Which assessment question should the nurse ask a patient with Gerd?
· The mainstay of treatment of GERD is acid suppression which can be achieved with several classes of medications including antacids, histamine-receptor antagonists (H 2 RAs) or proton-pump inhibitors (PPIs).
Where can I find Gerd NCLEX flashcards?
Encourage adequate hydration (drink water) Encourage good oral hygiene. Tooth enamel erosion often occurs in patients with severe vomiting due to GERD. Encourage patients to maintain …
Which disease is the client diagnosed with Gerd at greater risk for?
An older patient with gastroesophageal reflux disease (GERD) asks about long-term effects from taking pantoprazole, a proton pump inhibitor. Which statement should the nurse respond to …
What does a Gerd nurse do?
The nurse caring for a client diagnosed with GERD writes the client problem of "behavior modification." Which intervention should be included for this problem? 1. Teach the client to …
What is the recommended treatment for GERD?
Proton pump inhibitors (PPIs). PPIs lower the amount of acid your stomach makes. PPIs are better at treating GERD symptoms than H2 blockers, and they can heal the esophageal lining in most people with GERD. You can buy PPIs over the counter, or your doctor can prescribe one.
Which recommendation would the nurse provide to a client with GERD?
Encourage small frequent meals of high calories and high protein foods. Small and frequent meals are easier to digest. Instruct to remain in upright position at least 2 hours after meals; avoiding eating 3 hours before bedtime. Helps control reflux and causes less irritation from reflux action into esophagus.
What is the first-line treatment for GERD?
Lifestyle modifications and acid-suppressive therapy through the use of antacids, H2RAs, or PPIs remain first-line treatment options for the management of GERD despite limited supporting data.
When should antacids be taken for GERD?
Take antacids about 1 hour after eating or when you have heartburn. If you are taking them for symptoms at night, do not take them with food.
How GERD is diagnosed?
The esophageal pH test is commonly used to help confirm the diagnosis of GERD or to identify the cause of various symptoms. Esophageal manometry is an outpatient test that can identify problems with movement and pressure in the esophagus that may lead to problems like heartburn.
What drug class will be used as a first line treatment for gastroesophageal reflux disease GERD that has not reacted to traditional medical treatment?
Antacids are usually the first line of defense because they're readily available over the counter. They may also be more affordable than prescription medications.
How to treat GERD symptoms?
These include smoking cessation, eating small frequent meals, sleeping with the head of the bed elevated, and avoiding caffeine intake.
What tests are used to diagnose GERD?
Rationale: The nurse would expect the healthcare provider to prescribe PPIs to control the symptoms of GERD. The Bernstein test, upper endoscopy, and 24-hour ambulatory pH monitoring are tests used to diagnose GERD.
When to take an antacid with PPI?
C."Take an antacid with your PPI at bedtime."
Why is Nissen fundoplication recommended?
D."Nissen fundoplication is also recommended to reduce risks associated with esophageal cancer."
Can esophageal strictures be caused by GERD?
Rationale: Esophageal strictures can occur from repeated irritation and ulceration from GERD. Asthma, trisomy 21, and hiatal hernias are risk factors, not complications.
Can you discuss this with the healthcare provider at your next visit?
A."You can discuss this with the healthcare provider at your next visit."
How to diagnose GERD?
The diagnosis of GERD is typically made by a combination of clinical symptoms, response to acid suppression, as well as objective testing with upper endoscopy and esophageal pH monitoring. For example, the combination of moderate to severe typical symptoms and endoscopic changes (erosive esophagitis or Barrett’s esophagus) are highly specific (97%) for GERD (confirmed with pH testing)[10]. However, a well-taken history alone can prove very valuable in the diagnosis, especially in the setting of heartburn and acid regurgitation which have a very high specificity (89% and 95%, respectively), albeit low sensitivity (38% and 6%) for GERD[4]. This can allow one to make a presumptive diagnosis and begin empiric therapy, thereby avoiding a comprehensive and costly evaluation in every patient presenting with uncomplicated symptoms[11]. Additional testing may be necessary, however, for those who do not respond to acid suppression, those who have alarm symptoms (e.g., dysphagia, odynophagia, iron deficiency anemia, weight loss, etc.) and those who have suffered from the disease for an extended period of time due to concern for Barrett’s esophagus[1]. The rationale for pursuing additional testing includes confirmation of GERD as well as evaluation of GERD associated complications or alternate diagnoses (Table (Table22).
How does GERD affect quality of life?
GERD symptoms have a profound impact on health-related quality of life (HRQoL). A 2011 systematic review of nine studies, including a total of 14774 patients with GERD, showed that persistent reflux symptoms on PPI therapy are associated with reduced physical and mental HRQoL, while reduced mental HRQoL at baseline seemed to impair symptomatic response to PPIs. The authors recommended that one consider behavioral and psychological factors when making decisions about disease management in those patients with persistent reflux symptoms and reduced well-being despite PPI treatment[7]. It is therefore important to recognize, diagnose and properly treat patients with GERD in order to avoid detrimental effects on quality of life as well as numerous complications.
What is ambulatory reflux monitoring?
Ambulatory reflux monitoring is the only modality allowing direct measurement of esophageal acid exposure, reflux episode frequency and association between symptoms and reflux episodes. It is typically used to evaluate patients with persistent symptoms despite medical therapy, particularly those without endoscopic evidence of GERD, in order to confirm the diagnosis. It can also be employed to monitor the control of reflux in those on therapy with persistent symptoms[1] and is also recommended in endoscopy negative patients prior to undergoing anti-reflux surgery in order to confirm the diagnosis.
Can GERD be evaluated prior to anti-reflux surgery?
Prior to anti-reflux surgery to rule out esophageal dysmotility (e.g., achalasia, scleroderma), otherwise not recommended for GERD evaluation
Does Barrett's esophagus require additional testing?
Additional testing may be necessary, however, for those who do not respond to acid suppression, those who have alarm symptoms (e.g., dysphagia, odynophagia, iron deficiency anemia, weight loss, etc.) and those who have suffered from the disease for an extended period of time due to concern for Barrett’s esophagus[1].
Is extraesophageal reflux secondary to GERD?
However, extraesophageal symptoms could be secondary to a host of other conditions and should not uniformly be attributed to a diagnosis of GERD, especially when typical symptoms are absent. Table 1. Symptoms of gastroesophageal reflux disease. Typical Symptoms.
Is bloating a sign of GERD?
Atypical symptoms such as epigastric pain, dyspepsia, nausea, bloating, and belching may be suggestive of GERD but may overlap with other conditions in the differential diagnosis such as peptic ulcer disease, achalasia, gastritis, dyspepsia and gastroparesis.
What is the pathophysiology of GERD?
GERD is the return (reflux) of stomach acid and contents into the esophagus, past the Lower Esophageal Sphincter (LES) causing irritation and thinning of the lower esophagus. Regurgitation often occurs without effort, such as when lying down or bending over. Frequent recurrences without treatment may lead to erosion ...
How to reduce reflux in the stomach?
Avoid tight-fitting clothes – clothes that are tight around the waist put extra pressure on the stomach and esophageal sphincter. Elevate the head of the bed by 6-9 inches with risers, boards or blocks to allow gravity to help reduce reflux.
What is the procedure to rule out cardiac etiology of chest pain?
To rule out possible cardiac etiology of chest pain. Prepare for and assist with upper endoscopy. Endoscopy is a procedure that is done by a doctor using a scope that is placed orally to visualize the upper GI tract including the esophagus, stomach, and upper portion of the small intestine.
Can you reduce reflux symptoms by avoiding trigger foods?
And the big thing here is understanding that avoiding those trigger foods can decrease your reflux symptoms.
What is the best medicine for acid reflux?
Proton pump inhibitors– reduce the amount of acid produced in the stomach. Antacids– are alkaline substances that counteract the acid in the stomach. Antibiotic– Erythromycin can help empty the stomach.
Does smoking cause reflux?
And of course, smoking increases reflux. Smoking causes lots and lots and lots of problems. So always do smoking cessation if you have a patient who is a smoker. So again, what are expected outcomes? Well, when we do patient education, we always want to verbalize or demonstrate, right? So verbalize lifestyle or diet changes to make. You can even give an actual number here. You can say the patient will verbalize 2 diet changes. They will make or they will verbalize three trigger foods that they’re going to avoid. Or you can actually talk about them quitting smoking and give them a little timeline. So this is our best way to just put this on paper and see a big picture of what we need to do for this patient. Again, an isolated GERD patient were pretending like they have absolutely no other issues besides GERD, but it helps you to get a picture, big picture of the different things you need to be looking for in this patient.
How to treat GERD symptoms?
These include smoking cessation, eating small frequent meals, sleeping with the head of the bed elevated, and avoiding caffeine intake.
What tests are used to diagnose GERD?
Rationale: The nurse would expect the healthcare provider to prescribe PPIs to control the symptoms of GERD. The Bernstein test, upper endoscopy, and 24-hour ambulatory pH monitoring are tests used to diagnose GERD.
What chapter is NUR 303?
NUR 303 - Chapter 47: Management of Patients With…
Can a GERD patient complain of chest pain?
Rationale: It is not uncommon for a client with GERD to complain of chest pain. This assessment finding, however, should not be ignored and would require the nurse to provide immediate intervention. The other assessment findings are typical of GERD and do not require immediate attention
Does antacid help with GERD?
Rationale: A client with GERD should sleep with the head of the bed elevated, as it decreases reflux. Sleeping aids and relaxing music do help with sleep, but will not control the symptoms of reflux. Antacids are helpful but are not a lifestyle modification.
Which diagnostic test involves the insertion of a pH electrode into the esophagus?
Rationale: The diagnostic test that involves the insertion of a pH electrode into the esophagus is the 24-hour ambulatory pH monitoring test. The Bernstein test involves the instillation of acid and saline to determine the presence of reflux. A barium swallow and upper endoscopy involve the visualization of the esophagus and the stomach.
Can you take an antacid with PPI?
Having a snack before bedtime is contraindicated as it can worsen reflux. A sleeping pill will not decrease the symptoms of GERD. An antacid should not be taken at the same time as a PPI because this will decrease its effectiveness.
What does GERD mean?
A patient with gastroesophageal reflux disease (GERD) reports heartburn and reflux after eating.
What is the best medication for gastroesophageal reflux disease?
The nurse notes that a patient with gastroesophageal reflux disease (GERD) is prescribed famotidine, an H2-blocker.
What are the symptoms of GERD in children?
An infant or child may exhibit poor eating, arching of the back, recurrent vomiting, irritability, and respiratory symptoms. Watery stools, edema in the extremities, and frequent drooling do not support the diagnosis of GERD.
Is gastric bypass surgery necessary for GERD?
Rationale: Surgery may be necessary for patients who do not respond to pharmacologic and lifestyle interventions. Laparoscopic fundoplication is the treatment of choice for GERD. Proton pump inhibitors would not be prescribed since medication has not been effective. Gastric bypass surgery is for weight loss, not GERD. The patient has already used lifestyle modifications for treatment without success. Therefore, stress management techniques would not be the best treatment option.
Is pregnancy a risk factor for GERD?
Rationale: Pregnancy is a known risk factor for developing GERD. Heart disease, asthma, and pancreatitis are not risk factors for developing GERD.
Can GERD cause wheezing?
Rationale: Atypical symptoms of gastroesophageal reflux disease (GERD) happen in the older adult due to decreased gastric acid production. This can lead to atypical respiratory symptoms such as wheezing. Normal symptoms of GERD include heartburn and regurgitation. Barrett esophagus develops from constant reflux changing cells in the esophagus.
What does a nurse suspect an infant is experiencing?
The nurse suspects that an infant is experiencing gastroesophageal reflux disease (GERD).
Do most people with GERD self medicate?
ANSWER: 2. Most clients with GERD have been selfmedicating
Does the esophagus heal?
esophagus has had a chance to heal.
How to prevent reflux in the esophagus?
1. The client should elevate the head of the bed on blocks or use a foam wedge to use gravity to help keep the gastric acid in the stomach and prevent reflux into the esophagus. behavior modification is changing ones behavior.
How many cases of asthma are caused by GERD?
1. Of adult onset asthma cases, 80% to 90% are caused by GERD.
Can GERD be self medicated?
2. Most clients with GERD have been self medicating with over the counter medications prior to seeking advice from a health-care provider. It is important to know what the client has been using to treat the problem.
What causes GERD in the upper stomach?
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.
What is the name of the disease that causes acid reflux in the esophagus?
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.
Does being overweight cause GERD?
Being overweight-Obesity poses a higher chance of developing GERD because the fat around your stomach presses against the abdominal wall weakening the LES.
Can GERD cause nausea?
6. Nausea and vomiting– GERD can cause nausea, so sometimes you may be nauseous and vomit due to heartburn.
Why does food come back up from the esophagus?
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.
Does smoking cause GERD?
2. Smoking- Smoking increases acid production. If you smoke, it makes GERD more likely to happen to you.
Can GERD cause heartburn?
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.