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Adult health nursing

Presented to
Mam
Presented by
Miara
 Student Name:
MAIRA
Roll no:
Case study Topic: gestroesophagus
reflux disease (GERD)
Lecturer name:

Acknowledgment
I bow my head before Almighty Allah in gratitude for giving me the opportunity to
make this case study and further for sustaining the interest which many times
oscillates.

First and foremost my utmost gratitude to Me, Principal College of Nursing

Benazir Bhutto hospital Rawalpindi, whose sincerity and encouragement I shall
never forget, who permitted me to take start of this activity.

We deem it as our honor to express our heartiest gratitude to acknowledge the total
support and standard of excellence provided by Mam , Clinical instructor, College
of nursing Benazir hospital, for continued patience, all the moral support and
guidance throughout my case study. I am highly indebted to him for graciously
offered help to complete this tedious task. May ALLAH bless her with health,
happiness and long life.

I would also like to thank my institution and faculty members of College of

Nursing Benazir Bhutto hospital hospital, without who’s this project would have
been distinct reality. I would also like to thank my mother, sister and friend for his
guidance. It would be unfair if I would not say thanks to my patient and his family
for co-operation.

MAIRA

BSCN 2nd year

Case Study
(Gestroesuphagus reflux disease)
Contents
Contents
 Introduction
 Case study disease
 Definition of GERD
 Anatomy of disease related organs
 Etiology of disease
 Clinical manifestations
 Complications
 Laboratory investigations
 Management
 Diet chart
 Discharge plan
 Nursing health history
 Demographic data
 Patient`s history


 Introduction
Background.
I chose gestroesophagus reflux disease (GERD) as my case to be
studied out of curiosity. Its my 1st time to encounter this kind of case and because
of that I was so interested in it. I was willing to do this case to challenge my mind
in analyzing the problems and to enhance my hidden knowledge and also to gain
new experiences which would bring new learning for me.

Significance of study:
The case study will help me in understanding the disease process of
the patient. This would also help the group in identifying the primary need of the
patients with GERD. By the patient that would address the needs and problems
effectively. Effective management of the problems identified will help the patient
to recover faster and maintain a holistic sense of wellness even while in hospital.
This case study would also provide knowledge skills and attitude on how
to manage future patients with GERD.

Scope:
This case study was conducted in Benazir Bhutto hospital Rawalpimdi on
the 25 years old young patient in medical surgical ward with GERD.

Goals:
I aim to develop essential as well as skillful nursing care which is based
in better and effective approach
That will serve as catalyst to promote health, reduce illness and
prevent/eliminate such diseases.
Nursing Health
History
 Case scenario
A 25 years old young was in his
usually state of rest of health. He is
admitted in medical ward and
complain of wheezing, difficulty
breathing, right side chest pain
with deep inspiration and nausea
and vomiting. He also has past
history of GERD and asthma in
three years. He also wake up in last
three days at 3:00 a.m.
Demographic Data

Name: XYZ
Age: 25 years
Sex: Male
Marital status: single
Nationality: Pakistani
Religion: Islam
Occupation: N/A
Admission date: 02 December 2022 – 10.00AM
Admitting diagnose:
Diagnosis: gestroesophagus reflux disease (GERD)
Consultant name: Dr. Lubna Riaz
 Patient`s history

 H/o present illness:

A 25 years old young was in his usually state of rest of health. He is admitted in
medical ward and complain of wheezing, difficulty breathing, right side chest pain
with deep inspiration and nausea and vomiting. He also has past history of GERD
and asthma in three years.

Vital signs:
Temp: 99F
Pulse: 89 bpm
Resp: 24b/m
SPO2: 99%
Weight: 30kg
Wheezing
Right side chest pain with deep inspiration

 Past medical history:

. He also has past history of GERD and asthma in three years.

 Past surgical history:

There is no significant past surgical history

 Family history:
Malnourished mother

 Birth history:
 Normal birth

 Vaccination history:
Completed according to epi schedule

 Allergy history:
Not significant
 Gastro esophageal reflux
Definition:
Gastroesophageal reflux disease is a condition that develop when there is
retrograde flow of stomach contents back into the esophagus. OR,

GERD (chronic acid reflux) is a digestive disorder that occurs when acidic
stomach juices, or food and fluids back up from the stomach into the esophagus

The term “gastroesophageal” refers to the stomach and esophagus. Reflux means
to flow back or return.

Stages of GERD:
GERD is broken down into different stages based on how
serious your symptoms are and how often they occur:
Stage 1: Mild GERD. Minimal acid reflux occurs once or twice
a month..
Stage 2: Moderate GERD. ...
Stage 3: Severe GERD. ...
Stage 4: Precancer or cancer
ANATOMY
&
PHYSIOLOGY
 Anatomy and physiology of disease
related organs
PATHOPHYSIOLOG
Y
 Pathophysiology
 Inappropriate relaxation of lower esophageal sphincter
 Impaired esophageal clearance
 Impaired mucosal defensive factor
 Delayed gastric emptying
 Hiatal hernia
 Delayed gastric emptying
.
Etiology
Etiology of Gastro esophageal reflux disease
 Gastro esophageal reflux happens when the
lower esophageal sphincter (LES) is weak or
relaxes when it shouldn’t. This lets the stomach's
contents flow up into the esophagus.
 Being overweight or having obesity
 Being pregnant
 Smoking or inhaling secondhand smoke.
 Medication such as aspirin
 Eating large meals or eating at late night
 Fatty or fried foods
 Drinking beverages such as alcohol
 CLINICAL
MANIFESTATIONS
 Clinical manifestations

Signs and symptoms of gastroesophageal reflux disease (GERD) may include

 A burning sensation in your chest (heart burn)

 Regurgitation
 Pyrosis (burning sensation in the esophagus)
 Hypersalivation
 Dysphagia
 dyspepsia (indigestion)
 Esophagitis
 Chest pain
COMPLICATIONS
 Esophagitis
 Stricture (Narrowing of the esophagus)
 Regurgitation of acid into the lungs
 Sinusitis
 Ulcerations/bleeding
 Barrett’s Esophagus (Pre-cancerous changes
to the esophagus)
Laboratory
INVESTIGATIONS

Diagnosis
.
MEDICAL
MANAGEMENT
 Medical management

 Antacids or H2 receptor antagonists

 famotidine (Pepcid), nizatidine (Axid), or
 ranitidine (Zantac),
• Proton pump inhibitors
 (medications that decrease the release of gastric
 acid, such as lansoprazole [Prevacid], rabeprazole
 [AcipHex], esomeprazole [Nexium], omeprazole
 [Prilosec], and pantoprazole [Protonix])
• Prokinetic agents, which accelerate gastric
 emptying include bethanechol (Urecholine),
 domperidone (Motilium), and metoclopramid
Nursing
Managment
 Nursing management

Nursing interventions
 Encouraging adequate Nutritional Intake.
 Decreasing risk of Aspiration
 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.
 Maintain a healthy weight. ...
 Stop smoking. ...
 Elevate the head of your bed. ...
 Don't lie down after a meal. ...
 Eat food slowly and chew thoroughly. ...
 Avoid foods and drinks that trigger reflux. ...
 Avoid tight-fitting clothing
 Perform a detailed pain assessment
 Pain may be associated with eating or lying flat. It is also
typically burning.
 Obtain 12-lead EKG
 (To rule out possible cardiac etiology of chest pain.)
  .Prepare for and assist with upper endoscopy
 Tissue samples may be taken during this procedure if
necessary.

DIET CHART:

 Avoid situations that decrease lower esophageal

sphincter
 pressure or cause esophageal irritation.
• Eat a low-fat diet
• Avoid caffeine, tobacco, beer, milk,
• Foods containing peppermint or spearmint,
carbonate
 beverages;
• Avoid eating or drinking 2 hours before bedtime
• To maintain normal body weight
• To avoid tight-fitting clothes;
• To elevate the head of the bed on 6- to 8-inch
(15- to 20-
 cm) blocks
• To elevate the upper body on pillows
Discharge
Plan
Home care:

 Give your child plenty of water and other fluids.

 Include high-fibre foods like fruits, vegetables, beans, or
whole grains in your child’s diet each day.
 Have your child take medicines exactly as prescribed. Call
your doctor or nurse advice line if you think your child is
having a problem with a medicine.
 Make sure your child gets daily exercise. It helps the body
have regular bowel movements.
 Tell your child to go to the toilet when they have the urge.
 Do not give laxatives or enemas to your child unless your
child’s doctor recommends it.
 Make a routine of putting your child on the toilet or potty
chair after the same meal each day.
Education of Lifestyle changes
Encourage patients to stop smoking – nicotine
relaxes the LES
Maintain a healthy weight – obesity and belly
fat create stress and pressure on the abdomen
and stomach
Avoid tight-fitting clothes – clothes that are
tight around the waist put extra pressure on the
stomach and esophageal sphincter

Reference:
 Brunner& suddarth’s text book of medical and surgical
nursing,12th ed.)
 Robbins & catron, pathological basis of disease,8th ed.
 Ross & Wilson, anatomy and physiology,10th ed.
 http://emedicine.medscape.com