1. What risk factors for gastroesophageal reflux or ulcer disease should the nurse ask about during her nursing assessment?
Does the patient is using over-the-counter and/or prescription NSAIDs? COX-1 produces a prostaglandin that protects the stomach lining from stomach acid. NSAIDs inhibits COX-1 and increases the risk of ulcer disease developing. (Crowe & Peura, 2011)
Does the patient smoke, how long have they been smoking, how much do they smoke/pack/day? Smoking decreases the LES muscle function, increases acid excretion, weakens muscle reflexes in the throat, damages mucus membranes, and reduces salivation, which helps neutralize acid. (UMMC, 2015)
Does the patient drink alcohol regularly? Alcohol relaxes the LES muscles and irritates the
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People with asthma and/or COPD are at higher risk for GERD. (UMMC, 2015)
What are the patient’s eating patterns? Are they eating a lot of acidic or spicy foods. To they experience heartburn when lifting, bending over, or lying down after eating a large meal? Are they eating foods high in fat? (UMMC, 2015)
If the patient was female I would also ask about pregnancy and hormone replacement therapy. When a pregnant woman is in her third trimester, the uterus puts increasing pressure on the stomach. (UMMC, 2015)
2. What history and physical examination findings given in the scenario above can increase this patient’s risk of ulcer disease?
The physical examination findings the increase his risk of ulcer disease include:
Ibuprofen use. COX-1 produces a prostaglandin that protects the stomach lining from stomach acid. NSAIDs inhibits COX-1 and increases the risk of ulcer disease developing. (Crowe & Peura, 2011)
BMI of 35. Obesity changes the gastroesophageal anatomy and physiology which puts patients at higher risk for ulcer disease. Such changes may include a weakened lower esophageal sphincter pressure, a hiatal hernia, and/or an increased gastric pressure. (Lagergren,