Etiology

A weakened esophageal sphincter allowing the acid or bile up into the

esophagus from the stomach. Also increased amount of acid or bile can cause
a patient to have GERD signs and symptoms. Patients at high risk include:
Obese patients, pregnant patients, patients who smoke, and those with a
hiatal hernia. Some medications can place a patient at higher risk too, such as
antihistamines, pain medications, calcium channel blockers, and
antidepressants.

Desired Outcome

Maintain a normal amount of acid in the stomach, eliminate or decrease

burning in the esophagus from acid splashing up and protect the GI tract from
bleeding.

Subjective and Objective Data

Subjective Data

Chest burning/pain

Dysphagia

Regurgitation

Sore throat

‘Heartburn’
Nausea

Objective Data

Holding or pressing on the chest due to discomfort

Normal ECG

Normal vital signs

Non-reproducible chest pain

Weight-loss

Vomiting

Erosion of teeth enamel

Wheezing

Laryngitis

Nursing Interventions and Rationales

1.
Educate on the benefits of lifestyle changes: Quitting smoking Wear loose
fitting clothing Keeping active

2.

1. Quitting smoking: Nicotine relaxes the esophageal sphincter.

Teaching the patients about the connection helps give them
another reason to quit.

Wear loose fitting clothing: Having the midsection squeezed puts

pressure on the stomach-this is the same concept as being
overweight.

Keeping active: Helps the patient lose weight, which is important

since excess weight pushes on the stomach.

3.

Medications! Proton Pump Inhibitors: Esomeprazole Lansoprazole

Omeprazole Pantoprazole Antacids: Maalox Mylanta Rolaids H2
Blockers: Cimetidine Famotidine Nizatidine Ranitidine Prokinetics:
Bethanechol Metoclopramide Antibiotics: Erythromycin

4.

1. Proton Pump Inhibitors:

Decreases the amount of acid made in the stomach
-Prevents the transport of H ions into the gastric lumen by
binding to gastric parietal cells, ↓ gastric acid production

Antacids:
Neutralizes stomach acid

H2 Blockers:
Decreases the amount of acid made in the stomach
-Inhibits action of histamine leading to inhibition of gastric acid
secretion
 Prokinetics:
Helps to empty the stomach faster.
-Accelerates gastric emptying by stimulating motility

Antibiotics:
Helps to empty the stomach faster (watch out for diarrhea
though!)

5.

Educate on nutritional changes

6.

1. Nutritional changes such as not over eating, avoiding acidic foods

like orange juice or spicy foods such as salsa.

Also after eating, be sure to have the patient sitting in an upright

position for at least 2-3 hours. Also, having a patient sleep with
their HOB greater than 30 degrees helps.

7.

Prepare the patient for a Barium Swallow Test

8.

1. An X-Ray tech will perform this test, your job as a nurse is to

prepare the patient for this appointment. Generally the patient
has been NPO but check with the hospital policy or through the
X-Ray tech as to how long they would like the patient to be NPO
prior to the test.

9.

Assist with Endoscopy

10.
 1. This procedure allows the visualization of the esophagus and the
esophageal sphincter.

The nurse will be administering sedative medications,

maintaining the airway and monitoring vital signs.

11.

Obtain an ECG

12.

1. The symptoms of chest burning and pain are similar to that of a

heart attack. It is always important to eliminate the heart as a
problem, and not to just assume that the patient is experiencing
GERD symptoms.

13.

Encourage a healthy weight

14.

1. Access fat on a patient usually shows up in their abdomen and

the displaces their stomach, increasing the risk of acid or bile
deviously sneaking into the supposed off limits zones.