8 Gastroesophageal Reflux Disease (GERD) Nursing Care Plans

Discover how nursing care plans based on nursing diagnosis for gastroesophageal reflux disease (GERD) can help alleviate symptoms and enhance the well-being of those affected by this condition. Explore effective interventions and best practices for GERD management in this comprehensive guide.

What is Gastroesophageal Reflux Disease?

Gastroesophageal reflux disease or simply GERD is the excessive backflow of gastric or duodenal contents, or both into the esophagus and past the lower esophageal sphincter (LES) for a sustained length of time without associated belching or vomiting.

Nursing Care Plans and Management
See also

Nursing Care Plans and Management

The nursing care planning goals for patients with gastroesophageal reflux disease (GERD) include relieving symptoms such as heartburn and regurgitation, promoting healing of the esophageal tissue, educating the patient about dietary and lifestyle modifications, promoting medication adherence, and providing emotional support to manage the chronic nature of GERD.

Nursing Problem Priorities

The following are the nursing priorities for patients with gastroesophageal reflux disease (GERD) :

Manage and alleviate symptoms of acid reflux.
Reduce gastric acid production to minimize acid reflux episodes.
Promote lifestyle modifications to reduce triggers and improve symptoms.
Provide education on dietary adjustments to avoid aggravating foods and beverages.
Offer guidance on weight management to reduce pressure on the stomach.
Recommend elevation of the head during sleep to prevent nocturnal reflux.
Monitor and address complications, such as esophagitis or Barrett’s esophagus.
Administer appropriate medications, such as proton pump inhibitors or antacids.

Nursing Assessment

Assess for the following subjective and objective data:

Complaints of heartburn, described as a burning sensation or discomfort in the chest or throat.
Reports of regurgitation, feeling a sour or acidic taste in the mouth or throat.
Difficulty swallowing, with a sensation of food sticking in the throat.
Chronic cough, especially worse at night.
Recurrent sore throat or hoarseness.
Indigestion or discomfort after meals.
Reports of disrupted sleep due to symptoms.

Nursing Diagnosis

Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with gastroesophageal reflux disease (GERD) based on the nurse’s clinical judgement and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.

Nursing Goals

Goals and expected outcomes may include:

The patient will ingest daily nutritional requirements in accordance to his activity level and metabolic needs.
The client will report pain is relieved.
The client will achieve and maintain adequate body weight.
The client will carry out an exercise program and weight reduction plan as devised.
The client will maintain a patent airway.
The client will have increased knowledge of actions that reduce reflux.
The child will report a decrease in anxiety level to none or mild.
The child will experience an absence of esophageal bleeding (negative Guaiac tests).
The child will manifest appropriate growth.

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients with gastroesophageal reflux disease (GERD) may include:

1. Promoting Optimal Nutritional Balance

The nutritional status of patients with gastroesophageal reflux disease (GERD) can be affected by various factors. Avoidance of trigger foods and beverages, maintaining healthy body weight, practicing portion control, and adopting dietary modifications such as avoiding late-night meals and eating smaller, more frequent meals can help manage symptoms and promote optimal nutritional status in individuals with GERD.

Obtain a nutritional history.
Determining the feeding habits of the client can provide a basis for establishing a nutritional plan.

Assess the patient for dietary history intake, eating patterns, the importance of eating, and potentials for where dietary exercises can be limited.
Provides information regarding factors associated with being overweight or obesity problems and assists in establishing a plan of care for weight reduction. Note: Elderly tend to gain weight faster and easily because of decreased activity and a lower metabolic rate.

Identify the amount of weight loss needed for optimal body size and frame.
Provides the basis for dietary planning.

Weight the patient every day, on the same scale, same time if possible, and with the same amount of clothing.
Provides goal achievement weight loss information, or lack of progress that may require changes or deviation in the plan of care. Weighing on the same scale helps the consistency of data.

Monitor the results of the following diagnostic procedures.
See Laboratory and Diagnostic Procedures

Encourage small frequent meals of high calories and high-protein foods.
Small and frequent meals are easier to digest.

Instruct to remain in an upright position at least 2 hours after meals; avoid eating 3 hours before bedtime.
Helps control reflux and causes less irritation from reflux action in the esophagus.

Instruct the patient to eat slowly and masticate foods well.
Helps prevent reflux.

Establish a dietary plan for weekly goals of weight loss of one pound. Encourage the patient to make gradual changes in dietary habits.
Prevents frustration from lack of achieving goals. A reduction of approximately 500 calories per day will achieve the prescribed goal.

Provide activities for the patient that do not center around or are associated with meals or snacks.
Utilize calories and provides a diversion from eating; being overweight increases abdominal pressure, which can then push stomach contents up into the esophagus.

Commend the patient for his success and efforts in losing weight.
Weight reduction may alleviate some of the patient’s physical symptoms, and praise encourages continued progress.

Assist the patient and develop a modified exercise program, such as walking, or low-impact exercises.
Increases utilization of calories, increases endurance and maintains musculoskeletal strength. Regularly scheduled exercise facilitates the improvement of self-worth and self-esteem.

Instruct patient and/or family regarding dietary restrictions, modifying favorite foods to use lower calorie substitute ingredients, and making choices that provide for adequate nutritional intake.
Promotes weight-reduction plan by allowing the patient to use familiar foods that have had calories cut down.

Instruct the patient to keep a dietary log of intake for calorie counting.
Facilitates adequate nutritional intake and calorie reduction. Most patients are unaware of the “hidden” calories in the food they ingest.

Instruct patients regarding community resources, weight reduction programs, or support groups.
Dietary requirements usually decrease with age by approximately 10-25%. Overeating, together with a reduction in metabolic rate, continues obesity.

Consult with a dietician for meal planning and food preparation.
Provides meal planning and appropriate nutritional guidance.

2. Managing Acute Pain

Pain in patients with GERD may occur due to the irritation of the esophageal mucosa and oral cavity from stomach acid reflux. This can lead to symptoms such as coughing, aspiration, and further irritation, which exacerbates the pain and discomfort experienced by the patient.

Assess for heartburn.
Heartburn is the most common feature of GERD. This becomes more severe with vigorous exercise, bending, or lying down.

Carefully assess pain location and discern pain from GERD and angina pectoris.
The pain of esophageal spasm resulting from reflux esophagitis tends to be chronic and may mimic angina pectoris: radiating to the neck, jaws, and arms.

3. Preventing Aspiration

Patients with GERD may be at risk for aspiration due to factors such as compromised lower esophageal sphincter, impaired swallowing, and depressed gag and cough reflexes. These conditions can lead to increased intragastric pressure, causing stomach contents to reflux into the lungs and airways, potentially leading to aspiration pneumonia or other respiratory complications.

Assess for pulmonary symptoms resulting from reflux of gastric content.
These include subsequent aspiration, chronic pulmonary disease, nocturnal wheezing, bronchitis, asthma, morning hoarseness, and cough.

Assess for nocturnal regurgitation.
This is a rare condition wherein the patient awakens with coughing, choking, and a mouthful of saliva.

Assess the patient’s ability to swallow and the presence of a gag reflex. Have the patient swallow a sip of water.
Loss of the gag reflex increases the risk of aspiration.

Avoid placing the patient in a supine position, have the patient sit upright after meals.
A supine position after meals can increase the regurgitation of acid.

Instruct the patient to avoid highly seasoned food, acidic juices, alcoholic drinks, bedtime snacks, and foods high in fat.
These can reduce the lower esophageal sphincter pressure.

Elevate HOB while in bed.
To prevent aspiration by preventing the gastric acid to flow back into the esophagus.

Avoid nasogastric intubation for more than five (5) days.
The tube interferes with sphincter integrity and allows reflux, especially when the patient lies flat.

Instruct the patient to chew food thoroughly and eat slowly.
Well-masticated food is easier to swallow. Food should be cut into small pieces.

If the patient has dysphagia, put the patient on NPO and notify the physician.
Patients at high risk for aspiration should be kept NPO until the swallowing study has been completed.

4. Reducing Anxiety

Patients with GERD may experience anxiety due to the discomfort and pain associated with the condition, which can be especially distressing for young children who may not understand what is happening to them. The fear of experiencing symptoms or not being able to communicate their symptoms effectively can further exacerbate anxiety in these patients.

Assess the cause of anxiety and how anxiety is manifested: need for information that will ease anxiety. Ask clients to rate anxiety from none to mild, moderate, severe, or panic levels.
Provides information about the level of anxiety and the need for measures to relieve it; sources for the parents include fear and uncertainty about treatment and recovery and guilt for the occurrence of illness.

Allow verbalization of concerns and ask inquiries about illness, treatment, surgery, and recovery by parents.
Provides an opportunity to release sentiments and fears and secure information to decrease anxiety.

Encourage parents to stay with the child and assist in care.
Allows parents to support and care for the child and resume their parental role.

Communicate frequently with parents and provide easy-to-understand and truthful answers to questions; utilize pictures, drawings, and models for explanations.
Promotes a calm and supportive trusting environment.

Involve parents in the decision-making regarding care and routines as possible.
Allows for more control over the situation.

Provide infants with consistent care through a familiar staff assigned for care.
Promotes trust and decreases anxiety.

Inform parents about the disease process, physical effects, and symptoms of the condition.
Provides information to alleviate anxiety by knowledge of what to expect.

Explain the reason for each pre and postoperative procedure or type of therapy, diagnostic exam, surgical procedure, and rationales including IV, nasogastric tube, dressings, and gastrostomy tube.
Decreases fear which eases anxiety.

Inform parents about the removal of the nasogastric tube when postoperative ileus is resolved and the gastrostomy tube is removed 2 or more weeks after surgery.
Diminishes anxiety brought about by tube placements and care.

Instruct in care of and feeding through a gastrostomy tube and explain postoperative complications such as delayed gastric emptying, inability to vomit, and gas bloating.
Information about what to expect will decrease anxiety.

Teach parents feeding techniques, allowing the infant to take a long time to feed and to report any feeding problems.
Familiarizes parents with changes in feeding patterns to prevent complications of choking, and aspiration.

Instruct to notify signs of wound infection (redness, swelling, increasing pain, bleeding, or discharge).
Allows for immediate treatment in presence of infectious procedures.

Demonstrate and instruct in wound care and dressing changes; allow for return demonstration, and information to protect dressing from a diaper.
Ensures wound healing without the complication of infection or recurrence of infection.

5. Minimizing Injury Risk

Pediatric patients with GERD may be at risk for injury due to factors such as vomiting, coughing, and esophageal damage. These conditions can lead to complications such as dental erosion, dehydration, and malnutrition, and may require medical intervention to prevent further injury or manage the symptoms associated with GERD.

Monitor for stool and vomit for occult blood, the severity of reflux, weight loss or gain, and failure to thrive.
Provides information about the complication of esophagitis or esophageal stricture, anemia, or failure to thrive.

Assist and prepare parents and infants for diagnostic examination and possible surgical procedures.
Determines the severity of reflux and the need for surgical interventions.

Inform parents that the infant usually outgrows the disorder and attains normal function by 6 weeks of age and those with a persistent reflux problem usually resolve by 6 months of age.
Provides guarantee to parents about the success of medical management and absence of complications.

Inform that severe reflux may need nothing per orem status and nasogastric tube insertion with suction.
Avoids abdominal distention and continuing reflux activity of stomach contents.

Educate and instruct to do Guaiac test on stool and vomitus and allow to return demonstration.
Shows the presence of occult blood in the esophagus.

6. Initiating Patient Education and Health Teachings

Patients with GERD may have a lack of knowledge about their condition due to the presence of preventable complications and difficulties in verbalizing their problems. Patients may not be aware of the potential long-term consequences of untreated GERD and may struggle to communicate their symptoms and concerns effectively, leading to delays in diagnosis and treatment.

Assess the patient for information needed and ability to perform actions independently.
Provides a basis for teaching.

Assist with the reduction in caloric intake.
Being overweight increases intraabdominal pressure.

Provide patients with information regarding disease processes, health practices that can be changed, and medications to be utilized.
Provides knowledge and facilitates compliance.

Instruct the patient regarding eating small amounts of bland food followed by a small amount of water. Instruct to remain in an upright position at least 1–2 hours after meals, and to avoid eating within 2–4 hours of bedtime.
Gravity helps control reflux and causes less irritation from reflux action in the esophagus.

Instruct patient to avoid bending over, coughing, straining at defecations, and other activities that increase reflux.
Promotes comfort through the decrease in intra-abdominal pressure, which reduces the reflux of gastric contents.

Instruct patients to eat slowly, chew foods well, and maintain a high-protein, low-fat diet.
Helps prevent reflux.

Instruct patient to avoid temperature extremes of food, spicy foods, citrus, and gas-forming foods.
These food items increase acid production which precipitates heartburn and increased reflux.

Instruct patient regarding avoidance of alcohol, smoking, and caffeinated beverages.
Increases acid production and may cause esophageal spasms.

Instruct the patient to raise both arms, fully extended towards the ceiling prior to eating.
Relieves spasms and allows for more comfort when eating.

Instruct patient on medications, effects, and side effects, and to report to the physician if symptoms persist despite medication treatment.
Promotes knowledge facilitates compliance with treatment and allows for prompt identification of potential need for changes in medication regimen to prevent complications.

Administer medications as ordered.
See Pharmacologic Management

Instruct the patient on the correct preparation for diagnostic testing.
No food intake for 6 to 8 hours prior to barium swallow or endoscopy.

Instruct the patient to avoid smoking.
Nicotine relaxes the esophageal sphincter and stimulates the production of stomach acid. It can also injure the esophagus causing irritation and making it more susceptible to damage from acid reflux. Lastly, smoking can decrease gastric motility and reduces the effectiveness of digestion because the stomach takes longer to empty.

Instruct the patient to avoid alcohol.
Alcohol can increase the production of stomach acid and can also lower the esophageal sphincter, which allows stomach acids to move up into the esophagus. Alcohol also makes the esophagus more sensitive to stomach acid.

7. Administer Medications and Provide Pharmacologic Support

Medications used in the management of gastroesophageal reflux disease (GERD) include antacids, proton pump inhibitors (PPIs), H2 receptor blockers, and prokinetic agents. Antacids provide temporary relief by neutralizing stomach acid, while PPIs and H2 receptor blockers work by reducing the production of stomach acid. Prokinetic agents help improve esophageal motility and reduce reflux episodes.

Antacids and H₂ receptor antagonists like famotidine (Pepcid), nizatidine (Axid), or ranitidine (Zantac)
Acts by neutralizing the acid in the stomach, therefore, helps relieve pain.

Proton pump inhibitors such as lansoprazole (Prevacid), rabeprazole (AcipHex), esomeprazole (Nexium), omeprazole (Prilosec), and pantoprazole (Protonix)
Works by decreasing the release of gastric acid.

Prokinetic agents such as bethanechol (Urecholine), domperidone (Motilium), and metoclopramide (Reglan)
Helps hasten the gastric emptying time. Metoclopramide has extrapyramidal side effects that are increased in certain neuromuscular disorders (e.g., Parkinson’s disease); it should only be used if no other option exists.

Sucralfate
Helps ulcer healing by forming a protective barrier on the surface of the ulcer.

Prostaglandin E1 analogues such as misoprostol (Cytotec)
Used to replace gastric prostaglandins that have been depleted by the use of NSAIDs; decreases the basal gastric acid secretion and increases gastric mucus and bicarbonate production.

8. Monitoring Results of Diagnostic and Laboratory Procedures

Tests such as complete blood count (CBC), liver function tests, or tests for Helicobacter pylori infection are done to assess the overall health and identify potential contributing factors. Diagnostic procedures such as upper endoscopy, esophageal pH monitoring, or imaging studies may also be performed to evaluate the esophagus and assess the extent of damage caused by acid reflux.

Complete blood count
To identify the presence of anemia that must be ruled out.

Cardiac enzymes
To rule out myocardial pain related to the atypical pain felt with GERD.

Serum iron
To identify the presence of iron-deficiency anemia.

Gastrin levels
To identify the toxicity of proton pump inhibitors or to diagnose Zollinger-Ellison syndrome.

Gastric acid secretory analysis
To determine if failure with pharmacologic agents is caused by inadequate suppression of gastric acid secretion, which may signify bile reflux or pill-induced disease.

Upper gastrointestinal endoscopy
Used to identify the type and extent of tissue damage.

Barium swallow
Can be used to identify structures and Hiatal hernias.

Esophageal pH monitoring
Used to document pathologic acid reflux, especially for patients who have atypical symptoms.

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
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