N512-19A Module Six: Disorders of the Digestive System Across the Life Span Assignment 3

Discussion 6

Luv Taub, a 32-year-old, married Hmong woman, presents to her primary care Nurse Practitioner complaining of a persistent burning sensation in her chest and upper abdomen. The symptoms are worse at night while she is lying down and after meals. She enjoys many years of cooking and eating “hot and spicy foods” common in her culture. She has tried drinking hot cocoa to help her sleep. She is a smoker and frequently relies on benzodiazepines for insomnia. She notes a sour taste in her mouth every morning. Physical examination is normal. N512-19A Module Six: Disorders of the Digestive System Across the Life Span Assignment 3

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In this discussion:

Discuss this patient’s likely diagnosis. Why do you support this “likely” diagnosis?
Describe the pathophysiology of this disorder.
Discuss a plan of care for this patient.
What is the anticipated prognosis for this patient? What lifestyle factors might alter her short- and long-term outcomes?

Include citations from the text or the external literature in your discussions. Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

Example Discussion Solution

REFLUX ESOPHAGITIS

Clinical Presentation

Luv T., a 32-year-old married Hmong woman, presented in the office today with typical clinical signs and symptoms of Reflux Esophagitis caused by Gastroesophageal Reflux Disease (GERD). Luv’s symptoms include persistent burning sensation in her chest and upper abdomen, increasing after meals, worsening at night while lying down. Luv states she has a sour, unpleasant, taste in her mouth when she wakes up in the morning. GERD is commonly diagnosed based on symptoms the patient is experiencing along with the effectiveness of the prescribed medication, namely a proton pump inhibitors (PPIs). The above symptoms Luv presented with were the typical symptoms; however, patients may present with the following atypical symptoms, dental erosion, chronic cough, laryngitis, chest pain as well as asthma.

Pathophysiology

According to (Antunes, 2020), GERD may result from multifactorial issues being intrinsic, structural, or both:

· Impaired Lower Esophageal Sphincter (LES) – relaxation of the sphincter muscle letting gastric acid content to reflux upward into the esophagus. Relaxation of the sphincter muscle could potentially be the result of taking certain medications, as seen by Luv’s frequent dose of benzodiazepines to help her sleep at night.

· Impaired esophageal mucosal defense against the gastric refluxate – occurs from prolonged exposure to gastric acids as pepsin and hydrochloric acid as well as alkaline duodenal contents including pancreatic enzymes and bile salts. Delayed gastric emptying, gastroparesis, may also be a factor since the stomach contents are delayed moving through the gastrointestinal tract (GI) causing an increased amount of pressure with bloating.

· Hiatal Hernia – commonly associated with GERD as it causes the LES to function inefficiently due to increased pressure the hiatal hernia places on the lower sphincter of the esophagus.

· Defective esophageal peristalsis – decreased movement, without clearance of refluxate from the esophagus increasing the inflammation in the esophagus from constant insult. N512-19A Module Six: Disorders of the Digestive System Across the Life Span Assignment 3

Prognosis/Plan of Care for Luv T.

Prognosis is very favorable as long as Luv follows the short-term and long-term goals we discussed together.

Short term goals:

Encouraging Luv to journal her dietary modifications discussed finding which foods seem to provoke her symptoms of discomfort. Since there is no known evidence according to (Antunes, 2020) to support this, and everyone is not affected by the same foods, this list should be specific to each individual. Some of the more common foods to avoid may be a diet including chocolates, hot and spicy foods, citrus, caffeine, and carbonated beverages to name a few (Antunes, 2020). Smoking cessation education will be offered as discussed with Luv. Sleeping at an angle, elevating the head of the bed at night, will help decrease the amount of reflux decreasing the amount of sour taste Luv experiences in the mornings. As previously discussed, hot cocoa or eating within three hours of laying down at night should be avoided since chocolate is one of the potential foods to avoid as well as eating and drinking before bed should be avoided so that there is not increased gastric pressure, causing stomach contents to reflux.

Long term goals:

Luv will be monitored closely to make sure that her symptoms decrease, as she will be able to get a good night’s sleep without the use of benzodiazepines or drinking hot cocoa before bed as these increase symptoms of the gastric refluxate by aiding to the relaxation of the sphincter muscle. Smoking cessation education will be monitored, as this will help decrease the symptoms of gastric acid formation and irritation of the esophagus and epithelium layers in the stomach (Hammer & McPhee, 2018, pp. 369-399). PIP will be continuously monitored, keeping in mind if current medication treatment fails to alleviate symptoms, another PIP can be utilized.

In Conclusion

Luv will be treated for Reflux Esophagitis caused by GERD with a PIP to decrease gastric contents from refluxing causing multiple symptoms. These symptoms will be decreased so Luv will not be predisposed to potential complications as Erosive Esophagitis, Esophageal strictures, or Barrett’s esophagitis. Luv will decrease the potential for complications by maintaining a healthy lifestyle, weight loss, dietary modifications, as well as exercise. Tests, including esophagogastroduodenoscopy (EGD), radiographic studies, ambulatory esophageal reflux monitoring will be done as needed (Antunes, 2020). If surgery is needed in the future, this will be done; however, great care will be executed to sustain a healthy lifestyle decreasing the chances of potential complications.

References

Antunes, C. (2020, July 8). Gastroesophageal Reflux Disease – StatPearls – NCBI Bookshelf. Https://Www.Ncbi.Nlm.Nih.Gov. https://www.ncbi.nlm.nih.gov/books/NBK441938/

Hammer, G. D., & McPhee, S. J. (2018). Pathophysiology of Disease: An Introduction to Clinical Medicine 8E (8th ed.). McGraw-Hill Education / Medical.

762 words

Hi Diane,

Thanks for your post. According to recent evidence and clinical practice guidelines, avoidance of certain foods does not have any a strong evidence to improve GERD symptoms. What is your thoughts about this? Would you still recommend avoidance of potential trigger foods if evidence is not strong?

-Dr. Reynaldo

51 words

Hi Dr. Reynaldo,
That’s a great question, thank you. As noted, according to (Antunes, 2020), there is no evidence to support that certain foods should be removed from one’s diet; however, yes I believe I would have my patients journal to see if there is a correlation between symptoms and certain foods eaten. Having said this, perhaps its timing of when foods were ingested and laying down for a nap or retiring for the night right after. I have had individuals tell me they avoid certain foods because they feel it causes them to have indigestion or heartburn. Diverticulitis is another GI disorder that diet modification is controversial. I know many individuals who will not touch nuts, seeds, or popcorn even though, they should be focusing more importantly on increasing their fiber and fluid intake. For these individuals, I would inform them everything in moderation is ok, but if they feel these are trigger foods, journal and see what particular foods, if any, and circumstances occurring at time, while also journaling fluid intake (water) as well as fiber intake.
Thank you,
DianeAntunes, C. (2020, July 8). Gastroesophageal Reflux Disease – StatPearls – NCBI Bookshelf. Https://Www.Ncbi.Nlm.Nih.Gov. https://www.ncbi.nlm.nih.gov/books/NBK441938/

207 words

Hi Diane,

A food diary is a great idea. As you said, it may not be the actual foods but could be the amount, timing, and patient positioning right after ingesting food that could result in the GERD.

Isn’t it diverticulosis wherein the patient cannot each foods, such as popcorn, nuts, and seeds, while for diverticulitis, they are encouraged to eat a high fiber diet? That’s very interesting that patients with diverticulitis will still try to avoid these foods. Good sharing!

-Dr. Reynaldo

83 words

Dr Reynaldo,
Yes, it is diverticulosis, thank you. It is controversial, as it is with GERD, that pt’s do not have to restrict eating nuts, seeds, and popcorn. I am actually a victim to diverticulosis which progresses to diverticulitis having a couple trips to the ED, antibiotics and CT scans. I wish it was possible to do an US opposed to having all the radiation with CT scans (conclusive study) as we saw with renal stones. I do think with the controversial dietary issues, everything eating a well balanced diet and moderation is the best. I also feel that stress plays a significant role in a lot of disease processes! Wouldn’t it be wonderful, a life without stress 🙂
Thank you,
Diane

121 words

Assignment 3

The purpose of this paper is to address the following clinical scenario with the use of your textbook, external credible literature, and/or reliable electronic sources. Use the guide below to draft your paper and review the rubric to ensure you have met the assignment criteria. The expected length of the paper is approximately 4-5 pages, which does not include the cover page and reference page(s).

James Alvarez is a 52 y.o., recently divorced, Latino male; new patient who arrives at the community health clinic for an appointment with a primary care Nurse Practitioner. His chief complaint of abdominal pain and vomiting, fatigue, and weight loss. He notes that although he has experienced overall weight loss, his stomach “looks huge.” As his history is taken, he notes no alcohol use. In speaking with him, the Nurse Practitioner notices a yellow tinge to the whites of his eyes. During examination, the Nurse Practitioner notes organomegaly in the right upper quadrant.

Please use the following headings/subheadings as a guide to draft your paper:

Introduction (including purpose statement)
What would be your priority diagnosis for Mr. Alvarez?
Identify the organ and describe the pathophysiological processes, which may have caused the organomegaly.
Develop a comprehensive and holistic plan of care for this patient based on James’ diagnosis.
Conclusion

1. Within your description, place in bold font the key pathophysiological concepts (terms).

1. Include recommendations for follow-up with the Nurse Practitioner.
2. Incorporate a population-based component to Mr. Alvarez’ plan of care.

In regards to APA format, please use the following as a guide:

Include a cover page and running head (this is not part of the 4-5 page limit)
Include transitions in your paper (i.e. headings or subheadings)
Use in-text references throughout the paper
Use double space, 12 point Times New Roman font
Spelling, grammar, and organization are appropriate
Include a reference list (this is not part of the 4-5 page limit)
Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. ANA)

Assignment 3 Rubric

Competency	20 Points	12 Points	6 Points	0 Points	Points Earned
Nursing Application and Analysis of Content with Connection to Expert Nurse Level Knowledge Base	Establishes very high level of nursing knowledge application and analysis to assignment that equates to the expert practice nurse knowledge base. N512-19A Module Six: Disorders of the Digestive System Across the Life Span Assignment 3	Briefly describes application to nursing knowledge or that knowledge is not of an expert nurse but more than a novice nurse base knowledge.	Level of nursing knowledge is of a novice nurse with little application or support to expert nurse practice.	Does not include established nursing knowledge base and/or does not apply this to current clinical practice.	/20
Teaching Considerations	Evidence of intentional inclusion of patient and family teaching considerations which is sensitive to diversity, demographics and education level as necessary for the assignment. These are well supported in the literature and demonstrate clear positive impact on compliance with excellent patient outcomes.	Moderate attempt to demonstrate patient and family inclusion in teaching approaches. Some consideration given to sensitive factors which would positively impact patient receptivity and implementation for impact on patient outcomes.	Little demonstration of awareness and inclusion of patient and family sensitive teaching considerations. Impact on outcomes is not clearly addressed but can be inferred.	No attempt to demonstrate sensitive approach to patient and family teaching considerations. Impact on outcomes is not addressed.	/20
Critical thinking	Pathophysiology content and integration with current best practice standards (supported by the scholarly literature) are used to construct critical examination and application of concepts and content.	Connection between pathophysiology knowledge and current best practices is stated but now well supported with scholarly sources and/or weakly used to construct examination and application of concepts and constructs.	Integration of pathophysiology and current best practice standards are anecdotal and not supported by the literature or are outdated based on current best practice standards. Little attempt to apply knowledge in examination and application to concepts and constructs.	No attempt to integrate pathophysiology and current best practice standards in examination and application to constructs and concepts with no support from relevant, scholarly literature.	/20
Scholarly, evidence based, current standards of practice, Sources: 3-5+	Current, relevant and authoritative scholarly sources are used to support content. Demonstrates current, evidence-based standards of practice. Minimum of 3-5+ sources.	Moderate inclusion of current, relevant and authoritative scholarly sources are used to support content. Demonstrates occasional current, evidence-based standards of practice.	Little attempt to include current, relevant and authoritative scholarly sources are used to support content. Or, information is purely anecdotal or not current, evidence-based practice knowledge.	No attempt to use current, relevant and authoritative scholarly sources to support content. Does not demonstrate current, evidence-based standards of practice.	/20
Competency	5 Points	3 Points	1 Point	0 Point	Points Earned
Organization	Organization excellent, ideas clear and arranged logically, transitions smooth, no flaws in logic.	Organization good; ideas usually clear and arranged in acceptable sequence; transitions usually smooth, good support	Organization minimally effective; problems in approach, sequence, support and transitions	Organization does not meet requirements	/5
Grammar	Grammar, punctuation, mechanics, and usage correct and idiomatic, consistent with Standard American English	Grammar, punctuation, mechanics, and usage good mostly consistent with Standard American English; errors do not interfere with meaning or understanding	Grammar, punctuation, mechanics and usage distracting and often interfere with meaning or understanding	Grammar, punctuation, mechanics, and usage interfere with understanding	/5
APA Format	Demonstrates competent use of mechanics and APA	Minimal APA errors	Many APA errors	Complete lack of understanding	/5
References	References are relevant, scholarly, authoritative and contemporary	Adequate references	Minimal use of appropriate references	Poor use and/or selection of references not relevant	/5
Total					/100

Assignment 3 Rubric

Competency

20 Points

12 Points

6 Points

0 Points

Points Earned

Nursing Application and Analysis of Content with Connection to Expert Nurse Level Knowledge Base. N512-19A Module Six: Disorders of the Digestive System Across the Life Span Assignment 3

Establishes very high level of nursing knowledge application and analysis to assignment that equates to the expert practice nurse knowledge base.

Briefly describes application to nursing knowledge or that knowledge is not of an expert nurse but more than a novice nurse base knowledge.

Level of nursing knowledge is of a novice nurse with little application or support to expert nurse practice.

Does not include established nursing knowledge base and/or does not apply this to current clinical practice.

/20

Teaching Considerations

Evidence of intentional inclusion of patient and family teaching considerations which is sensitive to diversity, demographics and education level as necessary for the assignment. These are well supported in the literature and demonstrate clear positive impact on compliance with excellent patient outcomes.

Moderate attempt to demonstrate patient and family inclusion in teaching approaches. Some consideration given to sensitive factors which would positively impact patient receptivity and implementation for impact on patient outcomes.

Little demonstration of awareness and inclusion of patient and family sensitive teaching considerations. Impact on outcomes is not clearly addressed but can be inferred.

No attempt to demonstrate sensitive approach to patient and family teaching considerations. Impact on outcomes is not addressed.

/20

Critical thinking

Pathophysiology content and integration with current best practice standards (supported by the scholarly literature) are used to construct critical examination and application of concepts and content.

Connection between pathophysiology knowledge and current best practices is stated but now well supported with scholarly sources and/or weakly used to construct examination and application of concepts and constructs.

Integration of pathophysiology and current best practice standards are anecdotal and not supported by the literature or are outdated based on current best practice standards. Little attempt to apply knowledge in examination and application to concepts and constructs.

No attempt to integrate pathophysiology and current best practice standards in examination and application to constructs and concepts with no support from relevant, scholarly literature.

/20

Scholarly, evidence based, current standards of practice, Sources: 3-5+

Current, relevant and authoritative scholarly sources are used to support content. Demonstrates current, evidence-based standards of practice. Minimum of 3-5+ sources.

Moderate inclusion of current, relevant and authoritative scholarly sources are used to support content. Demonstrates occasional current, evidence-based standards of practice.

Little attempt to include current, relevant and authoritative scholarly sources are used to support content. Or, information is purely anecdotal or not current, evidence-based practice knowledge.

No attempt to use current, relevant and authoritative scholarly sources to support content. Does not demonstrate current, evidence-based standards of practice. N512-19A Module Six: Disorders of the Digestive System Across the Life Span Assignment 3

/20

Competency

5 Points

3 Points

1 Point

0 Point

Points Earned

Organization

Organization excellent, ideas clear and arranged logically, transitions smooth, no flaws in logic.

Organization good; ideas usually clear and arranged in acceptable sequence; transitions usually smooth, good support

Organization minimally effective; problems in approach, sequence, support and transitions

Organization does not meet requirements

Grammar

Grammar, punctuation, mechanics, and usage correct and idiomatic, consistent with Standard American English

Grammar, punctuation, mechanics, and usage good mostly consistent with Standard American English; errors do not interfere with meaning or understanding

Grammar, punctuation, mechanics and usage distracting and often interfere with meaning or understanding

Grammar, punctuation, mechanics, and usage interfere with understanding

APA Format

Demonstrates competent use of mechanics and APA

Minimal APA errors

Many APA errors

Complete lack of understanding

References

References are relevant, scholarly, authoritative and contemporary

Adequate references

Minimal use of appropriate references

Poor use and/or selection of references not relevant

Total

/100 N512-19A Module Six: Disorders of the Digestive System Across the Life Span Assignment 3

N512-19A Module Six: Disorders of the Digestive System Across the Life Span Assignment 3