
Immature bloodstream, it 9:00 AM
granulocytes
granulocytes could mean that
(absolute) are
(includes there's a problem
within the normal
promyelocytes, with your bone 0.0
range.
myelocytes, marrow. The x10E3
metamyelocyte presence of /uL
s) are immature
premature granulocytes in
granulocytes peripheral blood
that are indicates
released from leukopoiesis and
bone morrow may represent the
during infection earliest indicator of
and bone marrow
inflammatory stimulation by
conditions. infection,
inflammation, or
any other stimuli.

Urinalysis

A urinalysis, also known as a urine test, is a test that examines the visual,
chemical, and microscopic aspects of your urine. It can include a variety of tests
that detect and measure various compounds that pass through your urine using a
single sample of urine. Healthcare providers often use urinalysis to screen for or

59
 monitor certain common health conditions, such as liver disease, kidney disease,
and diabetes, and to diagnose urinary tract infections (UTIs).

COMPO NORMAL RATIONALE RESULT INTERPRETATI NURSING

NENT RANGE AND ON AND RESPONSIBILITI
DEFINITION SIGNIFICANCE ES

Color Pale yellow to Color of urine is a Septemb Normal Before

Deep amber great indicator of er 8,
The patient’s ● Instruct the
dehydration. If it is 2022
Urine color is urine color is patient to void
a darker yellow or
the result of a @ 9:00 within the normal directly into a
orange, it can
pigment called AM range. clean, dry
mean you are
urochrome and container.
becoming
how diluted or Sterile
dehydrated. Yellow
concentrated disposable
Orange urine
the urine is. containers are
could indicate a
Pigments and recommended.
serious liver
other ● Women should
condition. Darker
compounds in always have a
brown can be
certain foods clean-catch
caused by foods
and specimen thus,
or medication.
medications feces,
can change discharges,
your urine color. vaginal
Beets, berries secretion and
and fava beans menstrual
are among the blood will
foods most contaminate
likely to affect the specimen.
the color. ● It is important

60
Appearan Clear Cloudy urine can Septemb Abnormal to instruct for a
ce be something as er 8, mid-stream
When the Cloudy urine can
minor as simple 2022 urine sample.
person is indicate the
dehydration. It can A mid-stream
hydrated, the @ 9:00 presence of
also indicate more urine sample
urine will be a AM phosphates which
serious disorders means that the
light yellow, can lead to kidney
such as kidney person should
close-to-clear stones. The most
disease or Cloudy not collect the
color. If common cause of
diabetes. first or last part
dehydrated, it cloudy urine is the
of urine that
will be presence of
comes out.
noticeable that alkaline. In this
This reduced
the urine is case, the patient
the risk of the
becoming a has an estimated
sample being
deep amber or water intake of
contaminated
even light 500 ml to 800 ml
with bacteria.
brown. per day as he was
also experiencing
vomiting. Cloudy During
urine can indicate
● Collect
dehydration
specimens
because a lack of
from infants
fluid makes urine
and young
more
children into a
concentrated.
disposable
collection
Specific 1.001-1.035 Specific gravity, in Septemb Normal
apparatus
Gravity the context of er 8,
The specific The patient’s consisting of a
clinical pathology, 2022
gravity of urine specific gravity is plastic bag with
is a urinalysis
refers to the @ 9:00 within the normal an adhesive
parameter
electrolytes and

61
 urine commonly used in AM range. backing
osmolality. the evaluation of around the
Depending on kidney function opening that
your doctor's and can aid in the 1.019 can be
concerns, they diagnosis of fastened to the
give you various renal perineal area
specific. diseases. A urine or around the
specific gravity penis to permit
test compares the voiding directly
density of urine to to the bag.
the density of ● Cover all
water. This quick specimens
test can help tightly, label
determine how properly, and
well your kidneys send
are diluting your immediately to
urine. the laboratory

pH 5.0-8.0 A urine pH test Septemb Normal

After
measures the er 8,
pH is a The patient’s pH
level of acid in 2022 ● Observe
quantitative is within the
urine. Some types standard
measure of the @ 9:00 normal range.
of kidney stones precautions
acidity or AM
are more prone to when handling
basicity of
develop in alkaline urine
aqueous or
urine and others specimens
other liquid 7.5
are more likely to ● If the specimen
solutions.
form in acidic cannot be
urine. Monitoring delivered to the
the urine pH may laboratory or

62
 be helpful in testes within
preventing the an hour, it
formation of should be
kidney stones. refrigerated or
have an
Glucose (-) Normally, urine Septemb (+) Presence of appropriate
contains very little er 8, Glucose preservative
Negative
or no glucose. But 2022 added.
Over time, high
Glucose is the if you have too
@ 9:00 blood sugar levels
main type of much glucose in
AM can damage the
sugar in the your blood, your
nerve, specifically
blood and is the kidneys will get rid
the vagus nerve,
major source of of some of the
3+ that controls the
energy for the extra glucose
muscles involved
body's cells. through your
in breaking up
urine. So, a high
food in the
level of urine
stomach and
glucose may
moving it through
mean that your
the
blood glucose is
gastrointestinal
high, too, and that
tract. When the
could be a sign of
vagus nerve is
diabetes.
damaged, the
stomach muscles
stop working
normally. Food
then moves
slowly from the
stomach to the
small intestine or

63
 stops moving
altogether.
Diabetes causes
glycosuria
because there
either isn't
enough insulin, or
your body can't
use what's
available. WIthout
insulin, blood
glucose levels
become too high,
and your kidneys
can't filter and
reabsorb it. Your
body gets rid of
the excess
through your
urine.

Bilirubin (-) Bilirubin in urine Septemb Normal

can be an early er 8,
Negative There is no
sign of liver 2022
bilirubin present in
Bilirubin is a damage. It may
@ 9:00 the patient’s
red-orange even show up
AM urine.
compound that before you have
occurs in the symptoms.
normal Bilirubin testing is (-)
catabolic usually done as Negative
pathway that

64
 breaks down part of a group of
heme in tests to check the
vertebrates. health of your
This catabolism liver. Bilirubin
is a necessary testing may be
process in the done to
body's investigate
clearance of jaundice, a
waste products yellowing of the
that arise from skin and eyes
the destruction caused by
of aged or elevated levels of
abnormal red bilirubin.
blood cells.
Bilirubin should
not be present
in the urine.

Ketone (-) A ketones in blood Septemb Normal

test measures the er 8,
Negative There is no
level of ketones in 2022
ketone present in
Normally, the the blood. Ketones
@ 9:00 the patient’s
cells in the body are acids that the
AM urine.
use blood body makes when
glucose for it breaks down fat
energy. If the for energy. (-)
cells can't get Ketonuria may be
Negative
enough seen with
glucose, the uncontrolled
body will break diabetes, diabetic
down fat for

65
 energy instead. ketoacidosis,
This process severe exercise,
produces starvation,
ketones. Apart vomiting, and
from serving as pregnancy.
energy fuels for
extrahepatic
tissues like
brain, heart, or
skeletal
muscle, ketone
bodies play
pivotal roles as
signaling
mediators,
drivers of
protein post-
translational
modification
(PTM), and
modulators of
inflammation
and oxidative
stress.

Occult (-) A positive test for Septemb (+) Positive

Blood occult blood er 8, presence of
Negative
means either 2022 Occult Blood
Occult blood is hematuria,
@ 9:00 For the H. pylori-
blood that hemoglobinuria,
AM positive patients
cannot be seen

66
without a and with peptic ulcer,
microscope. myoglobinuria. H. pylori infection
TRACE
The test is may be a risk
believed to be factor resulting in
highly specific, kidney damage.
and physicians H. pylori
generally seem eradication
unaware that probably benefits
false-positive to kidney damage
results occur. relief and chronic
Urinary tract kidney disease
infections (UTIs) prevention. One
are the most explanation is that
common cause of the systemic
hematuria. Since inflammation
the urinary tract is might play a role
composed of the in the relationship
bladder, ureters, between H. pylori
and kidneys, a UTI infection and
refers to an chronic kidney
infection damage. It has
anywhere in that been reported
system. A bladder that chronic
infection is called inflammation
cystitis, and a induced by H.
kidney infection is pylori may be one
called of the major
pyelonephritis. causes of renal
diseases.
Increasing

67
 inflammatory
cytokine level
leads to the
damage of
vascular
endothelial
structure in the
kidney, resulting
in albumin
escaping from the
kidneys into the
urine.

Protein (-) When the kidneys Septemb (+) Positive

are not working as er 8, Presence of
Negative
well as they 2022 Protein
Protein is an should, protein
@ 9:00 Approximately
important can leak through
AM 300 mg/ dL
macronutrient the kidney's filters
that every cell in and into your Patients have H.
the body needs. urine. High levels Pylori infection
3+
It helps build of protein in your show a significant
and repair cells urine over a period elevation in the
and body of time may be the urinary albumin/
tissues, first sign that creatinine ratio
including the kidney disease or and significant
skin, hair, another condition anemia
muscle, and has damaged the suggesting a role
bone. Protein is filters in your of H. Pylori
also important kidneys. A protein infection in the
for blood pathogenesis of

68
 clotting, in urine test can proteinuria and
immune system help you find anemia. Patients
responses, kidney damage with documented
hormones, and early so you can H-pylori may
enzymes. make changes to present with
protect your symptoms
kidneys. mimicking UTI.
This association
is involved in the
etiology of IC with
inflammation of
cells in the
bladder wall.
Treatment
ameliorates the
symptoms of
patients
dramatically after
two weeks of H-
pylori triple
therapy.

Nitrite (-) Nitrites in urine Septemb Normal

may be a sign of a er 8,
Negative There is no nitrite
urinary tract 2022
present in the
Nitrates and infection (UTI).
@ 9:00 patient’s urine.
nitrites circulate UTIs are caused
AM
from the by different types
digestive of bacteria. Many
system into the of these types of
(-)
blood, then into

69
saliva, and back bacteria change a Negative
into the normal chemical in
digestive your urine, called
system ( 9 ). nitrates, into
They may be another chemical,
useful in called nitrites.
keeping your Infected urine may
body healthy, as contain
they seem to considerable
function as amounts of nitrite
antimicrobials in as a result of
the digestive bacterial nitrate
system. They reductase activity,
can help to kill and detection of
bacteria, such nitrite in urine is
as Salmonella. routinely used in
Nitrite shows the diagnosis of
acute toxic bacterial cystitis. A
effects resulting positive nitrite
from reduced result signifies that
oxygen bacteria capable
transport by the of this conversion
bloodstream, such as
which is mainly Escherichia coli,
due to the Klebsiella,
conversion of Proteus,
hemoglobin to Enterobacter,
methaemoglobi Citrobacter,
n. Pseudomonas,
are present in the

70
 urinary tract.

Leukocyt (-) Leukocyte Septemb (+) Positive

e esterase is a er 8, Presence of
Negative
Esterase screening test 2022 Leukocyte
Leukocyte used to detect a Esterase
@ 9:00
esterase is an substance that
AM The peripheral
esterase, a type suggests there are
blood leukocyte
of enzyme, white blood cells in
count and
produced by the urine. This
1+ differential count
leukocytes or may mean you
were determined
white blood have a urinary
by the automatic
cells. tract infection. If
flow cytometric
this test is positive,
method. The total
the urine should
number of blood
be examined
leukocytes and
under a
the numbers of
microscope for
lymphocytes and
white blood cells
basophils were
and other signs
significantly
that point to an
increased in H.
infection.
pylori-positive
patients.
Additionally, The
build-up of the
white blood cells
is usually a
response to acid
reflux or an
allergic reaction to

71
 food and
allergens.

WBC ≤5 White blood cells Septemb High

in the urine may er 8,
WBC/ HPF The automatic
indicate 2022
flow cytometric
White blood inflammation of
@ 9:00 approach
cells are part of the kidneys or
AM calculated the
the body's urinary tract due to
differential and
immune bacterial infection.
peripheral blood
system. They Pyuria typically >60 leukocyte counts.
help the body implies a UTI.
Blood leukocyte
fight infection Sterile pyuria is
totals, lymphocyte
and other seen in analgesic
counts, and
diseases. nephropathy and
basophil counts
UTIs due to
all significantly
organisms that do
increased in H.
not grow by
patients who are
standard culture
pylori-positive.
techniques.
Furthermore, an
increase in white
blood cells is
frequently a
symptom of acid
reflux or an
allergic reaction to
certain foods or
allergens.

RBC ≤2 Blood in the urine Septemb Normal

72
 RBC/ HPF means there are er 8, The patient’s RBC
red blood cells 2022 level in his urine is
Red blood cells
(RBCs) in the within the normal
that carry @ 9:00
urine. Often, the limits.
oxygen from the AM
urine looks normal
lungs to the rest
to the naked eye.
of the body.
But when checked 0-2
Then they make
under a
the return trip,
microscope, it
taking carbon
contains a high
dioxide back to
number of red
the lungs to be
blood cells. In
exhaled.
some cases, the
urine is pink, red,
or the color of tea,
which you can see
without a
microscope. Most
of the causes of
blood in the urine
are not serious.
For example,
heavy exercise
may cause blood
in the urine, which
often goes away in
a day. However,
there are serious
causes such as
kidney infection

73
 and urinary tract
infection.

Squamou ≤ HPF If there are Septemb Normal

s squamous er 8,
Squamous There are no
Epithelial epithelial cells in 2022
epithelial cells squamous
your urine, it may
are large, @ 9:00 epithelial present
mean your sample
polygonal cells AM patient’s urine.
was
with small
contaminated.
round nuclei.
This means that NONE
They tend to
the sample SEEN
fold on
contains cells from
themselves and
another part of the
sometimes are
body. This can
confused with
happen if you do
casts. Their
not clean your
large size
genital area well
allows them to
enough when
be easily
collecting your
distinguished
urine sample with
from casts.
the clean catch
method.

Bacteria None Seen If bacteria grow in Septemb (+) Positive

HPF the urine culture er 8, Presence of
test and you have 2022 Bacteria
Urine contains
symptoms of an
fluids, salts and @ 9:00 The acidity of
infection or
waste products AM urine, as well as
bladder irritation, it
but is sterile or the presence of

74
 free of bacteria, means you have a small molecules
viruses and UTI. This result is related to diet,
MANY
other disease- a positive urine may influence
causing culture test or how well bacteria
organisms. A abnormal test can grow in the
UTI occurs result. The lab urinary tract.
when bacteria conducts an Dehydration may
from another antibiotic increase the risk
source, such as sensitivity test on of urinary tract
the nearby the bacteria in the infections (UTIs),
anus, gets into cultured sample. which can lead to
the urethra. confusion, falls,
acute kidney
injury and hospital
admission.

Crystals None Seen A crystals in urine Septemb (+) Positive

HPF test is often part of er 8, Presence of
a urinalysis, a test 2022 Crystals
Crystals in urine
that measures
occur when @ 9:00 In this case, the
different
there are too AM patient had
substances in your
many minerals decreased fluid
urine. A urinalysis
in your urine intake and had
is used to check FEW
and not enough been vomiting.
your general
liquid. The tiny Thus, urine can
health, including
pieces collect be concentrated
the health of your
and form of solutes
urinary tract and
masses. manifesting
kidneys. It may
crystals. Certain
include a visual
medicines, your

75
 check of your diet, not drinking
urine sample, enough fluids,
tests for certain and other things
chemicals, and an can lead to
examination under crystals in urine.
a microscope to
look for certain
types of cells.

A crystals in urine
test is part of a
microscopic exam
of urine. It may be
used to help
diagnose kidney
stones.

Triple None Seen Triple phosphate Septemb (+) Positive

Phosphat HPF crystals are seen er 8, Presence of
e in patients with 2022 Triple
Triple
Crystals urinary tract phosphate
phosphate @ 9:00
infections caused crystals
crystals, also AM
by urea-splitting
known as The formation of
bacteria, such as
magnesium magnesium
Proteus mirabilis, FEW
ammonium ammonium
and are frequently
phosphate phosphate
found in the urine
crystals, are crystals (triple
of patients with
found in phosphate
infected calculi
alkaline urine crystals) is

76
 (pH greater (struvite stones). caused by a
than 7). The combination of
formation of factors including
magnesium decreased urine
ammonium volume combined
phosphate with bacteria in
crystals (triple the renal system
phosphate that are capable
crystals) is of producing
caused by a ammonia and
combination of increasing the
factors urine pH. In this
including case, the patient
decreased had decreased
urine volume fluid intake and
combined with had been
bacteria in the vomiting. Thus,
renal system urine can be
that are capable concentrated in
of producing solutes
ammonia and manifesting
increasing the crystals.
urine pH

Casts None Seen Normally, the Septemb Normal

LPF presence of casts er 8,
There are no
in the urine is 2022
Urinary casts casts seen in the
considered to be
are tiny tube- @ 9:00 patient’s urine.
an unusual
shaped AM
finding. However,
particles found

77
 when urine is small amounts of
examined hyaline casts
NONE
under the (between 0–2
SEEN
microscope casts per low
during a test power field of the
called microscope) may
urinalysis. be detected in the
Urinary casts urine of healthy
may be made individuals without
up of white necessarily
blood cells, red indicating a
blood cells, serious condition
kidney cells, or like kidney
substances disease. In fact,
such as protein hyaline casts are
or fat. the only casts that
should be
detected in the
urine in the
absence of kidney,
or renal disease.

Yeasts None Seen Bacteria in the Septemb Normal

HPF urine mean a er 8,
There are no
urinary tract 2022
Yeasts can be yeasts seen in the
infection (UTI).
detected in @ 9:00 patient’s urine.
Yeast cells or
urine that is AM
parasites (such as
contaminated
the parasite that
during
causes NONE
collection, in

78
patients who trichomoniasis) SEEN
have bladder can mean an
colonization, urinary tract
and in patients infection. The
who have upper presence of
urinary tract squamous cells
infection that may mean that the
developed sample is not as
either from pure as it needs to
retrograde be. What causes
spread from the yeast infection in
bladder or urine?
hematogenous
Image result
spread from a
distant source. Yeast infections
occur due to an
overgrowth of the
Candida fungus,
while UTIs result
from bacterial
infections in the
urinary tract.
Yeast infections
cause itching,
pain, and odorless
vaginal discharge.

Blood Chemistry

Blood chemistry testing is defined simply as identifying the numerous

chemical substances found in the blood. Analyzing these substances will provide

79
 clues to the functioning of the major body systems. Most nurses are concerned
that many blood chemistry tests are performed on the serum derived from whole
blood. Serum, of course, is the liquid remaining after whole blood has clotted in the
sample tube. Some blood chemistry tests are also performed on other parts of the
blood. Blood chemistry tests give essential information about how well a person's
kidneys, liver, and other organs work. An abnormal amount of a substance in the
blood can be a sign of disease or a side effect of treatment.

FBS and Lipid Profile

A complete cholesterol test, also called a lipid panel or lipid profile, is a

blood test measuring the amount of cholesterol and triglycerides in your blood.
Serum lipid profile has now become almost a routine test. It is usually done in a
fasting state due to limitations in the non-fasting serum samples. In the recent past,
efforts have been made to simplify blood sampling by replacing fasting lipid profiles
with non-fasting lipid profiles. However, the fasting specimen is preferred if a
cardiovascular risk assessment is based on total, LDL, or non-HDL cholesterol.

COMPO NORMAL RATIONALE RESULT INTERPRETATIO NURSING

NENT RANGE AND N AND RESPONSIBILITI
DEFINITION SIGNIFICANCE ES

Glucose - 3.9 - 5.6 Fasting blood Septemb High Before

FBS mmol/L. sugar (FBS) er 9,
Some drugs used ● Tell the patient
measures blood 2022 @
Glucose is the for acid reflux are to fast before
glucose after you 9:00 AM
main type of linked with Type 2 undergoing a
have not eaten for
sugar in the diabetes. Doctors lipid profile
at least 8 hours. It
blood and is the frequently test. The
is often the first 7.72
major source of prescribe a proton samples are
test done to check mmol/L
energy for the pump inhibitor taken after 12-
for prediabetes
body's cells. (PPI) for chronic 14 hours of
and diabetes.
cases of acid overnight

80
reflux. But drugs fasting so that
have side effects. the results will
Published be more
research studies accurate.
show that taking
● Tell the patient
PPIs for long
they can drink
periods of time
clear fluids
can increase the
such as water,
risk of Type 2
but should
diabetes. If you’ve
avoid drinking
been taking a PPI
beverages
for more than two
such as coffee
years, you need
and tea.
your blood
glucose levels
checked regularly During
to determine if
● Patient’s blood
you’re diabetic.
sample is
Conversely, if you
taken by
already have Type
inserting a
2 diabetes, you’re
needle into the
more at risk for
vein.
acid reflux. One
characteristic of
diabetes is high
After
blood sugar. The
● The blood is
excess blood
collected in a
sugar damages
vial. Upon
your body’s
collection of
tissues and

81
 organs, including patient’s blood
your sample, it will
gastrointestinal be analysed in
tract, which holds the laboratory,
your esophagus. where the
level of
Cholester Less than 5.17 A cholesterol test Septemb Normal triglycerides,
ol mmol/L is a blood test that er 9, HDL
The patient’s
measures the 2022 @ cholesterol
Cholesterol’s cholesterol is
amount of 9:00 AM and LDL
main function is within the normal
cholesterol and cholesterol are
to maintain the range.
certain fats in your measured.
integrity and
blood. The liver 4.25
fluidity of cell ● Tell the patient
makes all the mmol/L
membranes that the
cholesterol your
and to serve as procedure
body needs. But it
a precursor for lasts only for a
can also get
the synthesis of few minutes.
cholesterol from
substances that
the foods,
are vital for the
especially meat,
organism
eggs, poultry, and
including
dairy products.
steroid
Foods that are
hormones, bile
high in dietary fat
acids, and
can also make the
vitamin D
liver produce more
cholesterol. A
cholesterol test is
an important tool.
High cholesterol

82
 levels often are a
significant risk
factor for coronary
artery disease.

Triglyceri Less than 1.7 A triglycerides test Septemb Normal

des mmol/L is a blood test that er 9,
The patient’s
measures the 2022 @
Triglycerides, triglycerides is
amount of a fat in 9:00 AM
cholesterol, within the normal
your blood called
and other range.
triglycerides. High
essential fatty
triglycerides may 1.23
acids--the
increase your risk mmol/L
scientific term
for a heart attack
for fats the body
or stroke. A
can't make on
triglycerides test
its own. Its main
can help you
functions are to
decide if you need
store energy, to
to take action to
insulate us and
lower your risk.
to protect the
vital organs.
They act as
messengers,
helping
proteins do
their jobs.

HDL-C Men: The purpose of Septemb Low

HDL cholesterol er 9,
1.1-1.8 mmol/L Significant
testing is to 2022 @
correlations

83
 Women: 1.2- assess your 9:00 AM between Reflux
2.0 mmol/L cardiovascular esophagitis and
health, including obesity, high
HDL
your risk for heart 0.64 triglyceride, low
cholesterol can
disease. HDL mmol/L HDL cholesterol,
be thought of as
cholesterol is high BP, and
the “good”
considered to be a elevated fasting
cholesterol
good type of glucose levels
because a
cholesterol that is suggested that RE
healthy level
associated with a might be part of
may protect
lower risk of the disease
against heart
coronary heart spectrum of
attack and
disease events. metabolic
stroke. HDL
syndrome. People
carries LDL
who have GERD
(bad)
are more likely
cholesterol
than others to end
away from the
up with heart
arteries and
disease,
back to the
characterized by
liver, where the
abnormal
LDL is broken
heartbeats,
down and
plaque buildup in
passed from
the heart arteries
the body.
or reduced blood
flow to the heart.

LDL Less than 2.6 LDL cholesterol Septemb High

mmol/L testing assesses er 9,
GERD, occurs
how much LDL 2022 @
LDLs are the when acid backs

84
 primary carriers cholesterol is in 9:00 AM up from the
of cholesterol in the blood. This stomach into your
blood because testing helps esophagus and
their main role inform the patient 3.05 causes a burning
is to deliver and the doctor mmol/L sensation in the
cholesterol to about the risk of chest area. A diet
both peripheral heart disease, high in fat and
and liver cells. stroke, diabetes, calories usually
Atherosclerosis and other health coincides with
develops when conditions. high cholesterol
oxidized LDL- Cholesterol numbers as well.
cholesterol is testing can also be Additionally,
taken up by used to evaluate medication to treat
macrophages whether treatment high cholesterol
and deposited for high often exacerbates
in cholesterol is GERD or causes
atheromatous working. the uncomfortable
plaques that symptoms of
develop into reflux. Moreover,
atherosclerotic it has been shown
lesions. that high
cholesterol intake
increases cholic
acid synthesis and
bile acid pools.

VLDL 0.1 to 1.7 Very low-density Septemb Normal

mmol/L lipoprotein er 9,
The patient’s
cholesterol 2022 @
Very-low- VLDL is within the
(VLDL-C) may be 9:00 AM
density normal range.

85
 lipoprotein reported as part of
(VLDL) a lipid profile, a
0.56
cholesterol is group of tests that
mmol/L
produced in the are often ordered
liver and together to
released into determine risk of
the coronary heart
bloodstream to disease and an
supply body important part of
tissues with a cardiac risk
type of fat assessments
(triglycerides).
There are
several types of
cholesterol,
each made up
of lipoproteins
and fats.

Basic Metabolic Panel

A basic metabolic panel (BMP) test analyzes eight distinct chemicals in the
blood. The panel offers valuable details regarding the body's chemical balance and
metabolism and how the body transforms the food eaten into energy. Additionally,
a BMP measures the following four electrolytes. When minerals are dissolved in a
liquid, they acquire an electric charge known as electrolytes. The blood's
electrolytes regulate nerve and muscle activity and your blood's pH, acid-base,
and water balance.

COMPO NORMAL RATIONALE RESULT INTERPRETATI NURSING

86
 NENT RANGE AND ON AND RESPONSIBILITI
DEFINITION SIGNIFICANCE ES

Sodium 135 - 147 The sodium blood Septemb Low Before

mmol/L test measures the er 8,
In this case, ● Explain the
concentration of 2022
Sodium plays a nutritional test procedure
sodium in the
key role in your @ 10:00 deficiencies can and that there
blood. Sodium can
body. It helps AM also lead to acid may be slight
also be measured
maintain reflux. If the discomfort
using a urine test.
normal blood person is on a low when skin is
Blood is drawn 130
pressure, sodium diet, the punctured.
from a vein mmol/L
supports the recipient might
(venipuncture), ● Encourage
work of your become deficient
usually inside the patient to
nerves and in sodium and
elbow or the back minimize
muscles, and chloride minerals.
of the hand. It may stress as much
regulates your Zinc, magnesium,
be used to help as possible
body's fluid vitamin C, and B
find and monitor because their
balance. vitamins are also
conditions that physiologic
needed to have a
affect the body's status
properly
balance of fluids, influences and
functioning
electrolytes, and changes their
stomach.
acidity. hematologic
Additionally,
values.
thiazides,
antidepressants, ● Clarify that

antipsychotic fasting isn't

drugs, and necessary.

antiepileptic drugs However,

are well-known because of

causes of lipidemia, fatty

87
 hyponatremia. meals may
Proton pump affect some
inhibitor use is a test results.
rare cause of
During
hyponatremia and
when reported, it ● Over the

is due to one puncture site,

specific proton apply manual

pump inhibitor, pressure and

mostly dressings.

omeprazole. The After

patient has been
● Keep an eye
taking
out for
omeprazole.
bleeding or
hematoma
Septemb Normal
formation at
er 9,
The patient’s the puncture
2022
sodium level is site.
@ 3:00 within the normal
● Instruct the
PM range
patient to
resume
136 normal
mmol/L activity and a
healthy diet.
Potassium 3.5-5.2 mmol/L A potassium blood Septemb Low
test measures er 8,
Potassium’s Potassium (K+)
how much 2022
main role in the ions are critical for
potassium is in
body is to help @ 10:00 the activation and
your blood. The
maintain catalytic cycle of

88
normal levels of test is often part of AM the gastric H+,
fluid inside our a group of routine K+-ATPase,
cells. blood tests called resulting in the
Potassium also an electrolyte 3.3 secretion of
helps muscles panel. It may be mmol/L hydrochloric acid
to contract and used to monitor or into the parietal
supports diagnose cell canaliculus. In
normal blood conditions related this case,
pressure. to abnormal vomiting and
potassium levels. regurgitation also
can result in
excessive
potassium loss
from the digestive
tract.
Occasionally, low
potassium is
caused by not
getting enough
potassium in your
diet.

Septemb Normal
er 9,
The patient’s
2022
potassium level is
@ 3:00 within the normal
PM range

3.5

89
 mmol/L

Chloride 95-107 mmol/L Chloride is one of Septemb Normal

the electrolytes in er 8,
Chloride is The patient’s
your blood. 2022
involved in chloride is within
Chloride blood
many of our @ 10:00 the normal range
tests check to
bodily AM
ensure you have
functions.
appropriate
Similar to
chloride levels in 100
sodium and
your blood to be mmol/L
potassium,
healthy. Many
chloride
factors can cause Septemb Normal
creates specific
an abnormal er 9,
channels in the The patient’s
chloride level in 2022
membranes of chloride is within
your blood,
our cells which @ 3:00 the normal range
including
help to carry out PM
dehydration,
different vital
vomiting, and
tasks. Chloride
certain medical 100
is also
conditions. mmol/L
important to
help the
muscles and
heart contract
and to help our
nerve cells
carry
messages.

CO2 22-30 mmol/L A carbon dioxide Septemb Normal

90
 Carbon dioxide (CO2) blood test er 8, The patient’s
plays various helps healthcare 2022 chloride is within
roles in the providers the normal range
@ 10:00
human body determine if the
AM
including body balances
regulation of electrolytes
blood pH, properly. A CO2 24
respiratory blood test mmol/L
drive, and measures the
affinity of bicarbonate level, Septemb Normal
hemoglobin for an indicator of er 9,
The patient’s
oxygen. It is a how much CO2 is 2022
chloride is within
waste product in your blood. CO2
@ 3:00 the normal range
that your body is a form of natural
PM
makes when it waste that your
uses food for body produces.
energy. The blood carries 24
CO2 to the lungs, mmol/L
where expiration
happens. Too little
or too much CO2
in the blood may
be a sign of a
more serious
health problem.

Urea 7-20 mg/dL The blood urea Septemb Normal

nitrogen test, er 8,
Nitrogen A BUN, or The patient’s
which is also 2022
blood urea Blood Urea
(BUN) called a BUN or
nitrogen test, @ 10:00 Nitrogen is within

91
 can provide serum BUN test, AM the normal range
important measures how
information much of the waste
about your product is in the 20

kidney function. blood. If the levels mg/dL

The main job of are off the normal

Septemb Normal
your kidneys is range, this could
er 9,
to remove mean that either The patient’s
2022
waste and extra the kidneys or the Blood Urea
fluid from your liver may not be @ 3:00 Nitrogen is within
body. If you working properly. PM the normal range
have kidney
disease, this
waste material 20
can build up in mg/dL
your blood.

Creatinine 0.5-1.2 mg/dL The creatinine Septemb Normal

blood test er 8,
Creatinine is a The patient’s
measures the 2022
by-product of Creatinine is
level of creatinine
normal muscle @ 10:00 within the normal
in the blood. This
contractions, AM range
test is done to see
which becomes
how well the
a chemical
kidneys are 1.2
waste product
working. mg/dL
filtered from the
blood through
Septemb Normal
the kidneys.
er 9,
The patient’s
2022
Creatinine is

92
 @ 3:00 within the normal
PM range

1.1
mg/dL

Glucose 60-110 mg/dL A blood glucose Septemb Normal

test is a blood test er 8,
Blood sugar, or The patient’s
that screens for 2022
glucose, is the Glucose is within
diabetes by
main sugar @ 10:00 the normal range
measuring the
found in your AM
level of glucose
blood. It comes
(sugar) in a
from the food
person's blood. 100
you eat, and is
Higher ranges mg/dL
your body's
could indicate pre-
main source of
diabetes or Septemb Normal
energy.
diabetes. er 9,
The patient’s
2022
Glucose is within
@ 3:00 the normal range
PM

106
mg/dL

Helicobacter Pylori Test

93
 Helicobacter pylori is a type of bacteria that is known to be a major cause
of peptic ulcers, which are sores on the lining of the esophagus, stomach or small
intestine. H. pylori testing detects an infection of the digestive tract caused by
bacteria to help diagnose the cause of symptoms and ulcers. Blood tests for H
pylori can only tell if your body has H pylori antibodies. It cannot tell if you have a
current infection or how long you have had it. There are also different ways to test
for an H. pylori infection. They include blood, stool, and breath tests.

COMPO NORMAL RATIONALE RESULT INTERPRETATI NURSING

NENT RANGE AND ON AND RESPONSIBILITI
DEFINITION SIGNIFICANCE ES

H. Pylori (-) Negative An H. pylori breath Septemb Infected Before

Test test, also called a er 8,
H. pylori The normal result ● Encourage to
urea breath test, 2022
infection occurs is negative, avoid stress if
helps in
when H. pylori @ 10:00 however, the possible
diagnosing
bacteria infect AM patient is positive. because
infections caused
your stomach. This indicates that altered
by this type of
H. pylori the patient has an physiologic
bacteria. (+)
bacteria are H. pylori infection. status
usually passed Blood tests are Positive The H. pylori influences and
from person to used to measure infection may changes
person through antibodies to H make people normal
direct contact pylori. Antibodies susceptible to hematologic
with saliva, are proteins made GERD by values
vomit or stool. by the body's increasing gastric
● Explain that
H. pylori may immune system acid secretion,
fasting is not
also be spread when it detects either directly
necessary
through harmful infecting the
However, fatty
contaminated substances such gastric-type
meals may

94
food or water. as bacteria. Blood columnar alter some
tests for H pylori epithelium, or by test results as
can only tell if your the action of a result of
body has H pylori noxious lipidemia.
antibodies. substances
● Explain test
secreted by the
procedure
infection into
Explain that
refluxed gastric
slight
juice. H. pylori
discomfort
seems to lead to
may be felt
much more
when the skin
complex changes
is punctured.
in the gastric
mucosa, including
the modification of During
afferent neural
● Apply manual
signals and the
pressure and
secretion of
dressings
specific gastric
over the
hormones.
puncture site
on removal of
needle.

After

● Monitor the
puncture site
for oozing or
hematoma

95
 formation

● Instruct to
resume
normal
activities and
diet.

B. POSSIBLE LABORATORY TEST

Stool Antigen Test

Fecal analysis is a noninvasive laboratory test useful in identifying disorders

of the digestive tract. These disorders may include malabsorption, inflammation,
infection (bacteria, viruses, or fungi), or cancer. It is performed in combination with
blood work, physical examination, x-ray imaging, and endoscopy in order to
confirm these conditions. The stool antigen test is the most common stool test to
detect H. pylori. The test looks for proteins (antigens) associated with H. pylori
infection in the stool.

COMPONENT NORMAL RANGE AND RATIONALE NURSING

DEFINITION RESPONSIBILITIES

H. pylori No evidence of H. pylori A fecalysis is a series of Before

antigen tests done on a stool
H. pylori antigen is a ● Assess the patient’s
(feces) sample to help
protein constituent of the level of comfort.
diagnose certain
H pylori bacterium, which Collecting stool
conditions affecting the
is shed in human stool. specimen may
digestive tract. These
This bacterium finds its produce a feeling of
conditions can include
way into the body via oral- embarrassment and

96
to-oral or fecal-to-oral infection (such as from discomfort to the
transmission, typically in parasites, viruses, or patient.
childhood. Risk factors bacteria), poor nutrient
● Encourage the
include an infected sibling absorption, or cancer.
patient to urinate.
and poor living conditions. Unlike other tests
Allow the patient to
The bacteria start in the normally used for the
urinate before
gastric antrum, where diagnosis of the infection,
collecting to avoid
they are most abundant, the stool antigen test
contaminating the
and move proximally. detects the antigen of the
stool with urine.
bacterium, as opposed to
the antibodies developed ● Avoid laxatives.

as a result. A stool Advise patient that

antigen test checks to see laxatives, enemas,

if substances that trigger or suppositories are

the immune system to avoided three days

fight an H. Pylori infection prior to collection.

● Instruct a red-meat
free and high residue
diet. The patient is
indicated for an
occult blood test,
must follow a special
diet that includes
generous amounts
of chicken, turkey,
and tuna, raw and
uncooked
vegetables and fruits
such as spinach,
celery, prunes and

97
 bran containing
cereal for two (2)
days before the test.

During

● Collect the stool in a

dry, clean, leakproof
container. Make sure
no urine, water, soil
or other material
gets in the container.

● Label a clean,
screw-top container
with your name, date
of birth and the date.

● Make sure the poo

doesn't touch the
inside of the toilet

● Place something in
the toilet to catch the
poo, such as a potty
or an empty plastic
food container, or
spread clean
newspaper or plastic
wrap over the rim of
the toilet

● If you've been given

98
 a container, aim to fill
around a third of it –
that's about the size
of a walnut if you're
using your own
container

After

● Instruct patient to do
handwashing. Allow
the patient to
thoroughly clean his
or her hands and
perianal area.

● Resume activities.
The patient may
resume his or her
normal diet and
medication therapy
unless otherwise
specified.

● Recommend regular
screening. The
American Cancer
Society
recommends yearly
occult blood test as
part of the screening

99
 for colorectal cancer
starting at the age of
45 years old for
people with average
risk.

Urea Breath Test

The urea breath test (UBT) detects active H. pylori infection and so it is
useful for making the primary diagnosis, confirming the accuracy of serology, and
documenting successful treatment. Urea breath tests are based on the large
urease production by all H. pylori strains. UBTs are very reliable, low-burden tests
that have been validated both in adults and children. Urea breath tests rely on the
breakdown of isotope-labeled urea by urease in the stomach. The UBT only takes
10 minutes and requires a single breath sample.

COMPONENT NORMAL RANGE AND RATIONALE NURSING

DEFINITION RESPONSIBILITIES

Urea Breath No evidence of H pylori H. pylori bacteria (if Before

Test present) breaks down the
The urea breath test is ● Collect a sample of
urea in the solution you
used to detect your breath before
drank, releasing carbon
Helicobacter pylori (H. the test starts.
dioxide in the breath you
pylori), a type of bacteria
exhale. So if the amount
that may infect the
of carbon dioxide in your
stomach and is a main During
second sample is higher
cause of ulcers in both the
than the amount in your ● Give the patient a
stomach and duodenum
first sample, you have a capsule or some
(the first part of the small
positive test for the water to swallow that
intestine). H. pylori

100
 produces an enzyme presence of H. pylori. contains tagged or
called urease, which radioactive material.
breaks urea down into
ammonia and carbon
dioxide. During the test, a After
tablet containing urea is
● Collect more
swallowed and the
samples of your
amount of exhaled carbon
breath. The samples
dioxide is measured. This
will be tested to see
indicates the presence of
if they contain
H. pylori in the stomach.
material formed
when H. pylori
comes into contact
with the tagged or
radioactive material.

C. DIAGNOSTIC EXAMINATION

Electrocardiogram (ECG)

An electrocardiogram (ECG) is one of the simplest and fastest tests used

to evaluate the heart. Electrodes are placed at certain spots on the chest, arms,
and legs. The electrodes are connected to an ECG machine by lead wires. The
electrical activity of the heart is then measured, interpreted, and printed out. No
electricity is sent into the body. Natural electrical impulses coordinate contractions
of the different parts of the heart to keep blood flowing the way it should. An ECG
records these impulses to show how fast the heart is beating, the rhythm of the
heart beats, and the strength and timing of the electrical impulses as they move
through the different parts of the heart. Changes in an ECG can be a sign of many
heart-related conditions.

101
COMPO NORMAL RATIONALE RESULT INTERPRETATI NURSING
NENT RANGE AND ON AND RESPONSIBILITI
DEFINITION SIGNIFICANCE ES

ECG If the test An ECG is often Essential Normal Before

results are used alongside ly normal
The patient’s ● Explain to the
normal, it must other tests to help ECG
ECG findings is patient the
demonstrate diagnose and findings
within the normal need to lie
that the heart monitor conditions
range still, relax, and
beats uniformly affecting the heart.
breathe
between 60 to It can be used to
normally
100 beats per investigate
during the
minute. symptoms of a
procedure.
possible heart
problem, such as ● Note current
Electrocardiogr chest pain, cardiac drug
am (ECG) is a palpitations therapy on the
quick test that (suddenly test request
can examine noticeable form as well
your heart's heartbeats), as any other
electrical dizziness and pertinent
activity and shortness of clinical
rhythm. The breath. information,
electrical such as chest
signals that pain or
your heart pacemaker.
beats out each
● Explain that
time it beats are
the test is
picked up by
painless and
sensors affixed
takes 5 to 10

102
to the skin. minutes.

● Ensure to
empty the
bladder.
Instruct
patient to void
prior and to
change into a
gown.

● Explain the
need to
darkened the
examination
field. The
room may be
darkened
slightly to aid
visualization
on the monitor
screen, and
that other
procedure
may be
performed
simultaneousl
y to time
events in the
cardiac
cycles.

103
During

● Inform that a
conductive gel
is applied to
the chest
area. A
conductive gel
will be applied
to his chest
and that a
quarter-sized
transducer will
be placed
over it. Warn
him that he
may feel
minor
discomfort
because
pressure is
exerted to
keep the
transducer in
contact with
the skin.

● Position the
patient on his
left side.

104
 Explain that
transducer is
angled to
observe
different areas
of the heart
and that he
may be
repositioned
on his left side
during the
procedure.

After

● Disconnect
the
equipment,
remove the
electrodes,
and remove
the gel with a
moist cloth
towel.

● If the patient is
having
recurrent
chest pain or if
serial ECGs
are ordered,

105
 leave the
electrode
patches in
place.

● Instruct
patient to
resume
regular diet
and activities.
There is no
special type of
care given
following the
test.

Chest X-Ray

Chest x-ray uses a very small dose of ionizing radiation to produce pictures
of the inside of the chest. It is used to evaluate the lungs, heart, and chest wall and
may be used to help diagnose shortness of breath, persistent cough, fever, chest
pain, or injury. It also may be used to help diagnose and monitor treatment for a
variety of lung conditions such as pneumonia, emphysema, and cancer. Because
chest x-ray is fast and easy, it is particularly useful in emergency diagnosis and
treatment.

COMPO NORMAL RATIONALE RESULT INTERPRETATI NURSING

NENT RANGE AND ON AND RESPONSIBILITI
DEFINITION SIGNIFICANCE ES

106
Chest X- Normal Chest Findings: The patient has Before
ray Findings: images normal findings in
The lungs are ● Remove all
should be terms of his
In a normal clear. metallic
examined in cardiopulmonary
chest x-ray will objects. Items
full imagery.
show a normal such as
inspiration Tracheal air However, he had
lung fields, jewelry, pins,
and erect if column is at Spondylosis
cardiac size, buttons etc
feasible to the midline deformans in his
mediastinal can hinder the
reduce thoracic area.
structures, visualization
cardiac Spondylosis
thoracic spine, of the chest.
magnification The heart is deformans is a
ribs, and
and not enlarged chronic condition ● No
diaphragm
demonstrate that is associated preparation is

fluid levels. with aging. required.

Both Fasting or
An imaging test Expiration Research
hemidiaphra medication
known as a images may indicates that it
gms and restriction is
chest X-ray be needed to often develops as
costophrenic not needed
employs X-rays identify a a secondary
sulci are unless
to examine the pneumothora problem related to
intact directed by
organs and x or locate degenerative
the health
structures in the foreign disease of the
care provider.
chest. It can let materials. intervertebral
Osteophytes
the medical Rib detail discs. ● Ensure the
are seen
professional images may patient is not
along the
assess how well be taken to pregnant or
margins of
the heart and delineate suspected to
thoracic
lungs function. It bone be pregnant.
vertebrae
can help the pathology, X-rays are
medical helpful when usually not
professional see chest The rest of recommende

107
the heart, lungs, radiographs the structures d for pregnant
bronchi, aorta, illustrate are women unless
pulmonary metastatic unremarkabl the benefit
arteries, lesions or e outweighs the
mediastinum, fractures. In risk of
and chest bones the onset of damage to the
and their sizes, the disease Impression: mother and
shapes, and process of ● Unremark fetus.
locations. asthma, able ● Assess the
tuberculosis, cardiopulm patient’s
and chronic onary ability to hold
obstructive findings his or her
pulmonary
● Thoracic breath.
disease,
spondylosi Holding one’s
chest x-ray
s breath after
results may
deformans inhaling
not correlate
enables the
with the
lungs and
patient’s
heart to be
clinical status
seen more
and may
clearly in the
even be
x-ray.
normal.
● Provide
appropriate
clothing.
Patients are
instructed to
remove
clothing from

108
 the waist up
and put on an
X-ray gown to
wear during
the
procedure.

● Instruct
patient to
cooperate
during the
procedure.
The patient is
asked to
remain still
because any
movement will
affect the
clarity of the
image.

During

● Leaving the
room during
X-ray
exposures
whenever
possible; ·

● Keep the time

109
 they are
exposed to X-
rays as short
as possible.

● Use protective
gear to be
protected
from the
radiation

After

● No special
care. Note
that no special
care is
required
following the
procedure

● Provide
comfort. If the
test is
facilitated at
the bedside,
reposition the
patient
properly.

Ultrasound Whole Abdomen

110
 An abdominal ultrasound is done to view structures inside the abdomen. It's
the preferred screening method for an abdominal aortic aneurysm, a weakened,
bulging spot in the abdominal aorta, the major blood vessel that supplies blood to
the body. However, the imaging test may be used to diagnose or rule out many
other health conditions.

COMPONE NORMAL RANGE RATIONALE RESULT INTERPRETATION

NT AND DEFINITION AND
SIGNIFICANCE

Ultrasound Normal findings: This helps in September 9, 2022 The results of the
Whole evaluating the patient’s abdominal
● No focal liver @ 10:00 AM
Abdomen cause of stomach ultrasound shows
lesions
pain or distention/ degenerative
● No gallstones in enlargement. changes in the spine
The liver is not
gallbladder Ultrasound is a enlarged. The right which indicates the

● No intra or new test proven lobe is diffusely patient has arthritis.

extrahepatic to be sensitive in hypodense to the The patient also

duct dilatation the spleen. The left indicates to have

demonstration of lobe is normal in peptic ulcer disease
● CBD diameter
gastroesophagea density as Gastric ulcer was
(1.8mm to 5.9
l reflux found in the results.
mm)
Hepatic Cyst at left
Triphastic study lobe indicates that
shows normal there are fluid-filled
Abdominal
hepatic cavities in the liver.
ultrasound is a type
enhancement. A 5 Atherosclerotic aorta
of imaging test. It is
mm ovoid non- indicates that there
used to look at
enhancing focus is a build up plaque in
organs in the
was seen in the aorta and
abdomen, including
segment 2 in all coronary artery
the liver,

111
gallbladder, spleen, phases of the disease indicates
pancreas, and study. Ducts and that there is a
kidneys. The blood CBD are not blockage in the
vessels that lead to dilated. Hepatic patient’s coronary
some of these vessels are normal. artery. Geographic
organs, such as the fat deposition refers
inferior vena cava to irregular multifocal
and aorta, can also Gallbladder, areas of fat infiltration
be examined. pancreas, spleen, alternating with
adrenals, and both regions of fat sparing
kidneys are normal within the liver
parenchyma. Hepatic
cysts are also found
Calcifications seen
and these are fluid-
in the aorta and
filled cavities in the
coronary arteries
liver generally
asymptomatic and
found incidentally on
Lung bases are
imaging studies.
clear
They can sometimes
be associated with
Degenerative serious
changes seen in complications such
the spine as infection,
hemorrhage, rupture,
or compression of the
GIT structures are biliary tree. In
not remarkable, addition, the fatty
except for the liver might contribute
ulcerations present to the development of

112
 in the patient’s GERD through
gastrum several mechanisms:
fatty liver and hepatic
cysts might be
Impression: correlated with

● Geographic fatty GERD through

liver, right lobe dysfunction of the

autonomic nervous
● Hepatic cyst, left
system.
lobe

● Atherosclerosis
aorta and
coronary artery
disease

● Gastric ulcer

● Rest of the
study is
unremarkable

D. POSSIBLE DIAGNOSTIC EXAMINATION

Esophageal Manometry

Esophageal manometry is a test that shows whether your esophagus is

working properly. The esophagus is a long, muscular tube that connects your
throat to your stomach. When you swallow, your esophagus contracts and pushes
food into your stomach. Esophageal manometry measures contractions

113
COMPONENT NORMAL RANGE AND RATIONALE NURSING
DEFINITION RESPONSIBILITIES

Esophageal Normal Results: This identifies or rules out Before

manometry a narrowing, complete
The LES pressure and ● For an A.M.
blockage or an area of
muscle contractions are appointment,
inflammation in the
normal when you swallow. Instruct patient for a
esophagus.
fat free dinner the
evening before.
Esophageal manometry is Nothing to eat or
a test that examines the drink from midnight
coordinated muscle until after the
movement (motility) of the examination. For a
esophagus. This uses a P.M. appointment,
narrow, flexible, pressure- clear liquid breakfast
sensitive tube called a (no milk) before 9
catheter. The catheter A.M. Nothing to eat
measures pressure or drink after
created by the muscles in breakfast.
the esophagus and the
valves in the top and
During
bottom portions of the
esophagus. ● An abdominal
ultrasound may be
done as an
outpatient or as part
of your stay in a
hospital.

114
After

● There is no special
care required after
an abdominal
ultrasound.

● Tell the patient

he/she may resume
to usual diet and
activities unless the
doctor advises
differently.

Before

● Instruct patient to
avoid eating and
drinking for a time
before esophageal
manometry. The
doctor will give a
specific instructions.

During

● While your patient is

sitting up, a member
of the health care

115
 team sprays the
patient’s throat with
a numbing
medication or puts
numbing gel in your
nose or both.

● A catheter is guided
through the patient’s
nose into his
esophagus. The
catheter may be
covered by a water-
filled sleeve.

● After the catheter is

in place, patient be
asked to lie on their
back on an exam
table or to remain
seated.

● Then let them

swallow small sips of
water. And a
computer connected
to the catheter
records the
pressure, speed and
pattern of their
esophageal muscle
contractions.

116
 ● During the test,
Patient will be asked
to breathe slowly
and smoothly

● A member of the
health care team
might move the
catheter up or down
into their stomach
while the catheter
continues its
measurements.

● The catheter then is

slowly withdrawn.

● The test usually lasts

about 30 minutes.

After

● Tell the patient

When their
esophageal
manometry is
complete, they can
return to their normal

117
 activities.

Upper Gastrointestinal Endoscopy

An upper endoscopy, also called an upper gastrointestinal endoscopy, is a

procedure used to visually examine your upper digestive system. This is done with
the help of a tiny camera on the end of a long, flexible tube. A specialist in diseases
of the digestive system, gastroenterologist, uses endoscopy to diagnose and
sometimes treat conditions that affect the upper part of the digestive system

COMPONENT NORMAL RANGE AND RATIONALE NURSING

DEFINITION RESPONSIBILITIES

Upper Normal endoscopy The procedure of choice Before

gastrointestinal results for evaluation of upper GI
● Patient assessment
(GI) endoscopy structures and function
● The esophagus, and preparation for
and allows for the
stomach, and the procedure
possibility of a therapeutic
duodenum should
intervention (stomach ● Explain what to
be smooth and of
biopsy, hemostatic ● expect from the
normal color ().
therapy for bleeding procedure
● No bleeding, ulcers and esophageal
growths, ulcers, or varices). ● Prepare the

inflammation. endoscopy room

with the right
instruments and
It allows direct device
visualization and

118
 therapeutic treatment of During
abnormal conditions of
● Assist endoscopist
esophagus, stomach,
during the procedure
and duodenum that uses
an endoscope, a flexible ● Assist anaesthetist

tube with camera, to see during the procedure

the lining of the upper GI ● Preventing infection

tract. and quality
assurance

● Keep the patient

comfortable

● Vital signs
monitoring

After

● Reprocessing of
endoscopic
instruments and
devices

● Transfer patient to
recovery room

● Handover to
recovery nurse

Esophageal pH Monitoring

119
 Esophageal pH monitoring is a test that measures how often and how long
stomach acid is entering the esophagus. The test also measures how long the acid
stays there. A small thin tube is introduced through the nose or mouth and into the
stomach, which is then drawn back up into the esophagus. The tube is attached to
a monitor which records the level of acidity in the esophagus. The patient records
symptoms and activity while the tube is left in place for the next 24 hours. This test
is helpful in determining the amount of stomach acid entering the esophagus.

COMPONENT NORMAL RANGE AND RATIONALE NURSING

DEFINITION RESPONSIBILITIES

Esophageal Esophageal pH It is done to quantify the Before

pH monitoring monitoring is a test that problem and also used to
● Instruct Patient to
measures how often determine effectiveness
not eat or drink after
stomach acid enters the of treatment. On the other
midnight before the
tube that leads from the hand, it is commonly used
test. You should also
mouth to the stomach. to diagnose GERD.
avoid smoking.
The test also measures
how long the acid stays
there. During

● Inform the patient

Normal esophageal pH that it will briefly feel

like gagging as the
● The normal pH for
tube is passed
the esophagus is
through your throat.
close to 7.0.
● The Bravo pH
monitor causes no
discomfort.

After

120
 ● Tell the patient that
he will return to the
hospital the next day
and the tube will be
removed. The
information from the
monitor will be
compared with his
diary notes

E. THERAPEUTICS
I. IVF

DATE ORDER RATIONALE

September 8, 2022 PNSS 1L @ 100 cc/hr x2 Plain Normal Saline

8am
Solution is a
crystalloid fluid that is
administered
intravenously. It is a
prescription
medication used to
replace fluids and
electrolytes, treat
metabolic alkalosis in
the presence of fluid
loss, and treat mild
sodium deficiency.

121
 II. Drug Study

GENERIC NAME

Ranitidine

BRAND NAME Zantac

CLASSIFICATION Histamine H2 Antagonists

MODE OF ACTION Ranitidine reduces the secretion of gastric acid by

reversible binding to histamine (H2) receptors, which
are found on gastric parietal cells. This process leads
to the inhibition of histamine binding to this receptor,
causing the reduction of gastric acid secretion.

ORDERED DOSE 50mg/2ml 1 amp IVTT BID

122
DOSE AND ROUTE Gastroesophageal Reflux Disease
• 150 mg orally every 12 hours or 50 mg
intramuscular/intravenously every 6-8 hours
Gastric Ulcer, Benign
• Treatment: 150 mg orally every 6 hours or 50
mg intermuscular/intravenously every 6-8 hours
intermittent bolus or infusion; alternatively, 6.25
mg/hours intravenously by continuous infusion
• Maintenance of healing: 150 mg orally every 12
hours
Hypersecretory Conditions
• 150 mg orally every 12 hours, up to 6 g/day
used
• Parenteral: 50 mg (2 mL) intramuscularly or
intermittent intravenous bolus or infusion every
6-8 hours, not to exceed 400 mg/day;
alternatively, 6.25 mg/hour continuous infusion

123
INDICATION It is used alone or with concomitant antacids for the
following conditions: short-term treatment of active
duodenal ulcer, treating gastric acid hypersecretion
due to Zollinger-Ellison syndrome, systemic
mastocytosis, and other conditions that may
pathologically raise gastric acid levels

It also used in the short term treatment of active benign

gastric ulcers and maintenance therapy of gastric
ulcers at a reduced dose.

Ranitidine can be used for the treatment of GERD

symptoms, treatment of erosive esophagitis
(endoscopically diagnosed) and the maintenance of
gastric or duodenal ulcer healing

CONTRAINDICATION • Hypersensitivity to Ranitidine

• History of acute porphyria

SIDE EFFECTS • Diarrhea

• Constipation
• Headache (may be severe)

ADVERSE EFFECTS • Reversible hepatitis

• blood dyscrasias occur rarely
• malaise
• dizziness
• insomnia
• tachycardia
• bradycardia

124
 • leukopenia
• gynecomastia
• increased serum creatinine

DRUG • Magnesium or Aluminum antacids may

INTERACTIONS decrease absorption
• May decrease absorption of atazanavir,
itraconazole, ketoconazole
• May decrease concentration effects
acalabrutinib, bosutinib, cefuroxime, neratinib,
pazopanib
• May increase concentration/effect of
risedronate, warfarin

NURSING Inform client to stop smoking

RESPONSIBILITIES R: smoking decreases the effectiveness of the drug

Monitor other CNS symptoms such as confusion,

hallucinations, and headache
R: mental issues most often affect the severely ill,
elderly patients

Inform patient to not overdose with the drug

R: may cause mild drowsiness. For children, it may
have a short term nausea and vomiting.

Long-term therapy may lead to vitamin B12

deficiency
R; blocking stomach acid and other secretion may also
block B12 absorption.

125
 Assess heart rate, ECG, and heart sounds
R: unexplained changes in heart rhythm can affect the
heart short term.

Monitor signs of hypersensitivity reactions

R: seek medical help if signs of hypersensitivity were
noted

Monitor IM injection site for pain, swelling, and

irritation
R: pain, swelling, and irritation can be a reaction to the
needle or to the medicine

Adhere to scheduled periodic laboratory checkups

during ranitidine treatment
R: ranitidine may interfere with laboratory tests. Daily
monitoring may be warranted

Generic Name Omeprazole

126
Brand Name Omeprazole (Inj: Na), Omeprazole cap, Prilosec,
Omeclamox-Pak, Losec

Classification Antacids, Antireflux Agents & Antiulcerants

Ordered Dose 40mg IVTT STAT then

40mg/cap 1 cap BID PO

Dosage and Route Intravenous

Adult: 40 mg once daily given via infusion over 20-30
minutes until oral administration is possible.
Oral
Adult: 20 mg once daily for 4-8 weeks.
For severe cases: 40 mg once daily for 8 weeks.
Maintenance: 10 mg once daily, may increase to 20-
40 mg once daily if necessary.
Child: ≥1 year weighing 10-20 kg: 10 mg once daily,
increased to 20 mg once daily if necessary. ≥2 years
weighing >20 kg: 20 mg once daily, increased to 40
mg once daily if necessary. Treatment duration: 4-8
weeks.

Mode of Action Omeprazole is a substituted benzimidazole gastric

antisecretory agent and is also known as proton pump
inhibitor (PPI). It blocks the final step in gastric acid
secretion by specific inhibition of the adenosine
triphosphatase (ATPase) enzyme system present on
the secretory surface of the gastric parietal cell. Both
basal and stimulated acid are inhibited.

Indication Intravenous:
Treatment of duodenal ulcers, prevention of relapse of
duodenal ulcers, treatment of gastric ulcers, prevention

127
 of relapse of gastric ulcers, Helicobacter pylori (H.
pylori) eradication in peptic ulcer disease, treatment of
NSAID-associated gastric and duodenal ulcers,
prevention of NSAID-associated gastric and duodenal
ulcers in patients at risk, treatment of reflux
oesophagitis, Long-term management of patients with
healed reflux oesophagitis, treatment of
symptomatic gastro-oesophageal reflux disease
and treatment of Zollinger-Ellison syndrome.

Cap:
Short-term treatment of active duodenal & gastric
ulcer, GERD & pathological hypersecretory conditions.

Contraindication Hypersensitivity to omeprazole, other proton pump

inhibitors. Concomitant use with products containing
rilpivirine.
Cautions: May increase risk of fractures,
gastrointestinal infections. Hepatic impairment, pts of
Asian descent.

Side Effects Frequent (7%): Headache.

Occasional (3%–2%): Diarrhea, abdominal pain,
nausea.
Rare (2%): Dizziness, asthenia, vomiting, constipation,
upper respiratory tract infection, back pain, rash,
cough.

Adverse Effects Significant: Hypomagnesaemia, cutaneous lupus

erythematosus, SLE, osteoporosis-related fractures,
fundic gland polyp, carcinoma, Clostridium difficile-
associated diarrhoea, interstitial nephritis, Vitamin B12

128
 deficiency (long-term therapy), gastrointestinal
infection (e.g. salmonella, Campylobacter).
Gastrointestinal disorders: Nausea, vomiting,
diarrhoea, constipation, flatulence, abdominal pain.
General disorders and administration site
conditions: Weakness, malaise.
Hepatobiliary disorders: Increased liver enzymes.
Immune system disorders: Urticaria.
Metabolism and nutrition disorders: Peripheral
oedema.
Musculoskeletal and connective tissue disorders:
Back pain.
Nervous system disorders: Headache, dizziness,
somnolence, paraesthesia, vertigo.
Psychiatric disorders: Insomnia.
Respiratory, thoracic and mediastinal disorders:
Cough. Skin and subcutaneous tissue disorders: Rash,
dermatitis, pruritus.

Drug Interaction DRUG:

• May decrease concentration/effects of
atazanavir, clopidogrel.
• May increase concentration/effects of
diazePAM, oral anticoagulants (e.g., warfarin),
phenytoin.
HERBAL:
• St. John’s wort may decrease
concentration/effects.
FOOD: None known.
LAB VALUES:

129
 • May increase serum alkaline phosphatase,
ALT, AST.

Nursing 1. Assess sensitivity to the drug and or history

Responsibilities of allergies.
R: To prevent unwanted allergic reactions.
2. Inform the patient about the reason for
treatment and the expected results.
R: The more knowledge the patient has about their
medication, the better decisions they will make in
improving their current status.
3. Observe 10 rights of drug administration.
R: To prevent medical errors.
4. Assess dizziness that might affect gait, and
other functional activities.
R: If one is taking omeprazole for more than 3 months,
the levels of magnesium in the blood may fall. Low
magnesium can make the individual feel tired,
confused, dizzy, and cause muscle twitches,
shakiness and an irregular heartbeat.
5. Advise patient to report severe diarrhea;
black tarry stool, abdominal cramps or pain,
changes in urinary elimination, or continuing
headache.
R: Urinating less than usual, or if you have blood in
your urine and diarrhea may be a sign of a new
infection and medication may have to be discontinued.
6. Advise patient to avoid alcohol and foods
that may cause an increase in GI irritation.

130
R: A person’s diet can affect the underlying condition
PPIs treat. This means PPIs may have a harder time
providing relief.
7. Instruct patient to report bothersome or
prolonged side effects, including skin problems
(itching, rash) or GI effects.
R: Reporting side effects is a key element in building
an improved system of pharmacovigilance.
8. Advise patient to not take other medicines
unless prescribed by the physician.
R: Taking other medications that are not prescribed by
the physician may lead to the disease getting worse,
hospitalization and even death.
9. Do not breastfeed while taking this drug.
R: Use only if benefits outweigh fetal risk; cautious use
in breastfeeding since this may pass into the breast
milk in tiny amounts.
10. Provide patient support.
R: Offering support and encouragement helps the
patient cope with the disease and the drug regimen.

131
GENERIC NAME Atorvastatin

BRAND NAME Caduet, Lipitor

CLASSIFICATION Pharmacologic class: HMG-CoA reductase inhibitor

Therapeutic class: Antihyperlipidemic

MODE OF ACTION Reduces plasma cholesterol and lipoprotein levels

by inhibiting HMG-CoA reductase and cholesterol
synthesis in the liver and by increasing the number
of LDL receptors on liver cells to enhance LDL
uptake and breakdown.

ORDERED 40mg/cap 1 cap OD @ HS

DOSE

132
SUGGESTED Dyslipidemias
DOSE/ROUT
E PO: ADULTS, ELDERLY: Initially, 10–20 mg/day (40
mg in pts requiring greater than 45% reduction in
LDL-C). Range: 10–80 mg/day.

Heterozygous Hypercholesterolemia
PO: CHILDREN 10–17 YRS: Initially, 10 mg/day.
Maximum: 20 mg/day.

Dosage in Renal Impairment

No dose adjustment.

Dosage in Hepatic Impairment

See contraindications.

133
INDICATION Atorvastatin is indicated for the treatment of
several types of dyslipidemias, including primary
hyperlipidemia and mixed dyslipidemia in adults,
hypertriglyceridemia, primary dysbetalipoproteinemia,
homozygous familial hypercholesterolemia, and
heterozygous familial hypercholesterolemia in
adolescent patients with failed dietary modifications

Atorvastatin is indicated, in combination with

dietary modifications, to prevent cardiovascular events
in patients with cardiac risk factors and/or abnormal
lipid profiles.

Atorvastatin can be used as a preventive agent

for myocardial infarction, stroke, revascularization, and
angina, in patients without coronary heart disease but
with multiple risk factors and in patients with type 2
diabetes without coronary heart disease but multiple
risk factors.

Atorvastatin may be used as a preventive agent

for non-fatal myocardial infarction, fatal and non-fatal
stroke, revascularization procedures, hospitalization
for congestive heart failure and angina in patients with
coronary heart disease

134
CONTRAINDICATIO Contraindications: Hypersensitivity to avelumab.
NS
Cautions: Acute infection, conditions predisposing to
infection (e.g., diabetes, immunocompromised pts,
renal failure, open wounds); corticosteroid in-
tolerance, hematologic cytopenias, hepatic
impairment, interstitial lung disease, renal
insufficiency; history of autoimmune dis- orders
(Crohn’s disease, demyelinating polyneuropathy,
Guillain-Barré syndrome, Hashimoto’s thyroiditis,
hyperthyroidism, myasthenia gravis, rheumatoid
arthritis, Type I diabetes, vasculitis); CVA, diabetes,
intestinal obstruction, pancreatitis.

• Contraindicated in patients hypersensitive to drug

and in those with active liver disease or unexplained
persistent elevations of transaminase levels.
• Some dosage forms contain polysorbate 80, which
can cause delayed hypersensitivity reactions.
• Use cautiously in patients with hepatic impairment or
heavy alcohol use, in patients with inadequately
treated hypothyroidism, with other drugs associated
with myopathy, and in elderly patients. • Withhold or
stop drug in patients at risk for renal failure caused
by rhabdomyolysis resulting from trauma; in serious,
acute conditions that suggest myopathy; and in
major surgery, severe acute infection, hypotension,
uncontrolled seizures, or severe metabolic,
endocrine, or electrolyte disorders.

135
SIDE EFFECTS Common: Atorvastatin is generally well
tolerated. Side effects are usually mild and
transient.
Frequent (16%): Headache.
Occasional (5%–2%): Myalgia, rash,
pruritus, allergy.
Rare (less than 2%–1%): Flatulence,
dyspepsia, depression.

ADVERSE Contraindications: Hypersensitivity to

EFFECTS atorvastatin. Active hepatic disease, breast-
feeding, pregnancy or women who may be- come
pregnant, unexplained elevated LFT results.
Cautions: Anticoagulant therapy; history of hepatic
disease; substantial alcohol consumption; pts with
prior stroke/TIA; concomitant use of potent CYP3A4
inhibitors; elderly (predisposed to myopathy).
CNS: insomnia
CV: Stroke

EENT: nasopharyngitis, pharyngolaryngeal pain,

GI: UTI.
Metabolic: Diabetes mellitus
Musculoskeletal: rhabdomyolysis, arthralgia,
myalgia, extremity pain, muscle spasms,
musculoskeletal pain.
Skin: Rash

136
DRUG Drug: Strong CYP3A4 inhibitors (e.g.,
INTERACTIO clarithromycin, protease inhibitors,
NS itraconazole) may in- crease concentration, risk of
rhabdomyolysis.
Cyclosporine may increase concentration.
Gemfibrozil, fibrates, niacin, colchicine may
increase risk of myopathy, rhabdomyolysis.
Strong CYP3A4 inducers (e.g., rifampin,
efavirenz) may decrease concentration.
HERBAL: St. John’s wort may decrease level.
FOOD: Grapefruit products may increase serum
concentrations.
Red yeast rice may increase serum levels (2.4 mg
lovastatin per 600 mg rice).
LAB VALUES: May increase serum transaminase,
creatinine kinase concentrations.

NURSING • Check the patient’s blood test results, particularly

RESPONSIBI the LDL and HDL levels. Assess the patient for
LITIES signs and symptoms of
hypercholesterolemia.

R: To conform the indication for administering

atorvastatin.

• Check the patient’s allergy status.

R: Previous allergic reaction to atorvastatin or any

its contents may render the patient unable to take
them.

• Assess if the patient is pregnant or lactating.

137
 R: Contraindication: atorvastatin should not be
prescribed to a pregnant woman or lactating
mother as these drugs can potentially harm the
fetus or newborn.

• If administering oral atorvastatin, assess the

patient’s mucous membranes and his/her ability
to swallow.

R: To check for any potential problems with

administration, hydration, and absorption.

• To ensure that the right form of atorvastatin is given

through the right route.

Assess for signs of renal impairment.

R: atorvastatin can increase liver enzyme levels.

They must be used with caution in people with
impaired renal function.

• Check for history of hypothyroidism. Collect

bloods for thyroid function tests as indicated.

R: Hypoactive thyroid can cause high cholesterol

levels. Treating this condition may correct the
problem without the need for taking atorvastatin.

• Check the patient’s list of current medications

fordigoxin, warfarin, or oral contraceptives.

R: Digoxin and warfarin – these drugs increase

the serum levels of atorvastatin, causing drug
toxicity. • Oral contraceptives – when

138
 taking both atorvastatin and oral contraceptives,
it is important to note that serum estrogen levels
may increase.

• Atorvastatin can increase liver enzyme levels.

They must be used with caution in people with
impaired renal function.

R: atorvastatin may cause myopathy, liver or

renal impairment, and high blood glucose levels,
and therefore should be prescribed with caution
in patients included in the listed risk groups.

139
Generic Name Metoclopramide hydrochloride

Brand Name Plazimide

Classification Antiemetic Agents; Prokinetic Agents

Mode of Action Metoclopramide hydrochloride stimulates motility of the

upper gastrointestinal tract without stimulating gastric,
biliary, or pancreatic secretions. Thus, it increases the tone
and amplitude of gastric contractions, relaxes the pyloric
sphincter and the duodenal bulb, and increases the
peristalsis of the duodenum and jejunum, resulting in
accelerated gastric emptying and intestinal transit. It also
increases the lower esophageal sphincter tone and blocks
dopamine receptors at the chemoreceptors trigger zone,
stimulating nausea and vomiting.

Ordered Dose Adult: 10 mg/ amp 1 amp IVTT STAT then, 1 amp IVTT
and Route PRN for active vomiting

Suggested Dose Chemotherapy-Induced Nausea & Vomiting

and Route Adults: 1-2 mg/kg IV (infused over at least 15 minutes) 30
minutes before chemotherapy, then repeat every 2 hours
for two doses (after initial dose)

140
 Diabetic Gastroparesis
Adults: 10 mg IV/IM/PO q6hr 30 minutes before meals and
at bedtime; use injectable dosing only if severe symptoms
are present

Small Bowel Intubation/Radiologic Examination of

Upper GI Tract
Adults and children older than age 14: 10 mg IV over 1-
2 minutes
Children ages 6 to 14: 2.5-5 mg IV as a single dose slowly
over 1 to 2 minutes
Children younger than 6: 0.1 mg/kg IV as a single dose
slowly over 1 to 2 minutes

Gastroesophageal Reflux Disease

Adults:10-15 mg PO q6hr 30 minutes before meals and at
bedtime; not to exceed 80 mg/day

Indication Metoclopramide is used as a short-term treatment for

ongoing heartburn when the usual medicines do not work
well enough. It is used primarily for heartburn that occurs
after a meal or during the daytime. Treating ongoing
heartburn can decrease the damage done by stomach acid
to the swallowing tube and help it heal.

Metoclopramide is also used by diabetic patients who have

poor emptying of their stomachs (gastroparesis). Treating
gastroparesis can decrease symptoms of nausea, vomiting,
and stomach/abdominal fullness. Also, it facilitated small-
bowel intubations

141
 Metoclopramide works by blocking a natural substance
(dopamine). It speeds up stomach emptying and movement
of the upper intestines. It prevents or reduces nausea and
vomiting from emetogenic cancer chemotherapy

Contraindication Contraindicated in patients hypersensitive to drugs and in

those with pheochromocytoma or other catecholamine-
releasing paragangliomas, tardive dyskinesia, or seizure
disorders

Contraindicated in patients for whom stimulation of GI

motility might be dangerous especially patients with
hemorrhage, obstruction or perforation

Side Effects Central Nervous System: Sedation, fatigue,

restlessness, headache, sleeplessness, dystonia,
dizziness,
Cardiovascular: Hypotension,
Gastrointestinal: Dry mouth, constipation, nausea,
anorexia, vomiting, diarrhea
Genitourinary: Decreased libido, prolactin secretion,
amenorrhea, galactorrhea
Integumentary: Urticaria, rash

Adverse Effects Central Nervous System: Suicidal ideation, seizures,

neuroleptic malignant syndrome, tardive dyskinesia
Cardiovascular: supraventricular tachycardia
Hematology: Neutropenia, leukopenia, agranulocytosis

Drug Interaction Individual drugs

Alcohol: increased sedation Haloperidol: increased
extrapyramidal reaction

142
 Drug classifications
Anticholinergics, opiates: decreased action of
metoclopramide
CNS depressants: increased sedation MAOIs: avoid use
Phenothiazines: increased extrapyramidal reaction

Nursing 1. Monitor BP carefully during IV administration. Prepare

Responsibilities phentolamine.
Rationale: blood pressure might get too high while you are
using this medicine. This may cause headaches,
dizziness, or blurred vision. Have phentolamine readily
available in case of hypertensive crisis; most likely to
occur with undiagnosed pheochromocytoma.

2. Monitor diabetic patients, and arrange for alteration

in insulin dose or timing if diabetic control is compromised
by alterations in the timing of food absorption.
Rationale: Medication can cause hyperglycemia if taken
excessively.

3. Monitor patient for involuntary movements of the

face, tongue, and extremities
Rationale: Drug may cause tardive dyskinesia,
parkinsonian symptoms for motor restlessness. These
could be symptoms of a serious condition called
neuroleptic malignant syndrome (NMS).

143
4. Do not use alcohol, sleep remedies, and sedatives.
Rationale: Serious sedation could occur.

5. Monitor for possible hypernatremia and

hypokalemia, especially if the patient has CHF or cirrhosis.
Rationale: Under normal conditions, dopamine causes
tonic inhibition of aldosterone. Metoclopramide is a D2
dopamine receptor antagonist hence, its administration
leads to increased aldosterone levels.

6. Guard against falls and trauma, especially if gait

and balance are affected by drowsiness, dizziness, or
ataxia
Rationale: Medication causes CNS depression.

7. Avoid driving and other potentially hazardous

activities for a few hours after drug administration
Rationale: Medication can cause dizziness and CNS
Depression

8. Check for breast swelling or soreness, unusual

breast milk production, absent, missed, or irregular
menstrual periods, stopping of menstrual bleeding, loss in
sexual ability, desire, drive, or performance, decreased
interest in sexual intercourse, or an inability to have or
keep an erection.

144
Rationale: This medicine may increase prolactin blood
levels if used for a long time. Both men and women with
high prolactin levels may have infertility, low sex drive, and
bone loss.

9. Do not breastfeed while taking this drug without

consulting a physician.
Rationale: Metoclopramide, a drug frequently used for
nausea and vomiting in pregnancy, is thought to be safe,
but information on the risk of specific malformations and
fetal death is lacking.

10. Eat bland foods; stay away from spicy, fatty, or

salty foods.
Rationale: Eating over-spicy foods can aggravate ulcers in
the sensitive mucosal lining or in the small intestine, called
the duodenum, or sometimes even in the esophagus
making it worse. These ulcers are excruciatingly painful,
further causing stomach pain, nausea, vomiting, and
weight loss.

145
IX. SURGICAL MANAGEMENT
A. Possible Surgical Interventions
PROCEDURE RATIONALE
Laparoscopic Laparoscopic fundoplication
fundoplication is a keyhole procedure
performed for patients with
severe acid reflux, Barrett's
esophagus and symptomatic
hiatus hernias that no longer
respond to medication. It is
done to prevent acid from the
stomach travelling the wrong
way into the esophagus.
Laparoscopic fundoplication
is indicated for the treatment
of objectively documented,
relatively severed
gastroesophageal reflux
disease (GERD).
The 2008 American
Gastroenterological
Association medical position
statement on
gastroesophageal reflux
disease notes ani reflux
surgery is a consideration in
chronic (long-term)
management of GERD.
NURSING
RESPONSIBILITIES
PRE:
● Secure the informed
consent.
R: To ensure that the patients
are
aware of the consequences of
the
treatment, and for the
institution’s legal
protection.
Bowel Preparation
R: Bowel prep is an essential
prerequisite of any surgical
procedure. Doctors usually
suggest liquid diets for bowel
evacuation. However, in case
there are some special
instructions, patients must pay
heed and follow them
steadfastly.
146
Laparoscopic fundoplication
is the standard surgical
treatment for GERD. It is
highly effective in curing
GERD with a 80% success
rate at 20-year follow-up
(Frazzoni et al., 2018)
Prepare the patient for the
following diagnostic
procedures:
Complete blood count
- To identify the
presence of anemia
that must be ruled out
Cardiac enzymes
- To rule out myocardial
pain related to the
atypical pain felt with
GERD.
Serum Ion
- To identify presence of
iron-deficiency anemia
Gastrin levels
- To identify toxicity of
proton pump inhibitors.
Gastric acid secretory
analysis
- o determine if failure
with pharmacologic
agents is caused by
inadequate
suppression of gastric
acid secretion, which
147
 may signify bile reflux
or pill-induced disease
Esophageal pH monitoring
- Used to document
pathologic acid reflux,
especially for patients
who have atypical
symptoms.

POST:

Encourage small frequent

meals of high calories and
high protein foods.
- Small and frequent
meals are easier to
digest

Instruct to remain in upright

position at least 2 hours after
meals; avoiding eating 3
hours before bedtime.
- Helps control reflux and
causes less irritation
from reflux action into
esophagus.

Instruct patient to eat

slowly and masticate foods
well.

148
 - Helps prevent reflux

Managing Shoulder Pain

R: Shoulder pain is a common

occurrence post laparoscopy.
The pain is due to the CO2
introduced in the abdomen
during the procedure. But
there is no reason to panic as
the pain subsides with time. In
the meantime, one can use
heat therapy for lessening the
pain.

Nissen Nissen fundoplication, also PRE-OP

Fundoplication referred to as a Lap Nissen, is
a laparoscopic procedure Secure the Informed consent
performed for patients with and waiver.
gastroesophageal reflux R: to ensure that the patient is
disease (GERD). In this
aware of the possible
procedure, the surgeon wraps
consequences of the treatment.
the top of the stomach around
the lower esophagus. This Prepare the patient for the
reinforces the lower diagnostic tests needed:
esophageal sphincter, making
it less likely that acid will back Esophageal Manometry
up in the esophagus. Nissen · It shows the strength of the
Fundoplication is indicated to lower esophageal sphinter and
treat gastroesophageal reflux how well the esophagus

149
disease (GERD) and hiatal pushes food and liquid in to the
hernias. stomach.

24 hour pH Probe
· A test that measure the
amount of time stomach acis is
splashing into the esophagus
and how high the acid goes up
into the esophagus

Barium Swallow or Upper GI x-

ray
· A good way to detect
strictures or other
abnormalities that may need to
be repaired during the surgery

POST-OP

Inform patient that he will be

on clear liquid diet such as
chicken broth
R: it will only be for first few
meals and will gradually
advanced depending on the
progress after surgery.

Encourage small frequent

meals

150
R: to prevent the stomach
from stretching

Instruct to remain in upright

position at least 2 hours after
meals; avoid eating 3 hours
before bedtime
R: gravity can help food move
down through your digestive
tract.

Instruct to avoid gas as much

as possible
R: increased tightness of the
LES may cause to swallow
more air when eating

151
 X. NURSING MANAGEMENT
A. Nursing Theory

“Self-Care Theory”
By: Dorothea Orem

Dorothea Elizabeth Orem (July 15, 1914 – June 22, 2007) was one of
America’s foremost nursing theorists who developed the Self-Care Deficit
Nursing Theory, also known as the Orem Model of Nursing.
Her theory defined Nursing as “The act of assisting others in the provision
and management of self-care to maintain or improve human functioning at the
home level of effectiveness.” It focuses on each individual’s ability to perform self-
care, defined as “the practice of activities that individuals initiate and perform on
their own behalf in maintaining life, health, and well-being.
The self-care deficit theory was formulated by Dorothea Orem in 2001 and
has become of the most popular nursing theories in contemporary practice and
education. The main principle offered in the theory is that all humans are capable
of self-care and the goal of nurses is to help patients to achieve a maximum level
of independence with their condition (Jarošová, 2014). The key focus of the theory
is thus on the person and his or her capacity for self-care. The environment is
viewed as a factor that might impair this capacity by impacting the person’s state.
Health is perceived to be the outcome of environmental influences on the person’s

152
capacity for self-care. Ideal health can be maintained only when the person is able
and willing to fulfill all of the self-care requisites appropriate to age, gender, and
developmental stage. Lastly, the nursing profession helps the person to fulfill the
self-care deficit by providing treatment, education, or physical aid (Jarošová, 2014).
In relation to this case, Orem’s Self Care theory is essential to guide the
nurse in giving care to patients with Gastroesophageal Reflux Disease which
occurs when acidic stomach juices, or food and fluids back up from the stomach
into the esophagus because in reducing the frequency of acid reflux, the person
must know how to provide a self-care, and one can achieve that by maintaining a
healthy diet, doing smoke cessation, eating food slowly and chew thoroughly,
avoiding drinks that could trigger reflux, and following a healthy life style. Orem’s
theory aims to have a healthy lives for the patients.

Care, Cure, Core Theory”

By: Lydia Hall

Lydia Eloise Hall (September 21, 1906 – February 27, 1969) was a nursing
theorist who developed the Care, Cure, Core model of nursing. Her theory defined
Nursing as “a participation in care, core and cure aspects of patient care, where
CARE is the sole function of nurses, whereas the CORE and CURE are shared

153
with other members of the health team. She was an innovator, motivator, mentor
to nurses in all phases of their careers, and an advocate for chronically ill patients.
Lydia Hall used her knowledge of psychiatry and nursing experiences to
formulate this theory known as “the Three Cs of Lydia Hall.” It contains three
independent but interconnected circles: the core, the care, and the cure. Her theory
was defined as the “participation in care, core and cure aspects of patient care,
where care is the sole function of nurses, whereas the core and cure are shared
with other members of the health team.” Moreover, the major purpose of care is to
achieve an interpersonal relationship with the individual to facilitate the
development of the core. The care circle is focused on performing the noble task
of nurturing patients which on the other hand solely represents the role of nurses.
The core circle is the patient receiving the care. And lastly, the cure circle is the
involvement of administration of medications and treatments.
In relation to Gastroesophageal Reflux Disease, the Care, Cure, Core
Theory would stand in aiding clients with this condition to help them cope with the
symptoms. This model is highly focused on meeting the needs of patients while
reflecting on the three essential subconcepts of the theory. Hall’s theory is
particularly helpful because clients with GERD are immunocompromised due to
esophagitis. The nurse is given the opportunity to establish closeness by reflecting
on the Care circle, to help clients explore their own feelings about their current
health status.
The student nurses chose this theory for the case analysis since it would
definitely help widen the perspective of the student nurses. In the context of the
care circle, It will help in understanding the roles of student nurses and redirect
their emphasis not just on completing duties but also on actions or interventions
that could benefit and improve the health status of the patients in the context of the
care circle. For the core, It will serve as a guide in re-evaluating the patient's
feelings and values, allowing the student nurses to deliver a more appropriate
treatment for the patient's benefit. And lastly, Understanding the cure circle will
enable the student nurses to re-evaluate their relationships with other healthcare
teams, as well as find methods to improve patient care.

154
 Human Caring Theory
By: Jean Watson

Jean Watson born on June 10, 1940, is an American nurse theorist and
nursing professor known for her “Philosophy and Theory of Transpersonal Caring.”
Her theory mainly concerns how nurses care for their patients and how that caring
progresses into better plans to promote health and wellness, prevent illness and
restore health. The student nurses chose the theory of human caring because as
Watson had said: “the disease might be cured, but illness would remain without
caring and health is not attained or achieved”. The student nurses can provide
comfort, privacy, and safety precautions that can help them.
The student nurses chose this theory for the case study since, it is clear that
without the caring love of the nurse, the illness will still remain and to an extent
worsen the ailment of the patient. Patients who suffer from GERD need special
care since they are at risk and vulnerable. Caring is mutually beneficial for both the
patient and the nurse, as well as the rest of the health team members. In addition,
it is important to remember that Watson emphasizes that “we must care for
ourselves to be able to care for others. Caring improves patient outcome and
customer satisfaction. It is the wonder of enduring relationships and human
connectedness”.

B. Nursing Care Plans

For the nursing care plans, see next page.

155
NCP #1- ACUTE PAIN

Date Cues Need Nursing Patient Nursing Implem Evaluation

and Diagnosis Outcome Intervention entation
Time

Subjective: C Acute Pain After 8 Rapport 1 September

related to hours of should be 22, 2022 @
S ● “Matagal-tagal
damage of initiation of established to 3pm
na din
O esophageal intervention, the client
E sumasakit ang
mucosa as the patient
tiyan ko like a
evidenced by will be “Goal
P month G
verbalization of relieved R: A tight and completely
already,but, I
chestl pain 8/10 from pain as harmonious met”
T usually ignore
and abdominal evidenced relationship with
it. Sometimes, N
guarding by: patients is
E I feel After 8
created via
nauseated and a. Pain hours of
good rapport. It
I
M may parang scale of initiation of
Rationale: enables the
heartburn lalo 2/10 to intervention,
nurse to grasp
B na Due to the 4/10,
the patient's the patient
T
pagsumasakit excessive mild to
emotions, was able to
E na tiyan ko. transient lower moderat
communicate relieve the

156
 Tulad ngayon, I esophageal e pain; effectively, and pain as
R nasa 8/10 ang sphincter, the HCl b. Stable obtain their evidenced
sakit na in the stomach vital cooperation. by a
2 nararamdaman V can be pushed up signs; verbalizatio
ko. I usually by increase of c. Absence n of “Hindi
feel na may intra-abdominal of Assess the na siya
6 E patients vital 2
reflux ako pressure, such as abdomin masyado
every after I exercise, obesity al signs and masakit
,
eat then hihiga and pregnancy, guarding characterestic compared
agad. or positional d. Absence s of pain at kanina. Mga
2 Pagsumasakit changes of facial least 30-40 nasa 3 na
na talaga, especially lying grimacin mins after siya,”
-
meron akong down. This g administration absent
0 of medication.
Zantac always repeated abdominal
with me to P regurgitation will guarding,
somehow cause repeated R: To monitor absent
2
relieve the damage to the effectiveness of facial
E
pain, but, right esophagus. Thus, medical grimacing,

2 now, it doesn’t epigastric or treatment for and stable

give some retrosternal the relief of vital signs
R
relief with my burning sensation heartburn. with a blood
condition,” by is felt. Continuous

157
8 the patient. esophageal pressure of
● “May mga damage will
C Elevate the 3 120/80,
times din po na cause scarring
bed in an respiratory
: nagigising ako and bleeding.
upright rate of 20
sa sobrang E position cpm and
sakit ng dibdib
0 pulse rate of
ko parang may Rationale:
85 bpm
burning tapos P Hinkle, J.L. & R: To reduce
may asim na Cheever, K.H. the backwash of
0
galing sa tiyan (2017). Brunner & acid from the
T
ko parang Suddarth's stomach to the
A ganon yong Textbook of esophagus.
lasa. Maybe, Medical-Surgical
U
sa sobrang Nursing (14 ed.). Kharyl
M stress sa Encourage the 4 Roisse C.
Philadelphia:
trabaho din. Elsevier patient to Castillano,
A
Kaya kaninang follow StN
umaga, hindi appropriate
ko na natiis L meals at times
kasi sobrang and meal Dale Jade
sakit na ng portions. It M. Cuta,
tiyan ko kaya should be in

158
 sabi ko, small frequent StN
papahospital meals.
P
na ako, hindi
na rin ako Aira Mae D.

nakakatulog ng R: To ensure Espanola,

A
maayos at that the patient StN

hindi ko na does not eat

talaga kaya T huge meal,or

ang sakit,” as that he does not

verbalized by eat late at night

T before bedtime
the patient
● Pain scale of as both of these

8/10 contribute to
E
GERD.
Objective:

● Facial R 5
Encourage to
grimacing
eat slowly
noted
● Guarding N
behavior at his R: To prevent
abdomen reflux

159
● Clammy skin
● Hoarseness of
Advise the
voice
client to avoid
● Inflamed 6
tight fitting
tonsils
clothes
● Enlarged
lymph nodes in
the neck R: To enhance
● Vital signs: breathing
○ BP: 140/90 pattern as this
○ PR: 105 bpm may contribute
○ RR: 23 cpm to alleviating the
pain.

Encourage
7
patient to
avoid alcoholic
bevearges,
ciggarettes
and coffee.

160
R: It can irritate
the stomach by
increasing the
HCL.

Provide calm, 8

restful
surroundings,
and minimize
environmental
activity and
noise. Limit
the number of
visitors and
length of stay.

R: It helps
lessen
sympathetic

161
stimulation;
promotes
relaxation.

Provide time
for the patient 9

to ask
questions and
express
feelings; be
reassuring and
supportive. Be
certain to
address the
patient’s main
concerns.

R: Expressing
feelings and

162
having
questions
answered are
essential ways
of reducing
confusion while
learning new
information.

Emphasize
importance of
10
adhering to
treatment
regimen

R: To promote
comfort and
wellness (and
that leads to fair
prognosis)

163
 NCP #2- DEFICIENT FLUID VOLUME

DATE & CUES NEED NURSING PATIENT INTERVENTION IMPLEMEN EVALUATION

TIME DIAGNOSIS OUTCOME TATION

S Subjective: N Deficient fluid Within 8 hours of Establish rapport 1 September 8,

volume related nursing 2022 @3PM
E “Now ng dahil U R: To encourage
to insufficient intervention, the
sa paulit-ulit cooperation with Goal Partially
P T fluid intake as patient will display
na sumasakit necessary Met
T R evidenced by improved hydration
tiyan at intervention and build
rapid weight as evidenced by: Within 8 hours
E sumusuka I trust between nurse
loss, of nursing
ako, wala na and patient.
M T decreased intervention, the
talaga akong
urine output a. Moist patient
B gana kumain I
and increased mucous displayed
like for two Monitor vital signs
E O membranes 2 improved
urine and compare with
weeks na
concentration. b. Intake within hydration as
R N the client's normal
limited na
the body evidenced by:
yong kain ko, and previous
A
requirement
hindi na readings. a. Moist
8, L R: Elderly and s
umaabot ng mucous
adults c. Vital signs R: Changes in BP and
three times a - membran
frequently within the pulse may be used for
day. Pumayat es
drink tea or normal rough estimates of

164
 2 talaga ako M coffee. These range fluid imbalances. b. Intake of
from 92 kgs to both have a fluid of
0 E
86 kgs na diuretic effect about
2 yata. Then, T that increases Monitor Intake and 3 2.3L
less water urine output. Weigh daily c. Normal
2 A
intake, and production R: Provides the best vital
B
sobrang sakit while also assessment of current signs
7-3 Shift and dry ng O depleting fluid status and Vital signs:
throat ko. electrolytes. adequacy of fluid
@8am L RR: 20
Natatakot Accompanied replacement.
I PR: 85
kasi ako pag- by limited
iinom na C intake of water
naman ako ng and water- Promote a
4
madaming containing food comfortable
tubig, isusuka P these factors environment. Cover Charisse
ko din naman. can easily lead the client with light Caydan, St. N
A
Konti lang to dehydration sheets.
T
talaga water and weight
R: Avoids
Jonji Dominic
intake” as T loss.
overheating, which
Coronel, St. N
verbalized by
E could promote further
the pt.
fluid loss

165
 R Reference:

N Reber, Gomes, Reinforce the 5

Dähn, importance of
Objective:
Vasiloglou, & proper hydration.
VS: Stanga.
R: To encourage
RR: 23 (12- (2019).
adherence to
20) Management
interventions and to
of Dehydration
PR: 105 (60- allow the patient to
in Patients
100) recognize the
Suffering
importance of
Swallowing
adequate hydration
Difficulties.
Limiting self
Journal of
fluid intake
Clinical Encourage the
6
Medicine, patient to increase
Cracked lips 8(11), 1923. fluid intake within
https://doi.org/ the body
10.3390/jcm81 requirement 1.5-2L /
Dry skin 11923 day. May start with
ice chips and small
frequent sips of
Nausea and

166
vomiting water until a large
amount of water
intake is tolerated.
Weight loss of
R: To relieve fluid loss
6kg from 92kg
and maintain
to 86kg.
adequate levels of
fluid in the body.

750 ml fluid Gradually increase

intake intake to make the

patient comfortable
with the increase in
Hoarseness intake.
of voice noted

Administer fluids, as
Constipation indicated such as IV. 7

R: Intravenous
solutions replace
Bloating and
extravascular and
distention of
intravascular fluids
Abdomen
and replenish

167
noted electrolyte losses.
They also dilute both
the levels of glucose
Decreased and circulating
urination with counterregulatory
cloudy urine hormones
output

Keep the head

8
elevated when lying
down.

R: The gravity
prevents the reflux of
acid.

Advise not to wear

9
tight clothes.

R: TIght clothes
increase the pressure
in the abdomen which

168
promotes reflux of
acid.

Maintain adequate
10
nutrition and follow
the prescribed diet.
Avoid dairy, coffee
and other highly
acidic food.

R: These foods are

highly acidic which
may promote
discomfort in the
patient. Additionally,
Increased acid intake
may precipitate acid
reflux.

11
Increase fiber diet
while avoiding

169
highly acidic food.

R: Increased fiber
intake can help
improve bowel
movement, it helps
pull water from the
colon, making the
stool softer and easier
to pass.

Administer
prescribed
medication
12
including
antiemetics, and
antihypertensive
medication.

R: This can help

prevent and reduce
incidence of vomiting

170
and increased blood
pressure in the
patient.

171
 NCP #3- DEFICIENT KNOWLEDGE

DATE & CUES NEED NURSING PATIENT INTERVENTION IMPLEMENT EVALUATION

TIME DIAGNOSIS OUTCOME ATION

S Subjective P Deficient Within 8 hours of Assess patient for 1 September 8,

Cues: knowledge nursing information needed 2022
E E
related to intervention the and ability to
● “matagal- 3PM
P R inadequate patient will be able perform actions
tagal na
T C knowledge of to: independently
din
resources as GOAL MET
E sumasakit E ● Verbalize R: provides a basis
evidenced by
ang tiyan understandin for teaching
M P inappropriate
ko like a g of the
behavior
B month T cause of acid
already reflux Provide patient with The patient was
E I
but, I ● Discuss own information able to:
R O 2
usually role in regarding disease
ignore it” R: Lack of preventing process, health
N
knowledge practices that can a. Verbalized
as recurrence
8 / understandi
verbalized about the ● Identify and be changes, and
C disease and its medications to be ng of the
by the implement
precautions utilized cause of
patient necessary

172
2 ● “Sometime O can jeopardize lifestyle R: provides acid reflux.
s, I feel one's safety changes knowledge and Patient
0 G
nauseated and quality of such as facilitates compliance verbalized
2 and may N life. As a result, eating “Kaya pala

2 parang I people seek smaller and may acid

heartburn medical frequent Instruct patient to reflux ako
T 3
lalo na attention when meals, avoid avoid bending over, kasi hindi
8 pagsumas I their condition foods that coughing, straining ako
akit na worsens. causes at defecations, and kumakain
A O
tiyan ko” (Osmosis.org, heartburn other activities that sa tamang
M N
● “Minsan, N.D) and avoid increase reflux. oras at
nakakalim alcohol R: promotes comfort usually
utan ko by the decrease in kape lang.
like di na intraabdominal Ngayon
pala ako pressure, which naiintindiha
nakakapa reduces the reflux of n ko na”
glunch gastric contents b. Discussed
basta may own role in
kape okay preventing
na araw Instruct patient to recurrence.
4
ko.” eat slowly, chew “Para di na
foods well and bumaik ang

173
 maintain a high- sakit
protein, low-fat diet kailangan
Objective
ko i-follow
Cues: R: this helps prevent
ang order ni
reflux
● Facial Doc at
grimacing alagaan ng
● Guarding mabuti ang
Instruct patient
behavior 5 sarili ko. If
regarding eating
● Weight may
small amounts of
loss of maramdam
bland food followed
6kgs (from an ako na
by a small amount
92 kgs to sintomas,
of water. Instruct to
86 kgs) mag pa
remain in upright
● Hoarsenes follow up
position at least 1–2
s of voice check up
hours after meals,
● Abdomen ako”
and to avoid eating
is c. Identify and
within 2–4 hours of
distended implement
bedtime.
and necessary
bloated R: gravity helps
lifestyle
with control reflux and
changes.
stomach causes less irritation
“Para di na

174
gurgling from reflux action into sumakit ulit
noises the esophagus tiyan ko,
kailangan
ko umiwas
Advise the patient to sa mga
6
avoid smoking pagkain like

R: Nicotine from fried food,

smoking relaxes the chili or

esophageal sphincter pepper at

and increases acid coffee.

production in the Dapat

stomach dahan-
dahan lang
kumain at
Instruct patient to 7 kailangan
raise both arms, ko din
fully extended umiwas sa
towards the ceiling alcohol” as
prior to eating verbalized
by the
patient.

175
R: relieves spasms
and allows for more
comfort when eating

Assist patient with

the reduction of 8

caloric intake

R: Being overweight
increases intra
Cavalida, Doreen
abdominal pressure
Mae P . St.

Instruct patient to
avoid temperature
extreme food, spicy Espineli, Alyssa
9
foods, and citrus Beatrice F. St.N
and gas forming
foods

R: These food items

increase acid

176
production that
precipitates heartburn
and increased reflux

Instruct patient in
medications, 10

effects, side effects,

and to report to
physician if
symptoms persist
despite medication
treatment

R: Promotes
knowledge, facilitates
compliance with
treatment, and allows
for promt
identification of
potential need for
changes in

177
medication regimen
to prevent
complications

178
 C. Review of Related Literature

Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of

Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-
related Disorders
Reference:
Wang, Y. J., Lang, X. Q., Wu, D., He, Y. Q., Lan, C. H., Xiao, X., Wang, B., Zou,
D. W., Wu, J. M., Zhao, Y. B., Dettmar, P. W., Chen, D. F., & Yang, M. (2020).
Salivary Pepsin as an Intrinsic Marker for Diagnosis of Sub-types of
Gastroesophageal Reflux Disease and Gastroesophageal Reflux Disease-related
Disorders. Journal of neurogastroenterology and motility, 26(1), 74–84. DOI:
https://doi.org/10.5056/jnm19032

The prevalence of GERD has increased recently, having a substantial

influence on the quality of life. Gastroesophageal reflux disease (GERD) is "a
condition that occurs when the reflux of stomach contents into the esophagus
causes symptoms and consequences." One of the key constituents in the reflux
fluid and one of the leading damage causes in GERD patients is pepsin, released
by the chief cells and activated in acidic gastric secretions. Pepsin can enter the
oral cavity with the reflux fluid and be mixed with saliva when reflux occurs. Pepsin
is deactivated at pH 7.0 and reactivated following re-acidification. Saliva pepsin
may therefore be crucial in diagnosing GERD as it can be used to predict the
development of the condition. The study aims to test whether salivary pepsin is a
definitive diagnostic value for GERD-related disorders.

The study demonstrated salivary pepsin's critical role in diagnosing GERD

and GERD-related diseases. Salivary Pepsin Collection was significantly higher in
the groups with extra-esophageal symptoms, Barrett's esophagus, non-erosive
reflux disease, erosive esophagitis, and EES + T-GERD than in the healthy control
group. Thus, salivary pepsin level is an intrinsic biomarker for diagnosing GERD
and GERD-related disorders. The positive rates of salivary pepsin in this study
ranged from 65.0 to 76.3% for the diagnosis of non-erosive reflux disease, erosive

179
esophagitis, extra-esophageal symptoms, and Barrett's esophagus. A previous
study reported a positive rate of 78.6% using salivary pepsin to diagnose reflux-
related diseases.

Salivary pepsin levels are crucial for evaluating GERD patients with
primarily respiratory symptoms because they can immediately discriminate
between real reflux and non-reflux disorders. This study demonstrated that the
salivary pepsin test positive rate for NERD patients was significantly higher than
the pathologic reflux as determined by 24-hour pH monitoring, indicating that the
salivary pepsin test can complement or combine with the 24-hour pH monitoring
and improve the efficiency in the diagnosis of GERD. The study also revealed that
SPC and positive rates dramatically decreased after PPI treatment in the NERD
and EES groups, indicating that PPI medication may lessen the SPC by preventing
gastric acid secretion.

A previous study by Li et al. revealed that the intercellular space

measurements were higher in the EE and NERD groups. Pepsin is one of the main
ingredients in the reflux fluid and one of the main injury factors in GERD. Previous
studies have shown that esophageal and throat tissues were sensitive to pepsin
and that a small amount of activated pepsin could cause inflammation in the
mucosa of the esophagus and throat. This would then cause Salivary pepsin levels
to be higher in NERD patients than in FH patients. In the NERD group, SPCs were
linked with the degree of mucosal integrity deterioration. Diagnostics can therefore
use low amounts of salivary pepsin to identify FH patients.

Therefore, salivary pepsin is crucial for diagnosing GERD and GERD-

related illnesses. Comparing the salivary pepsin test to conventional GERD
diagnostic techniques reveals some advantages. It is anticipated that the salivary
pepsin test will play a significant role in diagnosing GERD patients. Salivary pepsin
and 24-hour pH monitoring may work in conjunction to increase the effectiveness
of the diagnostic process.

180
Inverse correlation between gastroesophageal reflux disease and atrophic
gastritis assessed by endoscopy and serology
Reference:
Han, Y. M., Chung, S. J., Yoo, S., Yang, J. I., Choi, J. M., Lee, J., & Kim, J. S.
(2022). Inverse correlation between gastroesophageal reflux disease and atrophic
gastritis assessed by endoscopy and serology. World Journal of Gastroenterology,
28(8), 853–867. https://doi.org/10.3748/wjg.v28.i8.853

The condition known as gastroesophageal reflux disease (GERD) is

characterized by recurring reflux of gastric contents into the esophagus as a result
of momentary relaxation or low pressure of the lower esophageal sphincter.
Erosive reflux disease is a condition with bothersome symptoms and structural
changes in the esophagus, such as mucosal breaks, erosion, or ulcers. However,
only one-third to one-half of GERD patients have endoscopic findings that are
positive.
While this is going on, non-ERD is defined as the presence of normal
esophageal symptoms without endoscopic alterations. The rise in GERD
prevalence may be influenced by a number of variables, including an extended life
expectancy, a westernized lifestyle, and an increased incidence of obesity. As a
result of hospital visits, high medical costs for diagnosis and treatment, and
numerous issues with quality of life, GERD and its consequences, including reflux
esophagitis and Barrett's esophagus, place a heavy socioeconomic burden on
society. Numerous epidemiological studies have assessed the GERD risk factors.
There are several established risk factors for GERD, including male sex, caffeine
intake, smoking, alcohol consumption, dietary variables, a low level of education,
and obesity.
Numerous research studies have shown an inverse relationship between
GERD and Helicobacter pylori (H. pylori) infection. In a case-control study
conducted in Japan, the majority of instances of reflux esophagitis occurred in
patients with atrophic gastritis without H. pylori infection or in less severe cases of
gastritis with the infection. According to multiple epidemiological research and

181
systematic reviews, H. pylori infection lowers the likelihood and severity of GERD.
Furthermore, following H. pylori eradication therapy, the severity of reflux
esophagitis and GERD symptoms worsen. These results point to a potential
protective role for H. pylori infection in the prevention of GERD due to the reduction
in acid secretory capability brought on by gastric mucosal atrophy. Numerous
research have examined the connection between atrophic gastritis and GERD
because gastric mucosal atrophy is thought to be a crucial mechanism by which
H. pylori infection avoids the occurrence or aggravation of GERD.
H. pylori infection may not be the only factor influencing the development of
reflux esophagitis, according to a few studies that used endoscopic biopsies to
grade the severity of atrophic gastritis using a modified updated Sydney
classification. In the meantime, the gastric corpus's involvement and degree of
atrophy are separate protective factors against GERD. However, because to its
invasive character, endoscopic forcep biopsy-based histological diagnosis of
atrophic gastritis is not always practical in routine clinical settings. A recognized
serologic marker, pepsinogen, reflects the stomach gland's capacity to secrete
acid. As a result, it might be used to forecast if stomach atrophy will occur. It's
interesting to note that GERD was adversely linked with H. pylori IgG seropositivity.
The prevalence of H. pylori infection is noticeably lower in GERD patients,
according to several earlier research. It is believed that H. pylori-caused chronic
inflammation causes gastric atrophy, which further reduces the gastric mucosa's
ability to secrete acid. As a result, the kind and spread of gastritis caused by H.
pylori are more significant than the infection itself. Patients with antral gastritis have
a higher chance of developing GERD because antral gastritis causes
hypergastrinemia and increased acidity. Contrarily, it is believed that decreased
stomach acid production in situations of severe corpus gastritis is the primary
mechanism through which H. pylori infection protects against GERD.
Using this information, we calculated the risk of GERD based on the degree
of EAG. Interestingly, as the degree of EAG increased, the risk of GERD gradually
decreased. It was highest in connection with C1. This demonstrates that the main
risk factor for GERD is atrophic gastritis rather than H. pylori infection itself.

182
 D. Discharge Planning
Method Health Teaching
Medication Instruct the patient to follow
all prescription instructions
precisely. Stress the
importance of not skipping
doses or taking less than the medications exactly as prescribed.
prescribed dosage.
Exercise Maintain adequate rest
Do mild to moderate
exercise making sure not to
overwork the body and
avoiding exercises that
would taunt the lower
esophageal sphincter’s
barrier function
Treatment Avoid having tight clothing
especially around the
abdominal area, after eating
a meal.
Apply warm compress.
Rationale
In order to effectively treat the
illness and enhance the patient's
general health and wellbeing, it is
necessary to take all prescription
Being well rested will assist in
decreasing stress and in the
recovery process.
Certain exercises can decrease
blood flow to your gastrointestinal
area. This can cause gastric fluids
to pool, leading to inflammation and
irritation. Restrictive body positions
can also put pressure on your
stomach and chest, which may
trigger symptoms.
Tight clothing around the abdomen
can increase the pressure on the
stomach and promote reflux of acid
from the stomach, up into the
esophagus.
To alleviate pain and promote
relaxation in the epigastric area,
183

Avoid bending over or
reaching below your waist
for 2 hours after having a
meal for any activity, such
as tying shoe lace or picking
up items from the ground.
Always elevate the level of
head when lying down.
Hygiene Practice hand washing
before and after eating,
preparing foods, and in
contact with something dirty.
Secure clean and safe food
preparation and water
source
Avoid sharing eating
utensils.
Practice proper oral hygiene
Outpatient Instruct the patient or
caretaker to visit the doctor
These activities can increase the
pressure on the stomach and cause
reflux of acid from the stomach, up
into the esophagus.
Sleeping or lying down with the
head elevated lets the gravity
prevent the reflux.
Good hand hygiene will reduce the
risk of contagious diseases, food
poisoning, and spreading bacteria.
To ensure that food and water is
safe for human consumption
To reduce transmission of
communicable diseases and
microorganism
To prevent dental plaque formation.
Since in the oral cavity H. pylori is
mostly found in dental plaque, it
can be a source of gastric
infection.
A physician-ordered follow-up
guarantees appropriate drug
184
 for medical follow-up and if adherence, therapeutic response,
specific symptoms persist. and illness progression. This may
avoid the development of problems
and/or infections.

Consulting a physician with

specialized training in managing
If symptoms persist and
disease of the gastrointestinal tract
worsen, consult a
can help plan and follow more
gastroenterologist.
specified care.

To gain access and knowledge to

programs related to the patient’s

Refer to social services condition.

related to the health concern

Diet Instruct the patient to avoid These foods take more time to
food that is high in fats, empty and stay in the stomach
sodium, caffeine, dairy and longer and increase the risk to
sugar content. Avoid acidic promote GERD symptoms.
foods such as alcohol, acidic Additionally, these foods are highly
liquids, etc. acidic in the stomach which can
cause acid reflux.

Big meals increase the pressure in

the stomach and can contribute to
Instruct the patient to avoid
the return of acid contents into the
eating big meals. Eat small,
esophagus, resulting in GERD
frequent meals instead of a
symptoms.
big meal.

185
 Gravity acting in downward
direction, prevents acid from
traveling up into the esophagus and
Avoid eating closer to
helps with preventing GERD
bedtime.
symptoms. Eating closer to bedtime
and laying down can eliminate the
effect of gravity, contribute to the
return of acid contents into the
esophagus, and make GERD
symptoms.

XI. PROGNOSIS

The prognosis of GERD is extremely good with 80-90% of the affected

individuals recovering with the help of antacids. There is a possibility that some
patients will require additional medication, but it is difficult to predict how long it will
take for them to become better. In other cases, it's possible that the recovery will
only be temporary or in part (Tharu, 2018).

If gastroesophageal reflux disease (GERD) is not treated, it can lead to a

number of significant consequences, such as esophagitis and Barrett's esophagus.
The severity of esophagitis can range greatly, with the most severe cases leading
to widespread erosions and ulcerations in the esophagus as well as a narrowing
of its diameter. Additionally, esophagitis can result in bleeding in the

186
gastrointestinal (GI) tract. However, many people experience a recurrence after
therapy is stopped, underscoring the significance of continuing medicine for the
long term. Medication is helpful for the majority of patients who have GERD.
However, many people experience a relapse after treatment is stopped. It is critical
to rapidly treat patients who fall into the group of people who are at the highest risk
of developing the most serious consequences of GERD. This subset can be
determined by determining the individuals who are at the highest risk. When it
comes to these patients, performing surgery at a more preliminary stage is more
likely to be beneficial. Moreover, the majority of people are responsive, both to
alterations in lifestyle and to drugs that are prescribed for them. Nevertheless, it is
necessary for many patients to continue taking their prescribed drugs in order to
keep their symptoms under control.

The prognosis of the patient in the case study is also considered to be a good
prognosis because there is no history of bleeding and the causative factor for his
ulcers has already been identified as H. Pylori, which is typically responsive to
antibiotic treatment. As a result, the prognosis for the patient is considered to be a
good prognosis.Treatment of symptoms of gastroesophageal reflux disease
(GERD) that is successful has been associated with a considerable increase in
quality of life. This improvement involves a decrease in the amount of physical pain
that is experienced, as well as increases in vitality, physical and social function,
and mental well-being. In addition, this improvement includes a decrease in the
amount of time spent in pain. If treated effectively, gastroesophageal reflux disease
(GERD) has a favorable prognosis.

187
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190