Gastroesophageal Reflux Disease Case Study Patient’s Chief…

Question Answered step-by-step Gastroesophageal Reflux Disease Case Study Patient’s Chief… Gastroesophageal Reflux Disease Case StudyPatient’s Chief Complaints “My acid reflux is getting worse and my histamine blocker isn’t working anymore. About an hour after a meal, I get a burning pain in the middle of my chest. Sometimes, I have trouble getting food down. It seems to get stuck behind my breastbone. I’ve never had that problem before. My heartburn is affecting my quality of life again and I want it to stop.” History of Present IllnessW.R. is a 75 yo male with a significant history of GERD. He presents to the family practice clinic today for a routine follow-up visit. The patient reports that during the past three weeks he has experienced increasing episodes of post-prandial heartburn with some regurgitation and dysphagia. He has also begun using antacids daily in addition to histamine-2-receptor blockers for symptom relief. Despite sleeping with three pillows, the patient has also begun to experience frequent nocturnal awakenings from heartburn and regurgitation. Past Medical History • HTN x 15 years • GERD x 7 years • Alcoholic cirrhosis x 2 years • Hiatal hernia Family HistoryNon-contributory Social History• Patient is widowed and lives alone; daughter lives in same town, checks on him regularly,            and takes him grocery shopping every Saturday ·  Patient is a retired college basketball coach ·  Enjoys cooking, traveling, gourmet dining, and playing poker ·  (+) caffeine; 5 cups coffee/day ·  (+) EtOH; history of heavy alcohol use; current EtOH consumption reported is 6 beers with shots/week ·  (+) smoking; 55 pack-year history; currently smokes 3⁄4 ppd Meds Verapamil SR 120 mg po QD Hydrochlorothiazide 25 mg po QD Famotidine 20 mg po Q HS AllergiesCitrus fruits and juices (upset stomach) Dogs (itchy eyes, runny nose, sneezing) Erythromycin (unknown symptoms) Review of Systems·        (-) H/A, dizziness, recent visual changes, tinnitus, vertigo ·        (-) SOB, wheezing, cough, PND ·        (+) frequent episodes of burning, non-radiating substernal CP ·        (+) dysphagia ·        (-) sore throat or hoarseness ·        (-) N/V, diarrhea, BRBPR or dark/tarry stools ·        (-) recent weight change Physical Examination and Lab TestsGeneral The patient is a pleasant, talkative Native American man who is wearing a sports jacket, jeans, and tennis shoes. He looks his stated age and does not appear to be in distress. VS BP 155/90 RR 18 and unlabored HT 5’8″ P 75 and regular T 97.9°F WT 195 lbs  Skin No rashes or lesions noted HEENT • PERRLA • EOMI • (-) arteriolar narrowing and A-V nicking • Pink, moist mucous membranes • (-) tonsils • Oropharynx clear Lungs CTA Heart • Regular rhythm • (-) additional heart sounds Abdomen• Normoactive BS • Soft, NT/ND • (-) HSM • (-) bruits Genitourinary/Rectal • (-) hemorrhoids • (-) rectal masses • Brown stool without occult blood • Prostate WNL Extremities(-) CCE Neuro • A & O for person, time, place • CNs II-XII intact • Strength 5/5 upper/lower extremities bilaterally Patient Case Question 1. Which clinical information suggests worsening symptoms of GERD in this patient? Patient Case Question 2. Which symptom(s) indicates the possible severity of the patient’s GERD? Patient Case Question 3. Are the patient’s symptoms classic or atypical? Patient Case Question 4. Identify all those factors that may be contributing to the patient’s symptoms. Patient Case Question 5. Why is the drug verapamil a potential contributing factor to the patient’s symptoms? Patient Case Question 6. What non-pharmacologic therapies or lifestyle modifications might be beneficial in the management of this patient’s acid reflux disease? Patient Case Question 7. What pharmacotherapeutic alternatives are available for the treatment of this patient’s GERD? Clinical Course The patient underwent upper endoscopy, which revealed multiple, circular, confluent erosions of the distal esophagus. There was no evidence of bleeding, ulcerations, stricture, or esophageal metaplasia. The patient was treated with an 8-week course of 30 mg/day lansoprazole and both heartburn and dysphagia resolved. Approximately 10 weeks after PPI therapy was discontinued, the patient reported that his reflux symptoms had returned and that he was again suffering from frequent post-prandial and nocturnal episodes of reflux. Patient Case Question 8. What therapeutic options are now available for this patient? Patient Case Question 9. Based on upper endoscopy test results, what grade of esophagitis can be assigned to this patient’s condition? Health Science Science Nursing PATHO 224 Share QuestionEmailCopy link Comments (0)