UNIT 8 GERD AND HIATIAL HERNIA CHAPTER 49 Flashcards
What is GERD
An upper gastrointestinal disease caused by the backward flow (reflux) of gastrointestinal contents into the esophagus.
also known as (regurgitation)
What are the risk factors for GERD
Patients who are overweight or have obesity are at highest risk for GERD because increased weight increases intra-abdominal pressure, which contributes to reflux.
*constricting clothing by the abdomen
Other factors that increase intra-abdominal and intragastric pressure (e.g., pregnancy, wearing tight belts or abdominal binders, bending over, ascites
*Pregnancy
*Caffeine (COFFEE),
*chocolate,
*acidic foods,
*fatty foods
*Alcohol,
*smoking
Caffeinated beverages
, tea, and cola (SODA)
* Nitrates
* Citrus fruits
* Tomatoes and tomato products
* Peppermint, spearmint
What bacteria is also a Risk factor for GERD
A. Helicobacter Pylori
B. ebola
C. Covid-19
D. Pneumoccal bacterium
Helicobacter pylori may contribute to reflux (McCance et al., 2019) by causing gastritis and thus poor gastric emptying. This increases frequency of GER events and acid exposure to the esophagus.
Which of the following pt’s are at an increased risk for Ann weakened esophageal sphincter?
A. a pt who trains everyday
B. A pt who currently has a nasogastric tube
C. a patient with dysphagia
D. A pt with a peg tube
B. A pt who currently has a nasogastric tube
Patients who have a nasogastric (NG) tube have decreased esophageal sphincter function.
The tube keeps the cardiac sphincter open and allows acidic contents from the stomach to enter the esophagus.
Health Promotion for GERD
Adults with gastroesophageal reflux (GER) may initially be asymptomatic.
Teach patients to engage in healthy eating habits that include consuming small, frequent meals and limiting intake of fried, fatt y, and spicy foods, and caffeine.
Sitt ing upright for at least 1 hour after eating can promote proper digestion and reduce the risk for reflux.
Which client statement about GERD triggers requires further nursing teaching? Select all that apply.
A. “I will decrease my alcohol intake.”
B. “Smoking one or two cigare es a day won’t hurt.”
C. “My plan is to eat six small meals daily.”
D. “Tomato-based foods should be avoided.”’
E. “I love soda but I’m going to stop drinking it.”
F. “Our family eats tacos and burritos several times weekly.”
F. “Our family eats tacos and burritos several times weekly.”
B. “Smoking one or two cigarees a day won’t hurt.”
What are signs and symptoms of GERD
Dyspepsia -INDIGESTION
* Regurgitation (into pharynx)
* “Metallic” taste in mouth
* Heartburn – due to reflux of acidic gastric contents into esophagus - Worse
after eating
* Chest Pain
* Dysphagia
- Odynophagia (painful swallowing)
Ask about dysphagia and odynophagia (painful swallowing), which can accompany chronic GERD. - Poor dentition
- Cough
- Hoarseness
- Wheezing
- *Extraesophageal symptoms
Dyspepsia, also known as indigestion, and regurgitation are the main symptoms of GERD,
Can GERD be controlled?
A. NO
B. YES
B. YES
For most patients, GERD can be controlled with nutrition therapy, lifestyle changes, and drug therapy. The most important role of the nurse is patient and caregiver education. Teach the patient that GERD is a chronic disorder that requires ongoing management. The disease should be treated more aggressively in older adults.
Patient teaching for GERD
Teach patients to engage in healthy eating habits that include consuming small, frequent meals and limiting intake of fried, fatty, and spicy foods, and caffeine.
Sitting upright for at least 1 hour after eating can promote proper digestion and reduce the risk for reflux.
. The patient should also restrict spicy and acidic foods (e.g., orange juice, tomatoes) until esophageal healing occurs.
Recommend eating four to six small meals each day rather than three large ones. Advise the patient to eat slowly and chew thoroughly to facilitate digestion and prevent eructation (belching).
Teach to avoid eating at least 3 hours before going to bed, because reflux episodes are most damaging at night. The risk for aspiration is increased if regurgitation occurs when the patient is lying down.
NO TIGHT CLOTHING
Remind the patient to sleep propped up to promote gas exchange . This can be done by placing blocks under the head of the bed or by using a large, wedge-style pillow instead of a standard pillow.( ELEVATES HOB)
NO SMOKING OR ALCOHOL
REFER WEIGHT LOSS PROGRAMS
Which of the following drugs are used fro GERD?
A. Aspirin
B. Oxycodone
C. Proton Pump Inhibitor
D. Furosemide
C. Proton Pump Inhibitor
Drug therapy for GERD management includes three major types: antacids, histamine blockers, and proton pump inhibitors (PPIs). These drugs, which are also used for peptic ulcer disease, have one or more of these functions:
* Inhibit gastric acid secretion
* Accelerate gastric emptying
* Protect the gastric mucosa
Research has found that long-term use of proton pump inhibitors (PPIs) may increase the risk for hip fracture, especially in older adults. PPIs can interfere with calcium absorption and protein digestion and therefore reduce available calcium to bone tissue. Decreased calcium makes bones more bri le and likely to fracture, especially as adults get older (Maes
et al., 2017).
Surgical Procedure for pt with GERD consideration Nissen Fundoplication
Nissen Fundoplication
Postoperative Instructions for Patients Having the Stre a Procedure
* Remain on clear liquids for 24 hours after the procedure.
* After the first day, consume a soft diet, such as custard, pureed vegetables, mashed potatoes, and applesauce.
* Avoid NSAIDs and aspirin for 10 days.
* Continue drug therapy as prescribed, usually proton pump inhibitors.
* Use liquid medications whenever possible.
* Do not allow nasogastric tubes to be inserted for at least 1 month because the esophagus could be perforated.
* Contact the primary health care provider immediately if these problems occur:
* Abdominal pain * Bleeding
* Chest pain
* DYSPHAGIA
* Nausea or vomiting
* Shortness of breath
What is Hiatal Hernia?
Hiatal hernias, also called diaphragmatic hernias, involve the protrusion of the stomach through the esophageal hiatus of the diaphragm into the chest.
The esophageal hiatus is the opening in the diaphragm through which the esophagus passes from the thorax to the abdomen.
What foods should the pt avoid if they are diagnosed with Hiatal Hernia?
Teach patients to engage in healthy eating habits that include consuming small, frequent meals and limiting intake of fried, fatty, and spicy foods, and caffeine.
*Caffeine (COFFEE),
*chocolate,
*acidic foods,
*fatty foods
*Alcohol,
*smoking
Caffeinated beverages
, tea, and cola (SODA)
* Nitrates
* Citrus fruits
* Tomatoes and tomato products
* Peppermint, spearmint
Is a sliding Hiatial Hernia associated with GERD?
A. No
B. Yes
In a type I (sliding) hernia, the esophagogastric junction and a portion of the fundus of the stomach slide upward through the esophageal hiatus into the chest, usually as a result of weakening of the diaphragm (Fig. 49.7). The hernia generally moves freely and slides into and out of the chest during changes in position or intra-abdominal pressure. Although volvulus (twisting of a GI structure) and obstruction do occur rarely, the major concern for a sliding hernia is the development of esophageal reflux and associated complications (see the section Nutrition Concept Exemplar: Gastroesophageal Reflux Disease [GERD]earlier in this chapter).
Surgical Procedure to repairs Hiatal Hernia
Laparoscopic Nissen fundoplication (LNF) is a minimally invasive surgical procedure commonly used for hiatal hernia repair. Complications after LNF occur less frequently compared with those seen in patients having the more traditional open surgical approach. A small percentage of patients are not candidates for LNF and therefore require a conventional open fundoplication.
Prepare the patient undergoing a transthoracic approach for a chest tube and a nasogastric tube, which will be present after surgery. These will be inserted during surgery and remain in place for several days.
