1. The client/caregiver can define gastro- esophageal reflux (GERD).
   1. The esophagus carries food from the mouth to the stomach.
   2. A ring of muscle at the bottom of the esophagus acts like a valve between the esophagus and stomach.
   3. When that ring or sphincter does not close properly, stomach contents may leak back into the esophagus.
   4. Stomach contents contain acid, and when they touch the lining of the esophagus, they create a burning sensation called heartburn.
2. The client/caregiver can list symptoms of GERD and explain when to seek medical attention.
   1. Symptoms for adults with GERD are
      • Heartburn, which is the most common symptom (GERD can be present without this symptom)
      • Excessive clearing of the throat
      • Problems swallowing
      • Feeling that food is stuck in your throat
      • Burning in the mouth
      • Chest pain
   2. Symptoms for children with GERD may be
      • Repeated vomiting
      • Coughing
      • Respiratory problems
      • Most babies will outgrow GERD by the age of 1 year
   3. Reasons to consult with physician are
      • Heartburn or other symptoms more than twice a week
      • The use of antacids for more than 2 weeks
3. The client/caregiver can list methods of treatment and measures to manage this condition.
   1. Medication ordered by physician
      1. Take medicine as ordered.
      2. Consult the physician if medication is not effective.
   2. Lifestyle changes recommended by physician
      1. Do not consume alcohol.
      2. Do not smoke.
      3. Lose weight if necessary.
      4. Eat smaller, more frequent meals.
      5. Wear loose-fitting clothing.
      6. Avoid lying down for 3 hours after eating.
      7. Raise the head of bed 6 to 8 inches by placing blocks of wood under the bedposts.
      8. Use foam wedge to elevate head, but avoid pillows. Pillows create more pressure on stomach.
   3. Nutritional recommendations are to avoid the following:
      • Chocolate
      • Drinks with caffeine or carbonation
      • Fatty and fried food
      • Garlic and onions
      • Mint flavorings
      • Spicy foods
      • Tomato-based foods such as chili and pizza
4. The client/caregiver can list possible complications.
   1. Prolonged irritation can result in bleeding, ulceration, or scar formation of the esophagus.
   2. Development of Barrett’s esophagus that over time can lead to cancer.
   3. GERD can aggravate condition such as asthma, chronic cough, and pulmonary fibrosis.
   4. There may be a need for surgical repair.

Resources

Dietician

American College of Gastroenterology
www.acg.gi.org

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
www.naspghan.org

Pediatric/Adolescent Gastroesophageal Reflux Association, Inc.
www.reflux.org

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. Philadelphia: Mosby Inc.
Cohen, B. J., & Wood, D. L. (2000). Memmler’s the Human Body in Health and Disease (9th ed.). Philadelphia: Lippincott Williams & Wilkins.
Nutrition made incredibly easy. (2003). Springhouse: Lippincott, Williams & Wilkins.
Portable RN: The all-in-one nursing reference. (2002). Springhouse: Lippincott, Williams & Wilkins.
Taylor, C., Lillis, D., & LeMone, P. (2005). Fundamentals of nursing. Philadelphia: Lippincott Williams & Wilkins.
Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott Williams & Wilkins.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.
© 2008 Jones and Bartlett Publishers, Inc.
www.jbpub.com