Question

A client presents to the clinic complaining of heartburn and difficulty swallowing. A tentative diagnosis of GERD is made by the healthcare provider. What other symptom would the nurse expect the client to exhibit? A. Globus B. Dryness of the mouth C. Vomiting D. Blood in the stool

Short answer

Answer: Vomiting

Step-by-step solution

Identifying the problem

Our task is to select a symptom that would correlate with GERD, given the existing symptoms of heartburn and difficulty swallowing.

Review each option

We will analyse each of the provided options to determine whether they align with GERD symptoms. A. Globus: Globus sensation, the feeling of something stuck in the throat when there is no actual physical obstruction, can be related to GERD. B. Dryness of the mouth: Although this symptom might be uncomfortable, it is not specifically related to GERD. C. Vomiting: In severe cases of GERD, vomiting could occur as a result of the stomach contents flowing back into the esophagus. This symptom is relevant to GERD. D. Blood in the stool: This symptom might indicate a digestive issue, but it is not specifically related to GERD.

Selecting the correct answer

Comparing all options, the nurse would most likely expect the client to exhibit vomiting (Option C) as another symptom, given their current symptoms and diagnosis of GERD.

Key concepts

Gastroesophageal Reflux Disease

Gastroesophageal Reflux Disease (GERD) is a chronic digestive disorder where stomach acid or, occasionally, bile flows back (refluxes) into the esophagus. This backwash (acid reflux) can irritate the lining of your esophagus and cause symptoms such as a burning sensation in the chest (heartburn), difficulty swallowing, regurgitation of food or liquid, and even chest pain.

Other symptoms may include a sour or bitter taste in the mouth, a sensation known as 'water brash' where sudden salivation is accompanied by the sensation of acid in the esophagus, and chronic coughing or wheezing. In the context of our exercise, the client already experiences heartburn and difficulty swallowing. When we pair these symptoms with vomiting, a connection to GERD is strengthened, as chronic acid reflux can lead to the involuntary upward movement of stomach contents.

Nursing Care for GERD

When caring for a patient with GERD, nurses play a crucial role in management and education. Nursing care involves monitoring the patient's diet and identifying aggravating factors such as spicy foods, caffeine, and alcohol. Encouraging small, frequent meals and advising the patient to avoid lying down immediately after eating can also help manage symptoms.

Nurses can also educate patients on weight management, as obesity can increase intra-abdominal pressure, potentially exacerbating GERD symptoms. It's important to elevate the head of the bed to reduce nocturnal symptoms and to discuss potential over-the-counter or prescription medications that may be used to alleviate symptoms. Patients should also be educated about the importance of medication adherence and the potential side effects of their medications.

Diagnosis of GERD

The diagnosis of GERD generally starts with a clinical evaluation based on reported symptoms. However, additional tests can be performed when the diagnosis is uncertain or when patients have atypical symptoms, complications, or are resistant to therapy.

Typical diagnostic tests include upper endoscopy, which allows direct visualization of the esophageal lining. A 24-hour esophageal pH monitoring can be used to measure acid levels in the esophagus, and esophageal manometry can test the function of the esophagus and lower esophageal sphincter. Barium swallow radiographs may also help visualize structural abnormalities. As part of the nursing care, nurses should prepare patients for these tests, explain the procedures, and provide support throughout the process. In the context of the nursing exercise, understanding these diagnostic steps would aid a nurse in anticipating next steps in care following a tentative diagnosis of GERD.