Jamie is a 3-month-old female who presents with her mother for evaluation of “throwing up.” Mom reports that Jamie has been throwing up pretty much all the time since she was born. Jamie does not seem to be sick. In fact, she drinks her formula vigorously and often acts hungry. Jamie has normal soft brown bowel movements every day and, overall, seems like a happy and contented baby. She smiles readily and does not cry often. Other than the fact that she often throws up after drinking a bottle, she seems to be a very healthy, happy infant. A more precise history suggests that Jamie does not exactly throw up—she does not heave or act unwell—but rather it just seems that almost every time she drinks a bottle she regurgitates a milky substance. Mom thought that she might be allergic to her formula and switched her to a hypoallergenic formula. It didn’t appear to help at all, and now Mom is very concerned.

Cases like these are not uncommon. The mother was concerned and thinking her daughter may have an allergy; she changed to a different formula. However, sometimes babies have immature GI tracts that can lead to physiology reflux as they adapt to normal life outside the uterus. Parents often do not consider this possibility, prompting them to change formulas rather than seeking medical care. As in the case study above, GI alterations can often be difficult to identify because many cause similar symptoms. This same issue also arises with adults—adults may present with symptoms that have various potential causes. When evaluating patients, it is important for the advanced practice nurse to know the types of questions he or she needs to ask to obtain the appropriate information for diagnosis. For this reason, you must have an understanding of common GI disorders such as gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis.

To Prepare

• Review this week’s media presentation on the gastrointestinal system.
• Review Chapter 35 in the Huether and McCance text. Identify the normal pathophysiology of gastric acid stimulation and production.
• Review Chapter 37 in the Huether and McCance text. Consider the pathophysiology of gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and gastritis. Think about how these disorders are similar and different.
• Select a patient factor different from the one you selected in this week’s Discussion: genetics, gender, ethnicity, age, or behavior. Consider how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Reflect on how you would diagnose and prescribe treatment of these disorders for a patient based on this factor.
• Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in the Week 2 Learning Resources. Use the examples in the media as a guide to construct a mind map for gastritis. Consider the epidemiology and clinical presentation of gastritis.

To Complete

Write a 2- to 3-page paper that addresses the following:

• Describe the normal pathophysiology of gastric acid stimulation and production. Explain the changes that occur to gastric acid stimulation and production with GERD, PUD, and gastritis disorders.
• Explain how the factor you selected might impact the pathophysiology of GERD, PUD, and gastritis. Describe how you would diagnose and prescribe treatment of these disorders for a patient based on the factor you selected.
• Construct a mind map for gastritis. Include the epidemiology, pathophysiology, and clinical presentation, as well as the diagnosis and treatment you explained in your paper.

Rubric:

Quality of Work Submitted:
The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking.–Levels of Achievement:Excellent 27 (27%) – 30 (30%)
Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics.
Good 24 (24%) – 26 (26%)
Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics.
Fair 21 (21%) – 23 (23%)
Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed.
Poor 0 (0%) – 20 (20%)
Assignment superficially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed.Feedback:

Quality of Work Submitted:
The purpose of the paper is clear.–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
A clear and comprehensive purpose statement is provided which delineates all required criteria.
Good 4 (4%) – 4 (4%)
Purpose of the assignment is stated, yet is brief and not descriptive.
Fair 3.5 (3.5%) – 3.5 (3.5%)
Purpose of the assignment is vague or off topic.
Poor 0 (0%) – 3 (3%)
No purpose statement was provided.Feedback:

Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student’s ability to:

Understand and interpret the assignment’s key concepts.–Levels of Achievement:Excellent 9 (9%) – 10 (10%)
Demonstrates the ability to critically appraise and intellectually explore key concepts.
Good 8 (8%) – 8 (8%)
Demonstrates a clear understanding of key concepts.
Fair 7 (7%) – 7 (7%)
Shows some degree of understanding of key concepts.
Poor 0 (0%) – 6 (6%)
Shows a lack of understanding of key concepts, deviates from topics.Feedback:

Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student’s ability to:

Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources.–Levels of Achievement:Excellent 18 (18%) – 20 (20%)
Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 2-3 course resources to suppport point of view.
Good 16 (16%) – 17 (17%)
Integrates specific information from 1 credible outside resource and 2-3 course resources to support major points and point of view.
Fair 14 (14%) – 15 (15%)
Minimally includes and integrates specific information from 2-3 resources to support major points and point of view.
Poor 0 (0%) – 13 (13%)
Includes and integrates specific information from 0 to 1 resoruce to support major points and point of view.Feedback:

Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student’s ability to:

Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings,  textbook) and outside, credible resources by comparing different points of view and highlighting similarities, differences, and connections.–Levels of Achievement:Excellent 18 (18%) – 20 (20%)
Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice.
Good 16 (16%) – 17 (17%)
Summarizes information gleaned from sources to support major points, but does not synthesize.
Fair 14 (14%) – 15 (15%)
Identifies but does not interpret or apply concepts, and/or strategies correctly; ideas unclear and/or underdeveloped.
Poor 0 (0%) – 13 (13%)
Rarely or does not interpret, apply, and synthesize concepts, and/or strategies.Feedback:

Written Expression and Formatting

Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused–neither long and rambling nor short and lacking substance.–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity
Good 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 80% of the time.
Fair 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity 60%- 79% of the time.
Poor 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity < 60% of the time.Feedback:

Written Expression and Formatting

English writing standards: Correct grammar, mechanics, and proper punctuation–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
Good 4 (4%) – 4 (4%)
Contains a few (1-2) grammar, spelling, and punctuation errors.
Fair 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3-4) grammar, spelling, and punctuation errors.
Poor 0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.Feedback:

Written Expression and Formatting

The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.–Levels of Achievement:Excellent 5 (5%) – 5 (5%)
Uses correct APA format with no errors.
Good 4 (4%) – 4 (4%)
Contains a few (1-2) APA format errors.
Fair 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3-4) APA format errors.
Poor 0 (0%) – 3 (3%)