Discussion #2

Charlie Berger, a 58-year-old obese man, comes to a nurse practitioner because he has difficulty swallowing, heartburn, and occasional regurgitation. Answering his nurse practitioner’s questions, Mr. Berger says that his symptoms worsen when he drinks coffee or alcohol.

Endoscopy reveals inflammation in his lower esophagus and poor closure of the lower esophageal sphincter. There is no evidence of esophageal narrowing or movement of the proximal stomach into the thorax.

The nurse practitioner diagnoses gastroesophageal reflux disease (GERD) and tells Mr. Berger to do the following:

• Take proton-pump inhibitor drugs to reduce gastric acid.
• Elevate the head of his bed.
• Avoid eating large meals, especially near bedtime.
• Enter a weight-loss program.
• Reduce his use of caffeine and alcohol.

Answer the following questions about Mr. Berger and gastroesophageal reflux disease.

1. Why did his nurse practitioner tell Mr. Berger to elevate the head of his bed?

2. Why did his nurse practitioner suggest that Mr. Berger avoid eating large meals, especially near bedtime? 

3. Why did his nurse practitioner check to see if Mr. Berger had movement of the proximal stomach into the thorax?

4. Are Mr. Berger’s symptoms of dysphagia, heartburn, and regurgitation specific to GERD?

5. In addition to discomfort, what is a danger of untreated GERD?

6. What is the mechanism by which obesity contributes to GERD?

Use APA 6th Edition Format and support your work with at least 3 peer-reviewed references within 5 years of publication. All paragraphs need to be cited properly. All responses must be in a narrative (paragraph) format. Be sure to include references based on APA guidelines. 

For this discussion, you are not required to respond to your peers. Responses must be supported by peer-reviewed references, and in APA 6th ed format.

Reading Reflection Chapters 26 & 27

Reading and objective reflection, in one to two paragraphs, reflect on the objectives and what you have learned from your readings. How do you anticipate the use of research?

250 words , APA format . 

Chapter 26: Patient safety and quality research

What are the reasons for quality and research initiatives? As per Tappen (2015) states, there is not much imagination required to understand the reason for these research initiatives. Patient safety and improvement can lend itself to many concepts. Drug improvement, practice initiatives, mitigation of practice errors, and the list continues. Two immediate concepts that come to mind are safety as well as infection control. In conducting these studies, we must remember that we are responsible for safeguarding the well-being of our patients in the study.

The formulation of a design is not always easy, there are considerations that must be accounted for you. As per Tappen (2015), one issue is design formulation where one must look at defining the content, looking for an occurrence in existing records, the sequence of events, population comparison, baseline adherence rates, complex interventions, encompassing a complex system transformation, and complex data analysis. To add the list of requirements it is imperative to consider ethical considerations. Page 496 of your text highlights the guidelines for publishing safety and quality study results.

Article/Website Link:

Patient Safety and Quality Improvement

https://www.ahrq.gov/patient-safety/index.html

Medication Reconciliation

https://www.ncbi.nlm.nih.gov/books/NBK2648/

Chapter 27: Developing a program of research

Tappen (2015) states that this concept is a series of studies that are aimed at filling a knowledge gap in research. This is an area where there are insufficient studies to address an issue encountered. Additionally, this could also be viewed as purposeful construction of new knowledge to address a problem where scientific knowledge is lacking. One example is when a new disease surface. There is value in construction of new research, the methodology for its implementation involves a process, if you refer to page 501 of your course text and see how this development evolves or unfolds.

Article Link:

Basic Steps to Building a Research Program

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805347/

Developing a Program of Research in Nursing

http://lghttp.48653.nexcesscdn.net/80223CF/springer-static/media/samplechapters/9780826123251/9780826123251_chapter.pdf