NSG-320 Topic 7 Questions With Complete Solutions
Gastroesophageal reflux disease (GERD)
a chronic symptom of mucosal damage caused by reflux of
stomach acid into the lower esophagus
GERD results when
the reflux of acidic gastric contents (HCl acid and pepsin and
trypsin and bile) into the esophagus overwhelms the esophageal
defenses
Factors Affecting Lower Esophageal Sphincter Pressure
(incompetent LES lets gastric contents move from the stomach
to the esophagus)
Decrease Pressure:
alcohol, chocolate (theobromine), fatty foods, nicotine,
peppermint, spearmint, tea, coffee (caffeine) Drugs
(anticholinergics, B-adrenergic blockers, calcium channel
blockers, diazepam (Valium), morphine sulfate, nitrates
progesterone, theophylline)
Increase Pressure:
Bethanechol (urecholine), metoclopramide (reglan)
Clinical manifestations of GERD
Heartburn (pyrosis), chest pain (burning; squeezing; or radiating
to the back, neck, jaw, or arms), dyspepsia or regurgitation,
wheezing, coughing, and dyspnea, hoarseness, sore throat, a
,globus sensation (sense of a lump in the throat), hypersalivation,
and choking
Heartburn (pyrosis)
burning, tight sensation felt intermittently beneath the lower
sternum and spreading upward to the throat or jaw
Dyspepsia
pain or discomfort centered in the upper abdomen
complications of GERD
esophagitis : inflammation fo the esophagus
Barrett Esophagus: esophageal metaplasia (increased risk for
esophageal cancer)
cough, bronchospasm, laryngospasm, and cricopharyngeal
spasm (gastric sections irritating upper airway)
Dental erosion (acid reflux into the mouth.)
GERD is diagnosed by
based on symptoms and the patient's response to behavioral and
drug therapies
Endoscopy: assessing the LES competence + degree of
inflammation
Biopsy and cytologic specimens: distinguish stomach or
esophageal cancer from BE + degree of dysplasia
treatment of GERD
mainly medications
,Surgical therapy (antireflux surgery): reserved for patients with
complications. (Nissen and Toupet fundoplications are
laparoscopic antireflux surgeries)
nursing GERD
- HOB elevated 30 degrees (pillows or with 4- to 6-in blocks
under the bed)
- should not be supine for 2 to 3 hours after a meal
- Teach: avoid fatty foods, chocolate, peppermint
- Have the patient to eat small, frequent meals to prevent gastric
distention.
- avoid eating within 3 hr of bedtime.
- Tell the patient to avoid late evening meals, nighttime
snacking, and milk, especially at bedtime, since it increases
gastric acid secretion.
- Certain foods (e.g., tomato-based products, orange juice, cola,
red wine) may irritate the esophagus.
- increased saliva production associated with chewing gum will
help with GERD symptoms
If stomach content pH is less than 5
intermittent suction may be used, or the frequency or dosage of
the antacid or antisecretory agent increased
Proton Pump Inhibitors (PPIs) MOA
↓ HCl acid secretion by inhibiting the proton pump (H+-K+-
ATPase) responsible for the secretion of H+
↓ Irritation of the esophageal and gastric mucosa
, SE: Headache, abdominal pain, nausea, diarrhea, vomiting,
flatulence
Histamine (H2) Receptor Blockers MOA
Block the action of histamine on the H2 receptors to ↓ HCl acid
secretion
↓ Conversion of pepsinogen to pepsin
↓ Irritation of the esophageal and gastric mucosa
SE: Headache, abdominal pain, constipation, diarrhea
Antacids
Neutralize HCl acid
Taken 1–3 hr after meals and at bedtim
Prokinetic: metoclopramide (Reglan)
Block effect of dopamine
↑ Gastric motility and emptying
Reduce reflux
SE: CNS side effects ranging from anxiety to hallucinations
Extrapyramidal side effects (tremor and dyskinesias similar to
Parkinson's disease)
Cytoprotective: sucralfate (Carafate)
Act to form a protective layer and serve as a barrier against acid,
bile salts, and enzymes in the stomach
SE: Constipation
Gastroesophageal reflux disease (GERD)
a chronic symptom of mucosal damage caused by reflux of
stomach acid into the lower esophagus
GERD results when
the reflux of acidic gastric contents (HCl acid and pepsin and
trypsin and bile) into the esophagus overwhelms the esophageal
defenses
Factors Affecting Lower Esophageal Sphincter Pressure
(incompetent LES lets gastric contents move from the stomach
to the esophagus)
Decrease Pressure:
alcohol, chocolate (theobromine), fatty foods, nicotine,
peppermint, spearmint, tea, coffee (caffeine) Drugs
(anticholinergics, B-adrenergic blockers, calcium channel
blockers, diazepam (Valium), morphine sulfate, nitrates
progesterone, theophylline)
Increase Pressure:
Bethanechol (urecholine), metoclopramide (reglan)
Clinical manifestations of GERD
Heartburn (pyrosis), chest pain (burning; squeezing; or radiating
to the back, neck, jaw, or arms), dyspepsia or regurgitation,
wheezing, coughing, and dyspnea, hoarseness, sore throat, a
,globus sensation (sense of a lump in the throat), hypersalivation,
and choking
Heartburn (pyrosis)
burning, tight sensation felt intermittently beneath the lower
sternum and spreading upward to the throat or jaw
Dyspepsia
pain or discomfort centered in the upper abdomen
complications of GERD
esophagitis : inflammation fo the esophagus
Barrett Esophagus: esophageal metaplasia (increased risk for
esophageal cancer)
cough, bronchospasm, laryngospasm, and cricopharyngeal
spasm (gastric sections irritating upper airway)
Dental erosion (acid reflux into the mouth.)
GERD is diagnosed by
based on symptoms and the patient's response to behavioral and
drug therapies
Endoscopy: assessing the LES competence + degree of
inflammation
Biopsy and cytologic specimens: distinguish stomach or
esophageal cancer from BE + degree of dysplasia
treatment of GERD
mainly medications
,Surgical therapy (antireflux surgery): reserved for patients with
complications. (Nissen and Toupet fundoplications are
laparoscopic antireflux surgeries)
nursing GERD
- HOB elevated 30 degrees (pillows or with 4- to 6-in blocks
under the bed)
- should not be supine for 2 to 3 hours after a meal
- Teach: avoid fatty foods, chocolate, peppermint
- Have the patient to eat small, frequent meals to prevent gastric
distention.
- avoid eating within 3 hr of bedtime.
- Tell the patient to avoid late evening meals, nighttime
snacking, and milk, especially at bedtime, since it increases
gastric acid secretion.
- Certain foods (e.g., tomato-based products, orange juice, cola,
red wine) may irritate the esophagus.
- increased saliva production associated with chewing gum will
help with GERD symptoms
If stomach content pH is less than 5
intermittent suction may be used, or the frequency or dosage of
the antacid or antisecretory agent increased
Proton Pump Inhibitors (PPIs) MOA
↓ HCl acid secretion by inhibiting the proton pump (H+-K+-
ATPase) responsible for the secretion of H+
↓ Irritation of the esophageal and gastric mucosa
, SE: Headache, abdominal pain, nausea, diarrhea, vomiting,
flatulence
Histamine (H2) Receptor Blockers MOA
Block the action of histamine on the H2 receptors to ↓ HCl acid
secretion
↓ Conversion of pepsinogen to pepsin
↓ Irritation of the esophageal and gastric mucosa
SE: Headache, abdominal pain, constipation, diarrhea
Antacids
Neutralize HCl acid
Taken 1–3 hr after meals and at bedtim
Prokinetic: metoclopramide (Reglan)
Block effect of dopamine
↑ Gastric motility and emptying
Reduce reflux
SE: CNS side effects ranging from anxiety to hallucinations
Extrapyramidal side effects (tremor and dyskinesias similar to
Parkinson's disease)
Cytoprotective: sucralfate (Carafate)
Act to form a protective layer and serve as a barrier against acid,
bile salts, and enzymes in the stomach
SE: Constipation
