Nursing Care Plan for Esophagitis (Achalasia)

Esophagitis is the inflammation of the esophagus caused by physical or chemical trauma. Reflux esophagitis is the reflux of gastric contents into the esophagus caused by an incompetent lower esophageal sphincter or a sliding hiatal hernia. Achalasia (cardiospasm) is the dilatation of the lower esophagus caused by a decrease in motility in the lower two thirds of the esophagus and ineffective peristalisis. This results in a sphincter that does not relax in response to swallowing causing an obstruction as food and fluid accumulate in the lower esophagus.

Nursing Diagnoses: Pain related to physical injuring agents caused by esophageal spasm, distention of lower portion of esophagus from food and fluid accumulation. Altered nutrition less than body requirements related to inability to ingest foods and fluids caused by dysphagia, reflux of gastric contents.

Expected Outcomes: Adequate nutritional intake with minimal or absence of discomfort evidenced by verbalization that eating 6 small meals/day without discomfort.

Nursing Intervention with Rationale:
I. Assess for:
A. Substernal pain, bloated or full feeling, heartburn.
Rationale: Symptoms associated with esophagitis caused by reflux of gastric contents.

B. Halitosis, regurgitation, dysphagia, retrosternal pain after meals.
Rationale: Signs and symptoms associated with achalasia.

II. Administer:
A. Antacid (magaldrate, aluminum hydroxide)
Rationale: Acts to reduce acid concentration in stomach and increase lower esophageal sphincter.

B. Anticholinergic (propatheline bromide, bethanechol chloride)
Rationale: Acts to relax smooth muscle and prevent spasms; improves strength of esophageal sphincter.

III. Perform/Provide
A. Oral care before and after meals and as needed.
Rationale: Prevents halitosis.

B. Small frequent meals instead of 3 meals/daily.
Rationale: Prevents overdistention of lower esophagus and obstruction.

C.Sitting position for meals and avoid lying position for 2-3 hours after meals.
Rationale: Prevents regurgitation.

D. Bland diet.
Rationale: Prevents irritation to esophagus.

E. Sleep with head elevated.
Rationale: Prevents gastric juices from entering esophagus and irritating mucosa by promoting gastric emptying.

F. Eat slowly, take fluids with food.
Rationale: Dysphagia occurs more frequently when liquids are taken.

G. Fluids following eating.
Rationale: Cleanses esophagus to prevent irritation in esophagitis.

IV: Teach Patient/Family:
A. Avoid coughing, straining at defecation, bending at waist, wearing tight clothing at waist.
Rationale: Prevents gastric reflux.

B. Avoid sucking on candy, chewing gum, smoking, using straw.
Rationale: Reduces chance of swallowing air.

C. Avoid foods such as hot/cold, caffeine, alcohol, spices, fruit juices, carbonated drinks.
Rationale: Irritating to esophagus.