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
Nursing care planning goals of gastroesophageal reflux disease (GERD) involves teaching the patient to avoid situations that decrease lower esophageal sphincter pressure or cause esophageal irritation.
The following are seven (7) nursing care plans for gastroesophageal reflux disease (GERD):
- Imbalanced Nutrition: Less Than Body Requirements
- Acute Pain
- Imbalanced Nutrition: More Than Body Requirements
- Risk for Aspiration
- Deficient Knowledge
- NEW: Anxiety (Pediatric)
- NEW: Risk for Injury (Pediatric)
Imbalanced Nutrition: Less Than Body Requirements
Imbalanced Nutrition: Less Than Body Requirements: The state in which an individual who is not on NPO, experiences or is at risk for inadequate intake or metabolism of nutrients for metabolic needs with or without weight loss.
May be related to
- inability to intake enough food because of reflux
- increased metabolism caused by disease process
- early satiety
- heartburn
Possibly evidenced by
- inadequate food intake
- altered taste
- weight loss
- decreased peristalsis
- muscle mass loss
- nausea and vomiting
- abdominal pain or discomfort
- intolerance of fatty foods
- epigastric pain after eating
- heartburn
- regurgitation
- dysphagia
Desired Outcomes
- Patient will ingest daily nutritional requirements in accordance to his activity level and metabolic needs.
| Nursing Interventions | Rationale |
|---|---|
| Accurately measure the patient’s weight and height. | For baseline data. |
| Obtain a nutritional history. | Determining the feeding habits of the client can provide a basis for establishing a nutritional plan. |
| 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. |
| Instruct patient to eat slowly and masticate foods well. | Helps prevent reflux. |
| Prepare the patient for the following diagnostic procedures: | |
| 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 presence of iron-deficiency anemia |
| Gastrin levels | To identify 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. |
See Also
You may also like the following posts and care plans:
Gastrointestinal Care Plans
Care plans covering the disorders of the gastrointestinal and digestive system:
- Appendectomy | 4 Care Plans
- Cholecystectomy | 12 Care Plans
- Cholecystitis and Cholelithiasis | 4 Care Plans
- Gastroenteritis | 4 Care Plans
- Hemorrhoids | 3 Care Plans
- Hepatitis | 7 Care Plans
- Ileostomy & Colostomy | 10 Care Plans
- Inflammatory Bowel Disease | 7 Care Plans
- Intussusception | 3 Care Plans
- Liver Cirrhosis | 8 Care Plans
- Pancreatitis | 8+ Care Plans
- Peritonitis | 6 Care Plans
- Peptic Ulcer Disease | 5 Care Plans
- Subtotal Gastrectomy | 2 Care Plans
Further Reading
Recommended books and resources:
- Nursing Care Plans: Diagnoses, Interventions, and Outcomes
- Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
- Nursing Diagnoses 2015-17: Definitions and Classification
- Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
- Manual of Psychiatric Nursing Care Planning
- Maternal Newborn Nursing Care Plans
- Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
- Maternal Newborn Nursing Care Plans
Updated as of August 2018.
