Question Answered step-by-step Scenario John, a 56-year-old delivery truck driver, has been taken… ScenarioJohn, a 56-year-old delivery truck driver, has been taken to the emergency department (ED) because he was experiencing chest pain. It started just after he had a quick lunch at a food truck. He told the paramedic that he often has chest pain but that it goes away when he “takes a swig of antacid,” but this time the pain did not stop. On arrival he was given another dose of antacid and sublingual nitroglycerin, and the chest pain stopped. The first set of cardiac enzymes and basic metabolic profile (BMP) were drawn, and a 12-lead ECG was done. He weighs 275 pounds (125 kg), is 5 ft, 5 inches (165 cm) tall, and tells the nurse he has been overweight all his life. He said he’s had the chest pains for about 2 years but did not go to get checked because they always went away when he took antacids, and he was too busy with work to go to a doctor. He works late hours, “lives on coffee,” and grabs fast food when he has time to eat. He smokes 1.5 to 2 packs of cigarettes a day, has a beer every evening once he is home, and usually finishes a 6 pack on the weekends.Vital signs: T 98.9° F (37.2° C), P 110, R 14, BP 148/98.The test results are listed below:TestsResultsSodium142 mEq/LCreatinine1.1 mg/dLPotassium4.1 mEq/LCalcium5.1 mg/dLChloride102 mEq/LHemoglobin148 g/dLCarbon Dioxide28 mEq/LHematocrit48%Glucose168 mg/dLCardiac Troponin0.05 ng/dLBUN12 mg/dL12-lead EKGSinus Tachycardia 1. Review the test results and explain any abnormalities. 2. Six hours later, the second set of cardiac enzymes was normal. Do you think John has had a myocardial infarction (MI)? Defend your answer. Case Study ProgressAfter noting the ECG results and the normal second set of cardiac enzymes, the ED provider tells John that the “chest pain” was more likely gastrointestinal (GI) in origin. John was discharged from the ED with a referral to the hospital’s GI clinic with a possible diagnosis of GERD. One week later, at the GI clinic, he is examined by the GI nurse practitioner (NP). The NP tells John that she thinks he has GERD, but the diagnosis will be confirmed by an upper endoscopic examination. The upper endoscopy is scheduled for 0700 on Tuesday of the following week.3. What is GERD, and what causes it? 4. List the signs and symptoms of GERD. 5. Which of these are potential risk factors for GERD? Select all that apply. Place an asterisk (*) by the ones that pertain to John. a. Obesity b. Alcohol use c. Caffeine use d. Cardiac history e. Cigarette smoking 6. John has self-treated his pain with over-the-counter antacids for a few years. What concerns are there with this long-term self-treatment? 7. Describe the upper endoscopy procedure John will undergo. 8. John has several questions about the upper endoscopy. The nurse provides teaching about the procedure, required preparation, and what to expect afterward. Which statement by John indicates a need for further teaching? a. “I will be wide awake during the procedure.” b. “I will not eat or drink anything after midnight.” c. “I will not take any antacid the morning of this test.” d. “This test will help the doctor figure out why I have so much heartburn. Case Study ProgressThe upper endoscopy is performed successfully. The gastroenterologist tells John and his daughter that the GERD diagnosis is confirmed, and that he has severe esophageal erosion but no visible ulcers. In addition, a gastric mucosal biopsy was sent for Helicobacter pylori. His post procedure blood glucose level was 122 mg/dL.9. What is H. pylori, and how is it treated? 10. H. pylori can be detected with other diagnostic testing. Which tests are potential diagnostic tests for H. pylori? Select all that apply. a. Urine test b. Stool culture c. Urea breath test d. Stool antigen test e. Serum or whole antibody tests 11. Which nursing actions are appropriate for delegation to the UAP after the procedure? a. Taking John’s vital signs. b. Assessing John’s level of consciousness. c. Reviewing John’s point-of-care glucose results. d. Providing postop instructions to John and his daughter.Case Study ProgressJohn was started on Omeprazole (Prilosec) 20 mg every morning. The following week, John has a follow-up appointment with the GI nurse practitioner. It turns out that the testing for H. pylori is negative, but he is told that his symptoms are caused by GERD and he will need to make some lifestyle changes in addition to taking the omeprazole for 6 months.12. What is the mechanism of action of omeprazole? a. It neutralizes gastric acidity. b. It coats the stomach and provides relief of symptoms. c. It partially blocks histamine-2 receptors and reduces gastric acid secretion. d. It inhibits the proton pump, resulting in irreversible blocking of all gastric acid secretion13. The nurse has provided teaching regarding the omeprazole. Which statement by John indicates a correct understanding of therapy with a proton pump inhibitor (PPI) such as Omeprazole? a. “I will take it at night just before bedtime.” b. “I will take the capsule with breakfast every day.” c. “I will take it first thing in the morning, 30 to 60 minutes before breakfast.” d. “I will open the capsule and chew the contents thoroughly to help it work better.” 14. John asks the nurse, “Why do I have to take this fancy medicine? The antacid made my heartburn go away. Isn’t that enough?” How will you answer John? 15. List at least 6 lifestyle modifications that John can make to reduce the symptoms of GERD. Case Study OutcomeAfter 4 months, John lost almost 40 pounds and is determined to lose at least 40 more. He stopped smoking “cold turkey” and has reduced his beer intake to once on the weekend. His daughter has helped him with his meal-planning, and he now brings his lunch and snacks with him instead of stopping for fast food. He is happy with his weight loss, how he is feeling, and the amount of money he has saved by not buying his lunches and the cigarettes Health Science Science Nursing Share QuestionEmailCopy link Comments (0)
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