Gastroesophageal Reflux Disease

A. Teach the client to sleep with a foam wedge under the head

The nurse caring for a client diagnosed with GERD writes about the client's problem of "behavior modification." Which intervention should be included for this problem? A. Teach the client to sleep with a foam wedge under the head B. Encourage the client to decrease the amount of smoking C. Instruct the client to take over-the-counter medication for relief of pain D. Discuss the need to attend Alcoholics Anonymous to quit drinking

2. Famotidine (Pepsid®) Rationale: Famotidine blocks histamine 2 receptors on parietal cells, thus decreasing gastric acid production.

A client is unable to control gastroesophageal reflux with lifestyle modifications. A nurse instructs the client that by using which over-the-counter medication the client's symptoms can be successfully decreased? 1. Aspirin once a day 2. Famotidine (Pepsid®) 3. Ibuprofen (Advil®) 4. Desloratadine (Claritin®, Tavist®, Alavert®)

2. Urinary urgency. Rationale: Bethanechol (Urecholine), a cholinergic drug, may be used in GERD to increase lower esophageal sphincter pressure and facilitate gastric emptying. Cholinergic adverse effects may include urinary urgency, diarrhea, abdominal cramping, hypotension, and increased salivation.

Bethanechol (Urecholine) has been ordered for a client with gastroesophageal reflux disease (GERD). The nurse should assess the client for which of the following adverse effects? 1. Constipation. 2. Urinary urgency. 3. Hypertension. 4. Dry oral mucosa.

1. Coffee 2. Chocolate 3. Peppermint 5. Fried chicken Rationale: Foods that decrease lower esophageal sphincter (LES) pressure and irritate the esophagus will increase reflux and exacerbate the symptoms of GERD and therefore should be avoided. Aggravating substances include coffee, chocolate, peppermint, fried or fatty foods, carbonated beverages, and alcohol. Options 4 and 6 do not promote this effect

The nurse is planning to teach a client with gastroesophageal reflux disease (GERD) about substances to avoid. Which items should the nurse include on this list? Select all that apply. 1. Coffee 2. Chocolate 3. Peppermint 4. Nonfat milk 5. Fried chicken 6. Scrambled eggs

2. "I have been waking up at night lately with a burning feeling in my chest." Rationale: Heartburn, which is described as a burning, tight sensation in the lower sternum, is the most common symptom of GERD.

During a hospital admission history, a nurse suspects gastrointestinal reflux disease (GERD) when the client says: 1. "I have been experiencing headaches immediately after eating." 2. "I have been waking up at night lately with a burning feeling in my chest." 3. "I have been waking up at night sweating." 4. "Immediately after eating I feel sleepy.

4. "I should avoid drinking orange juice and eating tomatoes until my esophagus heals."

The nurse is preparing a client diagnosed with GERD for discharge following an esophagogastroduodenoscopy. Which statement indicates the client understands the dischargeinstructions? 1. "I should not eat for twenty-four (24) hours following this procedure." 2. "I can lie down whenever I want after a meal. It won't make a difference." 3. "The stomach contents won't bother my esophagus but will make me nauseous." 4. "I should avoid drinking orange juice and eating tomatoes until my esophagus heals."

1. Fats. Rationale: Fats are associated with decreased esophageal sphincter tone, which increases reflux. Obesity contributes to the development of hiatal hernia, and a low-fat diet might also aid in weight loss. Carbohydrates and foods high in sodium or calcium do not affect gastroesophageal reflux.

The client attends two sessions with the dietitian to learn about diet modifications to minimize gastroesophageal reflux. The teaching would be considered successful if the client says that she will decrease her intake of which of the following foods? 1. Fats. 2. High-sodium foods. 3. Carbohydrates. 4. High-calcium foods.

1. Take a laxative. Rationale: The client should take a laxative after an upper gastrointestinal series to stimulate a bowel movement. This examination involves the administration of barium, which must be promptly eliminated from the body because it may harden and cause an obstruction.

The client is scheduled to have an upper gastrointestinal tract series of x-rays. Following the x-rays, the nurse should instruct the client to: 1. Take a laxative. 2. Follow a clear liquid diet. 3. Administer an enema. 4. Take an antiemetic.

4. Thicken the feedings by adding rice cereal to the formula. Rationale: Gastroesophageal reflux is backflow of gastric contents into the esophagus as a result of relaxation or incompetence of the lower esophageal or cardiac sphincter. Small, more frequent feedings with frequent burping often are prescribed in the treatment of gastroesophageal reflux. Feedings thickened with rice cereal may reduce episodes of emesis. If thickened formula is used, cross-cutting of the nipple may be required.

The nurse provides feeding instructions to a parent of an infant diagnosed with gastroesophageal reflux disease. Which instruction should the nurse give to the parent to assist in reducing the episodes of emesis? 1. Provide less frequent, larger feedings. 2. Burp the infant less frequently during feedings. 3. Thin the feedings by adding water to the formula. 4. Thicken the feedings by adding rice cereal to the formula.

4. Alcohol. Rationale: Metoclopramide hydrochloride (Reglan) can cause sedation. Alcohol and other central nervous system depressants add to this sedation. A client who is taking this drug should be cautioned to avoid driving or performing other hazardous activities for a few hours after taking the drug.

The nurse should instruct the client to avoid which of the following drugs while taking metoclopramide hydrochloride (Reglan)? 2. High-sodium foods. 2. Antihypertensives. 3. Anticoagulants. 4. Alcohol.

2. Do not lie down for 2 hours after eating. Rationale: The nurse should instruct the client to not lie down for about 2 hours after eating to prevent refl ux. Caffeinated beverages decrease pressure in the lower esophageal sphincter and milk increases gastric acid secretion, so these beverages should be avoided. The client is encouraged to follow a high-protein, low-fat diet, and avoid foods that are irritating.

Which of the following instructions should the nurse include in the teaching plan for a client who is experiencing gastroesophageal reflux disease (GERD)? 1. Limit caffeine intake to two cups of coffee per day. 2. Do not lie down for 2 hours after eating. 3. Follow a low-protein diet. 4. Take medications with milk to decrease irritation.

3. Hot chocolate. Rationale: With GERD, eating substances that decrease lower esophageal sphincter pressure causes heartburn. A decrease in the lower esophageal sphincter pressure allows gastric contents to refl ux into the lower end of the esophagus. Foods that can cause a decrease in esophageal sphincter pressure include fatty foods, chocolate, caffeinated beverages, peppermint, and alcohol.

A client who has been diagnosed with gastroesophageal reflux disease (GERD) complains of heartburn. To decrease the heartburn, the nurse should instruct the client to eliminate which of the following items from the diet? 1. Lean beef. 2. Air-popped popcorn. 3. Hot chocolate. 4. Raw vegetables.

4. Aspiration of gastric contents. Rationale: Clients with GERD can develop pulmonary symptoms, such as coughing, wheezing, and dyspnea, that are caused by the aspiration of gastric contents. GERD does not predispose the client to the development of laryngeal cancer. Irritation of the esophagus and esophageal scar tissue formation can develop as a result of GERD. However, GERD is more likely to cause painful and diffi cult swallowing.

The client with gastroesophageal reflux disease (GERD) complains of a chronic cough. The nurse understands that in a client with GERD this symptom may be indicative of which of the following conditions? 1. Development of laryngeal cancer. 2. Irritation of the esophagus. 3. Esophageal scar tissue formation. 4. Aspiration of gastric contents.

3. Published national standards. Rationale: It is the responsibility of all health care members to protect the client. The provider may honestly not have realized that the glove was contaminated. Therefore, the nurse needs to alert the provider to the situation. Waiting until after the procedure to address the problem puts the child at unnecessary risk for infection.

The health care team wishes to establish a policy regarding sleep positions for infants with gastroesophageal reflux (GER). The first step should be to search for: 1. Policies from other hospitals. 2. Data from retrospective studies. 3. Published national standards. 4. Expert opinions.

D. Elevate the head of the bed 30 degrees and discuss lifestyle modifications with the client

The nurse is caring for a client diagnosed with GERD. Which nursing intervention should be implemented? A. Place the client prone in bed and administer nonsteroidal anti-inflammatory medications B. Have the client remain upright at all times and walk for 30 minutes three (3) times a week C. Instruct the client to maintain a right lateral side-lying position and take antacids before meals D. Elevate the head of the bed 30 degrees and discuss lifestyle modifications with the client

1. A review in the Cochrane Library. Rationale: The Cochrane Library provides systematic reviews of health care interventions and will provide the best resource for evidence for nursing care.

The nurse is developing standards of care for a client with gastroesophageal reflux disease and wants to review current evidence for practice. Which one of the following resources will provide the most helpful information? 1. A review in the Cochrane Library. 2. A literature search in a database, such as the Cumulative Index to Nursing and Allied Health Literature (CINHAL). 3. An online nursing textbook. 4. The online policy and procedure manual at the health care agency.

C. Eat four (4) to six (6) small meals a day and limit fluids during mealtimes

The nurse is planning the care of a client diagnosed with lower esophageal sphincter dysfunction. Which dietary modifications should be included in the plan of care? A. Allow any of the client's favorite foods as long as the amount is limited B. Have the client perform eructation exercises several times a day C. Eat four (4) to six (6) small meals a day and limit fluids during mealtimes D. Encourage the client to consume a glass of red wine with one (1) meal a day

3. Hamburger, french fries, and a cola beverage Rationale: Hamburgers and french fries are high-fat foods that decrease the lower esophageal sphincter (LES) pressure, thus allowing gastric contents to reflux back into the esophagus. Cola contains caffeine, which also decreases the LES pressure. The rest of the foods are not high in fat and do not contain caffeine or milk products

While assessing the dietary intake of a client with gastroesophageal reflux disease (GERD), a nurse should expect the client to report discomfort after consuming which of these foods? 1. Poached salmon, baked potatoes, and apple juice 2. Baked chicken, rice, and milk 3. Hamburger, french fries, and a cola beverage 4. Chef salad, rolls, and sparkling grape juice