{
  "name": "GERD",
  "slug": "gerd",
  "url": "https://nursingplex.com/care-plans/gerd",
  "category": "Gastrointestinal",
  "summary": "Reflux of gastric contents; positioning, meal timing, weight and acid-suppression teaching.",
  "nursing_diagnoses": [
    "Acute pain",
    "Risk for aspiration",
    "Imbalanced nutrition"
  ],
  "overview": [
    "Gastroesophageal reflux disease occurs when the lower esophageal sphincter relaxes inappropriately or is weakened, allowing acidic gastric contents to reflux into the esophagus. Persistent exposure causes esophagitis, stricture, Barrett's esophagus and, rarely, adenocarcinoma.",
    "Typical symptoms are heartburn 30–60 minutes after meals and worse when lying down or bending over, regurgitation and a sour taste. Atypical presentations include chronic cough, hoarseness, asthma exacerbation, dental erosion and non-cardiac chest pain that must be distinguished from angina.",
    "Nursing care emphasizes lifestyle and dietary modification, correct use of acid-suppressing medication, and monitoring for complications such as aspiration and bleeding."
  ],
  "key_facts": [
    {
      "label": "PPI timing",
      "text": "Proton pump inhibitors work best taken 30–60 minutes before the first meal of the day."
    },
    {
      "label": "Positioning",
      "text": "Elevate the head of the bed 6–8 inches with blocks; extra pillows bend the abdomen and can worsen reflux."
    },
    {
      "label": "Meal timing",
      "text": "Avoid eating within 3 hours of lying down and eat smaller, more frequent meals."
    },
    {
      "label": "Alarm symptoms",
      "text": "Dysphagia, odynophagia, weight loss, anemia or bleeding require endoscopic evaluation."
    }
  ],
  "nursing_priorities": [
    "Relieve heartburn and protect the esophageal mucosa.",
    "Distinguish reflux chest pain from cardiac causes.",
    "Prevent aspiration, especially at night.",
    "Support lifestyle and dietary changes.",
    "Monitor for complications and alarm features."
  ],
  "assessment": {
    "subjective": [
      "Reports of burning retrosternal pain after meals or when supine",
      "Reports of regurgitation, sour taste, belching or bloating",
      "Complaints of chronic cough, hoarseness or nighttime choking",
      "Reports of difficulty or painful swallowing",
      "Dietary, alcohol, smoking and weight history"
    ],
    "objective": [
      "Symptom pattern relative to meals and position",
      "Dental enamel erosion, hoarse voice, wheezing",
      "Weight trend and BMI",
      "Endoscopy or pH monitoring findings when available",
      "Anemia or occult blood suggesting erosive disease"
    ],
    "related_factors": [
      "Incompetent lower esophageal sphincter and hiatal hernia",
      "Obesity, pregnancy and increased intra-abdominal pressure",
      "Large fatty meals, caffeine, chocolate, peppermint, alcohol, citrus, tomato",
      "Smoking and certain medications: calcium channel blockers, nitrates, anticholinergics",
      "Delayed gastric emptying"
    ]
  },
  "goals": [
    "The client will report a reduction in heartburn episodes.",
    "The client will remain free from aspiration and respiratory symptoms.",
    "The client will describe and implement dietary and positional changes.",
    "The client will take acid-suppressing medication correctly."
  ],
  "interventions": [
    {
      "title": "Symptom relief",
      "points": [
        "Administer proton pump inhibitors 30–60 minutes before breakfast and H2 blockers or antacids as ordered.",
        "Teach that antacids are for breakthrough symptoms, not maintenance therapy.",
        "Evaluate chest pain carefully and rule out cardiac causes before attributing it to reflux.",
        "Document symptom frequency and triggers with the patient."
      ]
    },
    {
      "title": "Positioning and aspiration prevention",
      "points": [
        "Elevate the head of the bed 6–8 inches on blocks or use a wedge.",
        "Keep the patient upright for at least 2–3 hours after eating.",
        "Monitor for nocturnal cough, wheeze or hoarseness suggesting aspiration.",
        "Avoid tight belts and clothing that raise abdominal pressure."
      ]
    },
    {
      "title": "Lifestyle modification",
      "points": [
        "Advise small frequent meals and avoiding personal trigger foods.",
        "Support smoking cessation and alcohol reduction.",
        "Encourage weight loss when BMI is elevated — one of the most effective measures.",
        "Review medications that lower sphincter tone with the prescriber."
      ]
    }
  ],
  "patient_teaching": [
    "Keep a symptom and food diary to identify individual triggers.",
    "Take PPIs consistently before a meal rather than as needed.",
    "Report difficulty swallowing, vomiting blood, black stools or unexplained weight loss.",
    "Explain that untreated long-standing reflux can damage the esophagus, so follow-up matters."
  ]
}