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GERDGERD((GastroesophagealGastroesophageal
RefluxReflux DiseaseDisease))
CabaseCabase,, JennelynJennelyn
CamallaCamalla,, JunalynJunalyn FranciaFrancia
CarballoCarballo,, AbegailAbegailCecilioCecilio, Marjorie, Marjorie
CorpuzCorpuz, Cherrie Mae, Cherrie Mae
CuliatCuliat, Lea, Lea
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I. Patients Profile
Name: Mrs. EBV
Birthday: September 23, 1941
Age: 70
Address: Zone 2 Ayugan Vales, Ocampo,
Camarines Sur
Religion: Roman Catholic
Level of Education: College Graduate
Chief complaint:difficulty
swallowing,history of aspiration 3x
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HEALTHHEALTH
HISTORYHISTORY
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Mrs. EBV is a 70 year old woman, born on a
town of Nabua. A college graduate of education
at University of Nueva Caceres and presently
retired from work. Lives in a two story house
with her husband and her younger child and a
niece. Major reason for seeking health care isfor routine check-up.
Past Illnesses/Hospitalization:
Placenta Previa on the 3rd baby at the age of 37
UTI at the age of 69
Allergies:
Denies food, drug and environmental allergies.
a. Health history
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HEADHEAD--TOTO--TOETOEASSESSMENTASSESSMENT
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GENERALASSESSMENT
Vital signs:
BP:120/80HR: 82
RR: 16
The client is cooperative and alert, answers
question spontaneously.
Sitting comfortably on table with arms crossed andshoulders slightly slouched forward.
Dress neat and clean.
Walks steadily with posture slightly stooped.
b. Head-t0-toe assessment
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SKIN, HAIR ANDNAIL ASSESSMENT:
Skin: -warm and dry to touch.
-Skin fold returns to place after 1 second.
-Lesions and edema not noted to any part of
the body.
Hair: -hair black in color, medium textured, evenly
d istributed on head,
-no scalp lesions or flaking.
-No hair noted on the axilla, arms and legs or
on the chest, back or face.
Nails: fingernails medium in length with a
capillary refill of 2-3 seconds.
b. Head-t0-toe assessment
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Head and neck
assessment:
Head symmetrically rounded
neck nontender with full range of motion.
Neck symmetrical without masses, scars,
and pulsations.
Lymph nodes not palpable.
Trachea is in midline.
Carotid arteries equally strong without
bruits.
Identifies light and deep touch to various
parts on the face.
b. Head-t0-toe assessment
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Eye assessment:
Eye brows sparse with equal distribution, scaliness not
noted.
Lids pink without ptosis, edema or lesions and freely
closeable bilaterally sclera white without increased vascularity or lesions
noted.
EarAssessment: Auricle without deformities, lumps or lesions.
Mastoid process non palpable.
Both auditory canals contain moderate amount dark
brown cerumen.
Tympanic membrane difficult to view due to presence
of wax.
b. Head-t0-toe assessment
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Nose and SinusesAssessment:
External stricture without deformities, asymmetry and
inflammation.
Nares are both patent and the nasal septum midlinewithout bleeding, perforation or bleeding.
Mouth and pharynx:
No lesions or ulcerations.
Buccal mucosa pink and moist without discoloration or
increased pigmentation. Absence of all the molar teethand a lateral incisor tooth.
Hard and soft palate smooth without lesion or masses.
Tongue midline when protruded and with white
pigmentation on inner part. Gag reflex intact, tonsils
present without exudates, edema, ulcers or
enlargement.
b. Head-t0-toe assessment
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Cardiac Assessment:
No pulsations visible.
Clear brief heart sounds throughout auscultation.
Apical pulse: 83/min and regular.
MusculoskeletalAssessment
Posture slightly stooped with mild kyphosis.
Gait steady, smooth and coordinated with
even base. Limited range of motion of lateral flexion and
extension of the spine.
Upper and lower extremities have limited
ROM.
b. Head-t0-toe assessment
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Neurologic Assessment:
Mental Status: Talkative and friendly.
Dressed appropriately, clothes are neat and clean.
Facial expressions symmetrical and correlate with
mood and topic discussed.
Speech clear and appropriate.
Carefully chooses words to convey feelings and
ideas.
Oriented to person, place and time and events.
Remains attentive and able to focus during the
entire interaction.
Long and short term memory are intact.
b. Head-t0-toe assessment
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GORDONSGORDONS
FUNCTIONALFUNCTIONAL
HEALTHHEALTH
PATTERNPATTERN
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C. Gordons Functional
Health Pattern
A.Health Perception-Health ManagementPattern
Client rating of health:
Scale: 10-best; 1-worst 5 years ago: 10
Now: 7
5 years from now: 8
10 years from now: 7
Sees health deterioration as normal aging process and
states, \as age increases body resistance weakens,
natural naman yan i-kumpara mo na lang sa sarong
makina pag 10 years na nagpapalya naman.
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C. Gordons Functional
Health Pattern
A.Health Perception-Health ManagementPattern
Health does not interfere with self-care or other
desired activities of daily living. Unaware of signs andsymptoms of GERD. Never use alcohol, tobacco and
drugs but know that she is a 2nd hand smoker
because of her husband that consume of
approximately 40 sticks of cigarette a day.
Client seeks health care once in 6 months and intime of emergencies. Last medical exam was May
2011. Keeps active and feel well. Does not check own
blood pressure or do breast self exams.
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C. Gordons Functional
Health Pattern
A.Health Perception-Health ManagementPattern
Health does not interfere with self-care or other
desired activities of daily living. Unaware of signs andsymptoms of GERD. Never use alcohol, tobacco and
drugs but know that she is a 2nd hand smoker because
of her husband that consume of approximately 40
sticks of cigarette a day.
Client seeks health care once in 6 months and in timeof emergencies. Last medical exam was May 2011.
Keeps active and feel well. Does not check own blood
pressure or do breast self exams.
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C. Gordons Functional
Health Pattern
B. Nutritional-Metabolic Pattern
States that she prefer eating porridge food and
attempt to take on soft diet because of the reason that
she cannot tolerate hard food such as meat she experience a burning sensation in the esophagus,
difficulty of swallowing food, and experience sour
taste in the mouth for more than twice each week as a
result she consulted the doctor and term it as GERD.
states painscale 0f 7 when swallowing and verbalizesthat she experience aspiration thrice and now she is
afraid of eating alone
Reported the she like to eat fatty food, caffeinated
beverages, colas and spicy foods.
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C. Gordons Functional
Health Pattern
Drinks 8 glasses of water a day.
Drinks 2 cups of decaf coffee one in the morning and
one in the afternoon-no tea and occasionally drink
colas.
Never wears dentures even if she doesnt have all themolar teeth and a lateral incisor tooth. Last dental
exam was 2010. Complains of dyspepsia approximately
2x/month and never take any drug.
Describe the skin and scalp dry and uses lotion as
management. Denies easily bruising, pruritus and
nonhealing sore. Nails are hard and brittle and the hair
is grey in color, fine and soft.
Current weight: 136 lbs
Previous weight:140 lbs 3 weeks ago
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C. Gordons Functional
Health Pattern
C. Elimination Pattern
Bowel Habits: -soft, formed, medium brown bowel
movement every morning.
-Never report of mucous, bloody or tarry
stools, or rectal bleeding, change in color,consistency or habits.
Bladder Habits: -experiences urinary incontinence and
pain last 2010 when she was diagnosed of
urinary tract infection.
-B
ut now reports of regular urination 4-5xin a day, clear yellow urine.
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C. Gordons Functional
Health Pattern
D. ACTIVITY-EXERCISEPATTERN
ADLs on average day: -Arises at 8am in the morning.
-Eats breakfast and does housekeeping.
- Take lunch 1pm in the afternoon and by 4pm inthe afternoon takes a nap for 30minutes to 1
hour.
-Cleans own house and never report of any chest
pain, palpitation except for joint pain and it is
only relieve by rest. Hygiene: take a bath once a week.
Occupational activities: retires from being a teacher in
a public school in Naga City and points out that it is
the reason why she experiences joint pain.
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C. Gordons Functional
Health Pattern
E. Sexuality-Reproduction Pattern
Menstrual History:
age of menarche: 16 years old
age of menopause: approximately 58 years old
described menstrual period as regular, lasting for
5 to 7 days with moderate flow. Never report of
postmenopausal spotting at this time
Obstetric History: Gravida 3, Para 3, and the 3rd child
with complication of placenta previa.
Contraception: never used any form
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C. Gordons Functional
Health Pattern
F. Sleep-Rest Pattern
Goes to bed at 11:30 pm.
Did not complain of difficulty falling asleep or sleeping.
Feels well rested when she arises at 8am.
Take a nap of 30 minutes to an hour during the
afternoon.
Uses 3 pillows when sleeping.
G. Cognitive Pattern
Speech clear without slur and follow a verbal cues.
Expresses ideas and feelings clearly and concisely.
Can remember long and short term memory even the
date, time and places of events.
Makes major decisions jointly with the husband and
prayer to the Lord.
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C. Gordons Functional
Health Pattern
H. Role-RelationshipPattern
Client has been married for 48 years, describes
relationship as the best part of life right now.
She is very fond of 6 grandchildren most especiallywhen her youngest grandchild sent her videos of her
activities in Canada.
Received phone call from her 2nd child once a month
and the oldest child visit her trice a month.
Explains her relationship with other members in thecommunity as friendly.
She was the oldest of 10 children.
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C. Gordons Functional
Health Pattern
I. Coping-stresstolerance Pattern
Shares that the most stressful event is the accident
that happen to her 2nd eldest grandchild that she even
get hysterical and experience shortness of breath, itwas 2 years ago when it happen and the only coping
is prayers to the lord and the support of the relatives
and family
J. Value-Belief Pattern
Religious preference is Roman Catholic.B
elieve thatGod is the creator of all the things and when we
believe in him and trust in him God He will provide.
Places God as the center of the family.
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ANATOMY ANDANATOMY ANDPHYSIOLOGYPHYSIOLOGY
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anatomy and physiology
Gastrointestinal Tract- breakdown food into
nutrients which can be absorbed into the
body to provide energy.
- Food must be ingested into the mouth to
be mechanically processed and
moistened.
- Digestion occurs mainly in the stomach
and small intestine where proteins, fats
and carbohydrates are chemically brokendown into their basic building blocks.
- Smaller molecules are then absorbed
across the epithelium of the small intestine
and subsequently enter the circulation.
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anatomy and physiology
- The large intestine plays a key role in
reabsorbing excess water. Finally,
undigested material and secreted wasteproducts are excreted from the body via
defecation (passing of feces).
- Digestive tract is a tube extending from the
mouth to the anus, plus the associated
organs, which secrete fluids into thedigestive tract.
- It consists of the oral cavity, pharynx,
esophagus, stomach, small intestine, large
intestine and anus.
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anatomy and physiology
ORAL CAVITY
Responsible for the intake of food.
it is lined by a stratified squamous oral mucosa with
keratin covering those areas subject to significant
abrasion such as tongue, hard palate and roof of themouth.
TEETH there are 32 teeth in the normal adult.
Mastication is the mechanical breakdown of food by
chewing and chapping actions of the teeth.
TONGUE- strong muscular organ, manipulates thefood bulos to come in contact with the teeth.
-It is also the sensing organ of the mouth for
touch, temperature and taste using its specialized
sensors known aspapillae.
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anatomy and physiology
SALIVARY GLANDS
INSALIVATION the mixing of the oral cavity contents
with salivary gland secretion.
MUCIN (a glycoprotein) in saliva acts as a lubricant.
-The enzyme serum amylase, a component of
saliva, starts the process of digestion of complex
carbohydrates.
ACINI secrete contents into specialized ducts.
-Each gland is divided into smaller segments
called lobes.
SALIVATION occurs in response to the taste, smell or
even appearance of food.
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anatomy and physiology
PAROTID GLANDS are large, irregular shaped glands
located under the skin on the side of the face. They
secrete 25% of saliva.
SUBMANDIBULAR GLANDS secretes 70% of the salivain the mouth. Each gland can be felt as a soft lump
along the inferior border of the mandible.
SUBLINGUAL GLANDS covered by a thin layer of tissue
at the floor of the mouth. It produces approximately 5%of the saliva and their secretions are very sticky due to
the large concentration of Mucin. The main functions
are to provide buffer and lubrication.
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anatomy and physiology
PHARYNX
- throat
- which connects the mouth with the
esophagus, consists of three parts:-the nasopharynx
-oropharynx and
-laryngopharynx.
The posterior walls of the oropharynxand laryngopharynx are formed by the
superior, middle and inferior pharyngeal
constrictor muscles.
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anatomy and physiology
ESOPHAGUS
- It is a muscular tube approximately 25 cm
in length and 2 cm in diameter line with
moist stratified squamous epithelium that
extends from the pharynx to the stomach
and lies anterior to the vertebrae and
posterior to the trachea within the
mediastinum.
- It passes through the diaphragm and endsat the stomach.
- The esophagus transports food from the
pharynx and to the stomach.
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anatomy and physiology
ESOPHAGEAL SPHINCTERS-
-located at the upper and lower ends of
the esophagus,
-regulate the movement of food in and outof the esophagus.
CARDIAC SPHINCTER-
-lower esophageal sphincter.
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anatomy and physiology
STOMACH
-J shaped expanded bag, located just left of
the midline between the esophagus and small
intestine.
It is divided into four main regions and has
two borders called the greater and lesser
curvatures.
-The first section is the cardiac opening
which surrounds the cardiac orifice where theesophagus enters the stomach.
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anatomy and physiology
The fundus is the superior dilated portion of
the stomach is contracted into numerouslongitudinal folds called rugae.
The largest part of the stomach is the BODY
which turns to the right forming a greater
curvature on the left, and a lesser curvature
on the right.
The PYLORUS is the curved base of the
stomach. Gastric contents are expelled into
the proximal duodenum via the pyloric
sphincter.
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anatomy and physiology
Functions of the Stomach:
The short term storage of ingested food
Mechanical breakdown of food by chewing
and mixing motions. Chemical digestion of proteins by acids and
enzymes.
Stomach acid kills bugs and germs
Some absorption of substances such asalcohol.
-Most of these functions are achieved by the
secretion of stomach juices by gastric gland in the
body and fundus.
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anatomy and physiology
SMALL INTESTINE
-About 6 m in length extending from the
pyloric sphincter of the stomach to the
ileocaecal valve separating the ileum from thececum.
It performs the majority of digestion and
absorption of nutrients.
Partly digested food from the stomach is
further broken down by enzymes from the
pancreas and bile salts from the liver and gall
bladder.
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anatomy and physiology
DUODENUM C shaped section that
curves around the head of the
pancreas. Serve as a mixing function.
JEJUNUM a sharp bend, theduodenojejunal flexure. Majority of
digestion and absorption occurs.
ILEUM longest segment and final
portion. Empties into the cecum at the
ileocaecal junction.
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anatomy and physiology
TWO LARGEACCESSORY GLANDS:
LIVER- weighs about 1.36 kilograms and is
located in the right upper quadrant of theabdomen, tucked against the inferior
surface of the diaphragm.
The liver performs important digestive and
excretory functions, stores and processesnutrients, synthesizes new molecules and
detoxifies harmful chemicals.
secretes about 700 ml of bile each day.
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anatomy and physiology
Bile contains no digestive enzymes, but it
plays an important role in digestion by
diluting and neutralizing stomach acid and
by dramatically increasing the efficiency offat digestion and absorption.
Bile Salts emulsify fats, breaking the fat
globules into smaller droplets, much like
the action of detergents in dishwater.
Bilirubin is a bile pigment that results from
the breakdown of hemoglobin.
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anatomy and physiology
Thegall bladderis a pouch-shaped organ
which lies near the liver.
-It accepts bile from the liver, and
stores it.
When food is digested, the gallbladder
releases bile into the small intestine where it
is able to help dissolve fats.
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anatomy and physiology
PANCREAS- located retroperitoneal, posterior to
the stomach in the inferior part of the left upper
quadrant.
The exocrine secretions of the pancreas include
HCO3- , which neutralize the acidic chime that enters
the small intestine from the stomach.
-Pancreatic enzymes are also present in the exocrine
secretions and are important for the digestion of all
major classes of food.
Without the enzymes produced by the pancreas,
lipids, proteins and carbohydrates are not adequately
digested.
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anatomy and physiology
LARGE INTESTINE
Horse shoe shaped.
Consists of:
Cecum- expanded pouch that receives materialfrom the ileum and starts to compress food
products into fecal material.
Colon- is about 1.5-1.8 m long and consists of four
parts: ascending colon (extends superiorly from
the cecum to the right colic flexure, near the liver,
where it turns to the left; transverse colon
(extends from the right colic flexure to the left
colic flexure near the spleen, where the colon
turns inferiorly;
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anatomy and physiology
descending colon (extends from the left colic flexure to
the pelvis where it becomes sigmoid colon;
sigmoid colon (forms an S-shaped tube that extends
medially and then inferiorly into the pelvic cavity and
ends at the rectum.
Rectum- expands to hold fecal matter before it
passes through the anorectal canal to the anus.
The sphincter controls the passage of the feces.
Goblet cells line the glands that secrete mucous to
lubricate fecal matter as it solidifies.
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anatomy and physiology
Anal Canal
2-3 cm of the digestive tract.
-begins at the inferior end of the rectum and ends atthe anus.
-The smooth muscle layer of the anal canal is even
thicker than that of the rectum and forms the
internal anal sphincter at the superior end of the
anal canal.
-The external anal sphincter at the inferior end of the
anal canal is formed by skeletal muscle.
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PATHOPHYSIOLOGYPATHOPHYSIOLOGY
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PATHOPHYSIOLOGY
Gastroesophageal reflux disease (GERD)
or acid reflux disease
- is chronic symptoms ormucosal damage
caused by stomach acid coming up fromthe stomach into the esophagus.
A typical symptom is heartburn.
After swallowing,foods passes into the
ESOPHAGUS a 25 cm long tube
Down into the STOMACH where
DIGESTION HAPPENS
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PATHOPHYSIOLOGY
GASTRIC ACIDS confined into
the STOMACH through VALVE
MECHANISM
Involves two muscles
Lower
esophageal
sphincter (LES)
Diaphrag
m-Hiatus
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PATHOPHYSIOLOGY
if FUNCTION IMPROPERLY causes
GASTRIC ACID
Irritating the Lining of Esophagus
causing HEARTBURN
Gastroesophageal reflux
disease (GERD)
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DIAGNOSTICDIAGNOSTIC
ANDAND
LABORATORYLABORATORY
TESTTEST
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ENDOSCOPY
The upper endoscopy (also known asesophagogastroduodenoscopy or EGD)
- allows the doctor to examine the
inside of the patient's esophagus,stomach, and duodenum with an
instrument called an endoscope, a
thin flexible lighted tube.
- Allows visualization of the walls andtissue of the upper digestive tract.
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ENDOSCOPY
- will be able to detect disorders such
as strictures (narrowed areas), hiatal
hernias, ulcers and tumors. Ifnecessary, biopsies can be collected.
Endoscopy is often used in patients
who have had heartburn for manyyears to determine whether a
condition called Barretts esophagus
has developed
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ENDOSCOPY
What can be expected if the doctor orders an
EGD?
The patient is not to eat anything
for at least six hours before theprocedure.
A local anesthetic will be sprayed
into the patient's throat tosuppress the gag reflex, and an
intravenous sedative will help the
patient relax.
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ENDOSCOPY
The endoscope is then slowly passed
into the patient's mouth and down the
esophagus. The gag reflex and the urge to vomit
usually pass once the tube is in the
esophagus. The tube will not interfere
with breathing.
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ENDOSCOPY
Once the endoscope is in place,
- the doctor will be able to examine the
esophagus and stomach through a tinycamera, and detect any abnormalities.
- Other instruments can be inserted
through the endoscope tube, which will
allow the doctor to perform biopsies if
such conditions as cancer or infections
are evident.
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ENDOSCOPY
The patient may experience a sore
throat for a few days after the
procedure
If complications (such as vomiting alarge amount of blood or severe
stomach pains) occur, the doctor
should be notified immediately.
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MEDICATIONSMEDICATIONS
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MEDICATIONS
GENERIC NAME: esomeprazole-prescribed by Dr. Dabu
BRAND NAME: Nexium
DRUG CLASS AND MECHANISM: Esomeprazole is in aclass of drugs called proton pump inhibitors (PPIs)
which block the production of acid by the stomach.
Other drugs in the same class include omeprazole
(Prilosec), lansoprazole (Prevacid), rabeprazole
(Aciphex) and pantoprazole (Protonix). Chemically,
esomeprazole is very similar to omeprazole
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MEDICATIONS
Proton pump inhibitors are used for the treatment of conditions
such as stomach and duodenal ulcers, gastroesophageal reflux
disease (GERD) and the Zollinger-Ellison syndrome which all
are caused by stomach acid. Esomeprazole, like other proton-pump inhibitors, blocks the
enzyme in the wall of the stomach that produces acid. By
blocking the enzyme, the production of acid is decreased, and
this allows the stomach and esophagus to heal. Esomeprazole was approved by the FDA in February 2001.
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MEDICATIONS
GENERIC: No
PRESCRIPTION: Yes
PREPARATIONS: Capsules: 20 and 40 mg.Intravenous: 20 and 40 mg; Powder for Oral
Suspension: 10 mg, 20 mg, 40 mg
STORAGE: Store at room temperature, 15-30 C (59-
86 F) in a tightly closed container.
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MEDICATIONS
PRESCRIBED FOR: Esomeprazole is approved for the
treatment of gastroesophageal reflux disease (GERD)
and in combination with amoxicillin and clarithromycin
(Biaxin) for the treatment of patients with ulcers andH. pylori infection.
It also is used for reducing the risk ofgastric ulcers
associated with NSAIDs and the treatment ofZollinger-Ellison syndrome.
Esomeprazole also is approved for short term use in
children ages 1-11 for GERD.
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MEDICATIONS
DOSING:
For GERD, 20 or 40 mg of esomeprazole is given once daily for
4-8 weeks. In children ages 1-11, the dose is 10 or 20 mg
daily. For the treatment of H. pylori, 40 mg is administered once daily
in combination with amoxicillin and clarithromycin for 10 days.
The dose for preventing NSAID-induced ulcers is 20 to 40 mg
daily for 6 months.
Zollinger-Ellison syndrome is treated with 40 mg twice daily.
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MEDICATIONS
Esomeprazole capsules should be administered one
hour before meals, swallowed whole and should not be
crushed or chewed.
Patients with difficulty swallowing can open the capsule
and mix the pellets with applesauce.
The applesauce should not be hot and the pellets
should not be chewed or crushed.
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MEDICATIONS
DRUG INTERACTIONS:
Esomeprazole potentially can increase the concentration
in blood ofdiazepam (Valium, Diastat) by decreasing the
elimination of diazepam in the liver.
Esomeprazole may have fewer drug interactions than
omeprazole.
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MEDICATIONS
The absorption of certain drugs may be affected by
stomach acidity
-esomeprazole and other PPIs that reduce stomach acid
also reduce the absorption and concentration in blood of
ketoconazole (Nizoral) and increase the absorption and
concentration in blood ofdigoxin (Lanoxin).
This may lead to reduced effectiveness of ketoconazole orincreased digoxin toxicity, respectively.
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MEDICATIONS
Brand Name-prescribed by Dr.Pio
Pariet
Common Name: rabeprazole
DIN02243796 PARIET 10MG TABLET
02243797 PARIET20MG TABLET
DIN (Drug Identification Number)
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MEDICATIONS
Rabeprazole belongs to the class of medications known
as proton pump inhibitors (PPIs).
It works by slowing or preventing the production of
acid in the stomach.
Rabeprazole is used to treat and maintain healing of
gastroesophageal reflux disease (GERD). It is also used
to treat symptoms, such as heartburn andregurgitation, of non-erosive reflux disease (NERD).
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MEDICATIONS
It is also used for short-term treatment in the healing
and relief of symptoms associated with duodenal and
gastric ulcers.
Rabeprazole is used in combination with antibiotics to
treat ulcers caused by the bacterium Helicobacter
pylori.
rabeprazole is used for long-term treatment ofconditions associated with constant production of
excess acid in the stomach,.
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MEDICATIONS
To treat gastroesophageal reflux disease (GERD), the
recommended adult dose of rabeprazole is 20 mg,
taken once daily.
The recommended adult dose for maintaining long-
term healing of GERD is 10 mg to 20 mg, taken once
daily. The usual length of treatment for GERD is 4 to 8
weeks.
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MEDICATIONS
Rabeprazole delayed release tablet has been designed to work
throughout the day, and therefore needs to be taken only once
daily.
This medication may be taken with or without food. Swallowthe tablets whole with a beverage. Do not chew, crush, or split
the tablets.
Most people will experience some improvements in symptoms
1 to 2 weeks after starting rabeprazole. It may take up to 4weeks for people to experience maximum benefit from this
medication
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HEALTHHEALTH
TEACHINGTEACHING
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HEALTHTEACHING
Don't eat within 3 hours of bedtime.
This allows your stomach to empty and
acid production to decrease. If you
don't eat, your body isn't making acid todigest the food.
Don't lie down right after eating at any
time of day.
Elevate the head of your bed 6 incheswith blocks. Gravity helps prevent
reflux.
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HEALTHTEACHING
Avoid drinking alcohol. Alcohol
increases the likelihood that acid
from your stomach will back up.
Stop smoking. Smoking weakens
the lower esophageal sphincter
and increases reflux.
Lose excess weight. Overweightand obese people are much more
likely to have reflux than people of
healthy weight.
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HEALTHTEACHING
Stand upright or sit up straight,
maintain good posture. This helps
food and acid pass through the
stomach instead of backing up intothe esophagus.
Avoid wearing tight-fitting clothes
to reduce pressure in the stomach.
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NURSINGNURSINGCARECARE
PLANPLANImbalanced Nutrition: Less thanImbalanced Nutrition: Less than
Body Requirements related toBody Requirements related toaltered ability to ingest andaltered ability to ingest anddifficulty swallowing asdifficulty swallowing as
evidenced by weightevidenced by weight loss,alteredloss,alteredtaste sensationtaste sensation
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assessment
SUBJECTIVE:
Minsan nag aalsom na panlasa ko tapos nasasakitan na ako
maghalun karne kaya lugaw nalang kinakakan koas verbalized
by the patient. OBJECTIVE:
-weightloss
Current weight: 136 lbs Previous weight:140 lbs 3 weeks ago
-fatigue during swallowing
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nursing diagnosis
Imbalanced Nutrition: Less than Body
Requirements related to altered ability to
ingest and difficulty swallowing asevidenced by weight loss,altered taste
sensation
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planning
After 8hours of nsg. Interventions the client will display :
weight gain toward desired goal
be free of signs of malnutrition and
display improved energy level.
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inteventions
Assess ability to chew, taste, and
swallow.
other taste changes may limit clients ability to ingest food and
reducing desire to eat Encourage small, frequent meals and
snacks of nutritionally dense foods and
nonacidic foods and beverages, with
choice of foods palatable to client.
Fulfilling cravings for desired food may also improve intake
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inteventions
Advised client to chew food slowly and
thoroughly.
to avoid aspiration and lessen difficulty swallowing
Provide frequent mouth care, observingsecretion precautions. Avoid alcohol-
containing mouthwashes.
to prevent mouthsores and irritation in the mouth.
Monitor clients weight daily.
to evaluate nutritional changes
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evaluation
GOAL NOT MET
The client still preferred lugaw because it is easy to eat and
swallow .
The client have loss weight -4lbs.
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NURSINGNURSINGCARECARE
PLANPLAN
Acute pain related toAcute pain related to
esophageal reflux andesophageal reflux and
esophageal inflammationesophageal inflammation
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assessment
SUBJECTIVE:
pagnagkakakan ako, nagkukulog ang lalamunan ko
Lalo na pagmaaalsom tska mahaharang, naghaharaldat pati ang
sakuyang daghan as verbalized by the patient Pain scale: 7/10
OBJECTIVE:
Grimaced facial expression
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NURSINGDIAGNOSIS
Acute pain related to esophageal
reflux and esophageal
inflammation
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interventions
Encouraged toavoid irritating foods such as
beverages, sodas, teas and coffees that
contain caffeine,chocolate, citrus fruits and
other acidic foods, fried and fatty foods,
tomato sauce and juice, onion, garlic, mintflavoring and spices.
Different foods can trigger heartburn
Encouraged to chew and swallow foods
slowly.
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interventions
Advised to avoid bending
coughing,vigorous exercises, and
wearing tight clothing\
Prevents intra-abdominal pressure
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evaluation
GOAL PARTIALLY MET
Pain scale= 5/10
-still with pain while chewing and swallowing foods.
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NURSINGNURSINGCARECARE
PLANPLAN
Anxiety r/t physiologicAnxiety r/t physiologicfactor: such as GERDfactor: such as GERD
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assessment
SUBJECTIVE:
Client states that natatakot na ako magkakan solo ta 3
beses na ako nabulunan
Objective:
poor eye contact
-increased facial tension
-increased perspiration
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NURSINGDIAGNOSIS
Anxiety r/t physiologic factor: such
as GERD
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PLANNING
After 8 hours of nursing intervention the client will be
able to:
a. appear relaxed
b. report anxiety is reduced to a manageable level.
c. verbalize awareness of feeling of anxiety.
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INTERVENTIONS
Monitor vital sign
to identify physical responses associated with both medical and
emotional conditions.
Determine current medications orrecent OTC meds.
determine if the meds can heighten feelings or sense of anxiety
observe behaviors
be able to point the client's level of anxiety
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INTERVENTIONS
Establish a therapeutic
relationship
conveying empathy and unconditional positive regard
be available to ct,. For listening or
talking
provide feelings of sympathy and support to the pt. And
facilitate strong source of physical and emotional
contact
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INTERVENTIONS
explore coping strategies with
patient. (e.g breathing, relaxation
etc.)
Allows incorporating existing disabilities with clientsdesires& ability to adapt & organize care activities.
O
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EVALUATION
GOAL MET
Patient was able to feel relaxed, verbalize awareness and
feelings of anxiety is reduced to a manageable level
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NURSINGNURSINGCARECARE
PLANPLANDeficient knowledge aboutDeficient knowledge about
the disorder (GERD) relatedthe disorder (GERD) relatedto incomplete presentationto incomplete presentation
of informationof information
ASSESSMENT
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ASSESSMENT
SUBJECTIVE:
Ano man ang GERD, sain yan nakukua? as verbalized
by the patient.
Tanu ta pagnagkakakan akong maalsom tapos
maharang nagkukulog ang alanuhan ko? as verbalized
by the patient.
NURSINGDIAGNOSIS
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NURSINGDIAGNOSIS
Deficient knowledge about the
disorder (GERD) related to
incomplete presentation of
information
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INTERVENTIONS
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INTERVENTIONS
Provided a quiet environment
conducive to learning
A quiet environment will facilitate the learning of the patient
Discussed the disorder; its cause,manifestations, diagnostic test and
management
This will help patient to have a clear understanding of her
condition, the importance of treatment and increases herknowledge level
INTERVENTIONS
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INTERVENTIONS
Enumerated the foods that can
aggravate the pain and those that are
necessary to eat
This will help patent to choose the right foods she may eat andavoid those that can cause pain
Used short, simple terms that are
understandable to patient
For easy understanding and for patient to catch up theexplanation easily
INTERVENTIONS
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INTERVENTIONS
Asked patient to summarize what
she had learn
To make sure that the patient understand the
discussion and gain knowledge about her disorder
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