GERD | Gastroesophageal Reflux Disease Nursing NCLEX Lecture | Symptoms and Treatment

Hey everyone, it's Sara with RegisteredNurseRN.com and in this video I'm going to be doing an NCLEX

review over GERD. And this video is part of an NCLEX review series over the GI system,

so be sure to check out those other videos. And as always in the YouTube description below or at

the end of this video you can access the free review quiz that will test you on GERD. So let's

get started. So what is GERD? GERD stands for gastroesophageal reflux disease. And based on

this long name we know that we're dealing with the stomach which is gastro and the esophagus

which is esophageal. And GERD is a chronic condition where stomach contents is flowing

back into the esophagus. So in your stomach you eat food you have acid and enzymes and it's just

going back up through the esophagus. And the cells that line the esophagus are not made to withstand

acidic conditions so they start to become really irritated. Now why does this happen? This usually

happens due to a weak or damaged lower esophageal sphincter which we'll refer to as LES. Now GERD

is sometimes referred to as acid reflux disease. So if you hear someone say I have acid reflux

disease they mean this as well. And one thing you want to keep in mind is that some people

have random episodes of acid reflux and then it goes away. Now it's termed GERD when the acid

reflux tends to occur twice a week or more on a regular basis. So it's a chronic condition

that's been happening over time. And if a patient has this they have GERD acid reflux over a long

period of time they need to go to their physician who needs to look at that maybe prescribe some

medicines because this disease can cause some long-term complications. Now let's look at the

normal physiology of swallowing food. What happens when we chew our food and swallow it in someone

who doesn't have GERD? Because we know with GERD whenever the patient is swallowing their food and

it enters into the stomach it is getting back into the esophagus due to a weak lower esophageal

sphincter. So before we dive into the patho let's see what our body should do normally. Okay so we

chew our food digestion starts in the mouth and we swallow it. Now that food is squeezed down

through the esophagus and the esophagus is made up of smooth muscles that help guide that food

down to the stomach and that's called peristalsis. Now whenever that happens your lower esophageal

sphincter relaxes and it allows that food to go into the stomach. Now after it relaxes

it closes and it closes very tightly because it doesn't want any of that contents the acid

the enzymes the food to go back up through that esophagus. So that is what will happen to someone

who doesn't have GERD. Now with someone who has GERD what is happening is that we are having

issues with the following things. We're having issues with our esophagus our lower esophageal

sphincter our esophageal mucosal lining and the stomach acid and the food contents. So let's take

a look at what's going on with esophagus and GERD. Okay we learn that the esophagus squeezes food in

wave-like contractions and works with that lower esophageal sphincter which relaxes to let food in.

Well sometimes what can happen with the esophagus is that it can have impaired motility and it will

cause the lower esophageal sphincter to close at irregular times which can lead to GERD because

that acid is back flowing up through the esophagus and the LES is closing at irregular intervals and

it's allowing that acid to get into the esophagus and erode it and form ulcers. Now let's look at

LES lower esophageal sphincter. Now this is it's right here it's a collection of circular muscles

at the end of your esophagus and it opens and closes and when it closes it's supposed to be a

really nice tight seal so nothing can back up in there. Well with GERD we learned earlier that it

can become weak and why does it become weak? Well if it has some increased pressure on it it can

damage it and make it weak over time or medications or other chemicals can damage it and

make it not close as tightly. So let's talk about some things that can cause increased pressure on

the LES. Pregnancy, as that baby grows it pushes up on this diaphragm and the diaphragm is very

close to your stomach and your esophagus puts pressure on there which in turn will put pressure

on the LES because it's not closed properly and you get acid reflux. Obesity, same principle

overeating, eating too much food. If you eat a really huge meal put all that food into your

stomach and it will increase pressure upward onto the LES cause it to leak the gastric fluid into

your esophagus and a hiatal hernia. Let's talk a little bit about hiatal hernia. What is it?

Okay what happens is that the stomach is supposed to be below the diaphragm. Now with a hiatal

hernia the top part of the stomach has herniated through a weak part in the diaphragm. The diaphragm

is the blue area and it's just herniated up through there and what can happen is that gastric

acids and foods can just pull in there and it's very close proximity to the lower esophageal

sphincter which is going to cause a lot of pressure on that and mess it up and won't close

properly so a hiatal hernia can cause it. Now medications or some types of chemicals, antihistamines

can weaken your lower esophageal sphincter, calcium channel blockers, sedatives, smoking,

and certain foods which we'll really get into the diet teaching but just to list some like

fat and greasy foods, peppermint, spearmint, any of those type things can weaken that LES and

that's why you tell the patients to avoid consuming them or limit the consumption of them.

Another thing that can cause GERD is delayed gastric emptying and what's happened is that

the stomach isn't emptying its contents through the small intestine like it should instead it's

staying in there too long that increases pressure on the LES and can weaken it and some drugs that

can do that are anticholinergic so you really want to watch out for your patients who are taking

those medications. Next esophageal mucosal lining what happens to that is that the cells that line

your esophagus start to erode and they become inflamed because they're not made to be in contact

with all those acids and enzymes so the person can develop a condition called esophagitis

and due to that chronic inflammation irritating those cells there is an increased risk of

esophageal cancer. Also some other things that can happen with esophagus are these other complications

due to all that chronic inflammation they can get strictures and where you have narrowing of

the esophagus just from all that chronic inflammation causing scar tissue to build up over

time and it will narrow it. Another thing is that they can develop what's called Barrett's esophagus

and this is a very interesting disease and what happens is that the lining of the esophagus that

was normally there starts to change and it will actually match the cell lining that is found in

the intestine and because of that the patient is at risk for a rare form of cancer so it's very

interesting that it can do that. Another thing they can have bleeding as well. Next key player

is the stomach acid like the hydrochloric acid and pepsin and the food contents and again when

they do they just get up there in that esophagus and they erode those cells and that lining

and what can happen is that this acid not only can go past the lower esophageal sphincter it can

go up all the way past the upper esophageal sphincter and what's past that is your pharynx

up through your ear canals and then in front of that a little bit in front of your pharynx

is your respiratory system so that acid can really get in there and cause some problems

and whenever it does that it's referred to as laryngopharyngeal reflux and GERD can lead to

this so just think about it if the acid goes up into the pharynx what do we have up there we have

our throat we have our ears so we can get some ear infections it can even go down into the windpipe

where we can get some pneumonia lung infections also can aggravate the patient's signs and

symptoms if they have asthma they can have coughing and even voice changes like their voice

sounds hoarse from where that acid is just going up where the voice box is where everything's at

and just wearing that away and causes them to have this hoarse sounding voice now let's look

at the signs and symptoms that you may hear your patient report to you who has possibly GERD okay

the most common thing that patients will report is heartburn and this is like a burning sensation

in the chest it can even be so painful that the patient may confuse it as that they're having a

heart attack so they may need a cardiac workup as well just to ensure that that isn't what it is

or it's GERD another thing they can complain of is epigastric pain having stomach pain

regurgitation and this is where the acid contents is going up in through the throat they may report

like a bitter taste in their mouth or whenever they're laying down in a prone position they can

feel that food coming up as well another thing is a dry cough which tends to be worse at night when

they're lying down sleeping as that acid is coming up through that esophagus and they start to get

choked on it and they cough or they may have a cough throughout the day a nausea problem swallowing

a lot of patients i've had report just feels like there's a lump in my throat and that could be

again possibly from the erosion or regurgitation the acid coming up another thing is that they may

have recurrent lung infections and ear infections and we learned about in the patho why that is

now not all patients will report heartburn um some patients don't even have that typical

indigestion type pain they just may have that chronic coughing the voice changes where their

voice is hoarse or um ear infections so may want to look further into that see what it is

now how is GERD diagnosed as the nurse you need to be familiar with the names of these tests so

you can be able to tell your patient what they're going to be doing because a lot of times patients

are like hey i'm going for this test what is it and you'll have to talk to them about it or just

explain what to expect okay um one way to diagnose GERD is an endoscopy where they take a scope they

look down through the esophagus and they can assess the esophagus for any changes like narrowing

ulcers erosions things like that another test is esophageal manometry and this is where they assess

the function of the esophagus's ability to squeeze that food down into the stomach and how that lower

esophageal sphincter is closing so that can assess that another test is ph monitoring and this is

where they put in a small tube and the patient will have it in there for about 24 hours and

they'll just go on about their activities of daily living and the tube will measure the amount of

acid that comes in contact with the esophagus and that can help them see if they have GERD now what

are the treatments for GERD we're really going to hit on this and the nursing interventions and diet

and we're going to go over the medications in depth but let's see what the in a nutshell what

the treatment is um lifestyle changes such as losing weight um because obesity can cause this

changing your diet the foods that you eat quit smoking things like that medications and um in

the most severe cases they can have a surgery called fundoplication and this is where the

where the fundus of the stomach is placed around the lower part of the esophagus so in a sense it

helps strengthen it helps to strengthen the lower esophageal sphincter now let's talk about the

nursing interventions what are you going to do for a patient who has GERD or you suspect has GERD

okay one thing we're going to do is we're going to assess we're going to assess the patient's

frequency and quality of pain because a lot of times patients may say oh my reflux is just acting

up and in reality they may be having a myocardial infarction um a heart attack so you want to be

able to differentiate between those two um another thing is you want to assess them for other signs

and symptoms that's not the most obvious to GERD like that heartburn and indigestion you want to

look at the respiratory system um are they having chronic bouts of pneumonia or is their asthma

really flaring up or are they aspirating a lot where the regurgitation is happening that food's

coming up and it's going into the lungs and some signs and symptoms of aspiration or coughing

decreased oxygen saturations if their SATs were good then all of a sudden

they're down abnormal lung sounds and increased increased respiratory rate

um actually had a patient who did this um they were there going to be having surgery um they

were really mobile they could get up do things for themselves and they had just ate breakfast about

an hour after breakfast they had laid down to take a nap um and they had aspirated their food

where they were having regurgitation and um their SATs were like 97 98 98 percent throughout the

whole day and then all of a sudden they were dropping down in the 80s they're having chronic

coughing and they were having voice changes where um they were really hoarse and um their

respiratory rate was really high and uh we did a test x-ray and it showed that they had aspirated

some of that breakfast um from earlier and they had severe GERD so um can't happen another thing

is that uh you need to watch out for those voice changes and a chronic cough that tends to get

worse when they're lying down okay another thing is their pain ask them is aggravated after you

eat a heavy meal and ask them the foods that make it worse and help them develop a diet

to um substitute some other foods that they can incorporate instead of eating those foods that

make their GERD worse then you want to look at their medication history what meds are they

taking because we learned that certain meds can cause the LES to relax like antihistamines

calcium channel blockers and do they smoke as well that can affect that and anti-cholinergics

they decrease gastric emptying then you want to educate them so what you want to educate them

about mainly is a lot of food stuff because this is what's causing our problems our food so um you

want to educate them to eat small meals avoid really just filling up on these really large

meals because it's put a lot of pressure in the stomach and then in the end it's going to put a

lot of pressure on that lower esophageal sphincter and they need to avoid foods that relax the lower

esophageal sphincter like greasy fatty foods alcohol coffee peppermint or spearmint and watch

soft drinks because all that carbonation once you ingest those increases pressure in the stomach

and increases pressure on the LES another thing is that they want to make their last meal about

three hours before bedtime to decrease the chances of regurgitation because when they eat a meal they

lay down on their back that puts a lot of pressure on the lower esophageal sphincter

and it can cause some reflux then they want to sit up one hour after meals um if they're obese

they need weight loss because that puts a lot of pressure on the sphincter smoking cessation

and watch acidic foods especially if they have erosion in the esophagus um foods like tomatoes

or citrus fruits and juices can really irritate that esophagus even more and then plus if they're

having regurgitation where this contents is back flown it's just going to go from the stomach and

back into the esophagus so they need to watch those foods as well now let's look at the medications

ordered for patients who have GERD as the nurse you want to be familiar with these drug categories

and what they do okay so um first type the patients take are called antacids and what

antacids do is that they neutralize that acid so it's not as acidic whenever it back flows into the

esophagus and won't erode it as much um some drugs that are antacid are like magnesium hydroxide or

calcium carbonate and you give these to the patient they chew them and then they swallow them

um the one thing you need to remember about antacids is that they interfere with a lot of

drugs so it's best to give them alone and if you have to give like an h2 blocker because sometimes

patients are on histamine receptor blockers and you'll want to weigh about an hour to two hours

before you give um it if they've had an antacid along with if they're taking antibiotics or

carafate like your po antibiotics because it can interfere with absorption of the drugs

okay another group of category drugs ordered are histamine receptor blockers and these drugs work

by blocking the histamine and it causes the products product cells to decrease their projection

of hydrochloric acid which decreases gastric acid um some popular drugs are like rinitidine also

called xan xantac or famopidine also known as pepsin now these drugs are typically used short

term and a patient takes them as symptoms present like prm and again you don't give them with

antacids wait about hour or two before you give them because it can interfere with how they work

okay other drugs proton pump inhibitors ppis um some popular drugs that are ppis are like

omeprazole like prilosec or protanazole like protonics and these decrease stomach acid

and help the esophagus heal now one thing about ppis is that they will use them long term but

long term usage of ppis increases a patient's risk of bone fractures so watch out for that

and assess your patient for that now how ppis work is that they attach to the proton pump

of the parietal cells so your hydrogen and your potassium that's your proton pump however it

blocks the release of hydrogen so it can't mix with those chloride ions which would make

hydrochloric acid hcl so it's not formed so it'll decrease the stomach acid another group of drugs

used are called prokinetics and these work by preventing delayed gastric emptying by improving

the lower esophageal pressure and improves peristalsis so they have like a cholinergic

effect because remember our anti-cholinergics cause delayed gastric emptying and some drugs

that are considered prokinetics are bethanocoll or metroclopramide also called

reglan okay so that wraps up our lecture on GERD thank you so much for watching don't

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