Gastroesophageal Reflux Disease (GERD) Nursing Care Plan & Management

 Definition

  • Gastroesophageal reflux disease (GERD) is excessive reflux of hydrochloric acid into the esophagus.
Risk Factors
  • Incompetent lower esophageal sphincter (LES), pyloric stenosis or a motility disorder.
Pathophysiology
  • A weak or incompetent LES allows backward movement of gastric contents into the esophagus; decreased esophageal peristalsis and salivary function impair clearance of the refluxed acid, resulting in mucosal injury to the esophagus.


Assessment/Clinical Manifestations/Signs and Symptoms
  • Pyrosis (i.e. burning sensation in the esophagus)
  • Regurgitation of sour-tasting secretions
  • Dysphagia (i.e. difficulty swallowing) and odynophagia ( i.e pain on swallowing)
  • Symptoms mimicking those of a heart attack
Nursing Management
Teach the client to avoid factors that increase lower esophageal irritation.
  • Eat a low-fat, high-fiber diet
  • Avoid irritants, such as spicy or acidic foods, alcohol, caffeine, and tobacco, because they increase gastric acid production.
  • Avoid food or drink 2 hours before bedtime or lying down after eating
  • Elevate the head of the bed on 6” to 8” bocks
  • Lose weight if necessary
If symptoms persist, prepare the client for surgical repair, which includes a funduplication (i.e. wrapping a portion of the gastric fundus around the sphincter area of the esophagus)
Administer medications, which may include antacids, histamine-receptor antagonists, and proton-pump inhibitors.

 

Nursing Care Plan

Nursing Diagnosis

Imbalanced Nutrition: Less Than Body Requirements

  • The state in which an individual who is not on NPO, experiences or is at risk for inadequate intake or metabolism of nutrients for metabolic needs with or without weight loss.
May be related to
  • inability to intake enough food because of reflux
  • increased metabolism caused by disease process
  • early satiety
  • heartburn
Possibly evidenced by
  • inadequate food intake
  • altered taste
  • weight loss
  • decreased peristalsis
  • muscle mass loss
  • nausea and vomiting
  • abdominal pain or discomfort
  • intolerance of fatty foods
  • epigastric pain after eating
  • heartburn
  • regurgitation
  • dysphagia
Desired Outcomes
  • Patient will ingest daily nutritional requirements in accordance to his activity level and metabolic needs.
Nursing Interventions
  • Accurately measure the patient’s weight and height.
    • Rationale: For baseline data.
  • Obtain a nutritional history.
    • Rationale: Determining the feeding habits of the client can provide a basis for establishing a nutritional plan.
  • Encourage small frequent meals of high calories and high protein foods.
    • Rationale: Small and frequent meals are easier to digest.
  • Instruct to remain in upright position at least 2 hours after meals; avoiding eating 3 hours before bedtime.
    • Rationale: Helps control reflux and causes less irritation from reflux action into esophagus.
  • Instruct patient to eat slowly and masticate foods well.
    • Rationale: Helps prevent reflux.