gerd(gastroesophageal reflux disease)

8/3/2019 GERD(Gastroesophageal Reflux Disease)

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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.



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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.



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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.



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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.



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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.



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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.



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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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Health Pattern


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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Health Pattern


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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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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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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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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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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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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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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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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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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- 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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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.


89/112


PLANPLAN

Acute pain related toAcute pain related to

esophageal reflux andesophageal reflux and

esophageal inflammationesophageal inflammation


90/112

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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93/112


94/112

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.


95/112

interventions

Advised to avoid bending

coughing,vigorous exercises, and

wearing tight clothing\

Prevents intra-abdominal pressure


96/112

evaluation

GOAL PARTIALLY MET

Pain scale= 5/10

-still with pain while chewing and swallowing foods.


97/112


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


99/112

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.


101/112

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


102/112

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


103/112

INTERVENTIONS

explore coping strategies with

patient. (e.g breathing, relaxation

etc.)

Allows incorporating existing disabilities with clientsdesires& ability to adapt & organize care activities.

O


104/112

EVALUATION

GOAL MET

Patient was able to feel relaxed, verbalize awareness and

feelings of anxiety is reduced to a manageable level


105/112


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


107/112

NURSINGDIAGNOSIS

Deficient knowledge about the

disorder (GERD) related to

incomplete presentation of

information


108/112

INTERVENTIONS


109/112

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


112/112

gerd(gastroesophageal reflux disease)

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