Esophageal Reflux Case Studies A 45-year-old woman complained of heartburn and frequent regurgitation of “sour” material into her mouth. Often while sleeping, she would be awakened by a severe cough. The results of her physical examination were negative. Studies Results Routine laboratory studies Negative Barium swallow (BS), p. 941 Hiatal hernia Esophageal function studies (EFS), p. 624 Lower esophageal sphincter (LES) pressure 4 mm Hg (normal: 10–20 mm Hg) Acid reflux Positive in all positions (normal: negative) Acid clearing Cleared to pH 5 after 20 swallows (normal: <10 swallows) Swallowing waves Normal amplitude and normal progression Bernstein test Positive for pain (normal: negative) Esophagogastroduodenoscopy (EGD), p. 547 Reddened, hyperemic, esophageal mucosa Gastric scan, p. 743 Reflux of gastric contents to the lungs Swallowing function, p. 1014 No aspiration during swallowing Diagnostic Analysis The barium swallow indicated a hiatal hernia. Although many patients with a hiatal hernia have no reflux, this patient’s symptoms of reflux necessitated esophageal function studies. She was found to have a hypotensive LES pressure along with severe acid reflux into her esophagus. The abnormal acid clearing and the positive Bernstein test result indicated esophagitis caused by severe reflux. The esophagitis was directly visualized during esophagoscopy. Her coughing and shortness of breath at night were caused by aspiration of gastric contents while sleeping. This was demonstrated by the gastric nuclear scan. When awake, she did not aspirate, as evident during the swallowing function study. The patient was prescribed esomeprazole (Nexium). She was told to avoid the use of tobacco and caffeine. Her diet was limited to small, frequent, bland feedings. She was instructed to sleep with the head of her bed elevated at night. Because she had only minimal relief of her symptoms after 6 weeks of medical management, she underwent a laparoscopic surgical antireflux procedure. She had no further symptoms. Critical Thinking Questions 1. Why would the patient be instructed to avoid tobacco and caffeine? 2. Why did the physician recommend 6 weeks of medical management? Case Studies Copyright © 2018 by Elsevier Inc. All rights reserved. 2 3. How do antacid medication work in patients with gastroesophageal reflux? 4. What would you approach the situation, if your patient decided not to take the medication and asked you for an alternative medicine approach? 

 Week 1 Learning Exercise Analysis: Ethical Issues/Legal and Legislative IssuesSolve one of the following Learning Exercises from Huston’s Leadership Roles and Management Functions in Nursing, 11th edition.

• Learning Exercise 4.2 (page 85)
• Learning Exercise 4.7 (page 96)
• Learning Exercise 4.10 (page 98)
• Learning Exercise 5.2 (page 109)
• Learning Exercise 5.8 (page 126)
• Learning Exercise 5.9 (pages 126-127)

Screening is the administration of measures or tests to distinguish individuals who may have a condition from those who probably do not have it. Discuss the advantages and disadvantages of screening.

Post your disucssion with a minimun of 500 words. Using an APA 7 format for in text citations and references which needs to be less than 5 years old and you will need to use at least 2-3 references

 Last week you provided an overview of each nurse theorist/and or nursing theory that you have chosen.
This week, please expand upon your initial post by describing a situation from your experiences in nursing in which you would apply your particular nursing theories.
To be clear, you will describe a situation in detail and then apply each of your nursing theory(ies) to that situation separately.
Be sure to pick and example that clearly illustrates the strength of each nursing theory in application to either nursing practice, nursing research, nursing education, or nursing administration.
Describe why the classification of each theory is appropriate for the situation you have described.
Compare and contrast the the usefulness of each of your theories to this particular situation.

Be sure to use appropriate APA citation and when responding to your peers, begin with addressing them personally and end your response posting with your name.
Guidelines for Weekly Discussion Postings/ Discussion Participation: The online discussions will provide opportunities to explore different topics, share what you are learning with your classmates, and gain clarity about the course content. Your discussion responses should demonstrate critical thinking skills and your responses should be thoughtful and promote respectful discourse with the other students in the class. The rules of common courtesy are to be followed (e.g., one voice speaks at a time, polite debate occurs, and all opinions are honored). In order for an online discussion assignment to be considered complete, the student must effectively and adequately cover the assigned topic, reference the course text and other sources with appropriate APA citations, meet the 400 word minimum, the responses to classmates must be developed in a manner that furthers the conversation and learning, the spelling, grammar, and writing must be appropriate, and the online discussion assignment must be submitted on time. Interactions should be thorough, thoughtful and facilitate the learning community’s growth. Discussions will be reviewed on a weekly basis. Contribution toward the course grade total will be based on the pattern of demonstrating these characteristics. Please remember, initial posts should be submitted by deadline.