Ch. 46: GERD and Hiatal Hernia Nursing Care

What is Gastroesophageal Reflux Disease (GERD)?

A chronic condition characterized by abnormal backward flow of stomach contents into the esophagus, causing mucosal injury.

What causes the symptoms of GERD?

Decreased lower esophageal sphincter (LES) pressure leading to hyperemia, edema, erosion, and strictures.

What are common assessment findings in GERD?

Chronic heartburn, acid regurgitation, dysphagia, weight loss, chronic cough, asthma, laryngitis, hoarseness, and chest pain.

When do GERD symptoms typically worsen?

When lying down or with increased intraabdominal pressure, such as during coughing or vomiting.

What dietary modifications are recommended for GERD patients?

Limit/eliminate peppermint, chocolate, fried/fatty foods, caffeine, carbonated beverages, spicy and acidic foods.

What is a common drug therapy for managing GERD?

Proton pump inhibitors (PPIs) like lansoprazole and omeprazole.

What is a hiatal hernia?

Protrusion of a portion of the stomach through the esophageal hiatus of the diaphragm into the chest cavity.

What are the two types of hiatal hernias?

Sliding hiatal hernia and paraesophageal (rolling) hiatal hernia.

What symptoms may indicate a hiatal hernia?

Asymptomatic in many cases; may present with chest pain, severe heartburn, regurgitation, and a feeling of fullness after meals.

How are hiatal hernias managed?

Similar to GERD: strict positioning, small/frequent meals, and acid suppression therapies.

What is laparoscopic Nissen fundoplication?

A surgical procedure where the fundus of the stomach is wrapped around the back side of the lower esophagus.

What lifestyle modifications are recommended for patients with GERD or hiatal hernia?

Weight reduction, smoking cessation, elevating the head of the bed, avoiding tight clothing, and eating smaller meals.

What is the role of antacids in GERD management?

To provide symptomatic relief by neutralizing stomach acid.

What is Barrett esophagus?

A condition that can develop from chronic GERD, where the esophageal lining changes and may increase cancer risk.

What is the significance of chronic cough in GERD patients?

It may indicate aspiration or irritation of the airways due to acid reflux.

What is the effect of alcohol on GERD symptoms?

It can worsen symptoms and cause discomfort.

What are the potential complications of untreated GERD?

Esophagitis, strictures, Barrett esophagus, and increased risk of esophageal cancer.

What is the importance of chewing food thoroughly for GERD patients?

It aids digestion and may reduce the amount of acid produced in the stomach.

What is the recommended meal frequency for GERD management?

4-6 small meals daily rather than 3 large meals.

How does lying supine affect GERD symptoms?

It can exacerbate symptoms due to increased pressure on the LES.