NUR -1040-LD08 Gastroesophageal reflux disease (GERD) Makimosha Shemndolwa, Prossy Namukwaya, Nneka Nwadike, Rafael Verzonilla Instructor: Dr. Kedemah Joseph, Kristine Holden Prince George’s Community College Introduction Gastroesophageal reflux disease or GERD, is a chronic condition where stomach contents flows back up into the esophagus which is mainly due to a damaged/weak lower esophageal sphincter (LES). Pathophysiology • Digestion starts in the mouth when food is chewed. Then it is swallowed. The food is then squeezed down into the esophagus and the lower esophageal sphincter relaxes to let the food into the stomach and then it CLOSES again to prevent the food from back flowing. • Acid reflux occurs when the sphincter muscle at the lower end of your esophagus relaxes at the wrong time, allowing stomach acid to back up into your esophagus. This can cause heartburn and other signs and symptoms. • Frequent or constant reflux can lead to gastroesophageal reflux disease (GERD) Risk Factors • Obesity • Sleep apnea • Delayed gastric emptying • Nasogastric tube • Pregnancy Signs and Symptoms Common signs and symptoms of GERD include: • A burning sensation in your chest (heartburn), usually after eating, which might be worse at night • Chest pain • Difficulty swallowing • Regurgitation of food or sour liquid • Sensation of a lump in your throat • Bitter taste in mouth • Dry cough Laboratory Tests • A barium Swallow (Esophagram): can check for ulcers or a narrowing of the esophagus. You firs swallow a solution to help structures show up on an X-ray. • PH monitoring : can check for acid in your esophagus. The doctor inserts a device into your esophagus and leaves it in place for 1 to 2 days to measure the amount of acid in your esophagus. • Endoscopy : can check for problems in your esophagus or stomach. This test involves inserting a flexible, lighted tube with a camera down your throat. First, the doctor will spray the back of your throat with anesthetic and give you a sedative to make you more comfortable. • A biopsy : may be taken during endoscopy to check samples of tissue under a microscope for infe or abnormalities. • Esophageal manometry: Esophageal manometry is a test to assess motor function of the upper esophageal sphincter, esophageal body and lower esophageal sphincter Diagnosis Procedures • Upper endoscopy. Your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat, to examine the inside of your esophagus and stomach. Test results can often be normal when reflux is present, but an endoscopy may detect inflammation of the esophagus (esophagitis) or other complications. Laparoscopy is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera.Discussion: Development in RadiographyDiscussion: Development in RadiographyThe laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen. . Diagnosis Procedures • Laryngoscopy is endoscopy of the larynx, a part of the throat. It is a medical procedure that is used to obtain a view, for example, of the vocal folds and the glottis. • X-ray of your upper digestive system. X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. The coating allows your doctor to see a silhouette of your esophagus, stomach and upper intestine Treatment • The primary treatment of GERD is diet and lifestyle changes, advancing to medication use (antacids, H2 receptor antagonists, proton pump inhibitors) and surgery. • Untreated GERD leads to inflammation, breakdown, and long-term complications, such as Barrett’s esophagus or adenocarcinoma of the esophagus Medications • Proton pump inhibitors (PPIs) Pantoprazole, omeprazole, esomeprazole, rabeprazole and lansoprazole reduce gastric acid by inhibiting the cellular pump of the gastric parietal cells necessary for gastric acid secretion Nursing Consideration •Monitor for electrolyte imbalances and hypoglycemia in clients who have diabetes mellitus •Long term us of PPI increases the risk for fractures and has been related to the development of community acquired pneumonia and C. diff. incfections Medications • Antacids Aluminum hydroxide, magnesium hydroxide, calcium carbonate and sodium bicarbonate neutralize excess acid and increase lower esophageal sphincter (LES) pressure Nursing Consideration • Ensure there are no contraindications with other prescribed medications (levothyroxine), • Evaluate kidney function in clients taking magnesium hydroxide • Take antacids when acid secretion is the highest (1 to 3 hr after eating and at bed time), separate from other medications by at least 1 hour Medications • Prokinetics Metoclopramide increases the motility of the esophagus and stomach Nursing Consideration • Monitor clients taking metoclopramide for extrapyramidal side effects • Report abnormal, involuntary movements Medications • Histamine2 receptor antagonists Ranitidine, famotidine, and nizatidine reduce the secretion of acid. The onset is longer than antacid, but the effect has a longer duration Nursing Consideration • Use cautiously in clients who have kidney disease • Take with meals and at bed time • Separate dosages from antacids (1 hour before or after taking antacids) Therapeutic Procedure (Stretta) Stretta procedure uses radiofrequency energy, applied by an endoscope, to decrease vagus nerve activity.Discussion: Development in RadiographyDiscussion: Development in RadiographyThis causes the LES muscle tissue to contract and tighten Postoperative education • Intake clear liquids for the first 24 hours following the procedure, the advance to a soft diet • Do not take NSAIDs for 10 days following the procedure • Report chest or abdominal pain, bleeding, difficulty swallowing, dyspnea, and nausea/vomiting Therapeutic Procedure (Fundoplication) Fundoplication is indicated for patients who fail with other treatments. The fundus of the stomach is wrapped around and behind the esophagus through a laparoscope to create a physical barrier Nursing actions • Complications following fundoplication include temporary dysphagia, gas bloat syndrome, and atelectasis/pneumonia • Monitor for bowel sounds Nursing Intervention • Determine the cause of GERD with the client and review lifestyle changes that can decrease gastric reflux. • Monitor nutritional status which includes • Instructing to remain in upright position at least 2 hours after meals

avoiding eating 3 hours before bedtime. • Instructing patient to eat slowly and masticate foods well. • Encouraging small frequent meals of high calories and high protein foods. Complications • Aspiration of gastric secretion Reflux of gastric fluids into the esophagus can be aspirated into the trachea • Barrett esophagus This is a potentially serious complication of GERD. It is a damage to the lower portion of the tube that connects the mouth and stomach (esophagus). It develops because of chronic inflammation resulting from GERD. Complications • Esophageal cancer Cancer that begins in the esophagus is divided into two major types: • Squamous cell carcinoma: This type of cancer begins in the special cells—called squamous cells—that line the esophagus. This cancer usually affects the upper and middle part of the esophagus. Risk factors include smoking and heavy alcohol use. • Adenocarcinoma: This type of cancer usually develops in the lower part of the esophagus.

Discussion: Development in Radiography

Discussion: Development in Radiography

It can arise from Barrett’s esophagus. Complications • Ulcers Ulcers can form in the esophagus as a result of burning from stomach acid. In some cases, bleeding occurs. You may not be aware of bleeding, but it may be detected in a stool sample to test for traces of blood that may not be visible. This test is performed by putting a small amount of stool on a chemically coated card. • Stricture Damage from acid can cause the esophagus to scar and narrow, causing a blockage (stricture) that can cause food or pills to get stuck in the esophagus. The narrowing is caused by scar tissue that develops as a result of ulcers that repeatedly damage and then heal in the esophagus Health Promotion and Disease Prevention • Eat low-fat diet. • Limit or Avoid alcohol. • Stop smoking. • Maintain weight below BMI of 30. • Avoid foods that lower the lower esophageal sphincter (LES) pressure. • Avoid eating or drinking 2 hr before bed. • Avoid tight-fitting clothes. • Elevate the head of the bed 6 to 8 inches. Client Education • Instruct patient to avoid foods which might increase acid reflux. Food that is very hot or very cold, fried foods, peppermint, coffee, drinks that contain caffeine, spicy, highly seasoned foods, tomato-based dishes, citrus fruits and juices, chocolate and sweets. • Instruct patient not lie down right after eating and to remain upright for at least 2 hours • Pantoprazole is used to treat gastroesophageal reflux. Pantoprazole may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: headache, nausea and vomiting References Henry, N. J. E., McMichael, M., Johnson, J., DiStasi, A., Ball, B. S., Holman, H. C., … Lemon, T. (2016). Rn adult medical surgical nursing: review module. Leawood, KS: Assessment Technologies Institute. Gastroesophageal Reflux Disease (GERD). Retrieved from https://www.gripa.org/Patient-Education-Materials/GERD. Long-Term Complications of Gastroesophageal Reflux Disease (GERD). Retrieved from https://my.clevelandclinic.org/health/articles/9615long-term-complications-of-gastroesophageal-reflux-disease-gerd. . NCLEX Question on GERD 1. A patient reports frequent heartburn twice a week for the past 4 months. What other symptoms reported by the patient may indicate the patient has GERD? SELECT-ALL-THAT-APPLY: A. Bitter taste in mouth B. Dry cough C. Melena D. Difficulty swallowing E. Smooth, red tongue F. Murphy’s Sign NCLEX Question on GERD 1. Answers: A, B, D Rationale: These are signs and symptoms seen with GERD. Melena is seen with gastrointestinal bleeding as in peptic ulcer disease. Smooth, red tongue is seen with vitamin B12 deficiency, and Murphy’s Signs is seen with cholecystitis NCLEX Question on GERD 2. Your patient, who is presenting with signs and symptoms of GERD, is scheduled to have a test that assesses the function of the esophagus’ ability to squeeze food down into the stomach and the closer of the lower esophageal sphincter. The patient asks you, “What is the name of the test I’m having later today?” You tell the patient the name of the test is: A. Lower Esophageal Gastrointestinal Series B. Transesophageal echocardiogram C.

Discussion: Development in Radiography

Discussion: Development in Radiography

Esophageal manometry D. Esophageal pH monitoring NCLEX Question on GERD 2. Answer: C Rationale: An esophageal manometry assesses the function of the esophagus’ ability to squeeze the food down and how the lower esophageal sphincter closes. NCLEX Question on GERD 3. A nurse is caring for a client who has a new diagnosis of gastroesophageal reflux disease (GERD). The nurse should anticipate prescriptions for which of the following medications? (Select all that apply) A. Antacids B. Histamine2 receptor antagonists C. Opioid analgesics D. Fiber laxitives E. Proton pump inhibitors NCLEX Question on GERD 3. Answer: A, B, E Rationale: Antacids neutralize gastric acid which irritates the esophagus during reflux. Histamine2 receptors antagonist decrease acid secretion, which contributes to reflux. Proton pump inhibitors decrease gastric acid production, which contributes to reflux. NCLEX Question on GERD 4. A patient is taking Bethanechol “Urecholine” for treatment of GERD. This is known as what type of drug? A. Proton-pump inhibitor B. Histamine receptor blocker C. Prokinetic D. Mucosal Healing Agent NCLEX Question on GERD 4. Answer: C Rationale: Prokinetic drug prevents delayed gastric emptying by improving pressure in lower esophageal sphincter and improves peristalsis of the GI tract. NCLEX Question on GERD 5. After providing education to a patient with GERD. You ask the patient to list 4 things they can do to prevent or alleviate signs and symptoms of GERD. Which statement is INCORRECT? A. “It is best to try to consume small meals throughout the day than eat 3 large ones.” B. “I’m disappointed that I will have to limit my intake of peppermint and spearmint because I love eating those types of hard candies.” C. “It is important I avoid eating right before bedtime.” D. “I will try to lie down after eating a meal to help decrease pressure on the lower esophageal sphincter.” NCLEX Question on GERD 5. Answer: D Rationale: The answer is D. This statement is incorrect. The patient should have said I will AVOID lying down after eating a meal to help decrease pressure on the lower esophageal sphincter. It is important a patient does not immediately lie down after eating but wait for about 1 hour. THANK YOU ESSAY Write a short essay that addresses the following questions, utilizing knowledge acquired during your time in the radiography program. Use appropriate terminology, grammar, and sentence structure. Your answer should be a minimum of 400 – 800 words. Question 1: Why is continued professional development important to the radiographer? AND how does the patient benefit from a radiographer’s involvement in professional organizations?” RUBRIIC 1-Organization of thoughts :Writer answers both questions distinguishing between the benefits to the radiographer as well as the to the patient. Recognizes the general purpose of continued professional development 2- Evidence of knowledge assimilated through their didactic and clinical experience: Writer articulates a multifaceted comprehension of the benefits gained through their experiences. 3- Writer expresses a legitimate value (s) in continued professional development: Concise response with thorough and includes supporting statements Writer provides four or more values 4- Uses proper sentence structure, including grammar and spelling: Zero – 1 errors. Does not distract from content …