UPPER GI:GERDGroup 5:

Brooke Bevins, Lindsey Gamrat, Briana McKenney, Emily Mendel, Latifah Gray, Hannah Crist

PATIENT HISTORY

Joe is a 47 YO male who came in c/o intense burning sensation in his chest accompanied by nausea. He reports that he has also been belching frequently which gives him the sensation of regurgitation in his throat. Joe smokes ½ a pack of cigarettes per day and consumes

moderate amounts of alcohol Dx with asthma at 14 YO Recently dx with hiatal hernia NKA to food Reports that he frequently get a burning sensation in chest

after dinner Late dinner then watches TV in chair and goes to bed Symptoms worsen when he lays down Takes antacids occasionally which helps

PHYSICAL AND DIAGNOSTICS

Nurse calculates BMI as 31.2 A BMI over 30 indicates a patient is

obese A stool occult blood test is positive

Indicative of bleeding somewhere in the GI tract

Never had an endoscopy or acid probe test

PREVALENCE

Occurs in both men and women Most common in those that are

overweight

RISK FACTORS

Obesity Hiatal hernia Pregnancy Smoking Dry mouth Asthma Diabetes Delayed stomach emptying

PATHOPHYSIOLOGY

GERD- Gastroesophageal reflux disease (aka acid-reflux disease) is caused by excessive reflux occurring, either in frequency or volume, or if the esophagus fails to contract in response to stomach contents

Common cause is a hiatal hernia Effective diets relax the lower esophageal sphincter and

don’t stimulate gastric secretions

http://www.youtube.com/watch?v=TdK0jRFpWPQ

SYMPTOMS AND RISKS

Heart burn with pain occurring behind the sternum Pain can sometimes radiate to the neck and

the back of the throat Those at risk include pregnant women and

obese people In women, BMI may be associated with the

symptoms of GERD for those who are normal or overweight. Moderate weight gain may aggravate the

symptoms Smoking increases the risk of GERD

DIAGNOSIS

X-ray of esophagus Chalky liquid that coats the GI tract and allows physician to see

inside of tract and determine damage that has been done.

Endoscopy Physician passes a flexible tube with a light and camera down the

esophagus to view the stomach and esophagus

DIETARY INTERVENTIONS

Loose weight if it is needed Avoid lying down for three hours after eating Eat frequent and smaller portioned meals Do not eat close to bed time Stay away from food that may worsen GERD symptoms:

Citrus fruits, chocolate, caffeine, alcohol, fatty/fried foods, garlic, onions, spicy foods, tomato-based foods

NURSING INTERVENTIONS

Educate client and family on importance of a healthy diet. Educate client about risks attached to smoking and how it

perpetuates his condition. Promote regular exercise. Educate client foods that are harmful to his condition.

*see dietary interventions

Assist in obtaining resources to help track nutrient/calorie intake ChooseMyPlate.gov/SuperTracker https://www.choosemyplate.gov/SuperTracker/default.aspx

MEDICATIONS

OTC: Antacids/any medicine that slows acid production and heals the esophagus Alka-Seltzer

Prescription Strength: H-2 receptor Blockers (Pepcid, Zantac) Proton Pump Inhibitors (Prevacid, Prilosec)

Surgery is a last resort treatment that occurs if the medications do not help in controlling GERD

ALTERNATIVE MEDICATIONS

Not proven to treat or reverse damage, but are proven to provide some relief

Acupuncture Relaxation Therapy

Guided Imagery Progressive Muscle Relaxation

Herbal remedies * Licorice, Slippery Elm, Chamomile,

Marshmallow

*May interfere with some medications

PATIENT GOALS

Maintains a healthy weight Excess weight creates pressure on abdomen and acid

will build up in the esophagus. Patient avoids food and drinks causing heartburn

Fried foods, fast foods, soda, tomato sauce, onion, garlic, spicy foods, etc.

Eats smaller meals Obese clients should work towards loosing weight and

maintaining a healthier food diet. Doesn’t lie down after eating

Wait at least three hours to lie down.

OUTCOMES

Weight loss for obese clients Healthier food diet Engage in weekly physical activities Smaller meal portions Stop/reduce smoking habits

LONG-TERM IMPLICATIONS

Narrowing of the esophagus (esophageal stricture)

An open sore in the esophagus (esophageal ulcer)

Precancerous changes to the esophagus (Barrett’s esophagus)

QUESTIONS?

REFERENCES

Fennerty, Brian. (2007, May). Heartburn, gastroesophageal reflux (ger), and gastroesophageal reflux disease (gerd). Retrieved from http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/

Longstreth, G. F. (2011, August 11). Gastroesophageal reflux disease. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001311/

Center for Disease Control and Prevention. (2011, September 13). About bmi for adults. Retrieved from http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html

Mayo Foundation for Medical Education and Research (MFMER). (1998-2012). Retrieved from http://www.mayoclinic.com/health/gerd/DS00967/DSECTION=lifestyle-and-home-remedies

REFERENCES

Lutz, Carroll & Przytulski, Karen. (2011). Nutrition and Diet Therapy. Philadelphia, PA: F.A. Davis Company

Mayo Clinic Foundation for Medical Education and Research. (2011). GERD. Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/gerd/DS00967