Pandes, Sophia Mae O.

BSN-3A

CONCEPT MAP

Medical Diagnosis

Gastroesophageal reflux disease

Defined as:

A disorder marked by backflow of

gastric or duodenal contents into the
esophagus that causes troublesome
symptoms and/or mucosal injury to
the esophagus.

Caused by: Contributed by risk factors:

Usually due to incompetent • Old age
lower esophageal sphincter, • Patients with irritable bowel
pyloric stenosis or motility syndrome
disorder • Patients with obstructive
airway disorders, ulcer
disease, and angina
• Tobacco use
• Coffee drinking
• Alcohol consumption
• Gastric infection with H.
Pylori
• Less physical activity at work
• Eating habits

Pathophysiology

GERD is a result of gastric juices overcoming the lower

esophageal sphincter (LES) pressure and re-entering the
esophagus. Other factors include delayed gastric
emptying, decreased salivation, sliding and para-
esophageal hiatal hernia, increase or decrease of intra-
abdominal pressure.
 Assessment

• Appetite? Decrease
• Pain? Yes, mid epigastric
As manifested by signs and symptoms burning sensation in chest
• Dry cough
• Pyrosis (heartburn, specifically
more commonly described as a • Occasional regurgitation
burning sensation in the • Does change in position
esophagus) affect the discomfort? Yes,
• Dyspepsia pain worsens when lying flat
and after eating. Pain is
• Regurgitation
relived when in a sitting
• Dysphagia
position and taking OTC
• Hypersalivation
medications.
• Esophagitis
• postprandial fullness and
• Dental erosion
early satiety
• Ulcerations in the pharynx and
• Waking up from pain and
esophagus
burning, with a sore throat
• Laryngeal damage
and hoarse voice.
• Esophageal strictures
• The patient reports
• Adenocarcinoma
associated mid-thoracic,
• Pulmonary complications bilateral back pain that
occurs during the episodes.

Diagnostic test:

• Endoscopy
Nursing Diagnosis
• Barium swallow
• Gastric ambulatory pH analysis • Imbalanced nutrition: less
• Bilirubin monitoring than body requirements
reduced food intake
secondary to GERD
• Risk for aspiration related to
difficulty swallowing.
• Acute pain related to
irritated esophageal
mucosa.
• Anxiety related to deficient
knowledge about the
esophageal disorder.
Medical Management Surgical Pharmacologic Nursing Management
Management Management
• Lifestyle changes Promotive/Preventive
such as weight • Antireflux Antacids/Acid
• Encouraging
loss. Avoidance of surgery neutralizing agent:
adequate
carbonated,
• calcium nutritional intake
caffeine intake,
and alcoholic carbonate by asking patient
beverages. • aluminum to eat slowly and
hydroxide to chew all food
Avoiding spicy
thoroughly so that
and citrus foods.
Histamine 2 receptor it can pass easily
Maintaining low
analgesics in the stomach.
fat diet, elevating
the head of the • pepcide • Decreasing risk of
bed, and avoid • ranitidine aspiration by
keeping patient in
eating several • cimetidine
hours before a semi fowler
going to bed. Prokinetic agents position.
• • Providing patient
Administering • Metodopramide
medications for education to
severe symptoms Protein Pump Inhibitors ensure patient is
or persistent prepared
• Omeprazole physically and
symptoms. • Nexium psychologically for
Reflux inhibitors all tests and
treatments.
• urecholine
Curative/Restorative

• Relieving pain by
encouraging to
small, frequent
feedings.
• Advice patient to
avoid any
activities that
increase pain and
to remain upright
for 1 to 4 hours
after each meal