Jamie is a 3-month-old female who presents with her mother for
evaluation of “throwing up.” Mom reports that Jamie has been
throwing up pretty much all the time since she was born. Jamie does
not seem to be sick. In fact, she drinks her formula vigorously and
often acts hungry. Jamie has normal soft brown bowel movements
every day and, overall, seems like a happy and contented baby. She
smiles readily and does not cry often. Other than the fact that she
often throws up after drinking a bottle, she seems to be a very
healthy, happy infant. A more precise history suggests that Jamie
does not exactly throw up—she does not heave or act unwell—but
rather it just seems that almost every time she drinks a bottle she
regurgitates a milky substance. Mom thought that she might be
allergic to her formula and switched her to a hypoallergenic
formula. It didn’t appear to help at all, and now Mom is very
concerned.
Cases like these are not uncommon. The mother was concerned
and thinking her daughter may have an allergy; she changed to a
different formula. However, sometimes babies have immature GI
tracts that can lead to physiology reflux as they adapt to normal
life outside the uterus. Parents often do not consider this
possibility, prompting them to change formulas rather than seeking
medical care. As in the case study above, GI alterations can often
be difficult to identify because many cause similar symptoms. This
same issue also arises with adults—adults may present with symptoms
that have various potential causes. When evaluating patients, it is
important for the advanced practice nurse to know the types of
questions he or she needs to ask to obtain the appropriate
information for diagnosis. For this reason, you must have an
understanding of common GI disorders such as gastroesophageal
reflux disease (GERD), peptic ulcer disease (PUD), and gastritis.
To prepare:
Review this week’s media presentation on the gastrointestinal
system.
Review Chapter 33 in the Huether and McCance text. Identify
the normal pathophysiology of gastric acid stimulation and
production.
Review Chapter 35 in the Huether and McCance text. Consider
the pathophysiology of gastroesophageal reflux disease (GERD),
peptic ulcer disease (PUD), and gastritis. Think about how these
disorders are similar and different.
Select a patient factor different from the one you selected
in this week’s Discussion: genetics, gender, ethnicity, age, or
behavior. Consider how the factor you selected might impact the
pathophysiology of GERD, PUD, and gastritis. Reflect on how you
would diagnose and prescribe treatment of these disorders for a
patient based on this factor.
Review the “Mind Maps—Dementia, Endocarditis, and
Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2
Learning Resources. Use the examples in the media as a guide to
construct a mind map for gastritis. Consider the epidemiology and
clinical presentation of gastritis.
To complete:
Write a 2- to 3-page paper that addresses the following:
Describe the normal pathophysiology of gastric acid
stimulation and production. Explain the changes that occur to
gastric acid stimulation and production with GERD, PUD, and
gastritis disorders.
Explain how the factor you selected might impact the
pathophysiology of GERD, PUD, and gastritis. Describe how you would
diagnose and prescribe treatment of these disorders for a patient
based on the factor you selected.
Construct a mind map for gastritis. Include the epidemiology,
pathophysiology, and clinical presentation, as well as the
diagnosis and treatment you explained in your paper.
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