GERD (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Now, why is there an increased risk of GERD? Remember this. Gastroesophageal reflux disease.

    00:08 So stop for a minute and break that word down in your mind.

    00:11 Gastroesophageal, oh, gastro is always GI tract. Esophageal reflex disease, okay.

    00:19 Yeah. It's really true that geriatric clients have a higher risk for this.

    00:24 Now, there's other risk factors for GERD, but we're just focusing in on the geriatric population.

    00:31 Now, one more clue. You'll see here that Jose is very fit and trim. Right? He looks incredibly healthy. Enrique has this little grandpa belly and I'll talk about that in just a minute.

    00:43 But when we're focused on geriatric clients, let's go through normal.

    00:48 All right. So we already know that it came in through the mouth.

    00:49 It goes down to the upper esophageal sphincter.

    00:52 Now, we're in the lower esophageal sphincter. And now, we're into the stomach.

    00:56 Now, that sphincter at the bottom should stay closed.

    00:59 We want to make sure that that gastric acid that's rolling around in your stomach doesn't go back up through that valve and into your esophagus because it's going to burn and be painful.

    01:12 That's what gastroesophageal reflux disease is.

    01:17 That means that gastric acid is not staying in the stomach.

    01:22 So your stomach's - it's designed to kind of deal with that gastric acid.

    01:27 You need the gastric acid to help your body start breaking up the food and all the nutrients in it, so you can get it into your intestines and your blood stream, and get it into the cells where you need it.

    01:39 But other tissues can't handle gastric acid.

    01:43 In my stomach, I have a stomach lining. I've got bicarbonate.

    01:47 I've got this thick mucus. So it's well-protected.

    01:50 But if it scoots out of there like look at this picture.

    01:54 If that sphincter doesn't close tightly and securely, if it's open, that gastric acid is going to bubble up in that esophagus. And it is not a good day when that happens.

    02:07 That's what we call reflux. And it is miserable for patients.

    02:11 I've had some patients that had GERD that was so bad, they thought they were having a heart attack.

    02:16 Once we calmed down that GI tract, they were fine.

    02:20 But this is really important that you help your patients understand, as we age, everyone develops a little bit more of a risk for this.

    02:28 If you're overweight, there's even a higher risk.

    02:32 So Enrique is - well, grandpa belly puts him at an even greater risk for developing GERD.

    02:38 And we do some things at night with them.

    02:40 We'll encourage them to sleep with their shoulders elevated a little bit, so they're not completely laying flat. Yeah. Why? Well, think about what you know about the anatomy.

    02:50 We can kind of use gravity to keep that gastric acid in the stomach versus laying flat where he's more at risk for it to be flowing up and burning that esophagus.

    02:59 So what do you do? We've got Enrique here, and we've got a nurse.

    03:03 So the nurse is going to know because of Enrique's age that he's an increased risk for GERD.

    03:10 She's also going to know that he has some extra weight. We're not judging.

    03:15 We're just looking that as a risk factor that, "Okay, that's going to make it even worse for him." So she's going to ask or he, whoever the nurse happens to be.

    03:24 They're going to ask some really specific nursing admission history questions.

    03:30 So as she's meeting Enrique, no matter what the setting is.

    03:33 It could be in the community. It could be in the hospital.

    03:36 But she's going to take a look at Enrique and say, "Hey, I'm going to ask about GERD because I know that geriatric patients have an increased risk." So I'm going to ask really specific questions. I'm not going to say, "Enrique, do you have GERD?" No. I'm going to say, "Hey, have you ever felt like you had a burning sensation in your esophagus or maybe heartburn? Did you ever experience that? What foods caused that for you? Just to kind of gently open the door for them because don't use our medical terminology with clients.

    04:10 It really kind of distances us until you make sure they understand exactly what you're talking about.

    04:17 So you don't talk down to patients but you talk it at an appropriate level.

    04:20 They may not have taken the medical terminology class that you did.

    04:24 And so you have to think about, "How can I ask this question in a way that's going to get me the assessment information I really need?" Because that's how you identify potential problems.

    About the Lecture

    The lecture GERD (Nursing) by Rhonda Lawes, PhD, RN is from the course Assessment of the Geriatric Patient: Gastrointestinal System (Nursing).

    Included Quiz Questions

    1. Gastric acid travels back into the esophagus.
    2. Gastric acid cannot enter the stomach.
    3. Gastric acid travels into the intestines at an increased rate.
    4. Gastric acid is trapped in the stomach.
    1. Advanced age is a risk factor.
    2. Sleeping with the shoulders elevated can help ease discomfort.
    3. It can be described as a burning sensation in the esophagus.
    4. Being underweight is a risk factor.
    5. It rarely causes discomfort.

    Author of lecture GERD (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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