[solved]-Gastroesophageal Reflux Disease (GERD) Nursing Care Plans

Gastroesophageal reflux disease or simply GERD is the excessive backflow of gastric or duodenal contents, or both into the esophagus and past the lower esophageal sphincter (LES) for a sustained length of time without associated belching or vomiting.
Nursing Care Plans

Nursing care planning goals of gastroesophageal reflux disease (GERD) involves teaching the patient to avoid situations that decrease lower esophageal sphincter pressure or cause esophageal irritation.

The following are seven (7) nursing care plans for gastroesophageal reflux disease (GERD):

Imbalanced Nutrition: Less Than Body Requirements
Acute Pain
Imbalanced Nutrition: More Than Body Requirements
Risk for Aspiration
Deficient Knowledge
NEW: Anxiety (Pediatric)
NEW: Risk for Injury (Pediatric)

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Imbalanced Nutrition: Less Than Body Requirements

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 Rationale
Accurately measure the patient’s weight and height. For baseline data.
Obtain a nutritional history. 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. 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. Helps control reflux and causes less irritation from reflux action into esophagus.
Instruct patient to eat slowly and masticate foods well. Helps prevent reflux.
Prepare the patient for the following diagnostic procedures:
Complete blood count To identify the presence of anemia that must be ruled out
Cardiac enzymes To rule out myocardial pain related to the atypical pain felt with GERD
Serum iron To identify presence of iron-deficiency anemia
Gastrin levels To identify toxicity of proton pump inhibitors or to diagnose Zollinger-Ellison syndrome
Gastric acid secretory analysis To determine if failure with pharmacologic agents is caused by inadequate suppression of gastric acid secretion, which may signify bile reflux or pill-induced disease
Upper gastrointestinal endoscopy Used to identify the type and extent of tissue damage.
Barium swallow Can be used to identify structures and Hiatal hernias
Esophageal pH monitoring Used to document pathologic acid reflux, especially for patients who have atypical symptoms.

Expert Answer

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