GERD By: Kaitlyn Click and Meghan Chokreff. Background on GERD ❖ Stomach contents leak backwards...
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Transcript of GERD By: Kaitlyn Click and Meghan Chokreff. Background on GERD ❖ Stomach contents leak backwards...
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GERD
By: Kaitlyn Click and Meghan Chokreff
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Background on GERD❖ Stomach contents leak backwards from the stomach into the esophagus.
Reflux occurs if the muscular actions in the esophagus or other protective mechanisms fail, such as LES.
❖ Some complications include: ➢ Impaired swallowing, aspiration of gastric contents, ulcerations,
perforation or stricture of the esophagus, and Barrett’s Esophagus❖ Some signs and symptoms include:
➢ Dysphagia, heartburn, increases salvation, belching, pain throughout the body
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Patient Demographics
Jack Nelson: ❖ 48 years old ❖ Male❖ Caucasian ❖ Married--lives with his wife, Mary, and their 2 sons❖ Works M-F, on evenings and weekends as well❖ Protestant❖ BA
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Patient History❖ Onset:
➢ Experiencing increased indigestion over the past year➢ Used to be only at night but now it is more consistent throughout the day
❖ Medical: ➢ Essential HTN since a year ago
❖ Surgical:
➢ s/p Right knee arthroplasty 5 years ago
➢ gained almost 35 lbs since knee surgery❖ Medications:
➢ Atenolol 50 mg daily; 325 mg aspirin daily; multivitamin daily; 500 mg ibuprofen 2x daily for the last month❖ Family history:
➢ Father: CAD❖ Nutrition/dietary:
➢ Eating and drinking more over the past year due to stress: 1-2 beers 3-4 times a week➢ Does not exercise regularly: playing with his children is his only exercise➢ Does not follow any dietary restrictions; no previous nutrition therapy➢ No tobacco use➢ Fried foods make indigestion worse➢ Wife purchases food or they eat out
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Vitals
Temp: 98.6Pulse: 90BP: 119/75Height: 5’9” Weight: 215 lbs (mildly obese)
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Nutrition Usual Dietary Intake: ❖ AM: 1 ½-2 c dry cereal (Cheerios, bran flakes, Crispix), ½-¾ c skim milk, 16-
32 oz orange juice❖ Lunch: 1 ½ oz ham on ww bagel, 1 apple or other fruit, 1 c chips, diet soda❖ Snack when he comes home: Handful of crackers, cookies, or chips, 1-2 16
oz beers❖ PM: 6-9 oz meat (grilled, baked usually), pasta, rice, or potatoes, 1-2 c fresh
fruit, salad or other vegetable, bread, iced tea❖ Late PM: Ice cream, popcorn, or crackers. Drinks 5-6 12 oz diet sodas daily as
well as iced tea. Relates that his family’s schedule has been increasingly busy, so they order pizza or stop for fast food 1-2 times per week instead of cooking
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24-Hour Recall
Breakfast Crispix--2c, 1 c skim milk, 16 oz orange juice
At work snack 3 12-oz Diet Pepsis
Lunch Fried chicken sandwich from McDonald’s, small French fries, 32 oz iced tea
Late afternoon snack 2 c. chips, 1 beer
Dinner 1 breast, fried, from KFC, 1 ½ c potato salad, ¼ c green bean casserole, ½ c fruit salad, 1 c baked beans, iced tea
Bedtime snack 2 c ice cream mixed with 1 c skim milk for milkshake
Total kcal: ~3600 kcal
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Estimated Needs106 lbs + 6(9)= 160 lbs IBW160 lbs/2.2= 72.7 kg IBW + 0.25 (usual- IBW)= 160 + 0.25 (215-160)= 173.75 lbs173.75 lbs/2.2= 79.0 kg REE= 10 x wt(kg) + 6.25 x ht(cm) – 5 x age (yrs) + 5 = 10 x 79 kg + 6.25 x 175.3 cm – 5 x 48 + 5 = 790 + 1095.6 – 240 + 5 = 1650.6 kcal TEE= REE x activity factor
1650.6 x 1.6=2641 kcal
~2600-2700 kcal needed to maintain weight Protein RDA: 0.8 g/kg/day 0.8 g x 97.7 kg= 78.2 g protein/day
Hamwi Method
Mifflin-St.Jeor
Actual Needs with Activity Factor
Protein Requirement
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Abnormal Labs
Chemistry Reference Range 9/22
Cholesterol (mg/dL) 120-199 220
HDL-C (mg/dL) >55 F, >45 M 20
LDL (mg/dL) <130 165
LDL/HDL ratio <3.22 F<3.55 M
8.25
Triglycerides (mg/dL) 35-135 F40-160 M
178
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Foods to Steer Clear From… Bad Food Choices
Caffeine/Tea
Chocolate
Chips
Fried Foods
Foods High in Fat
Carbonated beverages
High Fat milk products
Alcohol
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Medication
❖ Take Omeprazole in the AM because it is a proton pump inhibitor, which means it will block H+, K+-ATPase enzymes
❖ Decrease aspirin to 75 mg and stop taking ibuprofen because these medications have an effect on the stomach and will decrease the lining in the stomach causing GERD.
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Nutrition Assessment
Food/nutrition hx: Biochemical data/Medical tests/procedures:
Anthropometric data:
Physical exam findings: Client hx:
Average intake: ~3600 kcal/dayEstimated needs: ~ 2600-2700 kcal/dayHas not followed any diet restrictions Meds: Atenolol 50 mg, aspirin 325 mg, multivitamin, ibuprofen 500 mg 2x/day
s/p R knee arthroplasty 5 years ago Labs: Chol 220 mg/dL, HDL 20 mg/dL, LDL 165 mg/dL, TG 178 mg/dL
Temp: 98.6Pulse: 90Resp rate: 16BP: 119/75Ht: 5’9”Wt: 215 lbs
Mildly obeseMild distressBMI: 31.8 kg/m2adjusted BW: 160 lbs
PA: little to no exercise Family history of heart diseaseGained 35 lbs since knee surgeryStress increased in past year
Jack Nelson❖ 48 year old male
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Nutrition Diagnosis
PES #1: Excessive energy intake (NI-1.3) related to being mildly obese as evidenced by patient’s 24-hour recall, weight of 215 pounds, and BMI of 31.8.
PES #2: Physical inactivity (NB-2.1) related to a sedentary lifestyle as evidenced by self-report of only activity is playing with children on the weekends.
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Nutrition Intervention Diet/Nutrition: Instruct client on 3000 kcal diet for 3 months and then 2600 kcal diet for 3 more months. Educate Mr. Nelson and his wife about healthy meal options, portion sizes, methods of cooking, and benefits of eating at home. Provide client with a “Foods to Avoid” list that will help alleviate symptoms of GERD.
Physical activity: Introduce client to physical activities that are easy on his knee, such as swimming, and parking a little further away from the entrance at work. We will also refer Mr. Nelson to a physical therapist to help him with knee discomfort. Once he is pain-free, we can implement a “step-plan” of 3,000 steps/day, increasing by 500 steps/week.
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Nutrition Monitoring/Evaluation
Monitor patient compliance with intervention: ★ Food journal--kcal, fat, sodium, total saturated fat★ Physical activity journal ★ Cholesterol, HDL, LDL, TG, BMI, BP
Compare this data to his initial visit. Have client email logs to dietitian before meetings and call about their progress on a weekly basis.
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Questions
1. What does GERD stand for? 2. What are the complications of GERD?3. What are some signs and symptoms of GERD?4. What is one controllable risk factor?
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References Academy of Nutrition and Dietetics (2014). Pocket guide for international dietetics & nutrition
terminology (IDNT) reference manual: Standardized language for the nutrition care process. Chicago, Ill: Academy of Nutrition and Dietetics.
Gastroesophageal Reflux Disease (GERD). (2011). Retrieved September 8, 2014, from
http://www.lef.org/protocols/gastrointestinal/gastroesophageal_reflux_06.htm
George F. Longstreth. Medline Plus. (2012). Esophageal pH Monitoring. Rockville Pike,
Bethesda, MD.
Nahikian-Nelms, M., & Roth, S. L. (2013). Medical nutrition therapy: A case study approach. Stamford, Connecticut: Cengage Learning.
Nelms, M. N., Sucher, K., Lacey, K., & Roth, S. L. (2011). Nutrition therapy and pathophysiology (2nd ed.). Belmont, CA: Brooks/Cole Cengage Learning
Understanding Upper Endoscopy. (n.d.). Retrieved September 8, 2014, from
http://www.asge.org/patients/patients.aspx?id=378