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TEACHING PLAN

Child was given a diagnosis of GE reflux at 6 months of age.

Parent is a single Mother and has lower mental abilities and needs help managing health concerns regarding the child.

Our main objective is to educate the mother on the disease process, management and care for the child.

Definition and Facts GER & GERD

GER and GERD in Infants

GER

Gastroesophageal reflux (GER) is a

normal physiological process occuring several times a day in healthy infants or children

  • Reflux can also be associated with:

vomiting, seen as a forceful expulsion of gastric contents.

  • It does not affect growth and development.

Gastroesophageal reflux (GER) happens when stomach contents come back up into the esophagus.

Gastroesophageal reflux disease (GERD) is a more serious and long-lasting form of GER and may prevent an infant from feeding.

Symptoms & Causes of GER and GERD in Infants

In order to give appropriate anticipatory guidance and teaching to parents, it is important to understand the natural history of GER in infants and provide education.

  • Parents can be reassured that regurgitation is common during the first year of life and most infants outgrow their regurgitation by 8-12 months of age.

  • Vomiting is the most common symptom
  • The presence of associated symptoms such as anemia, irritability, feeding resistance, hematemesis or failure to thrive distinguishes GERD from physiologic reflux.

REFERENCE

Ackley, B. (2010). Nursing diagnosis handbook: An evidence-based guide to planning care (9th ed.). Maryland Heights, Mo.: Mosby.

Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology,Vol. 49, No. 4, October 2009). Retrieved July 1, 2015, from http://www.naspghan.org/

Baldwin, C.D, K. (n.d.). APA Educational guidelines for Pediatric Residency. Retrieved July 7, 2015.

Treatment Option

of gastroesophageal reflux disease (GERD) depends on the infant’s symptoms and age. It may include changes in nutrition, medications, or surgery for GERD in Infants

Use appropriate level of education for parent due to mom's lower mental abilities

.

TEACHING THE FAMILY

Lifestyle changes,

pharmacological & surgery

Determine if teaching has been effective.

Parent can verbalize back the teaching that was provided fr her.

Parent demonstrates the proper positioning of infant after feeding

Parent asks additional questions if any arises.

Inform parent for the need to follow medical regimen as prescribed, and follow up with PCP as ordered

  • Antireflux surgery may be beneficial

  • Changing of formula composition and infant feeding techniques.
  • Trials of formulas include: Enfamilor Similac or a casein hydrolysate formula like Alimentum.

Positioning of Infant

  • Feeding changes in Infants such as

eliminating cow's milk from diet decreases vomiting within 24 hrs.

  • Risk of respiratory symptoms is greater in infants with GER, therefore educate family regarding these simple steps to reduce reflux:

PPIs are the most effective pharmacological therapy currently available

  • holding the infant in a head-elevated position by placing the infant's head on the shoulder for 20-30 minutes after feeding,
  • before putting infant in a supine or semi-supine position
  • burp in between and after feeds

Learning Objectives

and Goals

Beyond the emotional, social, cultural, or financial aspects some other clinical considerations include:

Objective 1

Describe the normal eating patterns from

birth through adolescence, including

expected weight gain and typical feeding

behaviors.

Dysphagia and associated respiratory complications

Neurologic conditions directly affecting gut motility and fecal evacuation

Comfort, sleep, and behavioral issues seen in a poorly nourished child

Objective 2

Describe the normal developmental patterns in gastrointestinal development, including

gastroesophageal reflux, symptoms, management.

GER is a common finding among children who have neurodevelopmental disabilities

GOAL

Careful communication between patient and provider

Therapy to be optimized and outcomes improved

Improvement in quality of life and a decrease in associated complications.

The adherent patient will attend provider's office less often, require fewer diagnostic tests, which will result in placing fewer phone calls to their clinician, and overall decrease cos.

Marzena Gaslawski

Tiwanna Bass

Melisa Diaz

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