MEDICAL MYSTERY FOR CHAPTER 8
 

HIS STORY:

For months, Michael was having trouble swallowing, and he often felt as if he had a lump in his throat. His voice sounded hoarse, and he had a dry cough, which he attributed to smoking. Even more troubling, Michael was plagued by mild chest pain. He was especially worried because his dad died of heart disease. Michael managed a retail store, and on the nights when he worked late, he often ate dinner right before bed. This led to indigestion and insomnia. Taking antacids usually helped his stomach and the pyrosisbut not the pain in his chest. One night, the pain was especially severe; though it eased a short time after it started, he was still having trouble swallowing. Concerned, Michael went to see his physicians assistant the next week. Because of Michaels concern about his heart, his PA ordered an electrocardiogram (EKG). When the results turned out to be normal, Michael wondered if his symptomsespecially the trouble swallowingmight be due to a gastrointestinal problem. His PA agreed and gave him a referral to our clinic.

THE EVALUATION:

In taking Michaels medical history, I learned that he had an irregular eating schedule. I asked about his diet, and Michael told me that he had a passion for chocolate, spicy foods, and coffee. I performed a physical exam and did not find any abnormalities. Because Michael reported having trouble swallowing, I wanted to make sure that there was no serious damage to his esophagus from his digestive problems. I had him undergo an esophagogastroduodenoscopy, a test that involves being sedated while an endoscope is inserted into the mouth and down the stomach. The endoscope allowed me to check for a hiatal hernia. Hiatal hernias can also cause reflux and pyrosis.

THE DIAGNOSIS:

Based on Michaels description of his symptoms, I suspected that he had gastroesophageal reflux disease (GERD), which occurs when the lower esophageal sphincter at the bottom of esophagus relaxes, allowing stomach acid to leak back into the esophagus. Over time, the stomach acid can irritate and damage the delicate lining of the esophagus. Fortunately, he did not have any significant buildup of scar tissue (in some GERD sufferers, scar tissue builds up in the esophagus, which can lead to blockages as well as cancer-causing tumors). Michael also did not have a hiatal hernia. What he had was a classic case of GERD.
 

Although most people with GERD suffer from frequent pyrosis, some do not. Some patients have chest pain, a lump in the throat, a cough, or hoarsenesswhich is exactly what Michael had described. Most patients can be diagnosed with GERD based on symptoms alone: iIf they respond to treatment, then the diagnosis is confirmed.

THE TREATMENT 
In order to ease his symptoms and prevent future damage, I prescribed a proton pump inhibitor (PPI) drug, which reduces the acid that is secreted in the stomach. I explained to Michael that medication was just part of the equation: He also had to make lifestyle changes. I urged Michael to limit his intake of coffee, chocolate, and fried or spicy foods, all of which can stimulate acid production in the stomach. In addition, he had to lose weight and stop smoking. GERD occurs when stomach acid leaks back into the esophagus, and smoking weakens the sphincter that separates the esophagus from the stomach. Excess weight puts pressure on the stomach, which may cause acid to back up into the esophagus. Finally, I advised him to eat smaller meals. Not only would eating smaller meals help him lose weight, but it would also prevent his stomach from becoming too full, which puts pressure on the lower esophageal sphincter and increases the chance that the food will reflux.

CASE CLOSED:

Over the next 3 months, Michael lost 8 pounds. He was taking his medication, and he had cut back his coffee consumption to one cup per day. Although he could not resist chocolate and Mexican cuisine, Michael started viewing these foods as occasional treats. He recently started a smoking cessation program at the local hospital. As a result, his chest pain had virtually disappeared, and he was no longer having trouble swallowing. His voice even sounded less hoarse. Now that his symptoms have eased, I was certain that I had diagnosed him correctly.

Discussion Questions

1. The esophagus is a muscular tube through which ingested food passes from the pharynx to the stomach. It is aided in this action by gravity and peristalsis. What is peristalsis?

2. GERD is an abbreviation for gastroesophageal reflux disease. Define the word parts that make up the word gastroesophageal.

3. The doctor decides that Michael does not have a hiatal hernia. What is this?  What are they symptoms of a hiatal hernia?

4. Michael underwent an endoscopy of his esophagus and stomach. Name two lower gastrointestinal system procedures that involve an endoscope, and describe why they are done.

Jordan is a 35-year-old woman who presents with intermittent diarrhea with cramping that is relieved by defecation. The diarrhea is not bloody or accompanied by nausea and vomiting. Review of past medical history includes some childhood stomach issues, HTN, and a recent cholecystectomy. She works in the environmental department of a large hotel. . She denies alcohol and cigarette.

Diagnosis: Irritable Bowel Syndrome (IBS)

I.      Discuss the epidemiology of IBS?

II.     What is your treatment goals for this patient?

III.    Discuss First line and second line drug therapy for IBS. Please include pharmacotherapeutic information.

Using APA 6th ed. Work must be supported by peer-reviewed article published within 5 years. 

Jordan is a 35-year-old woman who presents with intermittent diarrhea with cramping that is relieved by defecation. The diarrhea is not bloody or accompanied by nausea and vomiting. Review of past medical history includes some childhood stomach issues, HTN, and a recent cholecystectomy. She works in the environmental department of a large hotel. . She denies alcohol and cigarette.

Diagnosis: Irritable Bowel Syndrome (IBS)

I.      Discuss the epidemiology of IBS?

II.     What is your treatment goals for this patient?

III.    Discuss First line and second line drug therapy for IBS. Please include pharmacotherapeutic information.

  Using APA 6th ed. Work must be supported by peer-reviewed article published within 5 years. 

1. Please answer the question below.
   • What wasted resourses or wasted efforts have you seen/heard about in health care today?
2. Your essay should be:
   • Be a total of 200 words or more.
   • Original, work and will be checked for plagiarism.
   • Cite your sources type references according to the .

• I NEED THIS DONE BEFORE 10 PM  EASTERN TIME TODAY. 

Discussion Prompt 1

Review the following case study and discuss the questions that follow. 

EO is an 8-year-old girl with a history of asthma and allergy to bee stings. She has been brought to the clinic complaining of a throat infection. Her health care provider prescribes a course of penicillin to manage her current infection and cautions her parents to watch her closely for a reaction.

1. What type of reaction is the health care provider concerned about, and why?
2. Explain the role of IgE and mast cells in type I hypersensitivity reactions. Why might EO react adversely to the antibiotic with the first use?
3. What would you tell EOs parents to look for when they are assessing for a reaction?

Provide the case number in the subject line of the Discussion thread.

List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.

Identify people in the patients life you would need to speak to or get feedback from to further assess the patients situation. Include specific questions you might ask these people and why.

Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.

List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.

List two pharmacologic agents and their dosing that would be appropriate for the patients antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the clients ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?

If your assigned case includes check points (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.

Explain lessons learned from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations

ZERO PLAGIARISM

Please pay attention to the case study

In 1,500 words, describe the teaching experience and discuss your observations. The written portion of this assignment should include:

1. Summary of teaching plan (attached)
2. Epidemiological rationale for topic (Topic focuses on the prevention of Malaria)
3. Evaluation of teaching experience
4. Community response to teaching (Community consists of parents of children in a day care center)
5. Areas of strengths and areas of improvement

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the for assistance.

Prepare a power point presentation (no more than 30 minutes, no less than 15 slides) for the parents/guardians of a day care/school age children on communicable diseases and how to prevent the most common ones. 

General Requirements

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

Welcome to Team Yellow!

Your topic is:

AHRQuality Indicators

Please begin working with your group to find articles for your project. RUA 1 & 2 are individual papers, but you can’t repeat articles within your group. The final RUA 3 is the group PowerPoint presentation, which is done by the group and submitted by your team leader. Please be sure that everyone in the group submits their peer evaluation, which can be found under Module 7 individually.

Have a great course, and let me know if you need anything!

• A Mental Health Concern – and the Patient or Community – for your project.
• A brief history of the patient including diagnoses and medications – or a brief description of the community issue.
• Any substance abuse, addiction or violence issues surrounding this mental health problem. Describe the attempted interventions that have been made for your patient or community, and identify what has been successful and what has not. Submit a rough draft of information gathered so far.
• Describe your thoughts regarding your patient’s or community’s mental health issue. Are there any cognitive concerns? Think about interventions that may be helpful. Include sources for evidence-based practice.
• List appropriate nursing interventions for your chosen patient or community. How will you evaluate effectiveness? Include an evaluation tool or rubric.
• Complete your Semester Project by identifying mental health resources that can be used for your chosen patient or community. Finish with an educational tool for your patient or community.