● Gastroesophageal Reflux Disease (GERD)
○ Patho: backflow of gastric contents into the esophagus.
○ Causes: imcompenent weaken lower esophageal s... [Show More] phincter, increased intraabdominal pressure - (pregnancy, overeating, obesity, HH), pyloric stenosis, certain medications (antihistamines, CCBs sedatives), or mobility disorder.
○ Risk factors: diets that are chronically low in fresh produce. affects all ages- but elderly are more prone to complications , food irritants - Caffeine, chocolate, citrus, tamoties, smoking/tobacco, CCBs, nitrates, mint, alcohol. Medications: anticholinergics (delay gastric emptying), high estrogen/ progesterone, NG tube placement.
○ s/s: Pyrosis (heartburn), epigastric pain, dyspepsia (indigestion), pain and difficulty swallowing (dysphagia), hypersalivation, bitter taste in mouth, regurgitation (aspiration risk), Dry coughing/wheezing (worst at night), belching, nausea, pharyngitis, dental caries (serve).
○ eledery s/s: atypical chest pain, ear, nose throat infections, pulmonary problems (aspiration pneumonia, sleep apnea, asthma) more at risk for developing severe complications- HH and med s/e, barrett's esophagus or erosion
○ Labs:
○ Diagnostics: esophagogastroduodenoscopy (EGD)endoscopy - assess esophagus for s/s of narrowing and ulcers. Esophageal manometry - assesses function and ability of esophagus to squeeze food down and how LES closes. . pH monitoring - measures acid amount in esophagus for 24 hours (small tube stays in esophagus during.
○ Interventions: nutrient therapy is usually enough.
■ Eat 4-6 small meals a day. Low fat - high fiber
■ Limit or eliminate fatty foods, coffee, tea, cola, carbonated drinks , mint, chocolate
■ Reduce or eliminate from your diet any food that increases gastric
■ acid and causes pain
■ Limit or eliminate alcohol and tobacco, and reduce exposure to
■ secondhand smoke**Smoking and alcohol decrease LES pressure and irritate tissues.**
■ Do not eat 2-3 hours before bed
■ Eat slowly and chew your food thoroughly to reduce belching
■ Remain upright 1-2 hours after meals, if possible
■ Elevate HOB 6-12 inches using wooden blocks, or elevate your
■ head using foam wedges. Never sleep flat in bed.
■ If you are overweight, lose weight.
■ Do not wear constrictive clothing.
■ Avoid heavy lifting, straining, and working in a bent-over position.
■ Chew “chewable” antacids thoroughly, and follow with a glass of water
■ Do not take anticholinergics (dalay stomach emptying), NSAIDs (contains acetylsalicylic acid).
■ Surgery: laparoscopic nissen fundoplication (LNF),
○ Medications: Take antacids (calcium carbonate) (when taking wait 1-2 hours before taking H2 blocker, antibiotics, or caratate) , H2 receptor antagonist (IV Famotidine)(reduces gastric acid)
, PPIs (IV protonix) (reduces acid, helps esophagus heal, can be given long term, long term use complication = bone fractures; most common in elderly). Prokinetics ( oral metoclopramide)
○ Surgical: extreme cases only - fundoplication, wrapping gastric fundus around sphincter area of esophagus.
○ Complications: Esphogitis - where the esophagus cells start to erode and become inflamed due to acid. Barrett's esophagus - results from exposure to acid and pepsin (sometimes nitrosamines) which changes the cells DNA making them precancerous. Strictures- build up scar tissue in the esophagus causing narrowing. Laryngopharyneal reflux - acid going into the pharynx going into respiratory system causing lung infections, ear infections, coughing. complications are most common in eldery.
● Hiatal Hernia
● Increases risk of GERD because of increase of intra abdominal pressure. It's a hernia that is formed at the top of the stomach near the LES putting pressure on it causing it to not operate properly.
● Types s/s:
○ Sliding: heartburn, regurgitation, chest pain, dysphagia, belching.
○ Paraesophageal: feeling of fullness or breathlessness after eating, feeling of suffocation. Chest pain that mimics angina, s/s worse in recumbent position.
● Patho: (esophageal/ diaphragmatic hernia) portion of stomach herniates through diaphragm into thorax.
● Risk factors: Herniation results from weakening of muscles of diaphragm aggravated by that increase abdominal pressure (pregnancy, ascites, obesity, tumors, heavy lifting)
● Complications: ulceration, hemorrhage, regurgitation and aspiration of stomach contents, strangulation, and incarceration of the stomach in the chest with necrosis, peritonitis, mediastinitis.
● Interventions: The most important role of a nurse is health teaching for HH. small frequent meals, avoid eating at night, avoid food irritants. Sleep with the head of the bed elevated 6 inches, remain upright for several hours, avoid straining or excessive exercise, and avoid restrictive clothing. Teach patients and families that they need to follow a strict diet and exercise and should reduce body weight to reduce intra abdominal pressure.
● Medications: avoid anticholinergics (delay stomach emptying)
● Herniation
● Patho: weakness in abdominal muscle wall through which a segment of bowel protrudes
● Causes: congenital or acquired muscle weakness and increased intra abdominal pressure contribute to hernia formation.
● Types:
● Assessment: patient should be lying down and then assess when patient is standing. If hernia is reducible it may disappear when the patient is lying flat. Listen for bowel sounds (absence = GI obstruction)
● Interventions: truss- pad with firm support for people who can’t have surgery. Herniorrhapy - replaces contents of the hernia sac into the abdominal cavity and closing the opening. Hernioplasty - reinforces the weakened muscular wall with a mesh patch.
○ Pre/post care: avoid coughing - but deep breath. Inguinal repair - wear scrotal support and elevate scrotum with pillow in bed. Avoid bowel or bowel distension by - stimulating voiding techniques (standing them up), avoid constipation ( avoid straining during healing) [Show Less]
