Care of Patient with GERD amp; Peptic Ulcer.ppt

Care of Patient with GERD Peptic Ulcer 63-273 GERD: Background Gastroesophageal reflux is a normal physiologic phenomenon in most people, particularly after a meal. Gastroesophageal reflux disease (GERD) occurs when the amount of gastric juice that refluxes into the esophagus exceeds the normal limit Causes of GERD GERD: Symptoms Typical symptoms: Heartburn (Pyrosis): Most common Felt as a retrosternal sensation of burning or discomfort Occurs usually after eating or when lying down or bending over. Often relieved with milk or water Regurgitation: Effortless return of gastric and/or esophageal contents into the pharynx. It can induce respiratory complications if gastric contents spill into the tracheobronchial tree. Atypical symptoms Cough, dyspnea, hoarseness, and chestpain Diagnosis Role out other potential causes for the heartburn: Cardiac Peptic ulcer Esophagitis Esophageal Endoscopy: The gold standard as a definitive diagnosis Barium swallow Not as definitive in mild cases Collaborative Care Lifestyle modifications Nutritional therapy Decrease high-fat foods, avoid milk products at night, and avoid late snacking or meals Drug Therapy Surgical therapy Endoscopic therapy GERD: Complications Are related to HCl effect on the esophageal mucosa Esophagitis Can complicate to esophageal ulceration Barrett’s esophagus (esophageal metaplasia) Pre-cancerous lesion Nursing Management Avoid factors that cause reflux Stop smoking Avoid acid or acid producing foods Elevate HOB ~30° Do not lie down 2 to 3 hours after eating Patient teaching (see Table 40-10 in textbook) Drug therapy Evaluate effectiveness Observe for side effects Peptic ulcer Erosion or excavation of mucosal wall of the esophagus, stomach, pylorus, duodenum (most common). “Autodigestion” Requires acid environment to develop Mucosal defenses impaired; cannot protect from effects of acid/pepsin Result from infection with H. pylori or Zollinger-Ellison syndrome Risk factors: Alcohol