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This Concept Map, created with IHMC CmapTools, has information related to: GERD, GERD ???? Pharmacologic Management -Antacids -Histamine 2 Blockers: Cimetidine Famotidine Nizatidine Ranitidine -Proton pump inhibitors: Omeprazole Iansoprazole Rabeprazole Pantoprazole Esomeprazole Protonix pt. takes -Promotility agent: Metoclopromide, Causing pre-malignant cellular changes known as Barrett's esophagus ???? Nursing Diagnosis Imbalanced nutrition: more than body requirements r/t excessive intake AEB the patient’s weight of 277 lb., along with his height of only 5 feet 10 inches, lack of exercise patterns, and the fact the he has a poorly controlled diet, and has problems with controlling his blood sugars, finger stick glucose reading of 247, and a serum glucose level of 224., Causing fibrosis ???? Nursing Diagnosis Imbalanced nutrition: more than body requirements r/t excessive intake AEB the patient’s weight of 277 lb., along with his height of only 5 feet 10 inches, lack of exercise patterns, and the fact the he has a poorly controlled diet, and has problems with controlling his blood sugars, finger stick glucose reading of 247, and a serum glucose level of 224., Cell lysis and inflammatory response ???? Replacement of squamous epithelial cells by columnar type epithelium, GERD ???? Treatment Management -Follow-up care Support -Education -Adherence to pharmacological therapy -Dietary recommendations: avoiding chocolate, alcohol, cola, peppermint, fatty or spicy foods, citrus fruit and juice, coffee, onions, and garlic -Intervent ions to precent increased pressure against LES: Elevating head of bed by 6-10 inches, losing weight, avoid, large meals, avoid lying down within 3 hours of your last meal, avoid laying on right side -Discourage smoking -Avoid vigorous exercise within 1 hour of eating, GERD . Mucous secreting glands fail to secrete bicarbonate (neutralizes gastric acid), GERD ???? Patient's Risk Factors -Increased acid secretion -Altered esophageal buffering -Esophageal motility disorder -Frequent prone positioning -Smoking -Obesity -Diabetes, GERD ???? Cell lysis and inflammatory response, GERD ???? Certain Medications can cause GERD -Alendronate -Anticholinergic -Beta-blockers -Caffeine -Calcium channel blockers -Dopamine -Estrogen -Glucagon -Nitrates -NSAIDs -Phentolamine -Potassium supplements -Progesterone -Quinidine -Sedatives -Theophylline -Tetracycline, Replacement of squamous epithelial cells by columnar type epithelium ???? Causing pre-malignant cellular changes known as Barrett's esophagus, GERD ???? Signs and Symptoms -Recurrent heartburn or regurgitation -Noncardiac chest pain -Frequent hiccups -Aphthous ulcers -Chronic throat clearing -Hoarseness -Laryngeal cancer -Otitis media -Otalgia -Palatal dental erosion -Pharyngitis -Sinusitis -Vocal cord granulomas -Ashtma exacerbations -Bronchiectasis -Chronic bronchitis -Chronic cough -Idiopathic pulmonary fibrosis -Recurrent pneumonia, Cell death may exceed cell production ???? Causing fibrosis, Cell lysis and inflammatory response ???? Cell death may exceed cell production