1. GASTROESOPHAGEAL REFLUX DISEASE (GERD)
Risk Factors for Developing GERD
- Obesity - Hiatal Hernia - Pregnancy - Diet
- Smoking - Dry Mouth - Diabetes - Chest Trauma
- Delayed Stomach Emptying - Connective Tissue Disorders - Zollinger-Ellison Syndrome - Cancer
- Pyloric Surgery - Nasogastric Intubation for 4 days - Medicine (Anticholinergics) - Reduce LES pressure
- Intraabdominal Pressure - Alcoholic - Peptic Ulcer Disease -Lying down after meals
Nursing Interventions:
1. Offer emotional and psychological
Nursing Diagnosis:
support to help the patient to cope
1. Anxiety
with pain and discomfort.
2. Avoid situation or activities that 2. Imbalanced nutrition: less body
increase intra-abdominal pressure like requirements
coughing, bending, constipation Impaired Esophageal Defense
3. Risk for aspiration related to
promotes acid reflux. Mechanism
3. Avoid lying down for 3 hours after
incompetent LES
meals and eating late night snacks 4. Fluid volume deficit
promotes acid reflux. 5. Acute pain and chronic pain
4. Surgically, assess the respiratory status
related to physical injury to the
of the patient because the surgical
procedure is performed closely to LES
the diaphragm. 6. Altered elimination
5. Teach the patient to reduce intake of 7. Impaired swallowing related to
fatty foods, caffeinated beverages, Poor Esophageal Clearance inflammation of the Esophagus
chocolate, nicotine, alcohol, and
peppermint. Reducing the intake of 8. Ineffective breathing pattern
spicy and acidic foods lets 9. Impaired gas exchange
esophageal healing occur during 10.Ineffective Tissue Perfusion
times of acute inflammation.

2. Nursing Interventions:
6. Encourage the patient to eat five
to six small meals during the day
rather than large meals. Ingestion
of large amounts of food
increases gastric pressure and
Esophageal Clearance fails to
thereby increases esophageal neutralized acid reflux via LES
reflux.
7. Position the patient by elevating
the head of the bed during sleep.
May lessen symptoms.
Aspiration of Gastric
Exposure of the Esophagus from the
content in the Esophageal Ulcer
gastric acids of the stomach
tracheobronchial tree
Anemia, Nausea,
Coughing, DOB Voniting
Damaging the Lower Esophageal
Wheezing, Chest Sphincter
Pain

3. Nursing Interventions:
Dysfunctional Lower Esophageal
8. Encourage the patient to avoid Sphincter
restrictive clothing, lifting heavy
objects, straining, working in a
bent-over position, and stooping.
Worsens the condition of the
patient.
9. Encourage the patient to avoid
food for 3 hours before going to
sleep.
10. Place 6-inch blocks under the Permanent or Transient Relaxation of
head of the bed or place a wedge the Lower Esophageal Sphincter
under the mattress. to enhance
nocturnal clearance.
Compensatory
Mechanism
Decreases Intraluminal Pressure
Acid Irritates the Vocal produced by the LES
Chords
Excessive Production of
Saliva to Neutralize pH
in the Esophagus
Hoarseness, Dysphagia
Acid Irritates the Mucosa

4. Diagnostic Assessment:
Surgical Management: 1. 24hr Ambulatory pH monitoring
2. Esophageal Manometry /
1. Nissen fundoplication, a Motility Test
surgical wrapping of the Increases Abdominal Pressure 3. Esophagogastroduodenoscopy
stomach around the esophagus (EGD)
using a laporoscopic procedure 4. Endoscopy
stitched with silk sutures. 5. Auscultation
Medical Management:
Promoting More Acid Reflux
1. Proton pump inhibitors (reducing gastric
acid secretion)
2. Gastric H2 receptor blockers (reduce
gastric secretion of acid)
3. Antacids (can reduce gastric acidity)
4. Alginic acid (increase pH and decrease
reflux)
5. Prokinetics (strengthen the LES and
speed up gastric emptying.)
6. Sucralfate (heals and prevent esophageal
Gastroesophageal Reflux Disease damage)
7. Baclofen (decreases transient LES
relaxations)

5. CONCEPT MAP in GASTROINTESTINAL SYSTEM
GROUP MEMBERS:
1. Alejandro, Wyeth Paul
2. Custodio, Adrian
3. Penarubia, Theresa
4. Penaranda, Mark Francis
5. Alcantara,Frank
6. Blanca, Anthony Laurence
7. Lansangan, Fatima
8. Laguitan, April