Woman With GERD
Case Study: Woman With GERD
Reflux esophagitis is a medical condition characterized by the reflux of gastric contents into the esophagus. Pain and irritation to patients occur due to an injury occurring at the esophageal mucosa usually with a patchy distribution (American Academy of Allergy Asthma, & Immunology, 2020). In clinical terms, the condition is known as gastroesophageal reflux disease (GERD). According to the American College of Gastroenterology, GERD may be perceived as chronic damage to the mucosal caused by a reflux of gastric contents back to the esophagus which occurs abnormally. Esophageal stricture observed through the endoscope is a constriction or narrowing of the esophagus which results from scarring caused by acid irritation.
The effects of GERD may be the reason why a patient may experience heartburns, burping, and or acid taste in the mouth. The disease may also be indicated by acid regurgitation, excessive saliva, pain or difficulty during swallowing, cavities, gum inflammation, bad breath, hoarseness or laryngitis, and pain in the chest (Kristo et al., 2018).
Factors and behavior that increase Ms. Rinaldi’s reflux risk
The brief history of Ms. Rinaldi reveals several factors and behaviors that make her more likely to experience the abnormality. First, she takes large meals, which could excessively distend the stomach. An overly distended stomach may exert pressure on the esophageal sphincter at the lower end and cause the reflux of acidic contents hence the irritation (Nutrition & Diet Therapy text, 10th Edition, 2020). Also, taking dinner at 8 p.m. is risky for her as it barely leaves enough time to allow adequate digestion in case she chooses to sleep at 9.00 or 10.00 pm.
Another factor is the consumption of the alcoholic drink. Since Ms. Rinaldi takes wine at dinner before taking another alcoholic drink, her body may increase the secretion of gastric acid and decrease pressure at the lower end of the esophageal sphincter leading to reflux and irritation. Additionally, Ms. Rinaldi still smokes cigarettes despite the advice from her physician during the last visit. Smoking contributes to the relaxation of the lower esophageal sphincter, allowing the acidic contents of the stomach to return to the esophagus (Nutrition & Diet Therapy text, 10th Edition, 2020). Also, Ms. Rinaldi might be consuming a lot of carbonated drinks such as soda and spicy foods such as crisps which worsen irritation since she relies on fast foods for lunch at the office.
Finally, excessive body weight could be playing part in worsening Ms. Rinaldi’s condition. Such body weight exerts a lot of pressure on the abdomen, increasing the risk of reflux. Although she was advised by the physician to initiate a loss of weight, she has not taken any step hence making the risk of reflux remain high.
Recommendation for behavior change
Acquire diet and nutrition education
Ms. Rinaldi is currently doing very little to ensure a healthy diet even though there are consequences, some of which she is currently experiencing. Part of the reason she does not care about nutrition could be a lack of knowledge about health and nutrition (Collebrusco, Lombardini, & Censi, 2017). Taking a short nutrition course could help her understand the importance of managing her diet. It could also help her learn what constitutes a healthy diet and what is not. This knowledge can enable her to make informed decisions about the choice of meals.
Take light meals during dinner
Eating heavily during dinner not only increases pressure on her stomach and abdomen but it also reduces the need to take breakfast. Each of the two situations contributes to her current condition. While increased pressure at the digestion tract increases the risk of reflux, the omission of breakfast places at the challenging situation during lunchtime at which she is forced to rely on fast foods (Collebrusco, Lombardini, & Censi, 2017). Light meals during dinner will reduce the chances of exerting too much pressure on the abdomen thereby avoiding or reducing the chances of reflux of the acidic content into the esophagus.
Develop hobbies and alternative means of entertainment
One of the most common reasons why people drink alcohol is to ease stress even if the relieves lasts for a short time. As such, Ms. Rinaldi could be suffering from stress. The good news is that she does to have to take alcohol or smoke cigarettes to stay entertained and relieve stress. Rather, she can develop hobbies such as watching programs on the TV, reading novels, or even socializing with new friends to keep her busy. She could also try exercising during the day so that she feels exhausted at night to easily fall asleep. Exercising will also help her lose weight as the physician suggested to help manage the condition (Collebrusco, Lombardini, & Censi, 2017).
Make an alternative arrangement for lunchtime meals
Most organizations and workplaces barely allow enough time to prepare meals during lunchtime. Workers such as Ms. Rinaldi are forced to rely on fast foods such as carbonated drinks and snacks. Since such foods are associated with dietary problems including worsening GERD conditions, Ms. Rinaldi should try to avoid relying on them (Collebrusco, Lombardini, & Censi, 2017). A good way to achieve this is by carrying her own meals to work or get someone to cook for her while at work. Well planned and carefully cooked food will help her to maintain healthy eating habits including balancing the diet.
Prescribed Medication
Gastroesophageal Reflux Disease causes a lot of discomfort due to pain and irritation at the digestive tract which could continuously worsen especially when one has asthma. Luckily, there are several intervention measures that are available to GERD patients. First, patients may take proton pump inhibitors. These drugs reduce the pain and irritation felt during reflux by limiting the amount of acid produced in the stomach. Another type of medication prescribed for GERD patients is antacids which counteract the acid in the stomach through their alkaline properties. Finally, GERD patients may take Antibiotics such as erythromycin which accelerates the process of emptying the stomach thereby reducing the risk of reflux (“Nursing Care Plan for Gastroesophageal Reflux Disease (GERD) | NRSNG”, 2020).
In addition to the medications, certain lifestyle and behavioral changes are necessary to control the condition. People at high risks of reflux should avoid smoking, maintain a healthy weight, wear loose clothes, elevate their heads during bedtime and maintain good nutrition and diet (Collebrusco, Lombardini, & Censi, 2017). One way to maintain a healthy diet is by avoiding fast foods including carbonated beverages, eat at least three hours before bedtime, and avoid foods such as chocolate, onions, caffeine, and fatty foods that trigger reflux. It is also advisable to drink plenty of water to dilute any acidic contents that may form in the stomach.
In brief, Joanne Rinaldi faces the GERD condition which results from irritation of the esophagus by acidic components returned from the stomach. The condition causes a lot of pain, chest pain, nausea, burning sensation, vomiting, wheezing, and coughing, and weight loss. Fortunately, there are both behavioral and medicinal interventions available for her. These include adopting healthy eating habits and diet while avoiding foods that could cause irritation. There are also antacids, antibiotics, and proton pump inhibitors available for the medicinal option.
References
American Academy of Allergy Asthma, & Immunology. (2020). Gastroesophageal Reflux Disease | AAAAI. Retrieved 18 July 2020, from https://www.aaaai.org/conditions-and-treatments/related-conditions/gastroesophageal-reflux-disease#:~:text=Gastroesophageal%20Reflux%20Disease%20(GERD)%20is,higher%20risk%20of%20developing%20GERD.
Collebrusco, L., Lombardini, R., & Censi, G. (2017). An Alternative Approach to the Gastroesophageal Reflux Disease: Manual Techniques and Nutrition. Open Journal of Therapy and Rehabilitation, 5(3), 98-106.
Kristo, I., Schwameis, K., Maschke, S., Kainz, A., Rieder, E., Paireder, M., … & Schoppmann, S. F. (2018). Phenotypes of Jackhammer esophagus in patients with typical symptoms of gastroesophageal reflux disease responsive to proton pump inhibitors. Scientific reports, 8(1), 1-7.
Nursing Care Plan for Gastroesophageal Reflux Disease (GERD) | NRSNG. (2020). Retrieved 18 July 2020, from https://nursing.com/lesson/nursing-care-plan-for-gastroesophageal-reflux-disease-gerd/
Nutrition & Diet Therapy text, 10th Edition, 2020.