N512 Assignment 3 Disorders of the Digestive System Across the Life Span

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Assignment 3

The purpose of this paper is to address the following clinical scenario with the use of your textbook, external credible literature, and/or reliable electronic sources. Use the guide below to draft your paper and review the rubric to ensure you have met the assignment criteria. The expected length of the paper is approximately 4-5 pages, which does not include the cover page and reference page(s). N512 Assignment 3 Disorders of the Digestive System Across the Life Span

James Alvarez is a 52 y.o., recently divorced, Latino male; new patient who arrives at the community health clinic for an appointment with a primary care Nurse Practitioner. His chief complaint of abdominal pain and vomiting, fatigue, and weight loss. He notes that although he has experienced overall weight loss, his stomach “looks huge.” As his history is taken, he notes no alcohol use. In speaking with him, the Nurse Practitioner notices a yellow tinge to the whites of his eyes. During examination, the Nurse Practitioner notes organomegaly in the right upper quadrant.

Please use the following headings/subheadings as a guide to draft your paper:

Introduction (including purpose statement)
What would be your priority diagnosis for Mr. Alvarez?
Identify the organ and describe the pathophysiological processes, which may have caused the organomegaly.
Develop a comprehensive and holistic plan of care for this patient based on James’ diagnosis.
Conclusion

1. Within your description, place in bold font the key pathophysiological concepts (terms).

1. Include recommendations for follow-up with the Nurse Practitioner.
2. Incorporate a population-based component to Mr. Alvarez’ plan of care.

In regards to APA format, please use the following as a guide:

Include a cover page and running head (this is not part of the 4-5 page limit)
Include transitions in your paper (i.e. headings or subheadings)
Use in-text references throughout the paper
Use double space, 12 point Times New Roman font
Spelling, grammar, and organization are appropriate
Include a reference list (this is not part of the 4-5 page limit)
Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. ANA)

Assignment 3 Rubric – N512 Assignment 3 Disorders of the Digestive System Across the Life Span

Competency	20 Points	12 Points	6 Points	0 Points	Points Earned
Nursing Application and Analysis of Content with Connection to Expert Nurse Level Knowledge Base	Establishes very high level of nursing knowledge application and analysis to assignment that equates to the expert practice nurse knowledge base. N512 Assignment 3 Disorders of the Digestive System Across the Life Span	Briefly describes application to nursing knowledge or that knowledge is not of an expert nurse but more than a novice nurse base knowledge.	Level of nursing knowledge is of a novice nurse with little application or support to expert nurse practice.	Does not include established nursing knowledge base and/or does not apply this to current clinical practice.	/20
Teaching Considerations	Evidence of intentional inclusion of patient and family teaching considerations which is sensitive to diversity, demographics and education level as necessary for the assignment. These are well supported in the literature and demonstrate clear positive impact on compliance with excellent patient outcomes.	Moderate attempt to demonstrate patient and family inclusion in teaching approaches. Some consideration given to sensitive factors which would positively impact patient receptivity and implementation for impact on patient outcomes.	Little demonstration of awareness and inclusion of patient and family sensitive teaching considerations. Impact on outcomes is not clearly addressed but can be inferred.	No attempt to demonstrate sensitive approach to patient and family teaching considerations. Impact on outcomes is not addressed.	/20
Critical thinking	Pathophysiology content and integration with current best practice standards (supported by the scholarly literature) are used to construct critical examination and application of concepts and content.	Connection between pathophysiology knowledge and current best practices is stated but now well supported with scholarly sources and/or weakly used to construct examination and application of concepts and constructs.	Integration of pathophysiology and current best practice standards are anecdotal and not supported by the literature or are outdated based on current best practice standards. Little attempt to apply knowledge in examination and application to concepts and constructs.	No attempt to integrate pathophysiology and current best practice standards in examination and application to constructs and concepts with no support from relevant, scholarly literature.	/20
Scholarly, evidence based, current standards of practice, Sources: 3-5+	Current, relevant and authoritative scholarly sources are used to support content. Demonstrates current, evidence-based standards of practice. Minimum of 3-5+ sources.	Moderate inclusion of current, relevant and authoritative scholarly sources are used to support content. Demonstrates occasional current, evidence-based standards of practice.	Little attempt to include current, relevant and authoritative scholarly sources are used to support content. Or, information is purely anecdotal or not current, evidence-based practice knowledge.	No attempt to use current, relevant and authoritative scholarly sources to support content. Does not demonstrate current, evidence-based standards of practice.	/20
Competency	5 Points	3 Points	1 Point	0 Point	Points Earned
Organization	Organization excellent, ideas clear and arranged logically, transitions smooth, no flaws in logic.	Organization good; ideas usually clear and arranged in acceptable sequence; transitions usually smooth, good support	Organization minimally effective; problems in approach, sequence, support and transitions	Organization does not meet requirements	/5
Grammar	Grammar, punctuation, mechanics, and usage correct and idiomatic, consistent with Standard American English	Grammar, punctuation, mechanics, and usage good mostly consistent with Standard American English; errors do not interfere with meaning or understanding	Grammar, punctuation, mechanics and usage distracting and often interfere with meaning or understanding	Grammar, punctuation, mechanics, and usage interfere with understanding	/5
APA Format	Demonstrates competent use of mechanics and APA	Minimal APA errors	Many APA errors	Complete lack of understanding	/5
References	References are relevant, scholarly, authoritative and contemporary. N512 Assignment 3 Disorders of the Digestive System Across the Life Span	Adequate references	Minimal use of appropriate references	Poor use and/or selection of references not relevant	/5
Total					/100

Discussion 6

Luv Taub, a 32-year-old, married Hmong woman, presents to her primary care Nurse Practitioner complaining of a persistent burning sensation in her chest and upper abdomen. The symptoms are worse at night while she is lying down and after meals. She enjoys many years of cooking and eating “hot and spicy foods” common in her culture. She has tried drinking hot cocoa to help her sleep. She is a smoker and frequently relies on benzodiazepines for insomnia. She notes a sour taste in her mouth every morning. Physical examination is normal.

In this discussion:

Discuss this patient’s likely diagnosis. Why do you support this “likely” diagnosis?
Describe the pathophysiology of this disorder.
Discuss a plan of care for this patient.
What is the anticipated prognosis for this patient? What lifestyle factors might alter her short- and long-term outcomes?

Include citations from the text or the external literature in your discussions. Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

Example Discussion

Esophagitis can develop from variety of factors including infection, allergy response, reflux or be medication induced (Devuni, 2019), L.T. exhibits symptoms of reflux esophagitis. The persistent burning sensation or heartburn in her chest and upper abdomen that worsen after eating or lying down and the sour or acidic taste in her mouth after waking in the morning are typical manifestations of reflux esophagitis (Mills & Ciorba, 2019). Her lifestyle habits of smoking and ingestion of spicy foods and chocolate increase her risk of developing reflux esophagitis as well (Devuni, 2020). Her nightly medication may also be a contributing factor to the development of her esophagitis as some types of benzodiazepines can decrease lower esophageal sphincter tone (Mills & Ciorba, 2019) N512 Assignment 3 Disorders of the Digestive System Across the Life Span.

Reflux esophagitis is the destruction of mucosal lining of the esophagus, starting at the lower esophageal sphincter (Mills & Ciorba, 2019). The injury results from gastric contents backing up into the esophagus resulting in gastrin, pepsin and bile irritating the unprotected mucosal layer (Mills & Ciorba, 2019). Mills & Ciorba (2019) describe how the lower esophageal sphincter also plays a role in esophagitis development as decreased tone will allow stomach contents to regurgitate up into the esophagus damaging the epithelium.

A plan of care for L.T. would involve the health-care provider (HCP) confirming the diagnosis of reflux esophagitis by symptoms and physical assessment as diagnostic imaging is typically only indicated in severe cases where bleeding or hemodynamic instability is present and laboratory markers are inconclusive (Devuni, 2020). In L.T.’s case, because she is clinically stable, the HCP would likely start with a prescription for a proton pump inhibitor and/or a histamine-2 receptor agonist for a two week trial period and providing education on lifestyle changes including dietary changes, smoking cessation, and sleeping habit modifications (Devuni, 2020).

L.T. should anticipate good outcomes in terms of prognosis if she follows recommendations and takes her medication as prescribed, however, her lifestyle factors will have the greatest effect on her prospective outcomes. Devuni (2020) expresses how avoiding spicy foods, having multiple small meals, avoiding chocolate, quitting smoking, and not eating for several hours before bed help reduce instances of reflux. However, changing L.T.’s cultural cooking and eating habits, may be met with resistance especially if there are multiple people to feed. Sleeping with the head of the bed elevated may also help alleviate symptoms. Devuni (2020) recommend this is done with blocks, not pillows as this will increase abdominal pressure, negating the benefits of having the head elevated. This may also not be possible or easily done since she probably shares a bed with her husband, and neither may like to sleep with the head of the bed elevated. If she chooses to only take her medication and not change her lifestyle factors, it is expected she will be on medication long-term as the mucosal lining may never fully recover (Devuni, 2020).

References

Devuni, D. (28 May 2020). Esophagitis. Retrieved 17 August 2020 from https://emedicine.medscape.com/article/174223-overview#showall

Mills, J.C. & Ciorba, M.A. (2019). Gastrointestinal disease. In McPhee, S. J., & Hammer, G. D. (Eds.), Pathophysiology of disease: An introduction to clinical medicine (8th ed. pp.507-569). McGraw-Hill Education LLC. N512 Assignment 3 Disorders of the Digestive System Across the Life Span