hey everyone it's sarth register nurse ran.com and in this video I'm going to be doing an inlex review over gird and this video is part of an inlex review series over the GI system so be sure to check out those other videos and as always in the YouTube description below or at the end of this video you can access the free review quiz that will test you on gird so let's get started so what is gird gird stands for gastro esophageal reflux disease and based on this long name we know that we're dealing with the stomach which is gastro and the esophagus which is esophagal and gird is a chronic condition where stomach contents is flowing back into the esophagus so in your stomach you eat food you have acid and enzymes and it's just going back up through the esophagus and the cells that line in the esophagus are not made to withstand acidic conditions so they start to become really irritated now why does this happen this usually happens due to a weak or damaged lower esophageal sphincter which will refer to as Lees now gird is sometimes referred to as acid reflex disease so if you hear someone say I have acid reflex disease they mean this as well and um one thing you want to keep in mind is that some people have Random episodes of acid reflux and then it goes away now it's termed gird when the acid reflux tends to occur twice a week or more on a regular basis so it's a chronic condition that's been happening over time and if a patient has this they have uh gird acid reflux over a long period of time they need to go to their physician who needs to look at that maybe prescribe some medicines because this disease can cause some long-term complications now let's look at the normal physiology of swallowing food what happens when we chew our food and swallow it and someone who doesn't have gird because we know with gird whenever the patient is swallowing their food and it enters into the stomach it is getting back into the esophagus due to a weak lower esophagal sphincter so before we dive into the patho let's see what our body should do normally okay so we chew our food digestion starts in the mouth and um we swallow it now that food is squeezed down through the esophagus and the esophagus is made up of smooth muscles that help guide that food down to the stomach and that's called parolis now whenever that happens your lower sagil sphincter relaxes and it allows that food to go into the stomach now after it relaxes it closes and it closes very tightly because it doesn't want any of that contents acid the enzymes the food to go back up through that esophagus so that is what will happen to someone who doesn't have gird now with someone who has gird what is happening is that we're having issues with the following things we're having issues with our esophagus our lower esophagal sphincter our esophagal mucosal lining and the stomach acid and the food contents so let's take a look at what's going on with esophagus and gird okay we learned that um the esophagus squeezes food in wav like contractions and works with that lower esophagal sphincter which relaxes to let food in well sometimes what can happen with the esophagus is that it can have impaired motility and it will cause the lower sulag Gil sphincter to close at irregular times which can lead to gir because that acid is back flowing up through the esophagus and the Lees is closing at irregular intervals and it's allowing that acid to get into that esophagus and erode it and form ulcers now let's look at our Lees lower sagil sphincter now this is it's right here it's a collection of circular muscles at the end of your esophagus and it opens and closes and when it closes it's supposed to be a really nice tight seal so nothing can back up in there well with gird we learned earlier that it can become weak and why does it become weak well if it has some increased pressure on it it can damage it and make it weak over time or medications or or other chemicals can um damage it and make it not close as tightly so let's talk about some things that can cause increased pressure on the Lees pregnancy as that baby grows it pushes up on this diaphragm and the diaphragm is very close to your stomach and your esophagus puts pressure on there which in turn will put pressure on the Lees cause it to not close properly and you get acid reflux obesity same principle overeating eating too much food if you eat a really huge meal put all that food into your stomach um it will increase pressure upward onto the Lees cause it to leak the gastric fluid into your esophagus and a hiatal hernia let's talk a little bit about hiatal hernia what is it okay what happens is that the stomach is supposed to be below the diaphragm now with a hotal hernia top the top part of the stomach has herniated through through a weak part in the diaphragm the diaphragm is the blue area and it's just herniated up through there and what can happen is that gastric acids and foods can just pull in there and it's very close proximity to the lower esophageal sphincter which is going to cause a lot of pressure on that and mess it up and won't close properly so a highle hernia can cause it now medications are some types of chemicals and histamines can weaken your lower sagil sphincter calcium channel blockers sedatives smoking and certain foods which we'll really get into the diet teaching but um just to list some like fat and greasy Foods peppermints spearmint any of those type things can weaken that Lees and that's why you tell the patients to um avoid consuming them or limit the con the consumption of them and another thing that can cause Gir is delayed gastric EMP emptying and what's happened is that the stomach isn't emptying its contents through the small intestine like it should instead it's staying in there too long that increases pressure on the Lees and can weaken it and some drugs that can do that are anticholinergic so you really want to watch out for your patients who are taking those medications next is sagil mucosa lining what happens to that is that the cells that line your esophagus start to erode and they become inflamed because they're not made to be in contact with all those acids and enzymes so um the person can develop a condition called esophagitis and due to that chronic inflammation irritating those cells there is an increased risk of esophagal cancer also some other things that can happen with esophagus are these other complications due to all that chronic inflammation they can get strictured um where you have narrowing of the esophagus just from all that chronic inflammation um causing scar tissue to build up over time and it will narrow it um another thing is that they can develop what's called barretts esophagus and this is a very interesting disease and what happens is that the lining of the esophagus that was normally there starts to change and it will actually match the cell lining that is found in the intestine and because of that the patient is at risk for a rare form of cancer so it's very interesting that it can do that another thing they can have bleeding as well next key player is the stomach acid like the hydrochloric acid and pepsin and the food contents and again what they do they just get up there in that esophagus and they erod those cells in that lining and what can happen is that this acid not only can go past the lower sagil uh sphincter it can go up all the way past the upper sagil uh sphincter and what's past that is your faex um up through your ear canals and then in front of that a little bit in front of your ferx is your respiratory system so that acid can really get in there and cause some problems and whenever it does that it's referred to as laryngo fenal reflux and um gir can lead to this so just think about it if the acid go up into the ferx what do we have up there we have our throat we have our ears so we can get some ear infections um it can even go down into the windpipe where we can get some pneumonia lung infections um also can aggravate um the patient signs and symptoms if they have asthma they can have coughing and even voice changes like their voice sounds horse from where that acid is just going up where the voice box is where everything's at and just wearing that way and causes them to have this horse sounding voice now let's look at the signs and symptoms that you may hear your patient report to you who has possibly gird okay the most common thing that patients will report is heartburn and this is like a burning sensation in the chest it can even be so painful that the patient may confuse it as that they're having a heart attack so um they may need a cardiac work up as well just to Ure that that isn't what it is or um it's gir another thing they can complain of is epigastric pain having stomach pain regurgitation and this is where the acid contents is going up in through the throat they may report like a bitter taste in their mouth or whenever they're laying down in a prone position they can um feel that food coming up as well another thing is dry cough which tends to be worse at night when they're lying down sleeping as that acid is coming up through that esophagus um they start to get choked on it and they cough or they may have a cough throughout the day uh nausea problems swallowing a lot of patients I've had report just feels like there's a lump in my throat and um that could be again possibly from the erosion or regurgitation the acid coming up another thing is that um they may have reoccurring lung infections and ear infection and we learned about in the path though why that is now not all patients will report heartburn um some patients don't even have that typical indigestion type pain they just may have that chronic coughing the voice changes where their voice is horse or um ear infection so may want to look further into that see what it is now how is guard diagnosed as the nurse you need to be familiar with the names of these tests so you can be able to tell your patient what they're going to be doing because a lot of times patients are like hey I'm going for this test what is it and you'll have to talk to them about it or just explain what to expect okay um one way to um diagnose gird is an endoscopy where they take a scope they look down through um the esophagus and they can assess the esophagus for any changes like narrowing ulcers erosions things like that another test is a Sagel manometry and this is where they assess the function of the esophagus is ability to squeeze that food down into the stomach and how that lower Sagal sphincter is closing so that can assess that another test is pH monitoring and this is where they put in a small tube and the patient will um have it in there for about 24 hours and they'll just go on about their activities of daily living and um the tube will measure the amount of acid that comes in contact with the esophagus and that can help them see if they have gird now what are the treatments for gir we're really going to hit on this in the nursing interventions and diet and we're going to go over the medications in depth but let's see what in a nutshell what the treatment is um Lifestyle Changes such as losing weight um because obesity can cause this changing your diet the foods that you eat quit smoking things like that medications and um in the most severe cases they can have a surgery called fundoplication and this is where the St where the fundus of the stomach is placed around the lower part of the esophagus so in a sense it helps strengthens it helps to strengthen the lower esophageal sphincter now let's talk about the nursing interventions what are you going to do for a patient who has gir or you suspect has gir okay one thing we're going to do is we're going to assess we're going to assess the patient frequency and quality of pain because um a lot of times patients may say oh my reflux is just acting up and in reality they may be having a my cardial infarction um a heart attack so you want to be able to differentiate between those two um another thing is you want to assess them for other signs and symptoms that's not the most obvious to gird like that heartburn and indigestion you want to look at the respiratory system um are they having chronic bouts of pneumonia or is their asthma really flaring up or are they aspirating a lot where the regurgitation happening that food's coming up and it's going into the lungs and some signs and symptoms of aspiration or coughing decrease oxygen saturations if their SATs were good then all of a sudden they're down abnormal lung sounds and incre increased respiratory rate I'm actually had a p patient who did this um they were there going to be having surgery um they were really mobile they could get up do things for themselves and they had just ate breakfast about an hour after breakfast they had laid down to take a nap um and they had aspirated their food where they were having regurgitation and and their SES were like 97 98 98% throughout the whole day and then all of a sudden they were dropping down in the 80s they were having chronic coughing um they were having voice changes where um they were really horar and um their respiratory rate was really high and uh we did a chest x-ray and it showed that they had aspirated some of that breakfast um from earlier and they had severe gird so um Can Happen another thing is that U you need to watch out for those voice changes and a chronic cough that tends to get worse when they're lying down okay another thing is their pain Aspen is aggravated after you eat a heavy meal and as ask them the foods that make it worse and help them develop a diet to um substitute some other foods that they can incorporate instead of eating those foods that make their gird worse then you want to look at their medication history what meds are they taking because we learned that certain meds can cause the Lees to relax like uh antihistamines calcium channel blockers and do they smoke as well that can affect that and anticholinergics they decrease gastric emptying then you want to um educate them so what you want to educate them about mainly is a lot of food stuff because this is what's causing our problems our food so um you want to educate them to eat small meals avoid really just filling up on these really large meals CU it's put a lot of pressure in the stomach and then in the end is going to put a lot of pressure on that lower Sage sphincter and they need to avoid foods that relax the lower salil sphincter like greasy fatty foods alcohol coffee peppermint or speriment and watch soft drinks because all that carbonation once you ingest those increases pressure in the stomach and increases pressure on the Lees another thing is that they want to make their last meal about 3 hours before bedtime to decrease the chances of regurgitation because when they eat a meal they lay down on their back that puts a lot of pressure on the lower sagil sphincter and it can cause some reflux then they want to sit up 1 hour after meals um if they're obese they need weight loss because that puts a lot of pressure on the sphincter smoking sensation and watch acidic Foods especially if they have erosion in the esophagus um foods like tomatoes or citrus fruits and juices can really irritate at that esophagus even more and then plus if they're having regurgitation where this contents is back flowing it's just going to go from the stomach and back into the esophagus so they need to watch those Foods as well now let's look at the medications ordered for patients who have ger as the nurse you want to be familiar with these drug categories and what they do okay so um first type that patients take are called an acids and what an acids do is that they neutralize that acid so it's not as acidic whenever it back flows into the esophagus and um won't erode it as much um some drugs that are anti acid are like magnesium hydroxide or calcium carbonate and you give these to the patient they chew them and then they swallow them um the one thing you need to remember about an acids is that they interfere with a lot of drugs so it's best to give them a loan and if you have to give like an H2 blocker because sometimes patients are on histamine receptor blockers um you'll want to wait about an hour to two hours before you give um it if they've had an ant acid along with if they're taking antibiotics or carate like your PO antibiotics because it can interfere with the absorption of the drugs okay another group of category drugs ordered are histamine receptor blockers and these drugs work by blocking the histamine and um it causes the prod prodal cells to decrease their production of hydrochloric acid which decreas gastric acid um some popular drugs are like renadine also called Zan Zantac or fopid also known as pepsin now these drugs are typically used shortterm and a patient takes them as symptoms present like PRM and um again you don't give them with an acids wait about an hour or two before you give them because it can interfere with how they work okay other drugs proton pump inhibitors ppis um some popular drugs drugs that are ppis are like osol like prosc or protool like protonics and these decrease stomach acid and help the esophagus heal now one thing about ppis is that they will use them longterm but long-term usage of ppis increases the patient's risk of bone fractures so um watch out for that and assess your patient for that now how ppis work is that they attach to the proton pump of the prodal cells so your um hydrogen and your um potassium that's your proton pump however um it blocks the release of hydrogen so it can't mix with those chloride ions which would make hydrochloric acid HCL so it's not formed so it'll decrease the stomach acid another group of drugs used are called prokinetics and these work by preventing delayed gastric emptying by improving the lower esophagal pressure and improves pistolis so they have like a colonic effect because remember our anticholinergics um cause delayed gastric Iman um some drugs that are considered Pro kinetics are banol or Metro choide also called regulin okay so that wraps up our lecture on guard thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos