Which statement by the patient with chronic gastroesophageal reflux disease (GERD) indicates a need for further teaching?

"I have learned to sleep with the head of the bed elevated on blocks."

"I use antacids between meals and at bedtime."

"I enjoy eating large rich meals and snacks before bedtime.

"I quit smoking several years ago, but I still chew a lot of gum."

Answer and Explanation

The Correct Answer is C

A.   Elevating the head of the bed is a recommended practice for individuals with GERD, as it helps prevent stomach acid from flowing back into the esophagus during sleep. This shows the patient is taking proactive steps to manage their condition.
B.   Using antacids can provide symptomatic relief from heartburn and discomfort associated with GERD. Taking them between meals and at bedtime can help neutralize stomach acid, which is a common practice for managing GERD symptoms.
C.   Eating large meals, especially rich or fatty foods, and snacking before bedtime can exacerbate GERD symptoms by increasing stomach pressure and acid production. Patients with GERD are typically advised to eat smaller meals and avoid eating close to bedtime to reduce reflux episodes.
D.   Chewing gum can actually be beneficial for some GERD patients as it stimulates saliva production, which can help neutralize stomach acid.

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Correct Answer is D

Explanation

A. Borborygmi refers to the audible sounds produced by the movement of gas and fluid in the intestines. This can occur in dumping syndrome due to increased intestinal motility and rapid gastric emptying, making this a present manifestation.
B. Nausea and vomiting can occur in dumping syndrome, particularly shortly after eating, due to the rapid movement of food into the small intestine, which can irritate the gut. Therefore, this is a present manifestation.
C. Dizziness can occur in dumping syndrome, often as a result of rapid shifts in blood volume and blood sugar levels after eating. This symptom can be attributed to the body's response to the sudden influx of food and fluid into the intestines, leading to symptoms like weakness and dizziness. Hence, this is a present manifestation.
D. Hypertension is not typically associated with dumping syndrome. In fact, many individuals may experience hypotension (low blood pressure) due to the rapid shift of fluid to the intestines, which can reduce circulating blood volume.

A. Change the surgical dressing. B. Auscultate bowel sounds. C. Reposition the NG tube if patient is nauseated. D. Elevate the head of the bed at least 30 degrees.

Correct Answer is D

Explanation

A. While monitoring the surgical site is important, changing the dressing is not the highest priority immediately post-operatively. The initial focus should be on assessing the patient's stability and managing any complications rather than performing a dressing change.
B. Assessing bowel sounds is important to evaluate gastrointestinal function, particularly after gastrointestinal surgery. However, this can be done after ensuring that the patient is stable and that their airway, breathing, and circulation are prioritized. While important, it is not the immediate priority.
C. If the patient has a nasogastric (NG) tube in place and is experiencing nausea, this may require attention, as it can indicate a blockage or discomfort. However, repositioning the NG tube may not be the first intervention to prioritize in the immediate post-operative setting.
D. This intervention is critical for multiple reasons. Elevating the head of the bed helps reduce the risk of aspiration, improves breathing by enhancing lung expansion, and aids in reducing pressure on the surgical site. After abdominal surgery, especially in obese patients, elevating the head can also promote comfort and facilitate early ambulation.

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Which statement by the patient with chronic gastroesophageal reflux disease (GERD) indicates a need for further teaching?

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Explanation

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