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GERD Case Study PowerPoint Presentation

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Description : Reflux of HCl acid and pepsin secretions cause irritation and inflammation.

Tags : GERD,gastroesophageal reflux disease,GERD case study,GERD symptoms,GERD causes,GERD treatments

Published on : Sep 06, 2022 | Views : 3937 | Downloads : 9

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Slide 1-

Gastroesophageal Reflux Disease (GERD) Chapter 42
Slide 2-

Description of GERD Common problem Chronic manifestation of mucosal damage Caused by reflux of gastric contents into lower esophagus Not a disease, but a syndrome
Slide 3-

Etiology and Pathophysiology No one single cause Results when Defenses of lower esophagus are overwhelmed by reflux of gastric contents into esophagus
Slide 4-

Etiology and Pathophysiology Reflux of HCl acid and pepsin secretions cause irritation and inflammation Intestinal proteolytic enzymes and bile salts add to irritation
Slide 5-

Etiology and Pathophysiology of GERD
Slide 6-

Case Study M.C., a 20-year-old man, complains of loss of appetite and occasional lower sternal chest pain 30–60 minutes after meals. He says that symptoms began about 6 months ago. iStockphotos/Thinkstock
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Etiology and Pathophysiology Predisposing factors Hiatal hernia Incompetent lower esophageal sphincter (LES) Antireflux barrier Decreased esophageal clearance Decreased gastric emptying
Slide 8-

Etiology and Pathophysiology Incompetent LES Primary factor in GERD Results in ↓ pressure in distal portion of esophagus Gastric contents move from stomach to esophagus Can be due to certain foods (caffeine, chocolate) and drugs (anticholinergics)
Slide 9-

Etiology and Pathophysiology Obesity is a risk factor Pregnant women are at increased risk Cigarette and cigar smoking can contribute to GERD Hiatal hernia is a common cause of GERD
Slide 10-

Clinical Manifestations Symptoms of GERD Heartburn (pyrosis) Most common clinical manifestation Burning, tight sensation felt beneath the lower sternum and spreading upward to throat or jaw Felt intermittently
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Clinical Manifestations Symptoms of GERD Dyspepsia Pain or discomfort centered in upper abdomen Regurgitation Described as hot, bitter, or sour liquid coming into throat or mouth Hypersalivation may also be reported
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Case Study M.C. is 5 feet, 10 inches tall and weighs 190 lb. He states he smokes 2 packs of cigarettes/week. iStockphotos/Thinkstock
Slide 13-

Case Study Besides chest pain after meals, M.C. complains of heartburn several times a week and occasionally brings up a bitter liquid into his mouth. iStockphotos/Thinkstock
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Clinical Manifestations Most individuals have mild symptoms Heartburn after a meal Occurs once a week No evidence of mucosal damage
Slide 15-

Clinical Manifestations Health care provider should evaluate Heartburn occurring more than once a week, rated as severe, or occurring at night and waking patient Older adults with recent onset of heartburn
Slide 16-

Clinical Manifestations Heartburn occurs Following ingestion of food or drugs that ↓ LES pressure Directly irritates esophageal mucosa
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Case Study M.C. also has a history of asthma. He states he has needed inhaler “more than usual.” iStockphotos/Thinkstock
Slide 18-

Clinical Manifestations Individual may also report respiratory symptoms Wheezing Coughing Dyspnea Nocturnal coughing with loss of sleep
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Otolaryngologic symptoms include Hoarseness Sore throat Lump in throat Choking Clinical Manifestations
Slide 20-

Clinical Manifestations GERD-related chest pain Described as burning, squeezing, or radiating to back, neck, jaw, or arms Can mimic angina More common in older adults with GERD Relieved with antacids
Slide 21-

Case Study M.C. is scheduled for an endoscopy to evaluate his symptoms. The results indicate he has acute esophagitis as well as Barrett’s esophagus. iStockphotos/Thinkstock
Slide 22-

Complications Related to direct local effects of gastric acid on esophageal mucosa Esophagitis Inflammation of esophagus Frequent complication Repeated exposure: esophageal stricture Resulting in dysphagia
Slide 23-

Esophagitis
Slide 24-

Complications Barrett’s esophagus (esophageal metaplasia) Replacement of normal squamous epithelium with columnar epithelium Precancerous lesion Thought to be primarily due to GERD
Slide 25-

Complications Barrett’s esophagus Diagnosed in 5% to 15% of patients with chronic reflux Signs and symptoms: none to perforation Must be monitored every 2–3 years by endoscopy
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Complications Respiratory Due to irritation of upper airway by secretions Cough Bronchospasm Laryngospasm Cricopharyngeal spasm
Slide 27-

Complications Respiratory Potential for asthma, bronchitis, and pneumonia Dental erosion From acid reflux into mouth Especially posterior teeth
Slide 28-

Diagnostic Studies History and physical examination Barium swallow Can detect protrusion of gastric fundus Upper GI endoscopy Useful in assessing LES competence, degree of inflammation, scarring, strictures
Slide 29-

Diagnostic Studies Biopsy and cytologic specimens Differentiate cancer from Barrett’s esophagus Esophageal manometric (motility) studies Measure pressure in esophagus and LES
Slide 30-

Diagnostic Studies Radionuclide tests Detect reflux of gastric contents Demonstrate rate of esophageal clearance
Slide 31-

Diagnostic Studies Monitoring pH Laboratory or 24-hour ambulatory Determine esophageal pH by using specially designed probes
Slide 32-

Case Study M.C. is being discharged today. He expresses concern about what lifestyle changes may be necessary to prevent recurrences or complications. iStockphotos/Thinkstock
Slide 33-

Collaborative Care Lifestyle modifications Avoid triggers Nutritional therapy Decrease high-fat foods Take fluids between rather than with meals Avoid milk products at night Avoid late-night snacking or meals
Slide 34-

Collaborative Care Nutritional therapy Avoid chocolate, peppermint, caffeine, tomato products, orange juice Weight reduction therapy Chewing gum and oral lozenges can increase saliva production and help patients with mild symptoms
Slide 35-

Case Study M.C. is prescribed the following medications for home: Esomeprazole (Nexium), 20 mg daily Ranitidine (Zantac), 150 mg twice a day iStockphotos/Thinkstock
Slide 36-

Collaborative Care Drug therapy Proton pump inhibitors (PPIs) Promote esophageal healing in 80% to 90% of patients Decrease incidence of esophageal strictures Example: omeprazole (Prilosec) Headache: Most common side effect
Slide 37-

Drug Alert Proton pump inhibitors Long-term use or high doses of PPIs may increase the risk of fractures of hip, wrist, and spine Associated with increased risk of C. difficile infection in hospitalized patients
Slide 38-

Collaborative Care Drug therapy Histamine-2 receptor (H2R) blockers Decrease secretion of HCl acid Reduce symptoms and promote esophageal healing in 50% of patients Example: cimetidine (Tagamet) Side effects uncommon
Slide 39-

Collaborative Care Drug therapy Acid protective Used for cytoprotective properties Example: sucralfate (Carafate)
Slide 40-

Collaborative Care Drug therapy Cholinergic Increase LES pressure Improve esophageal emptying Increase gastric emptying Example: bethanechol (Urecholine)
Slide 41-

Collaborative Care Drug therapy Prokinetic drugs Promote gastric emptying Reduce risk of gastric acid reflux Example: metoclopramide (Reglan)
Slide 42-

Collaborative Care Drug therapy Antacids Quick but short-lived relief Neutralize HCl acid Taken 1–3 hours after meals/at bedtime Example: Maalox, Mylanta
Slide 43-

Collaborative Care Surgical therapy When necessary Failure of conservative therapy Medication intolerance Barrett’s metaplasia Esophageal stricture and stenosis Chronic esophagitis Nissen and Toupet fundoplications
Slide 44-

Nissen Fundoplication
Slide 45-

LINX Reflux Management System Titanium beads with a magnetic core strung together and implanted laparoscopically into LES Under resting, nonswallowing conditions, the ring tightens When individual swallows, the ring opens Collaborative Care
Slide 46-

Collaborative Care Endoscopic therapy Endoscopic mucosal resection Photodynamic therapy Cryotherapy Radiofrequency ablation
Slide 47-

Nursing Management Elevation of head of bed 30 degrees Not lying down for 2–3 hours after eating Avoidance of late-night eating
Slide 48-

Nursing Management Evaluating effectiveness of medications Observing for side effects of medications
Slide 49-

Nursing Management Avoidance of factors that cause reflux Stop smoking Avoid alcohol and caffeine Avoid acidic foods
Slide 50-

Nursing Management Stress reduction techniques Weight reduction, if appropriate Small, frequent meals
Slide 51-

Case Study M.C. has repeated exacerbations of esophagitis, despite maintaining his medication regimen and diet. His doctor refers him to a surgeon for evaluation. Surgeon recommends a Nissen fundoplication. iStockphotos/Thinkstock
Slide 52-

Nursing Management Postoperative care Focus Prevention of respiratory complications Maintenance of fluid/electrolyte balance Prevention of infection
Slide 53-

Nursing Management Postoperative care Respiratory assessment Respiratory rate/rhythm Pulse rate/rhythm Signs of pneumothorax Dyspnea Chest pain Cyanosis
Slide 54-

Nursing Management Postoperative care Deep breathing techniques Accurate I/O Observing for fluid/electrolyte imbalance Pain medication Medications to prevent nausea/vomiting
Slide 55-

Nursing Management Postoperative care When peristalsis returns, only fluids given initially Solids added gradually Normal diet gradually resumed Patient must avoid gas-forming foods and must chew foods thoroughly
Slide 56-

Case Study M.C.’s surgery was done laparoscopically. He has progressed to a soft diet and is able to ambulate independently. He is being discharged to home today. iStockphotos/Thinkstock
Slide 57-

Nursing Management Postoperative care First month after surgery, patient may report mild dysphagia; should resolve after edema subsides Patient should report persistent symptoms such as heartburn and regurgitation
Slide 58-

After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which statement by the patient indicates that the teaching has been effective? “I can have a glass of low-fat milk at bedtime.” “I will have to eliminate all spicy foods from my diet.” “I will have to use herbal teas instead of caffeinated drinks.” “I should keep something in my stomach all the time to neutralize the excess acids.” Audience Response Question