Nursing Guide to Gastroesophageal Reflux (GERD): Nursing Diagnosis, Interventions, & Care Plans

Etiology and Epidemiology 

GERD Definition

Gastroesophageal reflux, or GERD, is a normal physiological occurrence which allows non- complicating amounts of gastric contents to backflow into the lower esophagus. When exacerbations of GERD occur, it leads to recurrence, troubling symptoms, or complications. 

Multiple factors may play a part in this condition such as: 

• Transient relaxation or low pressure of the lower esophageal sphincter muscle 
• Delay of normal emptying of stomach contents 
• Dysfunction of normal peristaltic action 
• Herniation of stomach through the esophageal hiatus or sliding hiatal hernia 
• Presence of an “acid pocket” at esophagogastric junction 
• Impaired flap valve at esophagogastric junction 
• Prolonged esophageal clearance 

There is a global prevenance of GERD in about 15% of the adolescent and adult populations with 0.6% to 12.6% in infants and children (DynaMed, n.d.). 

Risk factors for GERD include: 

• Familial history 
• Excessive weight 
• Pregnancy 
• Alcohol use 
• Disturbed esophageal motility 
• Dry mouth 
• Hiatal hernia 
• Excessive gastric acid production 
• Medication use 

The potential complications of GERD include (National Institute of Health, 2020): 

• Esophagitis 
• Esophageal stricture 
• Barret’s esophagus 
• Extra-esophageal conditions such as: 
  • Asthma 
  • Chronic coughing 
  • Voice hoarseness 
  • Laryngitis 
  • Tooth enamel damage 

GERD ICD-10 Code (Gastro-esophageal reflux disease without esophagitis): K21.9

GERD Diagnosis 

The diagnosis is through history and physical examination. Signs and symptoms or the chief complaints may include: 

• Heartburn post-prandial and at night 
• Chest discomfort 
• Dysphagia 
• Bloating 
• Belching and hiccups 
• Regurgitation into throat 
• Full feeling in throat 
• Recurrent cough 
• Laryngitis 
• Onset or worsening asthma 
• Nausea and vomiting 

Studies to support diagnosis: 

• Trials of proton pump inhibitor medications 
• Reflux disease questionnaire 
• Esophagogastroduodenoscopy 
• Monitoring of stomach pH 
• Exclusion of cardiac causes of chest pain 

Management & GERD Treatment

Most cases of GERD is managed with medications known as proton pump inhibitors (PPI). These drugs strongly curtail gastric acid secretion. They are available for PO or IV administration. Individuals taking PPIs must eat a meal within 30 minutes of taking to activate the drug. There are currently six PPI drugs available in the U.S. including: 

• Omeprazole (Prilosec®, Zegerid®) 
• Lansoprazole (Prevacid®) 
• Pantoprazole (Protonix®) 
• Rabeprazole (Aciphex®) 
• Esomeprazole (Nexium®) 
• Dexlansoprazole (Dexilant®) 

Histamine receptor antagonist (H2RA) medications may be considered for individuals without erosive conditions. Current H2RA medications include: 

• Cimetadine (Tagamet®) 
• Famotadine (Pepcid®) 
• Nizatidine (Axid®) 

Antacids may be used for short-term relief, such as: 

• Sodium bicarbonate (Alka-Seltzer®) 
• Calcium carbonate (Osteo MD®) 
• Magnesium hydroxide (Mylanta®) 
• Aluminum hydroxide (Amphojel®) 

Alginate medications may be used for individuals without erosive diseases complications. Prokinetic agents such as baclofen (Lioresal®)) are also available but should only be used after careful diagnostic evaluation. 

Surgical management for GERD is a long-term therapeutic treatment option. Surgical correction is not recommended for individuals with a poor response to PPI treatment. Bariatric surgery may be a consideration for individuals with obesity. 

GERD Nursing Care Plan

Nursing Considerations 

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for gastroesophageal reflux disease are listed below. 

Assessment 

Assess subjective findings: 

• Nocturnal regurgitation 
• Coughing or choking 
• Dysphagia 
• Epigastric pain 
• Food intolerances 
• Changes in taste 
• Sore throat 
• Weight loss 
• Tooth discoloring 
• Nausea and vomiting 
• Sleep difficulty 
• Anxiety 

Assess objective findings: 

• Vital signs 
• Pain characteristics 
• Weight 
• Mouth and throat exam 
• Breath sounds 
• Anxiety level 
• Knowledge of disease process 
• Nutritional history 

Nursing Diagnosis/Risk For 

• Acute pain from GERD related to reflux symptoms, coughing, and irritated esophageal mucosa as evidenced by: 
  • Verbalization of pain 
  • Coughing 
  • Heartburn 
  • Atypical chest pain 
• Aspiration related to impaired swallowing or esophageal compromise as evidenced by: 
  • Diminished cough reflex 
  • Increased epigastric pressure 
  • Dysphagia 
• Anxiety related to acute illness as evidenced by: 
  • Elevated vital signs 
  • Activity level 
  • Tone of voice 
  • Nervousness 
  • Diaphoresis 
  • Muscle tension 
• Nutrition imbalance related to inability to intake enough food due to reflux as evidenced by: 
  • Inadequate food intake 
  • Altered tastes 
  • Weight loss 
  • Decreased peristalsis 
  • Epigastric pain after eating 
• Knowledge deficit related to understanding of symptom prevention and condition management as evidenced by: 
  • Request for information 
  • Verbalization of problems 
  • Presence of preventable complications 

Interventions 

• Develop plan of care and teaching plan 
• Manage epigastric pain 
• Promote avoidance of triggering medications and foods 
• Encourage diet modifications as prescribed 
• Support a relaxing atmosphere 
• Encourage routine weight monitoring 
• Encourage relaxation techniques 
• Include individual in creation of teaching plan 
• Provide clear explanations and demonstrations 
• Administer medications as ordered 

Expected Outcomes 

• Demonstrates reduced anxiety levels 
• Reports decreased pain 
• Maintains nutritional requirements 
• Demonstrates/verbalizes understanding of condition, prevention, and management 
• Remains free from complications 

Individual/Caregiver Education 

• General information about: 
  • Diagnosis and treatments 
  • Recognition of symptom progression 
  • Diet and lifestyle changes 
  • Support resources available 
• Medications they are prescribed and teach them to: 
  • Take medicine as directed 
  • Report any medication side effects 
• Call the provider if: 
  • Your pain or symptoms worsen 
  • There are questions or concerns about the condition or care 
• Recommended follow-up with healthcare provider

Content Release Date 

4/1/2022

Content Expiration

12/31/2025

Course Contributor 

The content for this course was created by Edward Bartels, RN, BSN, MICN. 

Ed has over 30 years of clinical and teaching experience, and his areas of expertise are emergency and critical care, skilled nursing, behavioral health, occupational health and safety, and home care. Ed served in several senior nursing leadership roles including: Emergency Services Director, Physician Practices Director, and Administrative Director of Nursing at the executive level. Ed is certified in LEAN efficiency fundamentals and tactics, which he has successfully deployed over the years in multiple settings resulting in cost savings, improved quality, and patient safety. Ed is a certified clinical nursing instructor in North Carolina. He earned his Diploma in Nursing from St. Vincent's School of Nursing in Staten Island, New York, in 1990 and Bachelor of Science in Nursing from the University of North Carolina, Greensboro in 2006. Ed is retired from the U.S. Coast Guard with 34 years. 

Resources 

• Gastroesophageal Reflux Disease. https://www.ncbi.nlm.nih.gov/books/NBK441938/ 

References 

• DynaMed. (n.d.). Gastroesophageal reflux disease (GERD). Retrieved October 26, 2021. https://www.dynamed.com/condition/gastroesophageal-reflux-disease-gerd#GUID-886D9495-E47C-4739-A2F1-ADDB7BD7EBAE 
• National Institutes of Health. (2020). Definition and facts for GER and GERD. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/definition-facts