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Nursing Care Plan for GastroEsophageal Reflux Disease (GERD)

Pathophysiology

GERD is the return (reflux) of stomach acid and contents into the esophagus, past the Lower Esophageal Sphincter (LES) causing irritation and thinning of the lower esophagus.  Regurgitation often occurs without effort, such as when lying down or bending over. Frequent recurrences without treatment may lead to erosion of the mucus membranes of the lower esophagus.

Etiology

Weakness or incompetence of the LES may be related to excessive pressure being placed on the abdomen such as in the case of obesity or pregnancy. Certain medications such as calcium channel blockers, sedatives, antidepressants and antihistamines relax the smooth muscle of the LES, which weakens the ability of the sphincter to fully close, thus allowing food and digestive acids to enter the esophagus. Patients who smoke or have a hiatal hernia are at increased risk of developing GERD.

Desired Outome

Eliminate pain of the esophagus and regurgitation while  maintaining normal function of lower esophageal sphincter and preservation of the esophageal tissue.

GastroEsophageal Reflux Disease (GERD) Nursing Care Plan

Subjective Data:

  • Burning sensation behind breastbone (heartburn)
  • Chest pain
  • Nausea, often with  vomiting
  • Dysphagia (difficulty swallowing)

Objective Data:

  • Vomiting
  • Coughing
  • Wheezing
  • Weight loss
  • Erosion of tooth enamel

Nursing Interventions and Rationales:

  1. Perform a detailed pain assessment (PQRST or OLDCARTS)
    • Pain may be associated with eating or lying flat. It is also typically burning. Getting details about the pain can help rule out possible cardiac etiology of chest pain
  2. Obtain 12-lead EKG
    • To rule out possible cardiac etiology of chest pain.
  3. Prepare for and assist with upper endoscopy
    • Endoscopy is a procedure that is done by a doctor using a scope that is placed orally to visualize the upper GI tract including the esophagus, stomach, and upper portion of the small intestine. Tissue samples may be taken during this procedure if necessary.

      Patients must be fasting, no food or drink for 4-8 hours prior to the procedure

      Administer conscious sedation

      Monitor vitals while patient is sedated per facility policy

      Assist with ambulation immediately following procedure until sedation is fully worn off

      NPO until gag reflex returns
  4. Education of Lifestyle changes
    • Encourage patients to stop smoking - nicotine relaxes the LES

      Maintain a healthy weight - obesity and belly fat create stress and pressure on the abdomen and stomach

      Avoid tight fitting clothes - clothes that are tight around the waist put extra pressure on the stomach and esophageal sphincter

      Elevate the head of the bed by 6-9 inches with risers, boards or blocks to allow gravity to help reduce reflux. Using pillows is not effective because it only raises the head and can become disarranged throughout the night
  5. Diet and nutrition education
    • Avoid highly acidic foods such as citrus, tomatoes and spicy foods

      Avoid carbonated beverages and alcohol that cause the stomach to expand and increase pressure on the LES

      Eat meals at least 2 hours prior to bedtime or lying down to allow the stomach to fully empty

      Avoid foods that trigger reflux such as fried foods, fatty foods, caffeine, garlic, onions and chocolate

      Encourage adequate hydration (drink water)
  6. Encourage good oral hygiene
    • Tooth enamel erosion often occurs in patients with severe vomiting due to GERD. Encourage patients to maintain good oral health to reduce the risk of infection and protect teeth
  7. Administer medications as ordered
    • Proton pump inhibitors- reduce the amount of acid produced in the stomach

      Antacids- are alkaline substances that counteract the acid in the stomach

      Antibiotic- Erythromycin can help empty the stomach

References

Date Published - Jun 2, 2017
Date Modified - Oct 30, 2018