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?

7 edition of APA format. 3 pargraphs. Please see references below. 2 references are needed. scholar authors only.

Post a description of the role of the staff nurse for promoting quality in a high-performing health care organization. Define the organizational culture of your health care organization, or one with which you are familiar, and identify the leadership style of the CEO and CNO in your organization. Explain how your senior leadership supports—or does not support—changes that require financing/budget to support patient safety. Describe the strategies you might be able to implement to move your health care organization to a high-performing organization.

References

Spath, P. (2018). Introduction to healthcare quality management (3rd ed.). Chicago, IL: Health Administration Press.
Chapter 10, “Managing the Use of Healthcare Resources” (pp. 249-280)
 

Yoder-Wise, P. S. (2019). Leading and managing in nursing (7th ed.). St. Louis, MO: Mosby.
Chapter 1, “Leading, Managing, and Following” (pp. 1-18)
Chapter 5, “Gaining Personal Insight: The Beginning of Being a Leader” (pp. 76-87)
Chapter 20, “Managing Costs and Budgets” (pp. 357-375)
 

U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2016). Surveys on patient safety culture. Retrieved from http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/index.html

Bashaw, E. S., & Lounsbury, K. (2012). Forging a new culture: Blending Magnet principles with just culture. Nursing Management, 43(10), 49–53. doi:10.1097/01.NUMA.0000419492.49675.25