Discussion Question 1

Mike is a 46-year-old who presents with a complaint of “heartburn” for 3 months. He describes the pain as burning and it is located in the epigastric area. The pain improves after he takes an antacid or drinks milk. He has been taking either over-the-counter (OTC) famotidine or ranitidine off and on for the past 2 months and he still has recurring epigastric pain. He has lost 6 lb since his last visit.

Assessment

His examination is unremarkable. His blood pressure (BP) is 118/72. Laboratory values are normal complete blood count (CBC) and a positive serum Helicobacter pylori test.

1. What would you prescribe initially?
2. How long would you prescribe these medications?
3. What other possible meds could you prescribe to assist with the side effects from the medications prescribed?
4. How would the treatment vary if the patient has GERD instead?

Discussion Question 2

List differential diagnosis that would help confirm GERD while ruling out other diagnosis. Which medication is the best medication for treatment of GERD and why? What labs or other diagnostic tests that are used to confirm GERD? Your response should be at least 350 words.

 

.MMRequired Resources
Read/review the following resources for this activity:

· Textbook: Chapter 8, 9, 17 (Introduction); review Chapter 7

· Lesson

Introduction
Remember – your actual journal entry should be somewhat brief; most of your time should be spent thinking about the questions asked and the issues raised. Your thoughts should then be distilled into a mini-argument that will respond affirmatively to the four tests for evaluating arguments. Truthfulness of premises, logical strength, relevance, and non-circularity.

Instructions
For this journal assignment, briefly answer each of the following prompts:

· Inference: The differing meanings of “valid inference” and “warranted inference” are closely related to the differing purposes of deductive. And inductive arguments – the purpose of deductive being to prove; the purpose of inductive to make the conclusion most probable.

oLook up the words “valid” and “warranted.” Each of these words, you will find, has what is known as a lexical definition – that is just the dictionary definition of the word. Words also have a certain connotations – meanings that go beyond their lexical definitions; associated ideas and concepts – think of terms such a “fur baby” as the name for a pet.

oBriefly discuss how the lexical definitions and connotations of “valid” and “warranted” can help us understand the differing purposes of deductive and inductive arguments.

fallacious argument templates

· Fallacies: In Section 8.2, the text states that there are “fallacious argument templates” (Facione & Gittens, p. 167) and then gives a number of examples. The authors further state: “Analysis of the meanings of the terms used. And the grammatical rules of the language reveal the source of error” (p.167).

oChoose one of the fallacies in this section. Such as Denying the Antecedent or False Classification and pair it with the valid argument template. For example, if you choose Denying the Antecedent. The valid argument template will be Denying the Consequent. False Classification would pair with one of the fallacies in Reasoning About Classes of Objects.

certain malfunctions will prevent it from working

oExplain, in your own words, how the fallacy is revealed through analysis of the valid argument template. Think of it this way – if you know how the heart works, you will know that certain malfunctions will prevent it from working.  For example, if you know that the coronary arteries supply the heart with blood, then you can reason that a blockage will stop that vital flow. So this journal prompt asks you to explain, in your own words, how one of the valid argument templates work – and how that exposes the fallacy connected with that type of argument.

· Civic Responsibility: At the end of Chapter 9 there is a Bonus Exercise that asks you to research and analyze the 2009 debate over the healthcare public option. If you were actually to complete that exercise, it would take quite a bit of time and effort.

oDo you think that completing such an exercise would be time well spent or time wasted? If well-spent, why? If time wasted, why?

oIs there any issue on which you think a comparable amount of time and effort would be worthwhile?

oAs a critical thinker, do you believe that citizens have an obligation to be informed on topics of current interest? If yes, why, if no, why not?

psychosocial problems

Please reply to the following discussion with one reference. Participate in the discussion by asking a question, , providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.

MB Discussion:

 

Which essential questions will you ask this pediatric patient or their caregiver during this well-child check? Why are these questions important? What lab tests or diagnostic studies will you order and why?

In this case study, the child is not at the appropriate weight. The parent did address that he is a selective eater. Therefore, I would begin with questions regarding his diet. How often is he eating? What is he eating? Does he eat vegetables or fruit? Is he still using a bottle? It is expected that children who still use bottles obtain most of their calories from milk or juice, which deters them from eating solid foods. I would inquire about how many ounces of milk does he drink a day? Does he drink water? It would be essential to address if he is meeting his developmental milestones. At three years old, he should be able to speak in 3-word sentences 75% of the time, feed himself, brush his teeth, use a cup, spoon, and crayon (Burns et al., 2019).

He should draw a circle, build a tower of 6-8 cubes, ride a tricycle, and throw a ball overhand. These assignments help identify any areas of concern and activate early intervention if needed. The child’s safety would need to be assessed. Does the child sit in a car seat, booster, or wear their seat belt? Is there a gun in the house, and is it kept in a locked area? Is he potty trained or in training? In addition, I would inquire about the child’s sleep and if he exhibits healthy sleeping habits.

psychosocial problems

Does he get the appropriate 10-13 hours a day that a preschooler should be obtaining each day? (Burns et al., 2019) Does he go to sleep at a reasonable hour? Does he wake during the night? I would also ask if there were any concerns with his behavior. Parents are typically to first to identify any medical or psychosocial problems.

Does she have any concerns about the child’s hearing and vision? In addition, I would ask if there has been a change in his routine at home? Does he go to daycare? If so, for how long? A change in family routine can affect the child’s eating habits. I would ask if there has been any recent trauma or trips to the emergency department since the last visit?

These questions are essential to help form a history and physical, diagnosis and treatment plan. The laboratory test I would obtain is the finger stick for hemoglobin and hematocrit. This will help identify if the child has anemia. Anemia is vital to assess in children that are nutrition deficit. This is a common medical condition, especially in children who are not eating adequate amounts of iron. Iron is required to form hemoglobin, allowing red blood cells to carry oxygen to other cells (Mantadakis et al., 2020).

What diagnoses would you give the patient in this case? Include the findings that support the diagnoses.

I would diagnosis this child with iron deficiency anemia (D50.9) because his hemoglobin result was 9.5 g/dL (100 g/L). The typical range is between 6 months old and six years old: 10.5-14 g/dL (105-140 g/L) (Mantadakis et al., 2020). The signs and symptoms include pale skin, weakness, cold intolerance, and dizziness. Furthermore, I would diagnose him with a nutritional deficiency (E63.9) due to his poor diet. Finally, I would diagnose him with eczema (L20.9) due to his persistent rash on the antecubital fossae of the elbow for several weeks.

What is your treatment recommendation and education for the patient and family? Why? Include anticipatory guidance.

The treatment plan would begin with replacing his iron by starting daily iron supplements. It is recommended to continue iron therapy for six months after correcting hemoglobin levels to replenish tissue stores (Mantadakis et al., 2020). If the treatment plan is followed accordingly, the anemia should be remedied within two months. The parents will be educated to stop using the bottle and encourage the child to drink water, and limit juice. This encourages the child to eat more solid food. In addition, the parents will be educated to reduce the amounts of desserts and unhealthy snacks to healthier food selections. To help the child’s eczema the parents will be educated to use topical anti-inflammatory agents for outbreaks (Gür Çetinkaya, & Şahiner, 2019). It will be essential to keep put a daily moisturizer on the child’s skin to prevent outbreaks.

References

Burns, C., Dunn, A., Brady, M., Starr, N., Blosser, C. (2019). Burns’ pediatric primary care (7th       ed.). Saunders. ISBN:9780323581967

Gür Çetinkaya, P., & Şahiner, Ü. M. (2019). Childhood atopic dermatitis: current developments, treatment approaches, and future expectations. Turkish journal of medical sciences, 49(4), 963984. https://doi.org/10.3906/sag-1810-105

Mantadakis, E., Chatzimichael, E., & Zikidou, P. (2020). Iron Deficiency Anemia in Children Residing in High and Low-Income Countries: Risk Factors, Prevention, Diagnosis and Therapy. Mediterranean journal of hematology and infectious diseases, 12(1), e2020041. https://doi.org/10.4084/MJHID.2020.041