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GERD NCLEX Review

This NCLEX review will discuss GERD (gastroesophageal reflux disease).

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As a nursing student, you must be familiar with GERD and how to care for patients who are
experiencing this condition.

These type of questions may be found on NCLEX and definitely on nursing lecture exams.
Don’t forget to take the GERD quiz.

You will learn the following from this NCLEX review:

Definition of GERD

Pathophysiology

Signs and Symptoms

How it is diagnosed

Treatment

Nursing Interventions for GERD

Medications

Lecture on GERD

GERD | Gastroesophageal Re1ux Disease Nursing NCLEX L…

GERD NCLEX Review

 What is GERD?

GERD stands for Gastroesophageal Reflux Disease and it is a chronic

condition where stomach contents flows back up into the esophagus
which is mainly due to a damaged/weak lower esophageal sphincter.

GERD is sometimes referred to as “acid reflux disease” as well.

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Some people have random episodes of acid reflux and it goes away, but GERD is when it occurs
more than twice a week for a long period of time.
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Why is GERD happening? In a nutshell, the LES (lower esophageal sphincter) is not staying closed
but opening. This allows backwash of stomach contents and acids into the esophagus, and this
leads to major irritation to the esophagus. See below the reasons for a weak/damaged LES.

First let’s cover what happens in normal swallowing:

Physiology of swallowing food:

Digestion starts in the mouth when food is chewed. Then it is swallowed. The food is then
squeezed down into the esophagus and the lower esophageal sphincter relaxes to let the food into
the stomach and then it CLOSES again to prevent the food from back flowing. Parietal and chief
cells are stimulated from the food to produce acid and digestive enzymes to break down the food.
In GERD, the acids and food can flow back into the esophagus.

Key Players in GERD

Esophagus: the tube that connects to the stomach to allow food to enter into the stomach. It
squeezes food down into the stomach each time we swallow and the lower esophageal sphincter
opens. It plays a role in GERD if the esophagus is unable to perform this role correctly due to
impaired motility.

Lower esophageal sphincter: collection of circular muscles at the end of the esophagus that
closes and prevents toxic acids and GI contents from flowing back into the esophagus once it
enters the stomach. The LES can become:
 weak from pressure: due to delayed gastric emptying (anticholinergics can delay
gastric emptying), hiatal hernia, pregnancy, obesity, overeating (stomach distention), or
medications: antihistamines, calcium channel blockers, antidepressants, sedatives,
smoking
How does a hiatal hernia cause GERD? A hiatal hernia happens when the
stomach pushes through a weak diaphragm and sits on top of it. All the stomach
should be below the diaphragm and the esophagus should be above the
diaphragm. When a hernia forms there is pooling of gastric acid/contents in the
herniated area and this increases pressure and causes the LES to become weak.

closes at irregular times due to impaired motility

Esophageal mucosal lining: erodes and becomes damaged over time from the constant backwash
of acids/contents and ulcer/sores form…hence “esophagitis”….complications: esophageal cancer,
Barrett’s esophagus, narrowing of the esophagus, bleeding

Stomach Acid & Contents: erodes the esophagus….if the acid and contents makes it pass the
upper esophageal sphincter it can enter into the lungs causing pneumonia, aggravate asthma signs
and symptoms, coughing, ear infections, voice changes, chronic cough, and night time
coughing…..called laryngopharyngeal reflux (GERD can lead to this)

Complications of GERD

Inflammation of the esophagus (increased risk of cancer from the chronic inflammation)

Narrowing of the esophagus: strictures

Lung problems: asthma, pneumonia, voice changes, wheezing, fluid in the lungs

Barrett’s esophagus: lining of the esophagus is replaced with similar lining that makes up the
intestinal lining…increase risk of cancer.

Signs and Symptoms of GERD

Note: not all people with GERD will have heartburn but may have chronic cough, recurrent
pneumonia, regurgitation of food

Gastric pain (upper)

Excess regurgitation of food… bitter taste in the back of the throat

 Regular, occurring burning sensation in the chest or abdomen (it can be so intense it feels
similar to a MI)

Dry cough (frequent)…worst at night

Nausea

Problems Swallowing…feels like a lump is in the throat

Lung Infections

How is GERD Diagnosed?

Endoscopy: used to assess the esophagus for changes…erosions, strictures etc.

Esophageal Manometry: looks at the function of the esophagus’ ability to squeeze the food
down and how to the lower esophageal sphincter closes

pH monitoring: measures the acid amounts in the esophagus for a 24 hour period as the
patient performs normal activities of daily living…small tube stays in the esophagus to help
measure the acid amounts

Treatment of GERD: lifestyle changes, medications, surgery such as: fundoplication which is
where the fundus of the stomach is placed around the lower part of the esophagus (most severe
cases)

Nursing Interventions for GERD

Assess patient for signs and symptoms of GERD, educating, administering medications per
MD order

Assess quality and characteristic of the pain and differentiate the signs and symptoms from a
heart attack?

Assess for other signs and symptoms rather than heartburn…do they have respiratory changes,
dry cough that is worst when lying down, hoarseness of the voice? Is the pain aggravated when
eating a heavy meal? What food makes it worst? (help develop a diet plan to decrease signs and
symptoms) What medications are they taking?
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Assess for signs and symptoms of aspiration? Coughing, voice changes, lower oxygen saturation,
increase respiration, abnormal lung sounds

Education for GERD

Eat small meals rather than large ones (prevents over eating)

Avoid foods that relax the LES: greasy, fatty, ETOH, soft drinks (increase pressure on the LES
and cause regurgitation), and coffee, peppermint/spearmint

Avoid eating right before bed (last meal should be 3 hours before bed)

Sit up after eating for at least 1 hour

Weight loss

Smoking cessation

Watch acidic foods: citrus and tomatoes

Medications for GERD

Antacids, H2 blockers, PPIs, prokinetics

Antacids: neutralizes acid

Types: Magnesium Hydroxide, Calcium Carbonate…these are chewed thoroughly and then
swallowed
 Interferes with MANY drugs: PO antibiotics, mucosal healing, H2 blockers…. so always give
alone and allow for 1-2 hours before administering other medications

Histamine-receptor blockers: decreases secretion of gastric acid

Types: “Ranitidine HCL “Zantac” or Famotidine “Pepcid”

End in “tidine”

Short-term or PRN basis

How do they work? They block histamine. When histamine is released it causes the parietal
cells to release HCL but this response will be blocked so gastric acid secretion will be
decreased.
Avoid giving at the same time with antacids or Carafate

Proton-pump Inhibitors (PPIs): decreases stomach acid and helps esophagus heal

Types: “Omeprazole “Prilosec” or Pantoprazole “Protonix”

end in “prazole”

Long-term usage but there are risks: increased risk for bone fractures

How do they work? Attaches to the “proton pump” on the parietal cells which is the
hydrogen/potassium (H+, K+) ATPase enzyme and blocks the release of hydrogen ions.
These ions would mixed with the chloride ions and form gastric acid but this is blocked so
there is a decrease in gastric acid.

Prokinetics: prevent delayed gastric emptying by improving pressure in LES and peristalsis of the
GI tract:

Types: “Bethanechol” Urecholine or Reglan “Metoclopramide”

More NCLEX Reviews

References

1. “Barrett’s Esophagus | NIDDK”. National Institute of Diabetes and Digestive and Kidney Diseases. Web. 4 Apr. 2017.

2. “Definition & Facts For GER & GERD | NIDDK”. National Institute of Diabetes and Digestive and Kidney Diseases. Web. 3 Apr. 2017.
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