Case Study Chapter 41 - GERD PDF

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CASE STUDY – CHAPTER 41 UPPER GI PROBLEMS Gastroesophageal Reflux Disease Patient Profile C.S. is a 49-year-old male who goes to the health care provider because he is experiencing heartburn more frequently and it is keeping him awake at night. He had asthma as a child. He is currently taking Mylanta as needed for heartburn. Subjective Data  Has had occasional heartburn about once a week for a few years, but the last couple of months it has become more frequent and is now occurring almost daily  Describes the pain as a burning pain in his sternal area that is relieved by drinking milk or taking Mylanta  Pain worsens after he goes to bed and he has been having difficulty sleeping  Denies any nausea or vomiting Objective Data  Temperature 98.4° F, pulse 78, respirations 16, blood pressure 124/70  Height 6’0”,weight 270 lb  Physical exam normal, no abdominal pain or tenderness noted Discussion Questions 1. As the admitting nurse, describe the additional history you would obtain from C.S. Smoking and drinking history color of vomitus and any blood present diet history and diet recall for last 24hr foods or precipitating factors that agitate the feeling medication history past medical history any surgeries is he taking any other OTCs or herbal or supplements medications any past abdominal problems any changes in elimination, gas, flatulence, incontinence any respiratory problems or heart disease

2. The health care provider informs C.S. that he probably has gastroesophageal reflux disease (GERD). What is GERD? What are some of the predisposing factors for GERD? *GERD is a chronic symptom of mucosal damage caused by reflux of stomach acid into the lower esophagus * It is a syndrome in which the esophageal defenses are overwhelmed and the refluxate causes esophageal irritation and inflammation (esophagitis)

*FACTORS that cause GERD from incompetent LES decreased LES pressure certain drugs and foods obesity increased intraabdominal pressure cigarette and cigar smoking hiatal hernia

3. Identify key findings from the assessment that led the health care provider to suspect that C. S. has GERD and describe their significance. Heartburn frequently at night Occurrence of heartburn almost daily Burning pain in sternal area relieved by drinking milk or taking Mylanta Pain worsens at night Difficulty sleeping Obesity

4. You are counseling C.S. on lifestyle modifications. What should you include for C.S.? Weight reduction Avoid foods and factors that trigger symptoms Avoid foods that affect the LES, acid secretion, or gastric emptying Smoking cessation Determine measures to cope with stress

5. The health care provider prescribes omeprazole for C.S. and instructs him to return for a followup visit in two weeks if his symptoms do not improve. What is the mechanism of action of omeprazole and the rationale for returning only if symptoms persist? This is a proton pump inhibitor (PPI) and Omeprazole decreases HCl secretion by inhibiting the protein pump from secreting H+ Decreases irritation of the esophagus and gastric mucosa It is advised to return if symptoms persist because their may be further damage can be more lifethreatening. Esophagitis can be present / inflammation of the esophagus with or without ulcerations. Barrett’s esophagus or esophageal metaplasia / precancerous lesion Recurrence is possible with GERD

6. If medications and lifestyle modifications are not effective at eliminating the symptoms of GERD, what is another option? Nutritional therapy  Avoiding foods that decrease LES pressure o Chocolates, peppermint, fatty foods, coffee, tea  Avoid foods that may irritate the esophagus o Tomato-based products, orange juice, cola, red wine o Avoid late night meals, nocturnal snacking and milk  Prevent overdistention by eating small frequent meals and not drinking while eating  Chewing gum and oral lozenges help with mild symptoms Surgical therapy  Antireflux surgery done laparoscopically  Fundus is wrapped around lower portion of the esophagus to reinforce and repair the defective barrier  Nissen and Toupet fundoplication common surgeries LINX reflux management system  Flexible magnets on a ring made with titanium beads and wiring implanted into the LES  Provides strength to weakened LES  Helps keep closed to prevent reflux...