Case Presentation:

Kristil Chavez and Christiana Cruz BN3A

Gastroesophageal
DEFINITION
Reflux Disease
- The excessive backflow of
(GERD) gastric or duodenal contents,
or both into the esophagus
and past the lower
esophageal sphincter (LES)
for a sustained length of time
without associated belching
or vomiting.
SIGNS AND Heartburn

SYMPTOMS
Regurgitation (food comes
back into your mouth from
the esophagus)
The feeling of food caught in
your throat
Coughing
Chest pain
Problem swallowing
Vomiting
Sore throat and hoarseness
CAUSES
Too much pressure on the abdomen. Some pregnant
women experience heartburn almost daily because of this
increased pressure.
Particular types of food (for example, dairy, spicy or fried
foods) and eating habits.
Medications that include medicines for asthma, high blood
pressure and allergies; as well as painkillers, sedatives and
anti-depressants.
A hiatal hernia. The upper part of the stomach bulges into
the diaphragm, getting in the way of normal intake of food.
COMPLICATIONS
Esophagitis: Esophagitis is the irritation and inflammation the stomach
acid causes in the lining of the esophagus.
Barrett's esophagus: Barrett's esophagus is a condition that develops in
some people (about 10%) who have long-term GERD.
Esophageal cancer: Cancer that begins in the esophagus is divided into
two major types. Adenocarcinoma usually develops in the lower part of
the esophagus. This type can develop from Barrett’s esophagus.
Squamous cell carcinoma begins in the cells that line the esophagus.
Strictures: Sometimes the damaged lining of the esophagus becomes
scarred, causing narrowing of the esophagus.
 DIAGNOSTIC TOOLS

Esophageal pH and impedance monitoring

Upper GI endoscope
Upper GI series
Esophageal manometry
Bravo wireless esophageal pH monitoring
Patient: Dawn Kristine Diaz
Address: Victorias City
Age: 54 years old
Sex: Female
Admission Date: February 14, 2023
Chief Complaint: Difficulty in swallowing,
Heartburn after eating, Blood-streaked
vomitus.
Attending Physician: Dr. Carla Mae Garcia
 Health History
Episodes of mid epigastric pain,
burning sensation in his chest, an
association dry cough, and occasional
regurgitation.
Waking up from the pain and burning
with a sore throat and hoarse voice.
Associated mid-thoracic, bilateral back
pain that occurs during the episodes.
Social History
She stated that due to her work, she
often skips her meals. She tends to eat
larger meals and she is also eating late
at night.
She loves to eat pork and beef. She is
fond of eating dishes that are fried and
fatty in preparation. She seldom eats
vegetables.
LABORATORIES RESULTS/INTERPRETATION

Chest Xray PA result Essentially normal lung fields

Barium Swallow Enlarged veins and varices

Reflux is 10% at any pressure level

*Normal values: reflux is less than or
Gastroesophageal Reflex
equal 4% across the esophageal
sphincte
PATHOPHYSIOLOGY
Precipitating Factor
Consumption of
Predisposing
high fat diet
Factor
Often skips meals
Age: 54 years old Gastroesophageal
Eating larger meals
Female Reflux
at night

digestive disorder that affects the

Lower esophageal Allowing the lower esophageal sphincter (LES),
Indigestion
sphincter (LES) is stomach's the ring of muscle between the
episodes and
weak or relaxes contents to esophagus and stomach
Regurgitation
inappropriately flow up

Increased Stomach acid

pressure in the frequently flows back This backwash (acid reflux)
abdomen
Hiatal into the tube can irritate the lining of
connecting your mouth esophagus
NURSING DIAGNOSIS
Acute Pain related to gastroesophageal reflux as evidenced
by heartburn.
Imbalanced Nutrition: Less than Body Requirements related to
inability to digest and metabolize food as evidenced by heartburn
and epigastric pain after eating.
Risk for Aspiration related to impaired swallowing.
 NURSING MANAGEMENT

Heartburn is the most common feature of
Assess for heartburn. GERD. This becomes more severe with

vigorous exercise, bending, or lying down.

Pain of esophageal spasm resulting from

Carefully assess pain location and discern
reflux esophagitis tends to be chronic and
pain from GERD and angina pectoris.
may mimic angina pectoris: radiating to

the neck, jaws, and arms.



Heartburn is the most common feature of

Avoid placing the patient in supine
GERD. This becomes more severe with
position, have the patient sit upright
vigorous Supine position after meals can
after meals.
increase regurgitation of acid., bending, or lying

down.

Drugs have varying effects based on each

Give analgesics as ordered,
person’s metabolism and efficacy should be
evaluating their effectiveness and
evaluated on a case-by-case basis. Monitoring
observing for side effects.
for side effects is also important to maintain

the patient’s comfort and safety.

 If the patient is experiencing an

altered passage of time due to pain,
Respond immediately to reports of fear about delayed pain relief can
pain. exacerbate the pain experience.

Prompt responses to reports of pain
reduce anxiety and promote trust.

PHARMACOLOGICAL
TREATMENT
Risec 40mg IVTT now
Risec 80mg + 100ml PNSS q8h via IV infusion
Calci-Aid 500mg 1 cap TID p.o.
Prelax 5mg 2 tabs ODHS p.o. x 2 days
Plazimide 10mg IVTT q8H PRN for nausea and
vomiting
Siverol 50mg IVTT q6h PRN for breakthrough pain
NON-PHARMACOLOGICAL
TREATMENT
Avoid foods and beverages triggers
Eat smaller servings/ Do not eat heavy
Chew your food thoroughly
Elevate your head when lying down in bed
Wear loose clothes.
REFERENCES
WebMD. (n.d.). Gerd: Symptoms, causes, treatments, remedies for relief. WebMD.
https://www.webmd.com/heartburn-gerd/guide/reflux-disease-gerd-1

Gerd (chronic acid reflux): Symptoms, treatment, & causes. Cleveland Clinic. (n.d.).
https://my.clevelandclinic.org/health/diseases/17019-gerd-or-acid-reflux-or-heartburn-overview

Gastroesophageal reflux disease (GERD). Harvard Health. (2023, February 2). Retrieved February 15, 2023,
from https://www.health.harvard.edu/a_to_z/gastroesophageal-reflux-disease-gerd-a-to-z

MediLexicon International. (n.d.). Gerd: Symptoms, causes, and treatment. Medical News Today.
Retrieved February 15, 2023, from https://www.medicalnewstoday.com/articles/14085
THANK YOU