Gastroesophageal Reflux Disease (GERD)

Nursing Diagnosis and Interventions for GERD- Student Guide

Introduction

According to the American Gastroenterological Association, over 20 million people in the United States suffer from GERD. The pain caused by GERD is usually on one side of your chest and can be severe enough that it wakes you up at night. You may also experience heartburn or acid regurgitation.

In this post, we will discuss what GERD is and nursing diagnoses, care plans, and interventions for gastroesophageal reflux disease. As you read, keep in mind that our ivy league nursing writers are ready to help in case you get stuck with your nursing assignment. 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.

What is GERD?

A gastroesophageal reflux disease (GERD) is a condition in which the stomach contents come back up from your stomach into your esophagus. This can happen when there is too much acid or if the valve between your stomach and esophagus does not close properly. GERD causes heartburn, regurgitation, nausea, vomiting, difficulty swallowing food or drink, chest pain, and hoarseness. 

Types of Gastroesophageal Reflux Disease

There are two types of GERD:

1. Acute Gastroesophageal Reflux Disease (AGE) – GERD symptoms are less frequent and severe. Usually, the symptoms are less than three times a week. 

2. Chronic Gastroesophageal Reflux Disease (CGE) – GERD symptoms are more frequent with no relief in between episodes. There is constant acid reflux into your esophagus.

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What Causes Gerd?

Gerd gastroesophageal reflux disease is caused by the following;

1. Hiatal hernia- A hiatal hernia is a condition in which the upper part of your stomach protrudes into your chest.  If you have this, then abdominal pressure and food passing through your esophagus will cause GERD.

2. Smoking- Smoking increases acid production. If you smoke, it makes GERD more likely to happen to you.

3. Age- People over 65 years old are more likely to have the disease.

4. Obesity– If you are overweight, you will be more likely to have it since fat cells in your abdomen produce excess acid, and the pressure from the extra weight on top of your stomach can cause GERD.

5. Heartburn drugs – Antacids and medications that are used to treat heartburn can cause it.

6. Relaxation of lower esophageal sphincter (LES) muscle. The LES is the valve between the esophagus and the stomach.

7. Change in intra-gastric pressure caused by eating, coughing, or lying down

8. Alcohol- Alcohol irritates the lining of your stomach, causing GERD

9. Pregnancy – Hormonal changes during pregnancy can cause GERD.

Image: Smoking is a cause of GERD

What Are the Signs and Symptoms of Gerd?

Signs and symptoms of gastroesophageal reflux disease include;

1. Regurgitation- Food comes back up from the esophagus into your mouth or throat due to strong muscle spasms in the upper part of the esophagus.

2. Heartburn – Burning sensation behind your breastbone that travels to the throat and mouth. Heartburn is usually in the middle or upper part of your abdomen, but it can also be near the lower end of your chest if you have a hiatal hernia.

3. Chest Pain – Sharp, burning pain on the left or right side of the chest. It can be uncomfortable to breathe deeply, and sometimes you may feel like there is a knot in your throat.

4. Hoarseness – Your voice sounds different because food or acid goes into your vocal cords when you have GERD.

5. Poor Appetite – You don’t feel like eating because you focus on relieving the burning in your chest.

6. Nausea and vomiting– GERD can cause nausea, so sometimes you may be nauseous and vomit due to heartburn.

7. Diarrhea – When acid from your stomach travels back up into your esophagus, it irritates the esophagus lining, causing diarrhea.

8. Recurrent Aphthous Stomatitis- This is better known as canker sores in your mouth and throat. Heartburn may cause these sores to develop because they are caused by an inflammation of your mouth and throat.

9. Burning sensation- You feel burning in your mouth, throat, and esophagus. It may be unbearable to swallow food.

10. Recurrent pneumonia –GERD symptoms are a risk factor for pneumonia because stomach acid can travel up into your lungs. Pneumonia makes you feel like you are having trouble breathing.

11. Stomach ulcers – GERD can cause stomach ulcers due to a chemical reaction caused by acid in your stomach, which is why you are more at risk for getting a stomach ulcer if you have GERD or heartburn.

 12. Esophageal cancer – GERD can cause a pre-cancerous condition called Barrett’s esophagus that increases your risk of developing esophageal cancer in the long term. 

13. Gastroesophageal reflux disease in babies – GERD symptoms are in children under two years old due to changes in hormones and the relaxation of the LES (the valve between esophagus and stomach).

Symptoms of GERD-Burning sensations

What Are the Risk Factors for Gerd?

Some risk factors for gastroesophageal reflux disease include;

  • Being overweight-Obesity poses a higher chance of developing GERD because the fat around your stomach presses against the abdominal wall weakening the LES.
  • Over 50 – GERD becomes more common after age 50.
  • Being male-Males are more likely than females to get the disease.
  • Histamine Intolerance – Some individuals who suffer from histamine intolerance (an abnormally high histamine level in the blood) also suffer from GERD. The intolerance is caused by an excess of histamines produced after consuming high amounts of tyramine or phenylalanine (Tyramines and phenylalanines are amino acids that occur naturally in many foods.)
  • Lifestyle factors such as smoking, high alcohol consumption, and not exercising or lack of physical activity.

Statistics

GERD or Gastroesophageal Reflux Disease (GERD) is a condition that creates severe burning pain and problems with digestion for several million Americans each year.

Any individual above eight years of age can develop GERD. There is no gender or racial group that is more likely to be affected by this problem than another.

The disease occurs when the acid in your stomach empties into your esophagus. Usually, there is a barrier between the stomach and the esophagus that prevents this from happening. However, some people have a weaker or thinner wall, which allows this acid to pass through.

Gerd Nursing Diagnosis

Methods of Diagnosing Gerd:

Your healthcare provider will use the following methods to diagnose GERD:

-History of the disease, family history-Details of the problem such as duration and how often it happens.

-Physical exam- Physical exam may show signs such as a hiatal hernia (an abnormally formed bulge or area in the diaphragm) that causes GERD. 

-Esophageal manometry, endoscopy-A procedure where a long, thin tube is put through your mouth into your esophagus to check for GERD. 

-Blood test – a blood test can be used to screen for gallstones, h. pylori bacteria and check your acid production levels

-Imaging tests – X-rays, CT scan, or MRI (to rule out other problems)

-Upper Endoscopy – A flexible tube with a camera on its end is used to examine the esophagus and stomach.

Cardiac Arrhythmia-Gerd can increase the risk of heart arrhythmia (a disturbance in the normal rhythm of your heartbeat) by causing a mild rise in heart rate and blood pressure.

Frequent heartburn- GERD can cause frequent heartburn, esophageal inflammation, a sore throat, and difficulty swallowing. If left untreated, GERD can also cause osteoporosis (a condition in which bones become brittle and break easily)

Regurgitation-A GER (gastroesophageal reflux) symptom in which the food does not go to the stomach as it should but comes back up the esophagus.

Stomach discomfort-This GERD symptom is a feeling of fullness or burning pain in your stomach that lasts for at least two weeks and can be present on most days.

Difficulty swallowing-Also called dysphagia. This GERD symptom implies that food does not go down smoothly and causes chest pain or burning in the throat.

Chest pain or discomfort-This GERD symptom is a pain that starts in either the upper chest or abdomen and may spread to the back, shoulders, throat, or arms.

Hoarseness, cough, or pneumonia (inflammation of the lungs)-GERD can cause inflammation of the larynx (voice box) and lungs, making it difficult to swallow or breathe.

Perforation-The GERD symptom is an abnormal hole or tears in the esophagus that allow stomach acid to flow into your body. This condition is dangerous.

Other Nursing Diagnosis

  • Anxiety-Anxiety could be a side effect of GERD.
  • Risk for injury related to activity intolerance or restricted mobility
  • Knowledge deficit/incomplete information (specify)
  • Impaired gastric mucosal integrity
  • Splanchnic ischemia
  • Imbalanced nutrition: less than body requirements
  • Chronic pain/ Acute pain related to chronic symptoms

Ps: We also have diagnosis for COPD

Nursing Intervention for Gerd

Gastroesophageal reflux disease Interventions include;

– Teaching relaxation techniques such as deep breathing exercises or progressive muscle relaxation reduce anxiety symptoms while promoting self-care behaviors through education about GERD.

– Using stress reduction techniques to reduce job and life stress to prevent worsening of the disease.

-Teaching patients about the relationship between the amount, type, and frequency of food eaten and condition.

– Educating patients on how to support their health by increasing dietary fiber intake, avoiding foods that worsen heartburn, and drinking at least eight glasses of water a day.

-Encourage patients to manage their weight as obesity increases the compression of the stomach contents into the esophagus, worsening the disease.

-Teaching abdominal breathing techniques such as diaphragmatic breathing or belly breathing exercises to help relax the patient and improve symptoms.

-Educating patients on the importance of limiting caffeine, which may worsen symptoms or trigger the disease.

-Teaching patients to avoid smoking and alcohol ingestion, as these can act as triggers for GERD.

GERD Nursing Care Plans

Nursing care plans include:   

1. Patient Education

2. Identify contributing factors- Review patient’s history for past episodes of GERD, smoking status, possible use of over-the-counter antacid medication, etc.

3. Patient diet therapy

4. Patient Lifestyle devices: Review patient’s use of tobacco, alcohol, coffee, and other stimulants to determine if these are contributing factors to the present episode or exacerbating symptoms.

5. -Monitor abdominal pain and heartburn symptoms

6. Administer medications as ordered by the physician-measure, prepare, and administer medications according to established policies and procedures.

7. Help patient learn relaxation techniques- encourage the use of these skills at home.

8. Teach dietary modifications-evaluate the effectiveness of the treatment plan and provide additional support as necessary.

9. Provide care related to stress management- refer patients for psychosocial counseling as needed.

Palliative and Symptomatic Care:

-Ensure adequate pain relief. Pain is more prominent in the upright position and relieved by resting in the supine position.

-Assist with activities of daily living as needed. Rest in the supine position is recommended.

-Encourage frequent rest periods and avoidance of strenuous activity.   

-Encourage the use of nonsedating antihistamines. Anticholinergic agents may be used to control nausea and vomiting, and H2-receptor antagonists may diminish heartburn symptoms.

Other measures: 

Temporarily discontinue the patient’s current antacid medication; consult with a physician before resuming medication.

A patient should avoid precipitating factors such as coffee, spicy foods, tobacco, and alcohol.

Also, please check the care plan of DVT

What Are the Complications of Gerd?

  • If gastroesophageal reflux disease symptoms are not treated, the patient will have health problems including:
  • Ulcers
  • Barrett’s esophagus
  • Cancer
  • Asthma
  • Chronic cough
  • Depression and anxiety disorders like panic disorder or social phobia
  • Fatigue and difficulty concentrating
  • Osteoporosis
  • Weight loss due to pain in swallowing
  • Sleep apnea or disrupted sleep patterns and poor quality sleep
  • Chronic airway inflammation may lead to asthma, bronchitis, or other lung infections (e.g., pneumonia)

Treatment

There are two types of treatment for GERD: lifestyle changes and medications.

1. Lifestyle Changes

They include;

-Having regular meals with smaller portions

-Elevating upper body during sleep to prevent pressure on the lower esophageal sphincter

-Staying well hydrated with water to promote gastric emptying

-A patient suffering from this disease should stay away from acid-producing foods such as citrus, tomatoes, coffee, chocolate, and fizzy drinks.

-The patient should instead eat foods like eggs, cabbage, and carrots.

-Avoiding smoking because it can worsen GERD symptoms.

-The patient should be advised to reduce weight

2. Drug Therapies/Medication

The client will be prescribed drugs to suppress acid production and lower the risk of complications. These are called proton pump inhibitors (PPIs) and histamine-2 blockers (H2Bs).

PPIs include:  Lopid, omeprazole, pantopazole, rabeprazole, dexetrandine. 

H2B blockers include: Zantac, ranitidine, and Tagamet.

In some patients, both types of medications may be prescribed.

In Severe Cases:

Oral morphine sulfate may be used for pain relief (Rx controlled substance)

Topical or oral sucralfate treatment may be given to control esophagitis

Acetaminophen with codeine treatment is available to help relieve mild to moderate pain. Naproxen sodium (WS-5226) is an anti-inflammatory agent that has been used with success to control acidity. The drug may be given in either oral or suppository form and can be used for long periods, if necessary. Gastroesophageal reflux disease cannot usually be cured, but there are several treatments available.

In Rare Cases: 

Antibiotics may be used as a treatment for bacterial infections in the esophagus. Surgery for severe, long-term hyperacidity is usually successful and can relieve pain and discomfort caused by extreme scarring of the esophagus (esophageal stricture).

Surgery

As a last resort, a patient may have surgery called fundoplication. This will help eliminate hyperacidity by permanently wrapping the stomach around the lower end of the esophagus.

Follow your doctor’s instructions precisely so as not to end up with complications. It is also essential for the patient to stick to an anti-reflux diet. Consult with the doctor about surgery before making a decision that could affect the rest of your life.

You may also check our other articles on treatment of Hypertension

Conclusion

Gastroesophageal reflux disease is a chronic disease that can be treated and managed.  The pain caused by GERD is usually on one side of your chest and can be severe enough that it wakes you up at night. You may also experience heartburn or acid regurgitation. If these symptoms are not treated, they can lead to other health problems, including ulcers, Barrett’s esophagus, cancer, asthma, chronic cough, and depression. It may also lead to anxiety disorders like panic disorder or social phobia, fatigue, and difficulty concentrating. The first step towards preventing complications from this disease is seeing your doctor and getting tested for acid reflux. Once diagnosed, the patient can make lifestyle changes that will help alleviate the symptoms of GERD and make the right food choices.

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