7908523
Description
Gastroesophageal
Reflux Disease
- Pathophysiology: A chronic disease of
the digestive system that effects the
lower esophageal sphincter (LES)
(Pettit, M, 2005)
- Abnormal reflux of gastric
acidic contents into the
esophagus Individual’s
gastric contents causes
complications or lead to
otherwise painful or
problematic symptoms
(Rubenstein & Chen
2014)
- Gastric
acidic
contents pH
of 4 and
below
- Gastric
acidic
contents pH
of 4 and
below
- Clinical
Manifestations
- Extra-Esophageal
- *Vocal Chord
Granuloma *Chest
pain (can feel like
angina pectoris)
*Globus *Subglottic
stenosis
*Hoarseness
*Chronic cough
*Pharyngitis
*Sinusitis (Pettit, M,
2005)
- *Vocal Chord
Granuloma *Chest
pain (can feel like
angina pectoris)
*Globus *Subglottic
stenosis
*Hoarseness
*Chronic cough
*Pharyngitis
*Sinusitis (Pettit, M,
2005)
- Erosive Esophagitis
- * Heartburn
*Epigastric Pain
*Regurgitation
*Retrosternal Pain
and burning (Pettit,
M, 2005)
- * Heartburn
*Epigastric Pain
*Regurgitation
*Retrosternal Pain
and burning (Pettit,
M, 2005)
- General Syptoms
- Burning sensation on the
(chest heartburn), chest
pain, dysphasia, dry
cough, regurgitation of
food (acid reflux) and
constant hiccups (Liker,
Hungin & Wiklund, 2005)
- Burning sensation on the
(chest heartburn), chest
pain, dysphasia, dry
cough, regurgitation of
food (acid reflux) and
constant hiccups (Liker,
Hungin & Wiklund, 2005)
- Extra-Esophageal
- Complications
- Esophageal
ulcer (sore in
the esophagus)
(Liker, Hunger &
Wiklund, 2005)
- Caused by the
severe injures
to the the
mucosa lining
of the
esophagus
- Caused by the
severe injures
to the the
mucosa lining
of the
esophagus
- Esophageal
stricture
(formation of
scare tissue)(Liker,
Hunger & Wiklund,
2005)
- Barrett
esophageal
(tissue lining the
lower esophagus
changes) (Liker,
Hunger &
Wiklund, 2005)
- Esophageal
ulcer (sore in
the esophagus)
(Liker, Hunger &
Wiklund, 2005)
- Abnormal reflux of gastric
acidic contents into the
esophagus Individual’s
gastric contents causes
complications or lead to
otherwise painful or
problematic symptoms
(Rubenstein & Chen
2014)
- Working with Patient beliefs(
Robbio 2017)
- Test and Diagnosis ( Epstein, et
al; Jones, Coyne,& Wiklund
2007)
- Ambulatory acid pH test
to ascertain acid in the
esophgus
- Barium swallow to
define anatomy of
upper digestive tract
- X-ray to determine
silhouette of the
esophaus
- X-ray to determine
silhouette of the
esophaus
- Esophgeal Manometry to
measure the muscle
pressure and movement
in the esophagus
- Endoscopy to collect
sample tissue (biopsy) for
further testing
- Ambulatory acid pH test
to ascertain acid in the
esophgus
- Surgical Management (
option for some patient)
Rubenstein & Chen, 2014
- Nissen fundoplication
involve tightening the
LES to prevent reflux
- Surgery to strenghten
the LES ( Link) ring
wrapped around the
junction of the stomach
- Nissen fundoplication
involve tightening the
LES to prevent reflux
- Medication & Treatment
(Jones,Coyne& Wiklund 2007)
- Antacid such as as
Maalox,Mylanta etc
that neutralize
stomach acid for
quick relief
- H-2 receptor blockers eg
Famotidine, nizatidine ,
to reduce acid
production
- Proton Pump inhibitors eg
Lansoprazole,
Omeprazole block acid
production
- Baclofen strengthen the
LES hence reduce acid
reflux
- Alternative Medicine
(Yang, Jian, Hou &
Song 2015
- Accupunture reduces pain
associated with GERD
- Relaxation therapy
- Meditation & deep
breathing
- Herbal remedies
- Collaborative therapy
- Elevation of head of bed to
10-15cm help control reflux
- Elevation of head of bed to
10-15cm help control reflux
- Accupunture reduces pain
associated with GERD
- Antacid such as as
Maalox,Mylanta etc
that neutralize
stomach acid for
quick relief
- Test and Diagnosis ( Epstein, et
al; Jones, Coyne,& Wiklund
2007)
- HIGH RISKS Groups (Pettit,
M, 2005)
- Elderly
- Caucasians
- Men
- Pregnant Women
- Higher
Abdominal
Pressure
- LES tone is reduce
by Progesterone
levels Estrogen
- Higher
Abdominal
Pressure
- People with related Disorders
- Gastric acid
hypersecretion
- Increased
volume of
gastric acid
- Increased
volume of
gastric acid
- Obesity
- intra-abdominal
pressure
increased
- intra-abdominal
pressure
increased
- Hiatus
hernia
- Esophageogastric
junction
is
weakened
- Disrupts
esophageal
clearance
- Esophageogastric
junction
is
weakened
- Gastric acid
hypersecretion
- Elderly
- Risk Factors (Rubenstein
& Chen 2014
- Smoking
- Alcohol
abuse
- Diabetes
- Zollinger
ellison
sydrome
- Barrier to care( social determinant
of health )
- Poverty will lead poor health outcome
- Education
- Unemployment
- Addiction or substances abuse
- Depression/stree
- Poverty will lead poor health outcome
- Smoking
- Nursing Intervention (
Robbio 2017, Lewis, Barry,
Goldsworthy & Goodrige
2009
- Clarifying
understanding of
disease to patient ( Lewis, Barry ,
Goldsworthy &
Goodridge
- Teach patient to
avoid trigerrs of
LES
- Encourage/teach
patient tonfeed small
but frequent meals
- Assess Patients'
pain location and
intensity (Liker,
Hungin & Wiklund
2005)
- Assess patients ability to
swallow and the
presences of gag reflex
- Teach patient in
medication, side
effect and report
to physician if
symptoms persist
- Discuss strategies for
overweight reduction if
possible
- Self care
- Teach patient to
avoid trigerrs of
LES
- Clarifying
understanding of
disease to patient ( Lewis, Barry ,
Goldsworthy &
Goodridge
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