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Copy of GERD Concept Map

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by

Mezzami Nadya

on 19 July 2014

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Transcript of Copy of GERD Concept Map

Assessment
Drug Therapy
LABS & DIAGNOSTICS
GERD Concept Map
Topic
Interventions
Position head of bed elevated <45
Administer medications as ordered
In severe cases:
I/Os
Assist with ambulation
Admin oxygen as prescribed
Serve high-protein, low-fat meals
Patient teaching
Consult with nutritionist
Planning
Evaluation
Heartburn more than 2x week, occurs at night, severe enough to wake them from sleep
Dyspepsia
Hypersalivation
Noncardiac chest pain
relieved with antacids
Respiratory sx-wheezing/coughing/dyspnea
Nocturnal discomfort
Otolaryngologic sx-hoarseness, sore throat, globus sensation (sense of lump in throat)
Regurgitation
-hot, bitter, sour liquid coming from throat

GERD
gastric contents reflux UP into the lower esophagus causing damage to mucosal and leading to esophagitis
chronic heartburn
most common upper GI problem seen in adults
Dx based on sx and pt response to therapy
H&P
Upper GI endoscopy w/ biopsy and cytologic analysis
Barium swallow
Motility studies (manometry)
pH monitoring
Radionuclide studies
Causes
Hiatal hernia
LES (incomplete lower esophageal sphincter)
decreased esophageal clearance
decreased gastric emptying
Proper bed positioning
Dietary changes
Drug Therapy
Antisecretory agents
Prokinetic
Cholinergic
Surgical options
Consent forms
Focus: decrease volume and acidity of reflux, improve LES function, increase esophageal clearance, protect esophageal mucosa
ANTISECRETORY
H2-receptor blockers
cimetidine (Tagamet)
famotidine (Pepcid)
nizatidine (Axid)
ranitidine (Zantac)
PPIs
omeprazole (Prilosec)
pantaprazole (Protonix)
lansoprazole (Prevacid)
esomeprazole (Nexium)
PROMOTILITY

Prokinetic
metoclopramide (Reglan)
INCREASE LES PRESSURE
Cholinergic
bethanechol (Urecholine)
PATIENT TEACHING
Supine positioning for 2-3 hours after meals
Avoid overeating
Avoid smoking and drinking
Avoid foods and activities that exacerbate discomfort and cause reflux
Take medications depending on severity of discomfort and at the appropriate times:
i.e. PPIs such as Pepcid should be taken before the first meal of the day
Teach side effects of meds:
PPIs-headache
metoclopramide-restlessness, anxiety, insomnia, hallucinations
Lifestyle modifications for selected patients:
obese pts should be advised on weight loss
counseling provided for pts needing help curbing dietary habits (late night eating, behaviors exacerbating discomfort)

Common
Nurse Dx
Impaired comfort
Pain (typically relieved with antacids)
Imbalanced nutrition: more than body req
Ineffective breathing pattern (due to cough/choking)
Activity intolerance/Risk for
Risk for altered nutrition
Risk for aspiration
Disturbed sleep pattern
Ineffective/Readiness for enhanced self-health management
Are the symptoms of dyspepsia/chest pain relieved with antacids?
Is the patient still suffering from hoarseness, sore throat, wheezing, coughing, dyspnea?
Is the patient able to sleep undisturbed throughout the night?
Has the patient's regurgitation reduced?
IF NOT:
Is the patient adhering to the appropriate diet?
Is the patient smoking or drinking?
Is the patient taking medications as prescribed?
Was the patient able to make the necessary life modifications that may exacerbate symtpoms?
Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2011) Medical-surgical nursing: Assessment and management of clinical problems (8th ed.). St. Louis, MO: Mosby.
References
(Lewis, 2011, p. 971)
(Lewis, 2011, p. 971-972)
(Lewis, 2011, p. 972)
(Lewis, 2011, p. 972)
(Lewis, 2011, p. 973)
(Lewis, 2011, p. 973-975)
(Lewis, 2011, p. 973-975)
Treatment &
Prevention
Lifestyle Modifications
Nutritional Therapy
Drug Therapy
Surgical Therapy
Antireflux surgery
Endoscopic Therapy
endoscopic mucosal resection
photodynamic therapy
cryotherapy
radiofrequency ablation

(Lewis, 2011, 973-974)
Jennifer Chatmon
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