Introduction
Gastroesophageal reflux disease, or GERD, is a digestive disorder that affects the ring of muscle between the esophagus and the stomach. This ring is called the lower esophageal sphincter (LES).
If a person has it, he/she may get heartburn or acid indigestion. Doctors think some people may have it because of a condition called hiatal hernia.
GERD symptoms might be eased through diet and lifestyle changes in most cases. But some people may need medication or surgery.
The term “gastroesophageal” refers to the stomach and esophagus. Reflux means to flow back or return. Gastroesophageal reflux is when what’s in your stomach backs up into your esophagus.
This blog post discusses what GERD is, its symptoms nursing care plans and interventions with some examples .As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!
Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
Symptoms of GERD
The most common symptom of GERD is heartburn (acid indigestion). It usually feels like a burning chest pain that starts behind the breastbone and moves upward to the neck and throat. Many people say it feels like food is coming back into the mouth, leaving an acid or bitter taste.
The burning, pressure, or heartburn pain can last as long as 2 hours. It’s often worse after eating. Lying down or bending over can also result in heartburn.
Many people feel better if they stand upright or take an antacid that clears acid from the esophagus.
People sometimes mistake heartburn pain for the pain of heart disease or a heart attack, but there are differences. Exercise may make heart disease pain worse, and rest may relieve it.
Heartburn pain is less likely to go along with the physical activity. But you can’t tell the difference, so seek medical help right away if you have any chest pain.
Besides pain, you may also have:
- Nausea
- Bad breath
- Trouble breathing
- A hard time swallowing
- Vomiting
- Wearing away of tooth enamel
- A lump in your throat
If you have acid reflux at night, you may also have:
- A lingering cough
- Laryngitis
- Asthma that comes on suddenly or gets worse
- Sleep problems
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Causes of GERD
In normal digestion, the LES opens to allow food into the stomach. Then it closes to stop food and acidic stomach juices from flowing back into the esophagus.
Gastroesophageal reflux happens when the LES is weak or relaxes when it shouldn’t. This lets the stomach’s contents flow up into the esophagus.
Risk Factors for GERD
More than 60 million American adults have heartburn at least once a month, and more than 15 million adults have heartburn every day, including many pregnant women.
Recent studies show that GERD in infants and children is more common than doctors thought. It can cause vomiting that happens over and over again. It can also cause coughing and other breathing problems.
Some doctors believe a hiatal hernia may weaken the LES and raise the chances of gastroesophageal reflux. A hiatal hernia happens when the upper part of your stomach moves up into the chest through a small opening in the diaphragm (diaphragmatic hiatus).
The diaphragm is the muscle separating the abdomen from the chest. Recent studies show that the opening in the diaphragm helps support the lower end of the esophagus.
Many people with a hiatal hernia will not have problems with heartburn or reflux. But having a hiatal hernia may allow stomach contents to reflux more easily into the esophagus.
Coughing, vomiting, straining, or sudden physical exertion can raise the pressure in the belly and lead to a hiatal hernia. Many otherwise healthy people ages 50 and over have a small one. Although it’s usually a condition of middle age, hiatal hernias affect people of all ages.
Hiatal hernias usually don’t need treatment. But it may be necessary if the hernia is in danger of becoming strangulated or twisted in a way that cuts off the blood supply.
A patient may also need to treat it if he/she has one along with severe GERD or esophagitis (inflammation of the esophagus). A doctor may perform surgery to make the hernia smaller or to prevent strangulation.
Several other things can make it more likely that you’ll have GERD:
- Being overweight or obese
- Pregnancy
- Delayed emptying of the stomach (gastroparesis)
- Diseases of connective tissue such as rheumatoid arthritis, scleroderma, or lupus
Diet and lifestyle choices may make acid reflux worse if you already have it:
- Smoking
- Certain foods and drinks, including chocolate and fatty or fried foods, coffee, and alcohol
- Large meals
- Eating too soon before bed
- Certain medications, including aspirin
GERD Treatments
GERD treatment aims to cut down on the amount of reflux or lessen damage to the esophagus lining from refluxed materials.
A doctor may recommend over-the-counter or prescription medications to treat the symptoms.
Antacids
These drugs can help neutralize the acid in the esophagus and stomach and stop heartburn. Many people find that nonprescription antacids provide temporary or partial relief. An antacid combined with a foaming agent helps some people. Researchers think these compounds form a foam barrier on top of the stomach that stops acid reflux.
But long-term use of antacids can bring side effects, including diarrhea, altered calcium metabolism (a change in the way the body breaks down and uses calcium), and magnesium buildup in the body. Too much magnesium can be serious for people who have kidney disease.
H2 blockers
For chronic reflux and heartburn, the doctor may recommend medications to reduce acid in the stomach. These medicines include H2 blockers, which help block acid secretion in the stomach. H2 blockers include cimetidine (Tagamet), famotidine (Pepcid), and nizatidine.
Proton pump inhibitors (PPIs)
Also known as acid pumps, these drugs block a protein needed to make stomach acid. PPIs include dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), omeprazole/sodium bicarbonate (Zegerid), pantoprazole (Protonix), and rabeprazole (Aciphex).
Prokinetics
In rare cases, these drugs help to empty the stomach faster, so a person doesn’t have as much acid left behind. They may also help with symptoms like bloating, nausea, and vomiting.
But they can also have serious side effects. Many people can’t take them, and those who can should do so only for a limited time. Examples of prokinetics include domperidone and metoclopramide (Clopra, Maxolon, Metozolv, Reglan).
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Severe GERD Diagnosis
If a person has severe, lasting esophageal reflux, or if the symptoms don’t get better with treatment, he/she may need tests for a better diagnosis. The doctor may use one or more procedures to do this:
Endoscopy -The doctor will put a small lighted tube with a tiny video camera on the end (endoscope) into the esophagus to look for inflammation or irritation of the tissue (esophagitis). If the results are abnormal or questionable, they may remove a small tissue sample for more testing (biopsy).
Upper GI series – This may be one of a doctor’s first tests. It’s a special X-ray that shows the esophagus, stomach, and the upper part of the small intestine (duodenum). It gives limited information about possible reflux, but it can help rule out other conditions like peptic ulcers.
Esophageal manometry and impedance study – This test checks for low pressure in the esophagus. It can also show defects in how the esophageal muscles contract.
pH testing – If it’s hard to make a definite diagnosis, a doctor may measure the acid levels inside the esophagus through this test. It tracks how much acid is in the esophagus during meals, activity, and sleep. Newer techniques of long-term pH tracking have made this a more effective tool.
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Complications of GERD
Sometimes GERD leads to serious complications:
Esophageal ulcer – Stomach acid eats away at the esophagus until an open sore form. These sores are often painful and may bleed. They can make it hard to swallow.
Esophageal stricture – Stomach acid damages the lower part of the esophagus and causes scar tissue to form. This scar tissue builds up until it narrows the inside of the esophagus and makes it hard to swallow food.
Barrett’s esophagus – Acid reflux changes the tissue cells that line the esophagus. The lining gets thicker and turns red. This condition is linked to a higher chance of esophageal cancer.
Lung problems – If reflux reaches the back of the throat, it can cause irritation and pain. From there, it can get into the lungs (aspiration). If this happens, a person’s voice may get hoarse. He/she could also have postnasal drip, chest congestion, and a lingering cough. If the lungs get inflamed, they can develop asthma, bronchitis, and possibly even pneumonia.
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Nursing Care Plans for GERD Based on Diagnosis
Nursing Care Plan 1: Diagnosis – Imbalanced Nutrition; Less than Body Requirements reduced food intake secondary to GERD
Evidenced by weight loss, nausea and vomiting, loss of appetite, dysphagia, heartburn, and muscle mass loss
Desired Outcome
The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.
| Intervention | Rationale |
| Explore the patient’s daily nutritional intake and food habits (e.g., mealtimes, duration of each meal session, snacking, etc.) | To create a baseline of the patient’s nutritional status and preferences. |
| Create a daily weight chart and a food and fluid chart. Discuss with the patient the short-term and long-term weight goals related to GERD. | To effectively monitor the patient’s daily nutritional intake and progress in weight goals. |
| Help the patient to select appropriate dietary choices to follow a low-fat diet with minimal fried foods, alcohol, and caffeine. | Low-fat foods are ideal for GERD patients. Fried foods, alcohol, and caffeine put the patient at high risk for acid reflux. |
| Refer the patient to the dietitian. | To provide more specialized care for the patient in terms of nutrition and diet in relation to newly diagnosed GERD. |
Nursing Care Plan 2: Diagnosis – Acute pain related to acid reflux secondary to GERD
As evidenced by a pain score of 10 out of 10, verbalization of chest pain after eating, guarding signs on the chest, the blood pressure level of 180/90, respiratory rate of 29 CPM, and restlessness.
Desired Outcome
The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and an absence of restlessness.
| Interventions | Rationale |
| Administer prescribed medications that alleviate the symptoms of heartburn/ chest pain. | Antacids help neutralize stomach acid. H2-receptor blockers reduce the production of stomach acid. Proton-pump inhibitors work by reducing the amount of stomach acid. Baclofen can help GERD patients by strengthening the lower esophageal sphincter. |
| Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication. | To monitor the effectiveness of medical treatment for the relief of heartburn. The time of monitoring of vital signs may depend on the peak time of the drug administered. |
| Elevate the head of the bed. | To reduce the backwash of acid from the stomach to the esophagus. |
| Encourage the patient to follow appropriate meal times and meal portions. | To ensure that the patient does not eat a huge meal or that he/she does not eat late at night/ before bedtime as both of these contributes to GERD. |
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Nursing Care Plan 3: Diagnosis – Impaired tissue integrity related to esophageal exposure to gastric acid.
Desired Outcome
The patient is able to verbalize knowledge of necessary lifestyle changes within 24 hours of discharge from the hospital.
| Intervention | Rationale |
| Teach the patient to avoid foods that cause pain and or can increase acid secretions. | Foods that can cause pain or increase acid secretion can worsen esophageal erosion. |
| If indicated, recommend strategies for smoking cessation. | Smoking impairs tissue healing and is associated with a higher incidence of complications that may necessitate surgery. |
| Teach the patient to avoid NSAIDs, ASA, chocolate, coffee, and alcohol. | These medicines and foods have been associated with increased GI erosions and acidity. |
| Administer acid suppression therapy as prescribed | To decrease the amount of acid that is produced and can cause mucosal erosion. |
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Nursing Care Plan 4: Diagnosis – Risk for aspiration related to an esophageal disease affecting the lower esophageal sphincter
Desired Outcome
Within 8 hours of interventions, the patient will have no episodes of aspiration.
| Intervention | Rationale |
| Assess the patient’s ability to swallow and the presence of gag reflex. | this will help to determine the presence and or effectiveness of protective mechanisms |
| Avoid placing a patient in a supine position. | Supine positioning has been indicated for increasing the risk of aspiration. |
| Elevate the HOB while in bed. | This position will prevent aspiration as it is more difficult for gastric acid to backflow back into the esophagus. |
References
Related FAQs
1. What is Gerd (acid reflux)?
Gastroesophageal reflux disease ( GERD ), also known as acid reflux, is a long-term condition in which stomach contents rise up into the esophagus, resulting in either symptoms or complications.
2. What is Gerd and how can it be treated?
In most cases, GERD can be relieved through diet and lifestyle changes; however, some people may require medication or surgery. What Is Gastroesophageal Reflux? Gastroesophageal refers to the stomach and esophagus. Reflux means to flow back or return.
3. What is the history of Gerd?
The classic symptoms of GERD were first described in 1925, when Friedenwald and Feldman commented on heartburn and its possible relationship to a hiatal hernia. In 1934 gastroenterologist Asher Winkelstein described reflux and attributed the symptoms to stomach acid.
4. When does reflux become a disease?
Reflux becomes a disease when it causes frequent or severe symptoms or injury. Reflux may damage the esophagus, pharynx or respiratory tract. The main symptom of GERD is heartburn, often described as a fiery feeling in one’s chest, and regurgitating sour or bitter liquid to the throat or mouth.
5. What is GERD nurse teaching
Gastroesophageal reflux disease Teaching 2115 SN instructed that gastroesophageal reflux disease ( GERD ) is a normal phenomenon, typically occurs transiently after eating.
