The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn following a meal. After administering an ordered antacid, the nurse encourages the client to lie in which of the following positions?
A. Supine with the head of the bed flat.
B. On the stomach with the head flat.
C. On the left side with the head of the bed elevated 30 degrees.
D. On the right side with the head of the bed elevated 30 degrees.
Correct Answer: C. On the left side with the head of the bed elevated 30 degrees.
The discomfort of reflux is aggravated by positions that compress the abdomen and the stomach. These include lying flat on the back or on the stomach after a meal or lying on the right side. The left side-lying position with the head of the bed elevated is most likely to give relief to the client. Heartburn is the most common feature of GERD. This becomes more severe with vigorous exercise, bending, or lying down.
Option A: Avoid placing the patient in supine position, have the patient sit upright after meals. Supine position after meals can increase regurgitation of acid. Instruct the patient to chew food thoroughly and eat slowly. Well-masticated food is easier to swallow. Food should be cut into small pieces.
Option B: Elevate HOB while in bed to prevent aspiration by preventing the gastric acid to flow back into the esophagus. Instruct the patient to avoid highly seasoned food, acidic juices, alcoholic drinks, bedtime snacks, and foods high in fat. These can reduce the lower esophageal sphincter pressure.
Option D: Instruct the patient to avoid bending over, coughing, straining at defecations, and other activities that increase reflux. This promotes comfort by the decrease in intra-abdominal pressure, which reduces the reflux of gastric contents.
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