Gastroesophageal Reflux Disease
CASE STUDY AND CARE PLAN OVERVIEW/DESCRIPTION
Throughout this course, you will be provided case studies that focus on cardiovascular, pulmonary, gastrointestinal, and musculoskeletal disorders. You will pick one of the provided case studies to analyze and create a comprehensive care plan for acute/chronic care, disease prevention and health promotion for that patient and disorder. Your care plan should be based on current best practices and supported with citations from current literature, such as systematic reviews, published practice guidelines, standards of care from specialty organizations and other research based resources. In addition, you will provide a detailed scientific rationale that justifies the inclusion of this evidence in your plan. Your paper should adhere to APA format for title page, headings, citations, and references. The paper should be no more than 8 pages typed excluding title page and references.
Case Study Evaluation Criteria:
- Analyzes the disorder addressing the following elements: pathophysiology, signs/symptoms, progression trajectory, diagnostic testing, and treatment options.
- Differentiates the disorder from normal development.
- Discusses the physical and psychological demands the disorder places on the patient and family.
- Explains the key concepts that must be shared with the patient and family to achieve optimal disorder management and outcomes.
- Identifies key interdisciplinary team personnel needed and how this team will provide care to achieve optimal disorder management and outcomes.
- Interprets facilitators and barriers to optimal disorder management and outcomes.
- Describes strategies to overcome the identified barriers.
Care Plan Synthesis Criteria:
- Designs a comprehensive and holistic recognition and planning for the disorder.
- Addresses how the patient’s socio-cultural background can potentially impact optimal management and outcomes.
- Demonstrates an evidence-based approach to address key issues identified in the case study.
- Formulates a comprehensive but tailored approach to disorder management.
Gastroesophageal Reflux Disease
CASE STUDY EVALUATION
Gastroesophageal reflux disease (GERD) is the uncontrolled movement of the abdominal contents to the esophagus (Richter, 2014). It results from the failure of the lower esophageal sphincter to close appropriately. The stomach contents contain acid that inflames the lining of the lower esophagus resulting into heartburn symptoms. GERD is a common disease that affects about thirty percent of the world’s population making it an important condition for analysis. This paper gives an evaluation of GERD and a care plan synthesis for the management of the disease.
The recognition of the factors that contribute to the occurrence of GERD has led to the evolution and the comprehension of the pathophysiology of the disease. GERD is not only a motor disorder, but also a sensory-motor disorder. Its core pathophysiological process involves the movement of gastric acid, pepsin, and other harmful intestinal contents from the stomach to the esophagus (Vela, Richter & Pandolfino, 2013). However, the intestinal movement occurs during normal physiology, but GERD results when its symptoms arise or tissue becomes damaged. The failure of the mucosal defensive factors to protect the esophagus from mucosal injury and the decreased ability of the esophagus to effectively clear the stomach acid results makes GERD to cause esophagus mucosal injury.
Patients and caregivers need to be aware of the symptoms of GERD, which include having a heartburn, chronic cough, shortness in breath, constant sore throat, recurrent laryngitis, globus sensation that is characterized by a feeling of chest tightness, and chest pain (Sugerman, 2014). In some instances, patients could be having a serious and complicated GERD. In such situations, the symptoms include dysphagia, rapid weight loss, odynophagia, gastrointestinal bleeding, nausea that leads to vomiting, and early satiety (Sugerman, 2014).
The prevalence of the symptoms of GERD increased significantly by fifty percent in the 1990s and plateaued from that time. However, since then the complications arising from the incidence of GERD increased significantly, but the complications have reduced lately. The complications include esophageal strictures and adenocarcinoma. Worldwide, the prevalence of GERD has been rising with heartburn symptoms being utilized for the identification of the disease. The cause of the increase in GERD prevalence has not been clearly identified, but it could be attributed to the increase in obesity levels and other dietary concerns (Khan, 2016).
GERD’s diagnosis entails the combination of symptom presentation, antisecretory therapy, ambulatory reflux monitoring and objective testing with endoscopy (Cornett, 2016). The most reliable symptoms for GERD identification are heartburn occurrence and regurgitation. These symptoms are most of the times sufficient for the formation of a presumptive diagnosis that centers on the patient’s history. In addition, the presence of chest pain that is not related to cardiac conditions could also be used for the diagnosis of GERD. Chest pain makes a response to the suppression of aggressive acid, which could lead to the determination of the level of GERD to patients that experience chest pain that has not been caused by cardiac related conditions.
Various diagnostic tests could be undertaken to determine the presence of GERD in patients. One of the tests includes the Proton Pump Inhibitor (PPI) test; a positive trial indicates the occurrence of GERD, but a negative trial does not automatically rule out its occurrence (Gawron, Balbale, Miskevics & LaVela, 2015). The other test involves the ambulatory reflux monitoring that shows the correlation of symptoms with reflux. It documents and gives an indication of the exposure of the patients to abnormal acid levels and gives their reflux frequency.
GERD is treatable and various options are available for its management. However, the first cause of action for its relief it a lifestyle change for individuals that suffer from the disease. The change could include the maintenance of a healthy weight through the establishment of a workout routine and the dietary control. In addition, the patients are advised to reduce their alcohol intake levels, quit smoking, and reduce the possible foods that could aggravate the occurrence of GERD. Once this is done the treatment of the disease should proceed gradually until the patient becomes better and treated. Doctors could prescribe medication to the patients, which is the most common treatment option. In addition, other patients might have to undergo surgery in chronic GERD conditions (Hom & Vaezi, 2013). This lowers the levels of medicine required by the GERD’s patients, but it the risk levels involved are higher (Jiang, 2015). Endoscopic treatment is the other option for the treatment of GERD, but it has not been extensively studied and less has been revealed on how it operates and the safety levels.
Distinction of GERD from normal development
Many individuals cannot differentiate between GERD and normal physiological development. The latter relates to Gastroesophageal reflux that involves the normal spillage of the stomach contents into the esophagus. On the other hand, GERD relates to the harmful symptoms or complications that result from Gastroesophageal reflux (Yellon & Goyal, 2013). The symptoms of GERD and normal development relate to the extent of the effect of acid regurgitation to the patient. Moreover, GERD is a chronic condition, in that the patients suffer for a prolonged period, while in normal development the symptoms last of Gastroesophageal reflux last for approximately three minutes or less for healthy individuals. Additionally, Gastroesophageal reflux could be a daily normal occurrence for most robust individuals, but GERD occurs occasionally with injurious symptoms that complicate ones health.
Physical and psychological demands placed by GERD on the patient and family
To begin with, GERD demands various physical changes of the patient, in order to effectively manage the disease. For instance, patient have to lose weight, in order to have a manageable weight that hastens the healing process. In addition, patients have to avoid lying down after taking their meals. This helps in the avoidance of more GERD to occur and cause more injury. Thus, they have to sit in an upright position and avoid eating meals just before bedtime. Moreover, patients have to lie in a certain position in their sleep, especially position that encourage the elevation of the head; through the use of pillows or physically elevating the head of the bed using stands (Johnson, 2017). For the families of the GERD patients, they have to encourage their loved ones suffering from the disease through joining their exercising programs and dietary programs. This increases their level of involvement in the lives of the patients, which hastens the healing process.
On the other hand, GERD places psychological demands on both the patients and the members of their families. The patients usually are required to manage their stress levels to avoid emotional pressures that aggravate the disease. Moreover, the patients need to avoid impulsiveness and fear that have an adverse effect on the healing process of GERD (Sugerman, 2014). The family members of patients suffering from the disease have to express their positive emotions on the patients and make them feel comfortable and loved. This aids the patients in the avoidance of social withdrawal, insomnia, and depression that do not favor the healing process. However, the family members could also depict some stress levels, which could require them to join therapy programs that aid families with patients suffering from GERD.
Key concepts shared with the patient and family
Caregivers usually share certain key concepts with the patients and their family to optimally manage GERD. The caregivers advocate for a balanced nutrition to encourage the intake of the necessary nutrients that help in the healing process. Moreover, the patients are advised to slowly chew their food to encourage the metabolism of the necessary nutrients. In addition, the caregivers require the patient and their family to have in store painkillers most of the time during the healing process for the management of acute pain (Richter, 2014). The family is encouraged to be aware of any other conditions that the patient might be suffering from and ensure that they are managed appropriately. For instance, if the GERD patient suffers from dysphagia they are required to seek the advise of their physician for the optimal management of GERD. The caregivers are required to share and provide the patients with ample information relating to proper health practices including the effective utility of medication to manage the disease.
Key Interdisciplinary team personnel needed for optimal management of GERD
The interdisciplinary team personnel include the family physician that is involved directly in health care needs. They are the first contact for GERD patients, as they provide the basic primary care including the administration of family medicine (Yellon & Goyal, 2013). The outcome includes a greater satisfaction for the patients in addition to better compliance of the basic procedures of GERD management.
In addition, the gastroenterologist is critically involved in the management of GERD. They are gastrointestinal tract specialists with scientific knowledge of the treatment of GERD (Al Sha’alan, Ferwana & Ur Rahman, 2013). The integration of specialists’ medical training, expertise, and experience aids them in the provision of optimal health care for the GERD patients.
The other specialist is the community pharmacist. They are responsible for the provision of medicine, especially for patients with a prescription. The community pharmacist aids the GERD patients in the purchase of the right medicine from a wide range of available medication for the optimal management of the disease.
IDENTIFY IN DETAIL
Facilitators and Barriers
One of the facilitators of optimal GERD management relates to the patient’s openness. This involves the relay of information regarding behavior modification in relation to the physical response to the treatment process. Moreover, the patients need to involve the interdisciplinary team personnel in their medical management; thus the need to be open on the issue for effective disorder management. Additionally, the other facilitator involves the physician’s level of skills and competencies (Richter, 2014). Their ability to communicate effectively to the patients regarding the procedures involved in the administration of GERD creates patients confidence in the practitioners; thus, meeting the patient’s expectations regarding optimal disorder management.
One of the barriers includes the inability to pay for GERD treatment. For instance, the conduction of PPI is costly and it becomes a barrier to treatment when patients are unable to pay for it. Moreover, the lack of effective care processes due to increased workflow of the GERD caregivers is another barrier for the optimal management of the disorder.
Strategies to overcome barriers
The patients need to have a comprehensive medical cover to cater for the cost of GERD treatment. This is beneficial, especially in emergency and critical conditions that require intensive medical attention (Yellon & Goyal, 2013). The other strategy in regards to workflow, caregivers need to work I shifts to avoid exhaustion, in order to engage actively in behavioral modification of the GERD patient in addition to the provision of support for medication adherence.
CARE PLAN SYNTHESIS CRITERIA
Planning for the disorder
Patients have to understand their disorder. They need to know its symptoms, treatment and the effect of GERD on their bodies. In addition, they have to determine their bodily response to specific treatments with the aid of their family physician. Moreover, they need to engage a nutritionist to aid devise a dietary plan for the management of the condition (Cornett, 2016). The community pharmacist needs to engage the patient and facilitate them with proper medication, including the administration of painkillers, as GERD could be painful. Furthermore, the patients need to engage a physical trainer and devise a workout plan to aid weight management. The patient’s family must give them physical and psychological support throughout GERD’s treatment process.
Patient’s socio-cultural background
The patient’s socio-cultural background influences GERD’s optimum management. One of the issues could involve the lack of trust for patients that have had a bad experience with specific physicians (Richter, 2014). In addition, language barrier between the patient and the physicians could hinder the patient’s level of openness. Furthermore, language barrier could hinder timely diagnosis, especially if medication is prescribed in a language not understood by the patient. In other cultures, individuals believe in self-treatment and certain religious beliefs regarding the treatment of GERD. Others cite embarrassment in seeking the attention of the doctor and prefer treating themselves. For the fear of illness and fatalism, some individuals suffering from GERD seek religious intervention, which hinders them from receiving immediate medical attention.
GERD is prevalent in the entire world. However, it is more prevalent in the United States, where a third of the population suffers from the disorder due to the high levels of obesity. The most common symptoms of GERD include heartburn and regurgitation. The conduction of PPI as a diagnostic test could aid in the identification of GERD and lead to the determination of its treatment (Patti, 2016). Lifestyle modifications, medication, surgery, and endoscopic procedures are some of the available treatment options for GERD. Once the diagnosis of the disorder has been founded, it is critical for a multidisciplinary team to handle the results with the determination of offering goal oriented and individualized treatment.
Comprehensive and tailored approach
Lifestyle modifications have been emphasized as being critical for the management of the disorder. In addition to weight management, patients have to avoid certain dietary sources such as fatty foods, acidic juices, carbonated beverages, coffee and other foods that aggravate the disorder. Moreover, patients could use antacids for symptom relief (Richter, 2014). They are readily available over the counter medication that could be prescribed by the community pharmacist. Furthermore, alternative medicine is available for GERD management including the conduction of progressive muscle relaxation techniques that suppress levels of acidity (Cornett, 2016). Lastly, promotility agents could be administered to GERD patients to aid in peristalsis, enhancement of esophageal clearance, and neutralization of acidity.
Al Sha’alan, K., Ferwana, M., & Ur Rahman, S. (2013). Knowledge and Practice of Primary Care Physicians in Management of Gastroesophageal Reflux Disease \\ World Family Medicine Journal. Victoria: Medi+World International.
Cornett, L. (2016). Gastroesophageal Reflux Disease (GERD). Hauppauge: Nova Science Publishers, Inc.
Gawron, A., Balbale, S., Miskevics, S., & LaVela, S. (2015). Tu1096 Perceptions of Patient-Centered Care Among Veterans With Gastroesophageal Reflux Disease on Proton Pump Inhibitor Therapy. Gastroenterology, 148(4), S-787. http://dx.doi.org/10.1016/s0016-5085(15)32685-8
Hom, C., & Vaezi, M. (2013). Extra-Esophageal Manifestations of Gastroesophageal Reflux Disease: Diagnosis and Treatment. Drugs, 73(12), 1281-1295. http://dx.doi.org/10.1007/s40265-013-0101-8
Jiang, Y. (2015). Antireflux surgery vs. medical treatment for gastroesophageal reflux disease: A meta-analysis. World Journal Of Meta-Analysis, 3(6), 284. http://dx.doi.org/10.13105/wjma.v3.i6.284
Johnson, D. (2017). Gastroesophageal Reflux Disease Related Sleep Dysfunction and Driving (Simulator) Impairment: Response to Treatment with Esomeprazole. Gastroenterology & Hepatology: Open Access, 6(1). http://dx.doi.org/10.15406/ghoa.2017.06.00180
Khan, A. (2016). Impact of obesity treatment on gastroesophageal reflux disease. World Journal Of Gastroenterology, 22(4), 1627. http://dx.doi.org/10.3748/wjg.v22.i4.1627
Patti, M. (2016). An Evidence-Based Approach to the Treatment of Gastroesophageal Reflux Disease. JAMA Surgery, 151(1), 73. http://dx.doi.org/10.1001/jamasurg.2015.4233