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GERD & Gastroenteritis Harlene Castillo Christine Valdez Claudia Vasquez November 17, 2010 NURS 120

DEFINITION GERD occurs after eating a meal Acidic contents refluxes or moves upwards towards the esophagus GASTROENTERITIS is when the stomach and both small and large intestines are inflamed.

ETIOLOGY GERD usually due to having a weak lower esophageal sphincter. GASTROENTERITIS Infection from different viruses Sometimes AKA “stomach flu” Nausea & vomiting NOT similar to Gastritis

PATHOPHYSIOLOGY for GERD Lower Esophageal Sphincter- doesn’t close Backflow of gastric or duodenal contents (or both) no belching or vomiting High acidity of the stomach causes irritation Heartburn occurs (hormonal fluctuations, mechanical stress, effects of foods and drugs)

PATHOPHYSIOLOGY for GASTROENTERITIS Infected Food Ingested These agents cause diarrhea by adherence, mucosal invasion, enterotoxin production, and/or cytotoxin production Increased fluid secretion and/or decreased absorption. increased luminal fluid content that cannot be adequately reabsorbed, leading to dehydration and the loss of electrolytes and nutrients. Small intestines are primarily affected

GORDON’s Functional Patterns GERD Nutritional Metabolic Patterns Imbalanced nutrition Impaired swallowing GASTROENTERITIS Nutritional Metabolic Pattern Nausea & vomiting Elimination Pattern Diarrhea

Nursing Process ASSESSMENT Determines client’s chief complaint Monitor for s/s (GERD) -dyspepsia, especially after eating -chronic cough -hypersalivation -flatulence (GASTROENTERITIS) -Vomitting -Diarrhea -Abdominal discomfort, fever, headache -Dehydration Diet Lifestyle…..Smoke? Drink? Medications Sleep pattern Severity of pain and frequency

DIAGNOSIS Acute Pain Deficit Knowledge Disturbed Sleep Pattern Fluid Electrolyte Imbalance Nutrition Imbalance

PLANNING Plan of care that are measurable and realistic Ex: One to two episodes of heartburn per week,6 weeks after start of Protonix Ex: Client’s electrolyte level within normal range before discharge

INTERVENTIONS Blood samples, stool specimens Diagnostic Tests (GERD) - Barium Upper GI - Endoscopy - Esophageal manometry Medications - Proton-pump inhibitors - Histamine2 receptor antagonists - Antacids - Anti-emetic - Anti-diarrheals - Antibiotics - IV Hydration Client teachings

PATIENT TEACHING for GERD PREVENT reflux occurring at night, elevate head of bed AVOID: Lying down right after eating Eating large meals Drinking alcohol Smoking Fatty foods Caffeine Chocolate

PATIENT TEACHING for GASTROENTERITIS Practice good hand hygiene ALWAYS hydrate with clear fluids for first 24 hours to replenish electrolyte imbalance After 24 hours of not vomiting, start BRAT diet However, when the patient is unable to take fluids PO, the physician can intravenously (IV) give fluid to hydrate the patient- ensure presence of IV access.

EVALUATION Minimized severity of pain Minimized frequency/duration No further episodes of LBM, vomitting Labs within normal limits Improved sleep patterns What the goal reached?