#1: A 9-year-old boy is helped to the nurse’s office at school because he is having difficulty breathing after playing outside on a windy, dusty day.  The nurse is aware the child has asthma and he has an inhaler for him.

A.  How should the nurse respond?

B.  The child used his inhaler per the prescription; however, the child’s condition is not improving.  How should you as the nurse proceed?

C.  What are you expected outcomes?

#2: A mother has come to urgent care with her 8 year old daughter because of a rash and swollen joints.  When asked about past illnesses, the mother relates that the daughter recently had a cold and sore throat but they went away.  She never took her daughter to the doctor, just kept her in bed a couple days with a fever and had her gargle with warm salt water.  Mom states to you, the nurse, “all the kids are sharing and no need to run to the doctor .  It will go away eventually.”

A.  What are some immediate concerns?

B.  What assessment should the nurse do or prepare the patient for?

C.  What potential treatment should the nurse prepare the mother and child for if it is rheumatic fever?

#3:  A6 year old child is brought to the emergency department by her parents in respiratory distress.  The parents state this started right after eating sandwiches.  They say this has never happened before.  When asked what she ate, the mom says “PBJ on whole wheat bread, celery and carrot sticks, and chocolate milk”  The physician is suspecting a peanut allergy.

A.  The mother states to you, the nurse, that she is very concerned because this has not happened before and the child eats peanut butter all the time.  How should you respond?

B.  Identify some ways to determining if there is allergy to peanuts.

C.  What are some nursing diagnoses that would be appropriate in this situation?

#4  A 15 year old girl complains of cold sores and wants antibiotics to clear them up.  The mother brought her into the clinic to get antibiotics.

A.  How should you, as the nurse, respond?

B.  What nursing care can you implement to assist this child?

#5 .  A 17 year old mother brought her 9 month old infant son in for a health maintenance check up.  You note the baby appears a little pale, capillary refill is greater than 5 seconds, and his conjunctiva are pale.  You ask Mom how the baby is eating and what she is feeing him.

A.  What are you trying to ascertain, in other words, what are some of the medical diagnosis that come to mind?

B.  What nursing care should you implement?

C.  What are some of your outcomes?

 

Gastroesophageal Reflux Disease and Peptic Ulcer Disease

Janet Pedrosa

Florida National University

Professor: Dr. Vardah Seraphin DNP, PMHNP-BC, FNP-C, APRN

July 7, 2021

 

 

Gastroesophageal Reflux Disease and Peptic Ulcer Disease

A peptic ulcer is a chronic condition affecting at least 10 percent of the American population. The digestive tract’s acid-induced lesion in the stomach. Or proximal duodenum is illustrated by denuded mucosa with the defect extending into the submucosa or muscularis propria. Thus, the term peptic ulcer describes stomach ulcerations. Usually, patients describe the main symptom as epigastric pain in the form of aching. Burning, or gnawing, manifesting for a few weeks before disappearing only to persist a few weeks later.

Specific Goals of Treatment for J.G.

Kuna et al. (2019) identify the following goals of peptic ulcer disease treatment: relieve symptoms, reduce the frequency. And duration of reflux, prevent a recurrence, and heal tissue injury. Comparably, Malfertheiner and Schulz (2020) identify therapy goals as relieving symptoms, promoting healing of the ulcer, eradicating Helicobacter pylori (H. pylori) (if present), preventing recurrences, and preventing complications. Accordingly, the treatment goals for the patient will be relieving symptoms preventing recurrences, frequencies, duration, and complications, promoting healing of tissue injury, and eradicating H. pylori if present.

Drug Therapy

Kuna et al. (2019) explain that the conventional antiulcer treatment options include the following proton pump inhibitors (PPIs), H2 receptor blockers, antacids, potassium competitive acid blockers, and cytoprotective agents. If H. pylori is present, Kuna et al. (2019) state that standard triple therapy in the form of PPI and two antibiotics should act as first-line treatment. Second-line treatment, bismuth-containing quadruple therapy, non-bismuth-based concomitant therapy, and Levofloxacin triple therapy are used. The salvage regimen is rifabutin-based triple therapy. In this case, treatment will first require identifying the cause of the condition. Then, treatment will involve a 7 to 14-day course of two antibiotics and one proton pump inhibitor (PPI + two antibiotics (clarithromycin + metronidazole), which have an efficiency of between 70 and 85 percent.

Patient Education

Patient education will cover the following. First, nutrition. Regardless of the ulcer cause. Smoking triggers ulcer disease hence the need for a smoking cessation. The patient will be guided on implementing dietary changes, such as eating small, more frequent meals to facilitate optimal energy requirements and healing; avoid any seasonings deemed intolerable or aggravating the condition; avoid stomach overdistention; and avoid beverages, such as coffee, colas, teas, alcoholic beverages (including beer), carbonated beverages, citric juices, peppermint, and spearmint, which can lead to discomfort. The patient will be advised against late-night meals or snacks that may trigger increased gastric secretions.

Also, the patient will be advised to avoid foods that aggravate the condition and eliminate them from the diet. The patient must drink small fluid amounts with the meal and drink regularly between meals. Second, pain and discomfort. The patient will be advised to maintain a written record of the onset, duration, location, and precipitating factors for pain (Kuna et al., 2019). It will be necessary for the patient to always sit upright during meals and avoid lying down for at least 2 hours after eating.

Adverse Reactions for Selected Agent

The adverse reaction that may lead to therapy change is an aggressive gastrointestinal disturbance, including abdominal discomfort, diarrhea, vomiting, and nausea (Malfertheiner & Schulz, 2020). Others include persistent headache, glossitis, stomatitis, and smell and taste disturbances.

Second-Line Therapy

In patients allergic to penicillin, Song and Zhou (2019) recommend the most effective second-line therapy, including levofloxacin-based triple therapy or rifabutin-based triple or quadruple treatment, which excludes amoxicillin. In this case, the second-line therapy for the patient will be bismuth-containing quadruple therapy. This therapy will entail PPI, bismuth salt, tetracycline, and metronidazole for 14 days (Kuna et al. 2019).

Lifestyle changes

Lifestyle changes for the patient will include cessation of smoking, abstaining from caffeinated beverages and alcohol, as well as avoiding intake of many nonsteroidal anti-inflammatory drugs (NSAIDs).

 

 

References

Kuna, L., Jakab, J., Smolic, R., Raguz-Lucic, N., Vcev, A., & Smolic, M. (2019). Peptic ulcer disease: A brief review of conventional therapy and herbal treatment options. Journal of Clinical Medicine, 8(2), 179. doi:10.3390/jcm8020179

Malfertheiner, P., & Schulz, C. (2020). Peptic ulcer: Chapter closed? Digestive Diseases, 38(2), 112-116. Doi:10.1159/000505367

Song, Z., Fu, W., & Zhou, L. (2019). Cefuroxime, levofloxacin, esomeprazole, and bismuth as first-line therapy for eradicating Helicobacter pylori in patients allergic to penicillin. BMC Gastroenterology, 19(132), 1-9. 132 https://doi.org/10.1186/s12876-    019-1056-3