Question

1. Marty is a 66-year-old male chef who has been experiencing severe reflux symptoms for the past several weeks that seem to be worsening at night. He had similar symptoms two to three years ago that went away when he stopped drinking alcohol. He claims to remain abstinent, but his symptoms have returned. What additional information should you obtain? What medications should you consider for his symptoms? Discuss your assessment and plan of care including clinical guidelines that support your decision.

Marty is a 66 years old male chef who has been experiencing severe reflux symptoms for the past several weeks that seem to be worsening at night. He had similar symptoms two to three years ago that went away wheb he stopped drinking alcohol. He claims to remain abstinent, but his symptoms have returned.
1. What additional information should you obtain?
2. What medications should you consider for his symptoms?
3. Discuss your assessment and plan of care including clinical guidelines that support your decision.

Answer 1

1 . Additional information that has to be obtained from Marty :

• Diet pattern --- frequency of meal intake, type of diet followed.
• History of smoking or use of tobacco.
• Exercise regimen.
• Eating spicy foods.
• Family history of reflux disease.
• Anxiety levels.
• Stress.

2 . Proton pump inhibitors like prantaprazole, rabeprazole, esomeprazole which reduce the production of hydrochloric acid in the stomach.

Antacids like ranitidine which soothes minor heartburn.

Antidiarrhoeals like loperamide if diarrhoea is persistent.

3. Assessment :

1. Assess for vital signs and BMI.
2. Assess oral cavity for tobacco use.
3. Assess abdomen - for any mass, tenderness .
4. Auscultate for Intestinal sounds.

Plan of care :

• Modify the dietary pattern --- eat small frequent meals rather than heavy single meal.
• Avoid stimulants like coffee , tea.
• Avoid spicy foods.
• Quit smoking if there is a habit.
• Sleep towards the left side.
• Practice yoga and meditation as it helps in relieving stress and anxiety which exacerbates reflux.
• Walking is best exercise.
• Plan for endoscopy to rule out any severe ulcers.
• Start with proton pump inhibitors to relieve the symptoms of heart burn.

All these measures helps to reduce the symptoms of Gastroesophageal reflux disease.

Thank you.