Primary Nursing Diagnosis

Pain related to esophageal reflux and esophageal inflammation

OUTCOMES. Comfort level; Pain control behavior; Pain level; Symptom control behavior; Symptom severity

370 Gastroesophageal Reflux Disease (GERD)

INTERVENTIONS. Medication administration; Medication management; Pain management; Positioning; Environmental management: Comfort; Nutritional monitoring; Weight management

U PLANNING AND IMPLEMENTATION Collaborative

Although diet therapy alone can manage symptoms in some patients, most patients can have their GERD managed pharmacologically. Dietary modifications that may decrease symptoms include reducing intake of fatty foods, caffeinated beverages, chocolate, nicotine, alcohol, and peppermint. Reducing the intake of spicy and acidic foods lets esophageal healing occur during times of acute inflammation. Encourage the patient to eat five to six small meals during the day rather than large meals. Ingestion of large amounts of food increases gastric pressure and thereby increases esophageal reflux. Both weight loss and smoking cessation programs are also important for any patients who have problems with obesity and tobacco use.

Surgical procedures to relieve reflux are generally reserved for those otherwise healthy patients who have not responded to medications. Three major surgical procedures are used: Nissen fundo-plication (surgeon wraps fundus of the stomach around esophagus to anchor the LES area below the diaphragm), Hill's repair (anchors gastroesophageal junction to the median arcuate ligament), and Belsey's repair (transthoracic approach with a fundic wrap around the distal esophagus).

Pharmacologic Highlights

Medication or

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