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

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

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

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

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

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

Discussion 6 (N512-19A Module Six: Disorders of the Digestive System Across the Life Span Assignment)

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.

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 6 Paper

L. T. is a 32-year-old Hmong female, who presents with complaints of burning in the chest and abdomen, especially while lying down, and after meals. According to Kahrilas (2020), one of the symptoms of gastroesophageal reflux disease (GERD) is heartburn, which is typically experienced after eating, and described as a burning sensation in the retrosternal area. Smoking (nicotine) and benzodiazepines may be contributing factors to her GERD due to their effects of relaxing the lower esophageal sphincter leading to reflux (Kahrilas, 2020). Another typical finding in GERD is the reported sour taste L.T. has in her mouth every morning, which is most likely due to regurgitation of undigested food mixed with acid throughout the night.

In those with GERD, the lower esophageal sphincter tone at rest tends to be more lax than normal due to either relaxation or a weakness of the sphincter. Bending, retching, lifting, coughing, and obesity increases pressure in the abdomen, contributing to the development of reflux (McCance & Huether, 2019). According to Kahrilas (2020), esophagitis is the result of a long-term inflammation due to cytokines, and not from exposure to acid and bile on the esophageal epithelium as was once thought. This has been proven by the development of esophagitis through lymphocytic inflammation and dilated intercellular spaces occurring deep in the epithelium, not at the surface, and that internal basal cell hyperplasia and papillary elongation occur prior to the progression of necrosis at the epithelial surface (Kahrilas, 2020). Also, in the absence of esophagitis, the inflammatory response may also cause alterations in esophageal sensitivity (Kahrilas, 2020). According to McCance and Huether (2019), this inflammatory response may also result in hyperemia, edema, erosion, and ulcerations. Precancerous lesions (Barrett esophagus) with progression to adenocarcinoma can be a long-term consequence (McCance & Huether, 2019).

L. T. is most likely having symptoms due to gastric reflux, however, because she is a smoker and has complaints of chest pain, I would order an EKG with stress test to rule out any coronary issues prior to evaluating her GI complaints. If her EKG is negative, she will be started on a proton pump inhibitor (PPI) such as omeprazole 20 mg every morning 30 minutes before breakfast (Kahrilas, 2020). UpToDate guidelines recommend an 8-week treatment course; if improvement seen after 8 weeks, will consider possible wean; if no response after 8 weeks on maximum dose of PPI, will order an endoscopy and referral to GI specialist (Kahrilas, 2020). I would recommend that L. T. discontinue the benzodiazepines and cigarettes (which will improve her sleep) and offer her Chantix (if no mental health issues) and nicotine gum/patches. I would provide education on the effects of smoking, along with other ideas for symptomatic relief such as: elevate the bed 6-8 inches, avoid spicy foods, chocolate, and alcohol, limit meal size and avoid heavy evening meals, allow at least a couple of hours between eating and going to bed, and weight loss if needed. L. T. needs to be aware of any red flag symptoms such as wheezing, coughing, weight loss, GI bleed, dysphagia, early fullness, vomiting, and anemia. Follow up in 2 weeks to evaluate treatment efficacy. May increase PPI dose at that time to 40 mg.

L. T.’s GERD symptoms should be manageable, provided she is willing to take her medication and adjust her eating and sleeping habits. She should see improvement in symptoms through lifestyle changes such as weight loss, quitting smoking, eating smaller portions, and sitting upright after meals. GERD won’t necessarily affect L. T.’s lifespan, and if she can effectively manage her symptoms, she will have a healthier and better quality of life (Zuckerman, 2020). Maintenance therapy is established for those who have continued symptoms without PPI, and for those with erosive esophagitis and Barrett’s. L. T. will most likely respond to treatment, but may relapse after discontinuing PPI therapy, however, there are risks associated with long-term PPI use; thus, discontinuing or reducing the PPI to the minimally therapeutic dose should always be a priority (Zuckerman, 2020). A serious, but rare complication of GERD is esophageal adenocarcinoma. In the setting of a healed mucosa at initial endoscopy, and in the absence of stricture, Barrett metaplasia, or adenocarcinoma, the risk of developing adenocarcinoma is about 0.1% in 7 years (Zuckerman, 2020).

Kahrilas, P. J. (2020). Clinical manifestations and diagnosis of gastroesophageal reflux in adults. In N. J. Talley (Ed.) UpToDate. https://www.uptodate.com

Kahrilas, P. J. (2020). Pathophysiology of reflux esophagitis. In N. J. Talley (Ed.) UpToDate. https://www.uptodate.com

McCance, K. L. & Huether, S. E. (2019). Alterations in cognitive systems, cerebral hemodynamics. In V. L. Brashers & N. S. Rote (Eds.), Pathophysiology: The biologic basis for disease in adults and children (pp. 546-549). Elsevier Mosby.

Zuckerman, M. J. (2020, August 12). Gastroesophageal reflux disease. Epocrates, Inc. Retrieved August, 25, 2020 from www.epocrates.com

806 words

Hi Lorri,

Thanks for your post. Since our patient is a regular smoker, this is major contributor to her GERD. According to a study by Kohata et al., (2016), patients with GERD who achieved success stopped smoking after a year were more likely to report improvement with GERD symptoms (43%) compared to those who did not stop smoking (16%). Frequency of reflux symptoms also reduced in the smoking cessation success group. Furthermore, quality of life also improved among those who stopped smoking (Kohata et al., 2016). This study supports that there are long-term benefits to smoking cessation for patients with GERD.

-Dr. Reynaldo

Reference:

Kohata, Y., Fujiwara, Y., Watanabe, T., Kobayashi, M., Takemoto, Y., Kamata, N., … & Tominaga, K. (2016). Long-term benefits of smoking cessation on gastroesophageal reflux disease and health-related quality of life. PloS one, 11(2), e0147860. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0147860

149 words

Hi Lorri,
Although the risk of this being a cardiac issue is low, I would also recommend the patient to have a cardiac workup done also. It is important to rule out any other causes since she is having chest pain. I also found mulitple articles in my research that having an upper endoscopy is not necessary unless the symptoms do not improve after a month or two of treatment. I believe that dietary and lifestyle changes would be most beneficial for this patient in relieving or resolving her issues.
I enjoyed reading your post.
Ivy

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

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