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NURS 3512 - Class 1-6 > Week 6 - GERD > Flashcards

Week 6 - GERD Flashcards

1
Q

what is GERD

A
  • a syndrome
  • encompasses any host of GI disruptions that are noted to be secondary to a reflux of gastric cobtents into the LES (esopahgus)
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2
Q

GERD occurs when??

A
  • when the defences of the lower esophagus are overwhelmed by the backflow or reflux of stomach acid into the esophagus = symptoms
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3
Q

what is the cause of GERD

A
  • no single 1 cause
  • caused by several factors that result in the dysfunction of the LES or when the LES defences become overhwhelmed by the stomach acid
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4
Q

what are predisposing conditions for GERD (6)

A
  • hiatal hernia
  • incompetent LES
  • decreased esophagal clearance (ability to clear liquids/food into the stomach)
  • impaired esophageal motility
  • decreased gastric emptying
  • increased intra abdominal pressure
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5
Q

what can cause an incompetent LES

A
  • decrease in pressure in the distal portion of the esophagus
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6
Q

what can caused decreased LES pressure (3)

A
  • caffeine
  • chocolate
  • anticholinergics
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7
Q

what type of symptoms are seen in gerd (5)

A
  • heartburn (pyrosis)
  • regurgitation
  • resp symptoms
  • otolaryngeal symptoms
  • gastric symptoms
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8
Q

what is heartburn described as

A
  • burning, tight sensation that is felt intermittently beneath the lower sternum & spreads upward towards the throat and jaw
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9
Q

what resp symptoms are seen in GERD (3)

A
  • dyspnea
  • wheezing
  • coughing
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10
Q

what otolaryngeal symptoms are seen in gerd (3)

A
  • sore throat
  • hoarseness
  • bolus sensation (lump in throat)
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11
Q

what is regurgitation r/t gerd

A
  • effortless return of food or gastric contents from the stomach into the esophagus or mouth
  • hot, bitter, sour liquid into the mouth
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12
Q

what gastric symptoms are seen in gerd (3)

A
  • early satiety
  • bloating after a meal
  • NV
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13
Q

what symptoms in gerd would prompt endoscopic evaluation (5)

A
  • dysphagia
  • odynophagia
  • bleeding & anemia
  • weight loss
  • persistent vomitting
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14
Q

what are complications of gerd and what causes them (3)

A

r/t to the direct local effects of gastric acid on the esophageal mucosa

  • esophagitis
  • barretts esophagus
  • resp complications
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15
Q

what is esophagitis

A
  • inflammation of the esophagus
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16
Q

what can esophagitis lead to

A
  • repeated exposure = scar tissue formation = decreased distensibility = esophageal stricture = dysphagi
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17
Q

what is Barrett’s esophagus

A
  • replacement of the normal squamous of the esophagus with columnar epithelium
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18
Q

what is the risk associated w barrets esophagus

A
  • considered precancerous lesions
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19
Q

what are signs of barrets esophagus (4)

A
  • range from none
  • to mild
  • to bleeding
  • to perforation
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20
Q

what are resp complications of GERD (4)

A
  • bronchospasm
  • laryngospasm
  • cricopharyngeal spasm
  • pneumonia (r/t aspiration of gastric contents)
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21
Q

what diagnostic studies are used for GERD (6)

A
  • endoscopy
  • barium swallow
  • biopsy and cytological specimens (to differentiate between barrets and a carcinoma)
  • esophageal manometric studies
  • ph
  • radionuclide tests
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22
Q

what is an esophageal manometric study

A

test to determine pressure in the esophagus & LES

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23
Q

what do radionuclide tests detect r/t gerd (2)

A
  • detect reflux

- rate of esophageal clearance

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24
Q

how are most patients w gerd managed (4)

A
  • lifestyle mods
  • drug therapy
  • nutritional therapy
  • surgery if these are ineffective
25
Q

what is the goal of treatment for gerd

A
  • prevent symptoms & complications
26
Q

what lifestyle mods are initiatted for GERD (5)

A
  • avoid factors that aggravate symptoms
  • encourage weight loss
  • encourage smoking cessation
  • avoid wearing tight clothing around the waist
  • sleep w HOB 30*
27
Q

what nutritional therapy is initiated for a pt with GERD (7)

A
  • food aggravates symptoms, does not cause*
  • avoid foods that lower LES pressure
  • avoid foods that slow rate of gastric emptying
  • small, frequent meals (prevent overdistension)
  • avoid late-evening & night snacking
  • fluids between meals (prevent overdistension)
  • avoid foods that irritate the acid-senstive esophagus
  • dont lying down or bending over for 2-3 hrs after eating
28
Q

what foods can lower LES pressure (6)

A
  • fatty foods
  • chocolate
  • peppermint
  • coffee
  • tea
  • alcohol
29
Q

what foods can lower the rate of gastric emptying (2)

A
  • high-fat foods

- milk products

30
Q

when in particular should you avoid milk products for gerd

A
  • at bedtime
31
Q

what are 2 examples of foods that irritate the acid senstive esophagus (2)

A
  • tomato based products

- orange juice

32
Q

what is drug therapy for gerd focused on (4)

A
  • improving LES function
  • increasing esophageal clearance
  • decreasing volume & acidity of reflux
  • protect esophageal mucosa
33
Q

what are the 2 approaches drug therapy for gerd

A
  • step-up approach

- step-down appraoch

34
Q

what does the step-up approach involve (3)

A
  • begin with antacids and OTC H2R blockers
  • progressing to prescription H2R blockers
  • and finally PPIs
35
Q

what does the step down approach involve (3)

A
  • begin with PPI
  • overtime titrate down to prescrption to H2R blockers
  • and then OTC H2R blockers and antacids
36
Q

what meds are used for gerd (6)

A
  • antacids
  • PPI
  • H2R blockers
  • cytoprotective drugs
  • prokinetic drugs
  • cholinergic drugs
37
Q

what impact do antacids have on gerd (2)

A
  • produce quick but short-lived relief of heartbirn

- neutralize HCl

38
Q

when should antacids be taken for gerd

A

1-2 h after meals and bedtime

39
Q

what is an example of an antacid for gerd (2)

A
  • mylanta

- maalox

40
Q

what do H2R blockers do

A
  • decrease secretion of HCl
41
Q

what are example of H2R blockers used for gerd(3)

A
  • rantidine (zantac)
  • famotidine (pepcid)
  • nizatidine (axid)
42
Q

what do PPIs do

A
  • decrease HCl secretion by inhibiting the proton pump responsible for secretion of H+ ions
43
Q

what are examples of PPIs used for gerd (3)

A
  • omeprazole
  • pantoprazole
  • more -prazoles
44
Q

what is a type of cytoprotective drug used for gerd

A
  • sucralfate
45
Q

what does sucralfate do

A
  • antiulcer drug
46
Q

how are cholinergic drugs helpful in treatment of gerd (3) what is a con to them

A
  • increase LES pressure
  • improve esophageal emptying into stomach
  • increase gastric emptying
  • ALSO stimulate HCl secretion
47
Q

what is a prokinetic drug used for gerd

A
  • metoclopramide
48
Q

what does metoclopromide do

A
  • promote gastric emptying
49
Q

when is surgery for gerd indicated (3)

A
  • if long-term conservative therapy fails
  • if hiatal hernia present
  • if complications exist
50
Q

what is the goal of surgical interventions for gerd

A
  • reduce reflux of gastric contents by enhancing integrity of LES
51
Q

what are surgical interventions for gerd called

A
  • antireflux procedures
52
Q

what occurs in antireflux procedures

A
  • the fundus of the stomach is wrapped around the lower portion of the esophagus in varying positions
53
Q

what is the standard for antireflux surgeries

A
  • the nissen fundoplication
54
Q

what is the nissen fundoplication procedure (2)

A
  • where the fundus of the stomach is wrapped around the dista esophagus
  • and the fundus is sutured to itself
55
Q

describe nursing care for a pt with gerd experiencing acute symptom (5)

A
  • ensure HOB at 30*
  • ensure dont lie down for 2-3 hr after eating
  • encourage pt to follow drug & lifestyle regimen
  • observe s/e of meds
  • monitor for resp symptoms
56
Q

describe pt teaching for gerd (4)

A
  • teach to avoid behaviors that cause reflux
  • explain nutritional therapy
  • explain lifestyle mods
  • explain drug regimen
57
Q

describe post-op care for gerd (7)

A
  • prevent resp complications –> resp assessment, deep breathing
  • IV fluids and electrolytes until return of peristalsis
  • maintain patency of NG tube
  • prevent infection
  • may get bloating and adminial discomfort r/t not being able to voluntarily vomit or burp
  • once peristalsis returns, fluids only initially, gradually add solid foods
  • record I&O
58
Q

describe post-op teaching for gerd (6)

A
  • should be no symptoms of gerd
  • so report symptoms
  • can return to normal diet
  • avoid foods that are gas forming
  • try to prevent gastric distension
  • chew foods thoroughly

NURS 3512 - Class 1-6 (47 decks)

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