GERD

(Gastroesophageal Reflux Disease)

Cabase, Cabase, Jennelyn Camalla, Camalla, Junalyn Francia Carballo, Carballo, Abegail Cecilio, Cecilio, Marjorie Corpuz, Corpuz, Cherrie Mae Culiat, Culiat, Lea

I. Patients Profile
Name: Mrs. EBV Birthday: September 23, 1941 Age: 70 Address: Zone 2 Ayugan Vales, Ocampo, Camarines Sur Religion: Roman Catholic Level of Education: College Graduate Chief complaint:difficulty swallowing,history of aspiration 3x

HEALTH HISTORY

a. Health history
Mrs. EBV is a 70 year old woman, born on a town of Nabua. A college graduate of education at University of Nueva Caceres and presently retired from work. Lives in a two story house with her husband and her younger child and a niece. Major reason for seeking health care is for routine check-up. Past Illnesses/Hospitalization: Placenta Previa on the 3rd baby at the age of 37 UTI at the age of 69 Allergies: Denies food, drug and environmental allergies.

HEAD-TOHEAD-TO-TOE ASSESSMENT

b. Head-t0-toe assessment
GENERAL ASSESSMENT
Vital signs: BP:120/80 HR: 82 RR: 16 The client is cooperative and alert, answers question spontaneously. Sitting comfortably on table with arms crossed and shoulders slightly slouched forward. Dress neat and clean. Walks steadily with posture slightly stooped.

b. Head-t0-toe assessment
SKIN, HAIR AND NAIL ASSESSMENT:
Skin: -warm and dry to touch. -Skin fold returns to place after 1 second. -Lesions and edema not noted to any part of the body. Hair: -hair black in color, medium textured, evenly d istributed on head, -no scalp lesions or flaking. -No hair noted on the axilla, arms and legs or on the chest, back or face. Nails: fingernails medium in length with a capillary refill of 2-3 seconds.

b. Head-t0-toe assessment
Head and neck assessment: Head symmetrically rounded neck nontender with full range of motion. Neck symmetrical without masses, scars, and pulsations. Lymph nodes not palpable. Trachea is in midline. Carotid arteries equally strong without bruits. Identifies light and deep touch to various parts on the face.

b. Head-t0-toe assessment
Eye assessment:
Eye brows sparse with equal distribution, scaliness not noted. Lids pink without ptosis, edema or lesions and freely closeable bilaterally sclera white without increased vascularity or lesions noted.

Ear Assessment:
Auricle without deformities, lumps or lesions. Mastoid process non palpable. Both auditory canals contain moderate amount dark brown cerumen. Tympanic membrane difficult to view due to presence of wax.

b. Head-t0-toe assessment
Nose and Sinuses Assessment: External stricture without deformities, asymmetry and inflammation. Nares are both patent and the nasal septum midline without bleeding, perforation or bleeding. Mouth and pharynx: No lesions or ulcerations. Buccal mucosa pink and moist without discoloration or increased pigmentation. Absence of all the molar teeth and a lateral incisor tooth. Hard and soft palate smooth without lesion or masses. Tongue midline when protruded and with white pigmentation on inner part. Gag reflex intact, tonsils present without exudates, edema, ulcers or enlargement.

b. Head-t0-toe assessment
Cardiac Assessment: No pulsations visible. Clear brief heart sounds throughout auscultation. Apical pulse: 83/min and regular. Musculoskeletal Assessment

Posture slightly stooped with mild kyphosis. Gait steady, smooth and coordinated with even base. Limited range of motion of lateral flexion and extension of the spine. Upper and lower extremities have limited ROM. Verbalize joint pain during long standing and

b. Head-t0-toe assessment
Neurologic Assessment: Mental Status: Talkative and friendly. Dressed appropriately, clothes are neat and clean. Facial expressions symmetrical and correlate with mood and topic discussed. Speech clear and appropriate. Carefully chooses words to convey feelings and ideas. Oriented to person, place and time and events. Remains attentive and able to focus during the entire interaction. Long and short term memory are intact.

GORDONS FUNCTIONAL HEALTH PATTERN

C. Gordons Functional Health Pattern

A.Health PerceptionHealth Management Pattern Client rating of health: Scale: 10-best; 1-worst 5 years ago: 10 Now: 7 5 years from now: 8 10 years from now: 7 Sees health deterioration as normal aging process and states, \as age increases body resistance weakens, natural naman yan i-kumpara mo na lang sa sarong makina pag 10 years na nagpapalya naman.

C. Gordons Functional Health Pattern

A.Health PerceptionHealth Management Pattern Health does not interfere with self-care or other desired activities of daily living. Unaware of signs and symptoms of GERD. Never use alcohol, tobacco and drugs but know that she is a 2nd hand smoker because of her husband that consume of approximately 40 sticks of cigarette a day. Client seeks health care once in 6 months and in time of emergencies. Last medical exam was May 2011. Keeps active and feel well. Does not check own blood pressure or do breast self exams.

C. Gordons Functional Health Pattern

A.Health PerceptionHealth Management Pattern Health does not interfere with self-care or other desired activities of daily living. Unaware of signs and symptoms of GERD. Never use alcohol, tobacco and drugs but know that she is a 2nd hand smoker because of her husband that consume of approximately 40 sticks of cigarette a day. Client seeks health care once in 6 months and in time of emergencies. Last medical exam was May 2011. Keeps active and feel well. Does not check own blood pressure or do breast self exams.

C. Gordons Functional Health Pattern

B. NutritionalMetabolic Pattern States that she prefer eating porridge food and attempt to take on soft diet because of the reason that she cannot tolerate hard food such as meat she experience a burning sensation in the esophagus, difficulty of swallowing food, and experience sour taste in the mouth for more than twice each week as a result she consulted the doctor and term it as GERD. states painscale 0f 7 when swallowing and verbalizes that she experience aspiration thrice and now she is afraid of eating alone Reported the she like to eat fatty food, caffeinated beverages, colas and spicy foods.

C. Gordons Functional Health Pattern

Drinks 8 glasses of water a day. Drinks 2 cups of decaf coffee one in the morning and one in the afternoon-no tea and occasionally drink colas. Never wears dentures even if she doesnt have all the molar teeth and a lateral incisor tooth. Last dental exam was 2010. Complains of dyspepsia approximately 2x/month and never take any drug. Describe the skin and scalp dry and uses lotion as management. Denies easily bruising, pruritus and nonhealing sore. Nails are hard and brittle and the hair is grey in color, fine and soft. Current weight: 136 lbs Previous weight:140 lbs 3 weeks ago

C. Gordons Functional Health Pattern

C. Elimination Pattern Bowel Habits: -soft, formed, medium brown bowel movement every morning. -Never report of mucous, bloody or tarry stools, or rectal bleeding, change in color, consistency or habits. Bladder Habits: -experiences urinary incontinence and pain last 2010 when she was diagnosed of urinary tract infection. -But now reports of regular urination 4-5x in a day, clear yellow urine.

C. Gordons Functional Health Pattern

D. ACTIVITY-EXERCISE PATTERN ADLs on average day: -Arises at 8am in the morning. -Eats breakfast and does housekeeping. - Take lunch 1pm in the afternoon and by 4pm in the afternoon takes a nap for 30minutes to 1 hour. -Cleans own house and never report of any chest pain, palpitation except for joint pain and it is only relieve by rest. Hygiene: take a bath once a week. Occupational activities: retires from being a teacher in a public school in Naga City and points out that it is the reason why she experiences joint pain.

C. Gordons Functional Health Pattern

E. SexualityReproduction Pattern Menstrual History: age of menarche: 16 years old age of menopause: approximately 58 years old described menstrual period as regular, lasting for 5 to 7 days with moderate flow. Never report of postmenopausal spotting at this time Obstetric History: Gravida 3, Para 3, and the 3rd child with complication of placenta previa. Contraception: never used any form

C. Gordons Functional Health Pattern

F. Sleep-Rest Pattern Goes to bed at 11:30 pm. Did not complain of difficulty falling asleep or sleeping. Feels well rested when she arises at 8am. Take a nap of 30 minutes to an hour during the afternoon. Uses 3 pillows when sleeping. G. Cognitive Pattern Speech clear without slur and follow a verbal cues. Expresses ideas and feelings clearly and concisely. Can remember long and short term memory even the date, time and places of events. Makes major decisions jointly with the husband and prayer to the Lord.

C. Gordons Functional Health Pattern

H. Role-Relationship Pattern Client has been married for 48 years, describes relationship as the best part of life right now. She is very fond of 6 grandchildren most especially when her youngest grandchild sent her videos of her activities in Canada. Received phone call from her 2nd child once a month and the oldest child visit her trice a month. Explains her relationship with other members in the community as friendly. She was the oldest of 10 children.

C. Gordons Functional Health Pattern

I. Coping-stress tolerance Pattern Shares that the most stressful event is the accident that happen to her 2nd eldest grandchild that she even get hysterical and experience shortness of breath, it was 2 years ago when it happen and the only coping is prayers to the lord and the support of the relatives and family J. Value-Belief Pattern Religious preference is Roman Catholic. Believe that God is the creator of all the things and when we believe in him and trust in him God He will provide. Places God as the center of the family.

ANATOMY AND PHYSIOLOGY

anatomy and physiology

Gastrointestinal Tract- breakdown food into nutrients which can be absorbed into the body to provide energy. - Food must be ingested into the mouth to be mechanically processed and moistened. - Digestion occurs mainly in the stomach and small intestine where proteins, fats and carbohydrates are chemically broken down into their basic building blocks. - Smaller molecules are then absorbed across the epithelium of the small intestine and subsequently enter the circulation.

anatomy and physiology

- The large intestine plays a key role in reabsorbing excess water. Finally, undigested material and secreted waste products are excreted from the body via defecation (passing of feces). - Digestive tract is a tube extending from the mouth to the anus, plus the associated organs, which secrete fluids into the digestive tract. - It consists of the oral cavity, pharynx, esophagus, stomach, small intestine, large intestine and anus.

anatomy and physiology

ORAL CAVITY Responsible for the intake of food. it is lined by a stratified squamous oral mucosa with keratin covering those areas subject to significant abrasion such as tongue, hard palate and roof of the mouth. TEETH there are 32 teeth in the normal adult. Mastication is the mechanical breakdown of food by chewing and chapping actions of the teeth. TONGUE- strong muscular organ, manipulates the food bulos to come in contact with the teeth. -It is also the sensing organ of the mouth for touch, temperature and taste using its specialized sensors known as papillae.

anatomy and physiology

SALIVARY GLANDS INSALIVATION the mixing of the oral cavity contents with salivary gland secretion. MUCIN (a glycoprotein) in saliva acts as a lubricant. -The enzyme serum amylase, a component of saliva, starts the process of digestion of complex carbohydrates. ACINI secrete contents into specialized ducts. -Each gland is divided into smaller segments called lobes. SALIVATION occurs in response to the taste, smell or even appearance of food.

anatomy and physiology

PAROTID GLANDS are large, irregular shaped glands located under the skin on the side of the face. They secrete 25% of saliva. SUBMANDIBULAR GLANDS secretes 70% of the saliva in the mouth. Each gland can be felt as a soft lump along the inferior border of the mandible. SUBLINGUAL GLANDS covered by a thin layer of tissue at the floor of the mouth. It produces approximately 5% of the saliva and their secretions are very sticky due to the large concentration of Mucin. The main functions are to provide buffer and lubrication.

anatomy and physiology

PHARYNX

- throat - which connects the mouth with the esophagus, consists of three parts: -the nasopharynx -oropharynx and -laryngopharynx. The posterior walls of the oropharynx and laryngopharynx are formed by the superior, middle and inferior pharyngeal constrictor muscles.

anatomy and physiology

ESOPHAGUS

- It is a muscular tube approximately 25 cm in length and 2 cm in diameter line with moist stratified squamous epithelium that extends from the pharynx to the stomach and lies anterior to the vertebrae and posterior to the trachea within the mediastinum. - It passes through the diaphragm and ends at the stomach. - The esophagus transports food from the pharynx and to the stomach.

anatomy and physiology

ESOPHAGEAL SPHINCTERS-located at the upper and lower ends of

the esophagus, -regulate the movement of food in and out of the esophagus.
CARDIAC SPHINCTER-

-lower esophageal sphincter.

anatomy and physiology

STOMACH

-J shaped expanded bag, located just left of the midline between the esophagus and small intestine. It is divided into four main regions and has two borders called the greater and lesser curvatures. -The first section is the cardiac opening which surrounds the cardiac orifice where the esophagus enters the stomach.

anatomy and physiology

The fundus is the superior dilated portion of the stomach is contracted into numerous longitudinal folds called rugae. The largest part of the stomach is the BODY which turns to the right forming a greater curvature on the left, and a lesser curvature on the right. The PYLORUS is the curved base of the stomach. Gastric contents are expelled into the proximal duodenum via the pyloric sphincter.

anatomy and physiology

 Functions of the Stomach: The short term storage of ingested food Mechanical breakdown of food by chewing and mixing motions. Chemical digestion of proteins by acids and enzymes. Stomach acid kills bugs and germs Some absorption of substances such as alcohol. -Most of these functions are achieved by the secretion of stomach juices by gastric gland in the body and fundus.

anatomy and physiology

SMALL INTESTINE - About 6 m in length extending from the pyloric sphincter of the stomach to the ileocaecal valve separating the ileum from the cecum. It performs the majority of digestion and absorption of nutrients. Partly digested food from the stomach is further broken down by enzymes from the pancreas and bile salts from the liver and gall bladder.

anatomy and physiology

DUODENUM C shaped section that curves around the head of the pancreas. Serve as a mixing function. JEJUNUM a sharp bend, the duodenojejunal flexure. Majority of digestion and absorption occurs. ILEUM longest segment and final portion. Empties into the cecum at the ileocaecal junction.

anatomy and physiology

TWO LARGE ACCESSORY GLANDS:

LIVER- weighs about 1.36 kilograms and is located in the right upper quadrant of the abdomen, tucked against the inferior surface of the diaphragm. The liver performs important digestive and excretory functions, stores and processes nutrients, synthesizes new molecules and detoxifies harmful chemicals. secretes about 700 ml of bile each day.

anatomy and physiology

Bile contains no digestive enzymes, but it plays an important role in digestion by diluting and neutralizing stomach acid and by dramatically increasing the efficiency of fat digestion and absorption. Bile Salts emulsify fats, breaking the fat globules into smaller droplets, much like the action of detergents in dishwater. Bilirubin is a bile pigment that results from the breakdown of hemoglobin.

anatomy and physiology

The gall bladder is a pouch-shaped organ which lies near the liver. -It accepts bile from the liver, and stores it. When food is digested, the gallbladder releases bile into the small intestine where it is able to help dissolve fats.

anatomy and physiology

PANCREAS- located retroperitoneal, posterior to the stomach in the inferior part of the left upper quadrant. The exocrine secretions of the pancreas include HCO3- , which neutralize the acidic chime that enters the small intestine from the stomach. -Pancreatic enzymes are also present in the exocrine secretions and are important for the digestion of all major classes of food. Without the enzymes produced by the pancreas, lipids, proteins and carbohydrates are not adequately digested.

anatomy and physiology

LARGE INTESTINE Horse shoe shaped. Consists of: Cecum- expanded pouch that receives material from the ileum and starts to compress food products into fecal material. Colon- is about 1.5-1.8 m long and consists of four parts: ascending colon (extends superiorly from the cecum to the right colic flexure, near the liver, where it turns to the left; transverse colon (extends from the right colic flexure to the left colic flexure near the spleen, where the colon turns inferiorly;

anatomy and physiology

descending colon (extends from the left colic flexure to the pelvis where it becomes sigmoid colon; sigmoid colon (forms an S-shaped tube that extends medially and then inferiorly into the pelvic cavity and ends at the rectum. Rectum- expands to hold fecal matter before it passes through the anorectal canal to the anus. The sphincter controls the passage of the feces. Goblet cells line the glands that secrete mucous to lubricate fecal matter as it solidifies.

anatomy and physiology

Anal Canal 2-3 cm of the digestive tract. -begins at the inferior end of the rectum and ends at the anus. -The smooth muscle layer of the anal canal is even thicker than that of the rectum and forms the internal anal sphincter at the superior end of the anal canal. -The external anal sphincter at the inferior end of the anal canal is formed by skeletal muscle.

PATHOPHYSIOLOGY

PATHOPHYSIOLOGY
Gastroesophageal reflux disease (GERD) or acid reflux disease - is chronic symptoms or mucosal damage caused by stomach acid coming up from the stomach into the esophagus. A typical symptom is heartburn.
After swallowing,foods passes into the ESOPHAGUS a 25 cm long tube

Down into the STOMACH where DIGESTION HAPPENS

PATHOPHYSIOLOGY
GASTRIC ACIDS confined into the STOMACH through VALVE MECHANISM

Involves two muscles

Lower esophageal sphincter (LES)

Diaphrag m-Hiatus

PATHOPHYSIOLOGY
if FUNCTION IMPROPERLY causes GASTRIC ACID

Irritating the Lining of Esophagus causing HEARTBURN

Gastroesophageal reflux disease (GERD)

DIAGNOSTIC AND LABORATORY TEST

ENDOSCOPY
The upper endoscopy (also known as esophagogastroduodenoscopy or EGD)

- allows the doctor to examine the inside of the patient's esophagus, stomach, and duodenum with an instrument called an endoscope, a thin flexible lighted tube. - Allows visualization of the walls and tissue of the upper digestive tract.

ENDOSCOPY
- will be able to detect disorders such as strictures (narrowed areas), hiatal hernias, ulcers and tumors. If necessary, biopsies can be collected. Endoscopy is often used in patients who have had heartburn for many years to determine whether a condition called Barretts esophagus has developed

ENDOSCOPY
What can be expected if the doctor orders an EGD?

The patient is not to eat anything for at least six hours before the procedure. A local anesthetic will be sprayed into the patient's throat to suppress the gag reflex, and an intravenous sedative will help the patient relax.

ENDOSCOPY
The endoscope is then slowly passed into the patient's mouth and down the esophagus. The gag reflex and the urge to vomit usually pass once the tube is in the esophagus. The tube will not interfere with breathing.

ENDOSCOPY
Once the endoscope is in place, - the doctor will be able to examine the esophagus and stomach through a tiny camera, and detect any abnormalities. - Other instruments can be inserted through the endoscope tube, which will allow the doctor to perform biopsies if such conditions as cancer or infections are evident.

ENDOSCOPY
The patient may experience a sore throat for a few days after the procedure If complications (such as vomiting a large amount of blood or severe stomach pains) occur, the doctor should be notified immediately.

MEDICATIONS

MEDICATIONS
GENERIC NAME: esomeprazole-prescribed by Dr. Dabu BRAND NAME: Nexium DRUG CLASS AND MECHANISM: Esomeprazole is in a class of drugs called proton pump inhibitors (PPIs) which block the production of acid by the stomach. Other drugs in the same class include omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex) and pantoprazole (Protonix). Chemically, esomeprazole is very similar to omeprazole

MEDICATIONS
Proton pump inhibitors are used for the treatment of conditions such as stomach and duodenal ulcers, gastroesophageal reflux disease (GERD) and the Zollinger-Ellison syndrome which all are caused by stomach acid. Esomeprazole, like other proton-pump inhibitors, blocks the enzyme in the wall of the stomach that produces acid. By blocking the enzyme, the production of acid is decreased, and this allows the stomach and esophagus to heal. Esomeprazole was approved by the FDA in February 2001.

MEDICATIONS
GENERIC: No PRESCRIPTION: Yes PREPARATIONS: Capsules: 20 and 40 mg. Intravenous: 20 and 40 mg; Powder for Oral Suspension: 10 mg, 20 mg, 40 mg STORAGE: Store at room temperature, 15-30 C (5986 F) in a tightly closed container.

MEDICATIONS
PRESCRIBED FOR: Esomeprazole is approved for the treatment of gastroesophageal reflux disease (GERD) and in combination with amoxicillin and clarithromycin (Biaxin) for the treatment of patients with ulcers and H. pylori infection. It also is used for reducing the risk of gastric ulcers associated with NSAIDs and the treatment of ZollingerEllison syndrome. Esomeprazole also is approved for short term use in children ages 1-11 for GERD.

MEDICATIONS
DOSING: For GERD, 20 or 40 mg of esomeprazole is given once daily for 4-8 weeks. In children ages 1-11, the dose is 10 or 20 mg daily. For the treatment of H. pylori, 40 mg is administered once daily in combination with amoxicillin and clarithromycin for 10 days. The dose for preventing NSAID-induced ulcers is 20 to 40 mg daily for 6 months. Zollinger-Ellison syndrome is treated with 40 mg twice daily.

MEDICATIONS
Esomeprazole capsules should be administered one hour before meals, swallowed whole and should not be crushed or chewed. Patients with difficulty swallowing can open the capsule and mix the pellets with applesauce. The applesauce should not be hot and the pellets should not be chewed or crushed.

MEDICATIONS
DRUG INTERACTIONS:

Esomeprazole potentially can increase the concentration in blood of diazepam (Valium, Diastat) by decreasing the elimination of diazepam in the liver. Esomeprazole may have fewer drug interactions than omeprazole.

MEDICATIONS
The absorption of certain drugs may be affected by stomach acidity -esomeprazole and other PPIs that reduce stomach acid also reduce the absorption and concentration in blood of ketoconazole (Nizoral) and increase the absorption and concentration in blood of digoxin (Lanoxin). This may lead to reduced effectiveness of ketoconazole or increased digoxin toxicity, respectively.

MEDICATIONS
Brand Name-prescribed by Dr.Pio Pariet Common Name: rabeprazole DIN (Drug Identification Number) DIN
02243796 PARIET 10MG TABLET 02243797 PARIET 20MG TABLET

MEDICATIONS
Rabeprazole belongs to the class of medications known as proton pump inhibitors (PPIs). It works by slowing or preventing the production of acid in the stomach. Rabeprazole is used to treat and maintain healing of gastroesophageal reflux disease (GERD). It is also used to treat symptoms, such as heartburn and regurgitation, of non-erosive reflux disease (NERD).

MEDICATIONS
It is also used for short-term treatment in the healing and relief of symptoms associated with duodenal and gastric ulcers. Rabeprazole is used in combination with antibiotics to treat ulcers caused by the bacterium Helicobacter pylori. rabeprazole is used for long-term treatment of conditions associated with constant production of excess acid in the stomach,.

MEDICATIONS
To treat gastroesophageal reflux disease (GERD), the recommended adult dose of rabeprazole is 20 mg, taken once daily. The recommended adult dose for maintaining longterm healing of GERD is 10 mg to 20 mg, taken once daily. The usual length of treatment for GERD is 4 to 8 weeks.

MEDICATIONS
Rabeprazole delayed release tablet has been designed to work throughout the day, and therefore needs to be taken only once daily. This medication may be taken with or without food. Swallow the tablets whole with a beverage. Do not chew, crush, or split the tablets. Most people will experience some improvements in symptoms 1 to 2 weeks after starting rabeprazole. It may take up to 4 weeks for people to experience maximum benefit from this medication

HEALTH TEACHING

HEALTH TEACHING
Don't eat within 3 hours of bedtime. This allows your stomach to empty and acid production to decrease. If you don't eat, your body isn't making acid to digest the food. Don't lie down right after eating at any time of day. Elevate the head of your bed 6 inches with blocks. Gravity helps prevent reflux.

HEALTH TEACHING
Don't eat large meals. Eating a lot of food at one time increases the amount of acid needed to digest it. Eat smaller, more frequent meals throughout the day. Avoid fatty or greasy foods, chocolate, caffeine, mints or mint-flavored foods, spicy foods, citrus, and tomato-based foods. These foods decrease the competence of the LES.

HEALTH TEACHING
Avoid drinking alcohol. Alcohol increases the likelihood that acid from your stomach will back up. Stop smoking. Smoking weakens the lower esophageal sphincter and increases reflux. Lose excess weight. Overweight and obese people are much more likely to have reflux than people of healthy weight.

HEALTH TEACHING
Stand upright or sit up straight, maintain good posture. This helps food and acid pass through the stomach instead of backing up into the esophagus. Avoid wearing tight-fitting clothes to reduce pressure in the stomach.

NURSING CARE PLAN

Imbalanced Nutrition: Less than Body Requirements related to altered ability to ingest and difficulty swallowing as evidenced by weight loss,altered taste sensation

assessment
SUBJECTIVE: Minsan nag aalsom na panlasa ko tapos nasasakitan na ako maghalun karne kaya lugaw nalang kinakakan koas verbalized by the patient. OBJECTIVE: -weightloss Current weight: 136 lbs Previous weight:140 lbs 3 weeks ago -fatigue during swallowing

nursing diagnosis

Imbalanced Nutrition: Less than Body Requirements related to altered ability to ingest and difficulty swallowing as evidenced by weight loss,altered taste sensation

planning
After 8hours of nsg. Interventions the client will display : weight gain toward desired goal be free of signs of malnutrition and display improved energy level.

inteventions
Assess ability to chew, taste, and swallow.  other taste changes may limit clients ability to ingest food and reducing desire to eat Encourage small, frequent meals and snacks of nutritionally dense foods and nonacidic foods and beverages, with choice of foods palatable to client.  Fulfilling cravings for desired food may also improve intake

inteventions
Advised client to chew food slowly and thoroughly.  to avoid aspiration and lessen difficulty swallowing Provide frequent mouth care, observing secretion precautions. Avoid alcoholcontaining mouthwashes.  to prevent mouthsores and irritation in the mouth. Monitor clients weight daily.  to evaluate nutritional changes

evaluation
GOAL NOT MET The client still preferred lugaw because it is easy to eat and swallow . The client have loss weight -4lbs.

NURSING CARE PLAN

Acute pain related to esophageal reflux and esophageal inflammation

assessment
SUBJECTIVE: pagnagkakakan ako, nagkukulog ang lalamunan ko Lalo na pagmaaalsom tska mahaharang, naghaharaldat pati ang sakuyang daghan as verbalized by the patient Pain scale: 7/10 OBJECTIVE: Grimaced facial expression

NURSING DIAGNOSIS
Acute pain related to esophageal reflux and esophageal inflammation

planning
After 12hrs the patient will: verbalize a decreased in pain scale from 7/10 to 5/10. able to chew and swallow foods without pain

interventions
Assessed the onset and progression of the symptoms  To prevent further complication Encouraged small frequent meals  Smaller meals are digested putting less pressure on the stomach muscles.
Advised to position self in an upright for 30 to 45 minutes after meal

 To prevent aspiration

interventions
Encouraged toavoid irritating foods such as beverages, sodas, teas and coffees that contain caffeine,chocolate, citrus fruits and other acidic foods, fried and fatty foods, tomato sauce and juice, onion, garlic, mint flavoring and spices.

 Different foods can trigger heartburn

Encouraged to chew and swallow foods slowly.

interventions
Advised to avoid bending coughing,vigorous exercises, and wearing tight clothing\

Prevents intra-abdominal pressure

evaluation
GOAL PARTIALLY MET Pain scale= 5/10 -still with pain while chewing and swallowing foods.

NURSING CARE PLAN

Anxiety r/t physiologic factor: such as GERD

assessment
SUBJECTIVE: Client states that natatakot na ako magkakan solo ta 3 beses na ako nabulunan Objective: poor eye contact -increased facial tension -increased perspiration

  

NURSING DIAGNOSIS
Anxiety r/t physiologic factor: such as GERD

PLANNING
After 8 hours of nursing intervention the client will be able to: a. appear relaxed b. report anxiety is reduced to a manageable level. c. verbalize awareness of feeling of anxiety.

INTERVENTIONS
Monitor vital sign  to identify physical responses associated with both medical and emotional conditions. Determine current medications or recent OTC meds.  determine if the meds can heighten feelings or sense of anxiety observe behaviors

be able to point the client's level of anxiety

INTERVENTIONS

Establish a therapeutic relationship conveying empathy and unconditional positive regard be available to ct,. For listening or talking provide feelings of sympathy and support to the pt. And facilitate strong source of physical and emotional contact

INTERVENTIONS
explore coping strategies with patient. (e.g breathing, relaxation etc.) Allows incorporating existing disabilities with clients desires& ability to adapt & organize care activities.

EVALUATION
GOAL MET Patient was able to feel relaxed, verbalize awareness and feelings of anxiety is reduced to a manageable level

NURSING CARE PLAN

Deficient knowledge about the disorder (GERD) related to incomplete presentation of information

ASSESSMENT
SUBJECTIVE:  Ano man ang GERD, sain yan nakukua? as verbalized by the patient.  Tanu ta pagnagkakakan akong maalsom tapos maharang nagkukulog ang alanuhan ko? as verbalized by the patient.

NURSING DIAGNOSIS
Deficient knowledge about the disorder (GERD) related to incomplete presentation of information

PLANNING After 2 hours of nursing intervention, the patient will be able to increase knowledge level about the disorder as evidenced by: verbalizing understanding of the condition initiating necessary changes in food preferences and participate in treatment regimen

INTERVENTIONS
Provided a quiet environment conducive to learning  A quiet environment will facilitate the learning of the patient Discussed the disorder; its cause, manifestations, diagnostic test and management  This will help patient to have a clear understanding of her condition, the importance of treatment and increases her knowledge level

INTERVENTIONS
Enumerated the foods that can aggravate the pain and those that are necessary to eat  This will help patent to choose the right foods she may eat and avoid those that can cause pain Used short, simple terms that are understandable to patient  For easy understanding and for patient to catch up the explanation easily

INTERVENTIONS
Asked patient to summarize what she had learn To make sure that the patient understand the discussion and gain knowledge about her disorder

EVALUATION
Goal met Patient was able to state all the information about GERD Patient was able to enumerate the proper foods that she should eat and not to be eat