Intermittent Nocturnal Gastroesophageal Reflux Essay

1) Lesson 5

Complaint: “My heartburn has been waking me up at night.”

A 47-year-old male patient presents to the clinic with complaints of intermittent nocturnal gastroesophageal reflux. History reveals that he awakens experiencing burning pain substernally and in the back of his throat. This results in “my larynx closing down” and his being “almost unable to breathe.” As soon as he can breathe effectively, he swallows “a lot” of antacid and flushes it down with water. The entire episode is very frightening, and he is often afraid to go back to sleep. Because he already has a problem with mild sleep apnea, he is becoming increasingly tired and unable to function at work due to lack of sleep. He now sleeps only in his recliner. Intermittent Nocturnal Gastroesophageal Reflux Essay He is also concerned about the substernal pain because his father had a myocardial infarction at age 49 and required coronary artery bypass surgery. He is 5 feet 9 inches tall and weighs 220 pounds (body mass index [BMI] is 32.5), with much of his excess weight carried in his abdomen. He is not a smoker, “occasionally” has three or four beers with friends, and “often” has pizza or submarine sandwiches for lunch with a “diet cola.” He takes no drugs other than the antacid after a reflux episode. Assessment A chest x-ray and electrocardiogram are negative for cardiopulmonary disease, and Greg is diagnosed by history with gastroesophageal reflux disease (GERD). Intermittent Nocturnal Gastroesophageal Reflux Essay

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What would be the initial management plan for GERD?
What education does the patient need?

2)Lesson 6: DiscussionContains unread posts
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Case Study Intermittent Nocturnal Gastroesophageal Reflux Essay

A graduate student has noticed that despite numerous unhealthy snacks weekly as a method to cope with their studies, they are losing weight. They attributed the faster pulse and “jitters” to the cups of coffee, several Red Bull drinks, and No Doz pills used to pull all-nighter study sessions. At first, they thought any nervousness was anxiety about school, but they present today believing “the stress” of school is so high they have trouble sleeping, cannot sit still, and is having problems concentrating. They have a sore throat that is different from a typical one because it appears to hurt only on the anterior aspect of the neck, not deep in the posterior mouth. Intermittent Nocturnal Gastroesophageal Reflux Essay

Which thyroid disorder(s) comes to mind?
What labs/imaging need to be ordered?
What medication alternatives need to be considered when you discover that they are 3 months pregnant?
What other differential diagnoses come to mind? Intermittent Nocturnal Gastroesophageal Reflux Essay