79209988 GERD Gastroesophageal Reflux Disease

GERD(Gastroesophageal Reflux Disease)

Cabase, JennelynCamalla, Junalyn FranciaCarballo, AbegailCecilio, MarjorieCorpuz, Cherrie MaeCuliat, Lea

I. Patients Profile

• Name: Mrs. EBV• Birthday: September 23, 1941• Age: 70• Address: Zone 2 Ayugan Vales,

Ocampo, Camarines Sur• Religion: Roman Catholic• Level of Education: College

Graduate• Chief complaint:difficulty

swallowing,history of aspiration 3x

HEALTH HISTORY

• Mrs. EBV is a 70 year old woman, born on a town of Nabua. A college graduate of education at University of Nueva Caceres and presently retired from work. Lives in a two story house with her husband and her younger child and a niece. Major reason for seeking health care is for routine check-up.

• Past Illnesses/Hospitalization:• Placenta Previa on the 3rd baby at the

age of 37• UTI at the age of 69

• Allergies:• Denies food, drug and environmental

allergies.

a. Health history

HEAD-TO-TOE ASSESSMENT

◊ GENERAL ASSESSMENTVital signs:

BP:120/80HR: 82RR: 16

• The client is cooperative and alert, answers question spontaneously.

• Sitting comfortably on table with arms crossed and shoulders slightly slouched forward.

• Dress neat and clean. • Walks steadily with posture slightly

stooped.

b. Head-t0-toe assessment

◊ SKIN, HAIR AND NAIL ASSESSMENT:• Skin: -warm and dry to touch.

-Skin fold returns to place after 1 second.

-Lesions and edema not noted to any part of the body.• Hair: -hair black in color, medium

textured, evenly d istributed on head, -no scalp lesions or flaking. -No hair noted on the axilla, arms

and legs or on the chest, back or face.• Nails: fingernails medium in length with a

capillary refill of 2-3 seconds.

b. Head-t0-toe assessment

◊ Head and neck assessment:• Head symmetrically rounded• neck nontender with full range of

motion. • Neck symmetrical without masses,

scars, and pulsations.• Lymph nodes not palpable. • Trachea is in midline.• Carotid arteries equally strong

without bruits.• Identifies light and deep touch to

various parts on the face.

b. Head-t0-toe assessment

◊ Eye assessment:• Eye brows sparse with equal distribution,

scaliness not noted. • Lids pink without ptosis, edema or lesions and

freely closeable bilaterally• sclera white without increased vascularity or

lesions noted.

◊ Ear Assessment:• Auricle without deformities, lumps or lesions. • Mastoid process non palpable. • Both auditory canals contain moderate amount

dark brown cerumen. • Tympanic membrane difficult to view due to

presence of wax.

b. Head-t0-toe assessment

◊ Nose and Sinuses Assessment:• External stricture without deformities,

asymmetry and inflammation.• Nares are both patent and the nasal septum

midline without bleeding, perforation or bleeding.

◊ Mouth and pharynx:• No lesions or ulcerations. • Buccal mucosa pink and moist without

discoloration or increased pigmentation. Absence of all the molar teeth and a lateral incisor tooth.

• Hard and soft palate smooth without lesion or masses. Tongue midline when protruded and with white pigmentation on inner part. Gag reflex intact, tonsils present without exudates, edema, ulcers or enlargement.

b. Head-t0-toe assessment

◊ Cardiac Assessment:• No pulsations visible. • Clear brief heart sounds throughout auscultation.• Apical pulse: 83/min and regular.◊ Musculoskeletal Assessment

• Posture slightly stooped with mild kyphosis.

• Gait steady, smooth and coordinated with even base.

• Limited range of motion of lateral flexion and extension of the spine.

• Upper and lower extremities have limited ROM.

• Verbalize joint pain during long standing and activities and relieve by rest.

b. Head-t0-toe assessment

◊ Neurologic Assessment:• Mental Status: Talkative and friendly. • Dressed appropriately, clothes are neat

and clean. • Facial expressions symmetrical and

correlate with mood and topic discussed. • Speech clear and appropriate. • Carefully chooses words to convey feelings

and ideas.• Oriented to person, place and time and

events. • Remains attentive and able to focus during

the entire interaction. • Long and short term memory are intact.

b. Head-t0-toe assessment

GORDON’SFUNCTIONAL HEALTH PATTERN

C. Gordon’s Functional Health PatternA. Health Perception-Health Management Pattern• Client rating of health:• Scale: 10-best; 1-worst• 5 years ago: 10• Now: 7• 5 years from now: 8• 10 years from now: 7• Sees health deterioration as normal aging

process and states, “as age increases body resistance weakens, natural naman yan i-kumpara mo na lang sa sarong makina pag 10 years na nagpapalya naman.

C. Gordon’s Functional Health PatternA. Health Perception-Health Management Pattern• Health does not interfere with self-care or other

desired activities of daily living. Unaware of signs and symptoms of GERD. Never use alcohol, tobacco and drugs but know that she is a 2nd hand smoker because of her husband that consume of approximately 40 sticks of cigarette a day.

• Client seeks health care once in 6 months and in time of emergencies. Last medical exam was May 2011. Keeps active and feel well. Does not check own blood pressure or do breast self exams.

C. Gordon’s Functional Health PatternA. Health Perception-Health Management Pattern• Health does not interfere with self-care or other

desired activities of daily living. Unaware of signs and symptoms of GERD. Never use alcohol, tobacco and drugs but know that she is a 2nd hand smoker because of her husband that consume of approximately 40 sticks of cigarette a day.

• Client seeks health care once in 6 months and in time of emergencies. Last medical exam was May 2011. Keeps active and feel well. Does not check own blood pressure or do breast self exams.

C. Gordon’s Functional Health PatternB. Nutritional-Metabolic Pattern• States that she prefer eating porridge food and

attempt to take on soft diet because of the reason that she cannot tolerate hard food such as meat

• she experience a burning sensation in the esophagus, difficulty of swallowing food, and experience sour taste in the mouth for more than twice each week as a result she consulted the doctor and term it as GERD.

• states painscale 0f 7 when swallowing and verbalizes that she experience aspiration thrice and now she is afraid of eating alone

• Reported the she like to eat fatty food, caffeinated beverages, colas and spicy foods.

C. Gordon’s Functional Health Pattern• Drinks 8 glasses of water a day. • Drinks 2 cups of decaf coffee one in the morning

and one in the afternoon-no tea and occasionally drink colas.

• Never wears dentures even if she doesn’t have all the molar teeth and a lateral incisor tooth. Last dental exam was 2010. Complains of dyspepsia approximately 2x/month and never take any drug.

• Describe the skin and scalp dry and uses lotion as management. Denies easily bruising, pruritus and nonhealing sore. Nails are hard and brittle and the hair is grey in color, fine and soft.

• Current weight: 136 lbs• Previous weight:140 lbs 3 weeks ago

C. Gordon’s Functional Health PatternC. Elimination Pattern• Bowel Habits: -soft, formed, medium brown

bowel movement every morning. -Never report of mucous, bloody or

tarry stools, or rectal bleeding, change in color, consistency or habits.• Bladder Habits: -experiences urinary

incontinence and pain last 2010 when she was diagnosed of urinary tract infection.

-But now reports of regular urination 4-5x in a day, clear yellow urine. 

C. Gordon’s Functional Health PatternD. ACTIVITY-EXERCISE PATTERN• ADLs on average day: -Arises at 8am in the

morning. -Eats breakfast and does housekeeping.

- Take lunch 1pm in the afternoon and by 4pm in the afternoon takes a nap for 30minutes to 1 hour.

-Cleans own house and never report of any chest pain, palpitation except for joint pain and it is only relieve by rest.• Hygiene: take a bath once a week.• Occupational activities: retires from being a

teacher in a public school in Naga City and points out that it is the reason why she experiences joint pain.

C. Gordon’s Functional Health PatternE. Sexuality-Reproduction Pattern• Menstrual History:

– age of menarche: 16 years old– age of menopause: approximately 58 years

old– described menstrual period as regular,

lasting for 5 to 7 days with moderate flow. Never report of postmenopausal spotting at this time

• Obstetric History: Gravida 3, Para 3, and the 3rd child with complication of placenta previa.

• Contraception: never used any form

C. Gordon’s Functional Health PatternF. Sleep-Rest Pattern • Goes to bed at 11:30 pm. • Did not complain of difficulty falling asleep or

sleeping.• Feels well rested when she arises at 8am. • Take a nap of 30 minutes to an hour during the

afternoon. • Uses 3 pillows when sleeping.G. Cognitive Pattern• Speech clear without slur and follow a verbal

cues. Expresses ideas and feelings clearly and concisely.

• Can remember long and short term memory even the date, time and places of events.

• Makes major decisions jointly with the husband and prayer to the Lord.

C. Gordon’s Functional Health PatternH. Role-Relationship Pattern• Client has been married for 48 years, describes

relationship as the best part of life right now. • She is very fond of 6 grandchildren most

especially when her youngest grandchild sent her videos of her activities in Canada.

• Received phone call from her 2nd child once a month and the oldest child visit her trice a month.

• Explains her relationship with other members in the community as friendly.

• She was the oldest of 10 children.

C. Gordon’s Functional Health PatternI. Coping-stress tolerance Pattern• Shares that the most stressful event is the

accident that happen to her 2nd eldest grandchild that she even get hysterical and experience shortness of breath, it was 2 years ago when it happen and the only coping is prayers to the lord and the support of the relatives and family

J. Value-Belief Pattern• Religious preference is Roman Catholic. Believe

that God is the creator of all the things and when we believe in him and trust in him God He will provide.

• Places God as the center of the family.

ANATOMY AND PHYSIOLOGY

anatomy and physiology

Gastrointestinal Tract- breakdown food into nutrients which can be absorbed into the body to provide energy.- Food must be ingested into the

mouth to be mechanically processed and moistened.

- Digestion occurs mainly in the stomach and small intestine where proteins, fats and carbohydrates are chemically broken down into their basic building blocks.

- Smaller molecules are then absorbed across the epithelium of the small intestine and subsequently enter the circulation.

anatomy and physiology

- The large intestine plays a key role in reabsorbing excess water. Finally, undigested material and secreted waste products are excreted from the body via defecation (passing of feces). - Digestive tract is a tube extending

from the mouth to the anus, plus the associated organs, which secrete fluids into the digestive tract.

- It consists of the oral cavity, pharynx, esophagus, stomach, small intestine, large intestine and anus.

anatomy and physiology

ORAL CAVITY• Responsible for the intake of food.• it is lined by a stratified squamous oral mucosa

with keratin covering those areas subject to significant abrasion such as tongue, hard palate and roof of the mouth.

• TEETH – there are 32 teeth in the normal adult.• Mastication is the mechanical breakdown of

food by chewing and chapping actions of the teeth.

• TONGUE- strong muscular organ, manipulates the food bulos to come in contact with the teeth.

-It is also the sensing organ of the mouth for touch, temperature and taste using its specialized sensors known as papillae.

anatomy and physiology

SALIVARY GLANDS• Insalivation – the mixing of the oral cavity

contents with salivary gland secretion.

• Mucin (a glycoprotein) in saliva acts as a lubricant.

-The enzyme serum amylase, a component of saliva, starts the process of digestion of complex carbohydrates.

• Acini secrete contents into specialized ducts.-Each gland is divided into smaller

segments called lobes.

• Salivation occurs in response to the taste, smell or even appearance of food.

anatomy and physiology

• Parotid Glands are large, irregular shaped glands located under the skin on the side of the face. They secrete 25% of saliva.

• Submandibular Glands secretes 70% of the saliva in the mouth. Each gland can be felt as a soft lump along the inferior border of the mandible.

• Sublingual Glands covered by a thin layer of tissue at the floor of the mouth. It produces approximately 5% of the saliva and their secretions are very sticky due to the large concentration of Mucin. The main functions are to provide buffer and lubrication.

anatomy and physiology

PHARYNX- “throat”- which connects the mouth with the

esophagus, consists of three parts: -the nasopharynx-oropharynx and -laryngopharynx. The posterior walls of the

oropharynx and laryngopharynx are formed by the superior, middle and inferior pharyngeal constrictor muscles.

anatomy and physiology

ESOPHAGUS- It is a muscular tube approximately

25 cm in length and 2 cm in diameter line with moist stratified squamous epithelium that extends from the pharynx to the stomach and lies anterior to the vertebrae and posterior to the trachea within the mediastinum.

- It passes through the diaphragm and ends at the stomach.

- The esophagus transports food from the pharynx and to the stomach.

anatomy and physiology

• Esophageal Sphincters-

-located at the upper and lower ends of the esophagus,

-regulate the movement of food in and out of the esophagus.• Cardiac Sphincter-

-lower esophageal sphincter.

anatomy and physiology

STOMACH

• -J shaped expanded bag, located just left of the midline between the esophagus and small intestine.

• It is divided into four main regions and has two borders called the greater and lesser curvatures.

• -The first section is the cardiac opening which surrounds the cardiac orifice where the esophagus enters the stomach.

anatomy and physiology

• The fundus is the superior dilated portion of the stomach is contracted into numerous longitudinal folds called rugae.

• The largest part of the stomach is the body which turns to the right forming a greater curvature on the left, and a lesser curvature on the right.

• The pylorus is the curved base of the stomach. Gastric contents are expelled into the proximal duodenum via the pyloric sphincter.

anatomy and physiology

Functions of the Stomach:• The short term storage of ingested food• Mechanical breakdown of food by

chewing and mixing motions.• Chemical digestion of proteins by acids

and enzymes.• Stomach acid kills bugs and germs• Some absorption of substances such as

alcohol.-Most of these functions are achieved by the secretion of stomach juices by gastric gland in the body and fundus.

anatomy and physiology

SMALL INTESTINE• - About 6 m in length extending from

the pyloric sphincter of the stomach to the ileocaecal valve separating the ileum from the cecum.

• It performs the majority of digestion and absorption of nutrients.

• Partly digested food from the stomach is further broken down by enzymes from the pancreas and bile salts from the liver and gall bladder.

anatomy and physiology

• Duodenum – C shaped section that curves around the head of the pancreas. Serve as a mixing function.

• Jejunum – a sharp bend, the duodenojejunal flexure. Majority of digestion and absorption occurs.

• Ileum – longest segment and final portion. Empties into the cecum at the ileocaecal junction.

anatomy and physiology

• TWO LARGE ACCESSORY GLANDS:

• LIVER- weighs about 1.36 kilograms and is located in the right upper quadrant of the abdomen, tucked against the inferior surface of the diaphragm.  

• The liver performs important digestive and excretory functions, stores and processes nutrients, synthesizes new molecules and detoxifies harmful chemicals. 

• secretes about 700 ml of bile each day.

anatomy and physiology

• Bile contains no digestive enzymes, but it plays an important role in digestion by diluting and neutralizing stomach acid and by dramatically increasing the efficiency of fat digestion and absorption.

• Bile Salts emulsify fats, breaking the fat globules into smaller droplets, much like the action of detergents in dishwater.

• Bilirubin is a bile pigment that results from the breakdown of hemoglobin.

anatomy and physiology

The gall bladder is a pouch-shaped organ which lies near the liver. 

-It accepts bile from the liver, and stores it. 

When food is digested, the gallbladder releases bile into the small intestine where it is able to help dissolve fats.

anatomy and physiology

PANCREAS- located retroperitoneal, posterior to the stomach in the inferior part of the left upper quadrant. 

The exocrine secretions of the pancreas include HCO3- , which neutralize the acidic chime that enters the small intestine from the stomach. -Pancreatic enzymes are also present in the exocrine secretions and are important for the digestion of all major classes of food. Without the enzymes produced by the pancreas, lipids, proteins and carbohydrates are not adequately digested. 

anatomy and physiology

LARGE INTESTINE•  Horse shoe shaped. Consists of:• Cecum- expanded pouch that receives material 

from the ileum and starts to compress food products into fecal material.

• Colon- is about 1.5-1.8 m long and consists of four parts: ascending colon (extends superiorly from the cecum to the right colic flexure, near the liver, where it turns to the left; transverse colon (extends from the right colic flexure to the left colic flexure near the spleen, where the colon turns inferiorly; 

anatomy and physiology

descending colon (extends from the left colic flexure to the pelvis where it becomes sigmoid colon;  sigmoid colon (forms an S-shaped tube that extends medially and then inferiorly into the pelvic cavity and ends at the rectum.Rectum- expands to hold fecal matter before it passes through the anorectal canal to the anus. The sphincter controls the passage of the feces. Goblet cells line the glands that secrete mucous to lubricate fecal matter as it solidifies.

anatomy and physiology

Anal Canal  2-3 cm of the digestive tract. -begins at the inferior end of the rectum and ends at the anus. -The smooth muscle layer of the anal canal is even thicker than that of the rectum and forms the internal anal sphincter at the superior end of the anal canal. -The external anal sphincter at the inferior end of the anal canal is formed by skeletal muscle.  

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY

• Gastroesophageal reflux disease (GERD) or acid reflux disease

• - is chronic symptoms or mucosal damage caused by stomach acid coming up from the stomach into the esophagus.

• A typical symptom is heartburn.After swallowing,foods passes

into the ESOPHAGUS a 25 cm long tube

Down into the STOMACH where DIGESTION HAPPENS

PATHOPHYSIOLOGY

GASTRIC ACIDS confined into the STOMACH through

VALVE MECHANISM

Involves two muscles

Lower esophageal sphincter (LES)

Diaphragm-Hiatus

PATHOPHYSIOLOGY

if FUNCTION IMPROPERLY causes GASTRIC ACID

Irritating the Lining of Esophagus causing HEARTBURN

Gastroesophageal reflux disease (GERD)

DIAGNOSTIC AND LABORATORY TEST

ENDOSCOPY

The upper endoscopy (also known as esophagogastroduodenoscopy or EGD)

- allows the doctor to examine the inside of the patient's esophagus, stomach, and duodenum with an instrument called an endoscope, a thin flexible lighted tube.

- Allows visualization of the walls and tissue of the upper digestive tract.

ENDOSCOPY

- will be able to detect disorders such as strictures (narrowed areas), hiatal hernias, ulcers and tumors. If necessary, biopsies can be collected.

Endoscopy is often used in patients who have had heartburn for many years to determine whether a condition called Barrett’s esophagus has developed

ENDOSCOPY

What can be expected if the doctor orders an EGD?

• The patient is not to eat anything for at least six hours before the procedure.

• A local anesthetic will be sprayed into the patient's throat to suppress the gag reflex, and an intravenous sedative will help the patient relax.

ENDOSCOPY

• The endoscope is then slowly passed into the patient's mouth and down the esophagus.

• The gag reflex and the urge to vomit usually pass once the tube is in the esophagus. The tube will not interfere with breathing.

ENDOSCOPY

Once the endoscope is in place, - the doctor will be able to examine

the esophagus and stomach through a tiny camera, and detect any abnormalities.

- Other instruments can be inserted through the endoscope tube, which will allow the doctor to perform biopsies if such conditions as cancer or infections are evident.

ENDOSCOPY

• The patient may experience a sore throat for a few days after the procedure

• If complications (such as vomiting a large amount of blood or severe stomach pains) occur, the doctor should be notified immediately.

MEDICATIONS

MEDICATIONS

GENERIC NAME: esomeprazole-prescribed by Dr. Dabu

BRAND NAME: NexiumDRUG CLASS AND

MECHANISM: Esomeprazole is in a class of drugs called proton pump inhibitors (PPIs) which block the production of acid by the stomach.

Other drugs in the same class include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex) and pantoprazole (Protonix). Chemically, esomeprazole is very similar to omeprazole

MEDICATIONS

Proton pump inhibitors are used for the treatment of conditions such as stomach and duodenal ulcers, gastroesophageal reflux disease (GERD) and the Zollinger-Ellison syndrome which all are caused by stomach acid.

Esomeprazole, like other proton-pump inhibitors, blocks the enzyme in the wall of the stomach that produces acid. By blocking the enzyme, the production of acid is decreased, and this allows the stomach and esophagus to heal.

Esomeprazole was approved by the FDA in February 2001.

MEDICATIONS

GENERIC: No PRESCRIPTION: Yes PREPARATIONS: Capsules: 20

and 40 mg. Intravenous: 20 and 40 mg; Powder for Oral Suspension: 10 mg, 20 mg, 40 mg

STORAGE: Store at room temperature, 15-30 C (59-86 F) in a tightly closed container.

MEDICATIONS

PRESCRIBED FOR: Esomeprazole is approved for the treatment of gastroesophageal reflux disease (GERD) and in combination with amoxicillin and clarithromycin (Biaxin) for the treatment of patients with ulcers and H. pylori infection.

It also is used for reducing the risk of gastric ulcers associated with NSAIDs and the treatment of Zollinger-Ellison syndrome.

Esomeprazole also is approved for short term use in children ages 1-11 for GERD.

MEDICATIONS

DOSING: • For GERD, 20 or 40 mg of

esomeprazole is given once daily for 4-8 weeks. In children ages 1-11, the dose is 10 or 20 mg daily.

• For the treatment of H. pylori, 40 mg is administered once daily in combination with amoxicillin and clarithromycin for 10 days.

• The dose for preventing NSAID-induced ulcers is 20 to 40 mg daily for 6 months.

• Zollinger-Ellison syndrome is treated with 40 mg twice daily.

MEDICATIONS

Esomeprazole capsules should be administered one hour before meals, swallowed whole and should not be crushed or chewed.

Patients with difficulty swallowing can open the capsule and mix the pellets with applesauce.

The applesauce should not be hot and the pellets should not be chewed or crushed.

MEDICATIONS

DRUG INTERACTIONS: 

Esomeprazole potentially can increase the concentration in blood of diazepam (Valium, Diastat) by decreasing the elimination of diazepam in the liver. Esomeprazole may have fewer drug interactions than omeprazole.

MEDICATIONS

The absorption of certain drugs may be affected by stomach acidity

-esomeprazole and other PPIs that reduce stomach acid also reduce the absorption and concentration in blood of ketoconazole (Nizoral) and increase the absorption and concentration in blood of digoxin (Lanoxin). This may lead to reduced effectiveness of ketoconazole or increased digoxin toxicity, respectively.

MEDICATIONS

• Brand Name-prescribed by Dr.PioPariet• Common Name: rabeprazole

DIN02243796 PARIET 10MG TABLET

02243797 PARIET 20MG TABLET

DIN (Drug Identification Number)

MEDICATIONS

Rabeprazole belongs to the class of medications known as proton pump inhibitors (PPIs).

It works by slowing or preventing the production of acid in the stomach.

Rabeprazole is used to treat and maintain healing of gastroesophageal reflux disease (GERD). It is also used to treat symptoms, such as heartburn and regurgitation, of non-erosive reflux disease (NERD).

MEDICATIONS

It is also used for short-term treatment in the healing and relief of symptoms associated with duodenal and gastric ulcers.

Rabeprazole is used in combination with antibiotics to treat ulcers caused by the bacterium Helicobacter pylori.

rabeprazole is used for long-term treatment of conditions associated with constant production of excess acid in the stomach,.

MEDICATIONS

To treat gastroesophageal reflux disease (GERD), the recommended adult dose of rabeprazole is 20 mg, taken once daily.

The recommended adult dose for maintaining long-term healing of GERD is 10 mg to 20 mg, taken once daily. The usual length of treatment for GERD is 4 to 8 weeks.

MEDICATIONS

Rabeprazole delayed release tablet has been designed to work throughout the day, and therefore needs to be taken only once daily.

This medication may be taken with or without food. Swallow the tablets whole with a beverage. Do not chew, crush, or split the tablets.

Most people will experience some improvements in symptoms 1 to 2 weeks after starting rabeprazole. It may take up to 4 weeks for people to experience maximum benefit from this medication

HEALTH TEACHING

HEALTH TEACHING

Don't eat within 3 hours of bedtime. This allows your stomach to empty and acid production to decrease. If you don't eat, your body isn't making acid to digest the food.

Don't lie down right after eating at any time of day.

Elevate the head of your bed 6 inches with blocks. Gravity helps prevent reflux.

HEALTH TEACHING

Don't eat large meals. Eating a lot of food at one time increases the amount of acid needed to digest it. Eat smaller, more frequent meals throughout the day.

Avoid fatty or greasy foods, chocolate, caffeine, mints or mint-flavored foods, spicy foods, citrus, and tomato-based foods. These foods decrease the competence of the LES.

HEALTH TEACHING

Avoid drinking alcohol. Alcohol increases the likelihood that acid from your stomach will back up.

Stop smoking. Smoking weakens the lower esophageal sphincter and increases reflux.

Lose excess weight. Overweight and obese people are much more likely to have reflux than people of healthy weight.

HEALTH TEACHING

Stand upright or sit up straight, maintain good posture. This helps food and acid pass through the stomach instead of backing up into the esophagus.

Avoid wearing tight-fitting clothes to reduce pressure in the stomach.

NURSING CARE PLAN

Imbalanced Nutrition: Less than Body Requirements related to

altered ability to ingest and difficulty swallowing as evidenced

by weight loss,altered taste sensation

assessment

SUBJECTIVE:• “Minsan nag aalsom na panlasa ko

tapos nasasakitan na ako maghalun karne kaya lugaw nalang kinakakan ko”as verbalized by the patient.

OBJECTIVE:• -weightloss• Current weight: 136 lbs• Previous weight:140 lbs 3 weeks

ago• -fatigue during swallowing

nursing diagnosis

Imbalanced Nutrition: Less than Body Requirements related to

altered ability to ingest and difficulty swallowing as evidenced by weight

loss,altered taste sensation

planning

After 8hours of nsg. Interventions the client will display :weight gain toward desired

goalbe free of signs of

malnutrition and display improved energy

level.

inteventions

Assess ability to chew, taste, and swallow.

other taste changes may limit client’s ability to ingest food and reducing desire to eat

Encourage small, frequent meals and snacks of nutritionally dense foods and nonacidic foods and beverages, with choice of foods palatable to client.

Fulfilling cravings for desired food may also improve intake

inteventions

Advised client to chew food slowly and thoroughly.

to avoid aspiration and lessen difficulty swallowing

Provide frequent mouth care, observing secretion precautions. Avoid alcohol-containing mouthwashes.

to prevent mouthsores and irritation in the mouth.

Monitor client’s weight daily. to evaluate nutritional changes

evaluation

GOAL NOT METThe client still preferred lugaw

because it is easy to eat and swallow .

The client have loss weight -4lbs.

NURSING CARE PLAN

Acute pain related to esophageal reflux and

esophageal inflammation

assessment

SUBJECTIVE: “pagnagkakakan ako, nagkukulog ang lalamunan koLalo na pagmaaalsom tska mahaharang, naghaharaldat pati ang sakuyang daghan” as verbalized by the patient• Pain scale: 7/10OBJECTIVE:• Grimaced facial expression

NURSING DIAGNOSIS

Acute pain related to esophageal reflux and esophageal inflammation

planning

After 12hrs the patient will:verbalize a decreased in pain

scale from 7/10 to 5/10.able to chew and swallow

foods without pain

interventions

Assessed the onset and progression of the symptoms

To prevent further complicationEncouraged small frequent mealsSmaller meals are digested

putting less pressure on the stomach muscles.

Advised to position self in an upright for 30 to 45 minutes after meal

To prevent aspiration

interventions

Encouraged toavoid irritating foods such as beverages, sodas, teas and coffees that contain caffeine,chocolate, citrus fruits and other acidic foods, fried and fatty foods, tomato sauce and juice, onion, garlic, mint flavoring and spices.

Different foods can trigger heartburn

Encouraged to chew and swallow foods slowly.

interventions

Advised to avoid bending coughing,vigorous exercises, and wearing tight clothing\

Prevents intra-abdominal pressure

evaluation

GOAL PARTIALLY METPain scale= 5/10-still with pain while chewing

and swallowing foods.

NURSING CARE PLAN

Anxiety r/t physiologic factor:

such as GERD

assessment

SUBJECTIVE:• Client states that “natatakot

na ako magkakan solo ta 3 beses na ako nabulunan”

Objective: poor eye contact -increased facial tension -increased perspiration

NURSING DIAGNOSIS

Anxiety r/t physiologic factor: such as GERD

PLANNING

After 8 hours of nursing intervention the client will be able to:

• a. appear relaxed• b. report anxiety is reduced to

a manageable level.• c. verbalize awareness of

feeling of anxiety.

INTERVENTIONS

Monitor vital sign to identify physical responses

associated with both medical and emotional conditions.

Determine current medications or recent OTC meds.

determine if the meds can heighten feelings or sense of anxiety

observe behaviorsbe able to point the client's

level of anxiety

INTERVENTIONS

Establish a therapeutic relationship

conveying empathy and unconditional positive regard

be available to ct,. For listening or talking

provide feelings of sympathy and support to the pt. And facilitate strong source of physical and emotional contact

INTERVENTIONS

explore coping strategies with patient. (e.g breathing, relaxation etc.)

Allows incorporating existing disabilities with clients’ desires& ability to adapt & organize care activities.

EVALUATION

GOAL METPatient was able to feel relaxed, verbalize awareness and feelings of anxiety is reduced to a manageable level

NURSING CARE PLAN

Deficient knowledge about the disorder (GERD) related to incomplete presentation

of information

ASSESSMENT

• SUBJECTIVE: “Ano man ang GERD, sain yan

nakukua?” as verbalized by the patient.

“Tanu ta pagnagkakakan akong maalsom tapos maharang nagkukulog ang alanuhan ko?” as verbalized by the patient.

NURSING DIAGNOSIS

Deficient knowledge about the disorder (GERD) related to incomplete presentation of information

PLANNING

After 2 hours of nursing intervention, the patient will be able to increase knowledge level about the disorder as evidenced by:verbalizing understanding

of the conditioninitiating necessary

changes in food preferences and participate in treatment regimen

INTERVENTIONS

Provided a quiet environment conducive to learning

A quiet environment will facilitate the learning of the patient

Discussed the disorder; its cause, manifestations, diagnostic test and management

This will help patient to have a clear understanding of her condition, the importance of treatment and increases her knowledge level

INTERVENTIONS

Enumerated the foods that can aggravate the pain and those that are necessary to eat

This will help patent to choose the right foods she may eat and avoid those that can cause pain

·Used short, simple terms that are understandable to patient

For easy understanding and for patient to catch up the explanation easily

INTERVENTIONS

Asked patient to summarize what she had learn

To make sure that the patient understand the discussion and gain knowledge about her disorder

EVALUATION

Goal met·Patient was able to state all

the information about GERD·Patient was able to

enumerate the proper foods that she should eat and not to be eat