Nutrition, part 25: Nutritional Guidance - Dysphagia, GERD, & Hiatal Hernia


Cathy discusses nutritional and lifestyle guidance for the following gastrointestinal disorders: dysphagia, GERD, and a hiatal hernia. At the end of the video, she provides a quiz to test your understanding of some of the key points she made during the video.

  • 00:00 Intro
  • 00:37 Dysphagia
  • 2:20 GERD
  • 3:34 Hiatal Hernia
  • 4:24 Quiz Time!

Full Transcript: Nutrition, part 25: Nutritional Guidance - Dysphagia, GERD, & Hiatal Hernia

Hi, I'm Cathy with Level Up RN. In this video, I am going to continue my coverage of topics from our Level Up RN Nutrition Flashcard deck. Specifically, I'll be talking about nutritional and lifestyle guidance for a number of gastrointestinal disorders, including dysphagia, GERD, and a hiatal hernia. At the end of the video, I'm going to give you guys a quiz to test your understanding of some of the key points I'll be covering. So definitely stay tuned for that. And if you have our Flashcards, go ahead and pull them out so you can follow along with me.

Dysphagia is difficulty swallowing, which places an individual at increased risk for aspiration, which is where food or liquid goes into the airway. And this, in turn, can lead to aspiration pneumonia. Dysphagia can be caused by a neurological disorder, such as a stroke or Parkinson's disease, for example. It can also be caused by an infection, GERD, or injury to the head, neck, or esophagus. Signs and symptoms of dysphagia include difficulty with eating or drinking, coughing, and throat clearing. When a patient has dysphagia, it is essential to have their swallowing ability evaluated by a speech-language pathologist. After evaluation, the speech-language pathologist can provide recommendations on the patient's diet and interventions to help the patient swallow safely.

Common interventions include raising the head of the bed to a high Fowler's position, during meals, and for 45 to 60 minutes after meals to help prevent aspiration. Many patients with dysphagia will also be prescribed a dysphagia diet, which includes thickened liquids and moist foods that are soft and/or puree. And in many cases, having the patient tuck their chin to their chest when swallowing can help make swallowing easier and help prevent aspiration. And then finally, it's important to minimize distractions during mealtime and have suction equipment available.

Now let's talk about gastroesophageal reflux disease, or GERD, which is a disorder where the gastric contents, which contain enzymes, backflow into the esophagus, causing pain and mucosal damage. Signs and symptoms include dyspepsia, which is a fancy name for indigestion, dysphagia, throat irritation, a chronic cough, and a burning pain in the esophagus that is worse when lying down and improves when sitting upright. In terms of nutritional and lifestyle guidance, we should advise our patient with GERD to eat smaller meals and to avoid fatty, fried, citrus, and spicy foods. They should remain upright after meals and avoid eating right before bedtime. Tight clothing should be avoided and losing weight when applicable can definitely improve symptoms. Nicotine should be avoided, and individuals should limit their intake of alcohol as well. And then finally, raising the head of the bed with blocks can help improve symptoms at night.

Finally, let's talk briefly about a hiatal hernia, which is where we have protrusion of part of the stomach through the diaphragm into the chest. This can be caused by weakening of the diaphragm or some kind of anatomical defect that allows this protrusion to occur. Signs and symptoms of a hiatal hernia are very similar to GERD, such as heartburn, dysphagia, and chest pain after meals. Of note, with a hiatal hernia, we have a risk of strangulation and obstruction of the stomach. Nutritional and lifestyle guidance for a hiatal hernia is the same as GERD. So if needed, you can back up this video to review those recommendations.

All right. It's quiz time. Are you guys ready? Question number one. Dysphagia places the patient at increased risk for blank pneumonia.

The answer is aspiration.

Question number two. How should the head of the bed be positioned during meals for a patient with dysphagia?

The answer is high Fowler's position.

Question number three. How can a patient with GERD improve their symptoms at night when trying to sleep?

The answer is they can avoid eating right before bedtime and also raise the head of the bed.

All right. That's it for this video. I hope it was helpful. Take care and good luck with studying.

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