NR 507 Week 5 Assignment; Obstructive Gastrointestinal Disorders

琀椀me, stomach contents can enter the esophageal area leading to the symptoma琀椀c burning. From the diagram to the right, you can see that LES sphincter is never fully closed with GERD. When evalua琀椀ng a pa琀椀ent with GERD, the NP must consider the types of presen琀椀ng symptoms. It is easy to evaluate typical GERD symptoms. But, with atypical and associated symptoms, the pa琀椀ent may not realize that these also re昀氀ect GERD. The typical, atypical and associated symptoms are listed below. Whether the symptoms are atypical or associated, all have heartburn and re昀氀ux in common. Typical, atypical, and associated GERD symptoms Symptom Typical Atypical Associated Heart burn x Dyspepsia x Asthma x Regurgitation (reflux) x Bloating x Globus (lump in throat) x Epigastric pain x Hoarseness x Cough x Nausea x GERD Risk Factors and Warning Signs Some individuals have risk factors for the development of GERD. Obesity is a risk factor that worsens not only the symptoms of GERD, but also its complica琀椀ons (i.e. Barre琀琀’s Esophagus; esophageal cancer). A hiatal hernia can trap gastric contents above the diaphragm which can also worsen GERD symptoms. Addi琀椀onally, some medica琀椀ons can worsen GERD symptoms, such as calcium channel blockers, an琀椀bio琀椀cs and bisphosphonates. Finally, pregnancy is also a condi琀椀on that can worsen GERD symptoms due to pressure that pushes the stomach above the diaphragm. GERD Treatment and Management Treatment Treatment goals include: • Elimina琀椀ng symptoms • Healing esophagi琀椀s • Preven琀椀ng the relapse or development of complica琀椀ons • Decreasing the amount of acid that re昀氀uxes from the stomach back to the esophagus Management In many pa琀椀ents, GERD is a chronic, relapsing disease and long-term treatment may be needed to control symptoms and prevent complica琀椀ons. Maintenance therapy will vary in individuals and may include simple lifestyle modi昀椀ca琀椀ons, over the counter antacids or prescrip琀椀on medica琀椀on. Proton- pump inhibitors (PPI) are the gold standard for trea琀椀ng GERD when it’s required. All PPIs are considered e昀昀ec琀椀ve for trea琀椀ng re昀氀ux. The NP must be mindful of the dosage and length of therapy recommenda琀椀ons when prescribing a PPI as well as each pa琀椀ent’s severity of symptoms. For example, in mild, intermi琀琀ent GERD ( • Eleva琀椀ng the head of bed • Avoiding food 2-3 hours prior to bed琀椀me • Elimina琀椀ng trigger foods. • Although trigger foods can vary for individuals, some of the universal trigger foods include chocolate, ca昀昀eine, alcohol or spicy and acidic food. Hiatal Hernia A hiatal hernia is a diaphragma琀椀c hernia that protrudes (herniates) through the upper part of the stomach through the diaphragm and into the thorax due to dila琀椀on of the gastroesophageal junc琀椀on (GJ). There are four types of hiatal hernias: 1. Sliding hiatal hernia. This is where the junc琀椀on of the esophagus slides up past the GE junc琀椀on. 2. Paraesophageal hernia. In a paraesophageal hernia, the contents of the abdomen slide up around the esophagus and into the chest. The GE junc琀椀on in the type 2 hernia does not go up into the chest. 3. Mixed hiatal hernia. This is a combina琀椀on of both Type 1 and