Question

The Patient with an Esophageal Problem

The 53-year-old man comes to the clinic for an appointment stating that he is experiencing heartburn, chest pain, and frequent belching. He describes the pain as a substernal burning sensation that tends to move up and down the chest in a wavelike fashion. He reports that the symptoms are impacting his ability to concentrate at work and to sleep through the night, even though he sleeps with his head elevated at least 6 inches.

What other questions should the nurse ask at this time? What are the possible causes of this substernal burning?

The patient is ordered to have 24-hour ambulatory pH monitoring. What patient teaching concerning to this test should the nurse provide?

The patient receives a diagnosis of GERD. What patient and family health promotion modifications to control reflux should the nurse include in the teaching?

Answer 1

What other questions should the nurse ask at this time?

Ask about the onset of heart burn or chest pain ( two hours after eating)

Ask for chronic cough( dry cough worse at night ), recurrent pneumonia, and regurgitation of food, bitter taste in the back of the throat, nausea, difficulty in swallowing( feels like a lump in the throat), voice changes( hoarseness). regular occurring of burning sensation in the chest or abdomen.

Ask for over eating, eating large meals and eating in lying down position,

What are the possible causes of this substernal burning?

Because of damaged or weak lower esophageal sphincter, the stomach contents are flows back up into the esophagus and leads to irritation of esophagus.

The patient is ordered to have 24-hour ambulatory pH monitoring. What patient teaching concerning to this test should the nurse provide?

1. Wear loose comfortable clothing.

2. Do not eat or drink six hours before catheter placement

3. No proton pump inhibitor for atleast 7 days and no H2 blockers for 48 hours.No antacids 24 hours before catheter placement.

4. No X-ray when the catheter in place.

5. Advice sponge bath only no shower or tub bath

The patient receives a diagnosis of GERD. What patient and family health promotion modifications to control reflux should the nurse include in the teaching?

1. Avoid acidic foods like citrus, tomatoes

2. Eat small frequent meals rather than a large meal.

3. Avoid eating right before bed( last meal should be 3 hours before bed)

4. Avoid fattyand fried foods , greasy foods

5. Avoid soft drinks , alcohol, and cofee

6. Avoid spicy food

7. Advise smoking sensation.

8. Maintain healthy weight

9. Avoid chocolates

10. Avoid garlic and onion.