Upper GI

Sitting up for how long after eating can promote proper digestion and reduce the risk for reflux.

1 hour

GERD (gastroesophageal reflux disease)

Chronic condition of backward flow of stomach contents into the esophagus causing esophageal irritation and inflammation

Drug therapy for GERD includes 3 major types

Antacids, histamine blockers, and protone pump inhibitors

Lifestyle modifications for GERD

small frequent meals, Avoid caffeine, spicy food, fried fatty food

1.The nurse is aware that which factors are related to the development of gastroesophageal reflux disease (GERD)? (Select all that apply.) a. Delayed gastric emptying b. Eating large meals c. Hiatal hernia d. Obesity e. Viral infections

ANS: A, B, C, D Many factors predispose a person to GERD, including delayed gastric emptying, eating large meals, hiatal hernia, and obesity. Viral infections are not implicated in the development of GERD, although infection with Helicobacter pylori is.

A client has gastroesophageal reflux disease (GERD). The provider prescribes a proton pump inhibitor. About what medication should the nurse anticipate teaching the client? a. Famotidine (Pepcid) b. Magnesium hydroxide (Maalox) c. Omeprazole (Prilosec) d. Ranitidine (Zantac)

ANS: C Omeprazole is a proton pump inhibitor used in the treatment of GERD. Famotidine and ranitidine are histamine blockers. Maalox is an antacid.

On assessment of a client with GERD, which statement requires nursing intervention? A. "I quit smoking several years ago." B. "Sometimes I wake up gasping for air in the middle of the night." C. "My family likes to eat small meals every 3 to 4 hours throughout the day." D. "When I buy meat, I ask for the leanest cut that is available."

B. "Sometimes I wake up gasping for air in the middle of the night."

regurgitation

Backward flow into the throat, of food particles or fluids is common. Risk for aspiration is increased if regurgitation occurs when the patient is lying down. Even if the patient is in an upright position, he or she may experience warm fluid traveling up the throat without nausea. If the fluid reaches the level of the pharynx, he or she notes a sour or bitter taste in the mouth.

A client reports ongoing episodes of heartburn. The nurse educates the client on prevention and control of reflux by recommending dietary elimination of which food item? A. Lean steak B. Carrot sticks C. Chocolate candy D. Air-popped popcorn

C. Chocolate candy

what are the contributing factors to GERD

Caffeinated beverages such as coffee, teal, cola. Chocolate, Citrus fruits, tomatoes, smoking, alcohol, calcium channel blockers, Nasogastric tube placement.

Antacids

Maalox & Mylanta Liquid form perferred take 1 hour before and 2 to 3 hours after each meal.

What is DX test for GERD that involves barium?

Patients may drink a solution and then have x-rays performed as part of a barium swallow, which shows hiatal hernias, strictures, and other structural or anatomic esophageal problems.

What is the main treatment for severe GERD and can be given in a single daily dose.

Proton pump inhibitors (PPIs), such as omeprazole (Prilosec), rabeprazole (AcipHex), pantoprazole (Protonix), lansoprazole (Prevacid), and esomeprazole (Nexium)

what are the main symptom of GERD?

Dyspepsia, also know as indigestion & regurgitation. INDIGESTION: abdominal discomfort, feeling uncomfortably full, nausea, and burping.

what is the most accurate method of diagnosing GERD

pH monitoring examination This involves either (1) placing a small catheter through the nose into the distal esophagus or (2) temporarily attaching a small capsule to the wall of the esophagus during an upper endoscopy (the 48-hour Bravo esophageal pH test)

A nurse is teaching clients with gastroesophageal reflux disease (GERD) about foods to avoid. Which foods should the nurse include in the teaching? (Select all that apply.) a. Chocolate b. Decaffeinated coffee c. Citrus fruits d. Peppermint e. Tomato sauce

ANS: A, C, D, E Chocolate, citrus fruits such as oranges and grapefruit, peppermint and spearmint, and tomato-based products all contribute to the reflux associated with GERD. Caffeinated teas, coffee, and sodas should be avoided.

The most common cause of GERD is?

excessive relaxation the LES, which allows the reflux of gastric contents into the esophagus and exposure of the of the esophageal mucosa to acidic gastric content.

Histamine blockers that are long acting, decrease acid and have fewer side effects and allows less frequent dosing. AVAILABE OVER THE COUNTER

famotidine (Pepcid), cimetidine (Tagamet), and ranitidine (Zantac)

DX test upper endoscopy also called esophagogastroduodenoscopy [EGD]

involves insertion of an endoscope (a flexible plastic tube equipped with a light and lens) down the throat, which allows the health care provider to see the esophagus and look for abnormalities. A biopsy can be taken This test requires the use of moderate sedation during the procedure, and patients must have someone accompany them home after recovery

The nurse has taught a client about lifestyle modifications for gastroesophageal reflux disease (GERD). What statements by the client indicate good understanding of the teaching? (Select all that apply.) a. I just joined a gym, so I hope that helps me lose weight. b. I sure hate to give up my coffee, but I guess I have to. c. I will eat three small meals and three small snacks a day. d. Sitting upright and not lying down after meals will help. e. Smoking a pipe is not a problem and I dont have to stop.

ANS: A, B, C, D Lifestyle modifications can help control GERD and include losing weight if needed; avoiding chocolate, caffeine, and carbonated beverages; eating frequent small meals or snacks; and remaining upright after meals. Tobacco is a risk factor for GERD and should be avoided in all forms.

A very effective drug for GERD that is combo of alginic acid and sodium bicarbonate is

Gaviscon It forms thick foam that floats on top of the gastric contents and theoretically decreases the incidence of reflux. If reflux occurs, the foam enters the esophagus first and buffers the acid in the refluxed material, causing less pain and decreasing the risk for further mucosal irritation. Remind the patient to take this drug when food is in the stomach

Lifestyle changes for GERD

Weight loss Raise head of bed 6 to 12 inches using wooden blocks or foam Never sleep flat Avoid acid reflux-inducing food Quit smoking Avoid large meals late at night Eat 4 to 6 small meals a day Do not wear constrictive clothing Avoid heavy lifting, straining Do not snack in the evening and do not eat 2 -3 hours before bed.