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 Part 1

• 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 constructing 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 the 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.
• 3 to 4 references within 5 years

Respond one of your colleagues’ posts by offering a possible resolution to their  questions/concerns with supporting documentation.

at least 2 references in each peer responses! 

Nursing boards were created to establish guidelines for the scope of nursing practice. Each state has established its own board; thus regulations can vary by state. Advanced practice registered nurses must be familiar with their own state board’s regulations as it pertains to their practice, and advocate for the expansion of the nurse practitioner’s ability to practice and provide best care. 

Regulation 1

A main topic of conversation among nursing boards is the ability of advanced practice registered nurses (APRN’s) to practice independently of a collaborating physician. As discussed by Bosse et al., (2017), the ability of APRN’s to practice independently would help fill the gap in access to care associated with physician shortages and remote locations. Greater access to care has the potential to improve outcomes and reduce healthcare costs and complications. Currently, Missouri and Illinois both require APRN’s to maintain a collaborative practice agreement with a physician within a certain geographic range (Nurse Practice Act, 2018; Nursing & Collaborative Practice, 1996). The National Council of State Boards of Nursing (NCSBN) encourages APRN’s to advocate for independent practice in their states (Bosse et al., 2017). 

Regulation 2 

As technology plays an increasingly central role in the provision of healthcare, the use of technology must be addressed by regulatory boards. Telehealth is another solution to improving access to healthcare, especially in rural areas. Missouri permits APRN’s to practice virtually if the care is being provided to patients in remote areas (Utilization of telehealth, 2014). Illinois permits APRN’s to treat residents of the state via telehealth without geographical stipulations (Telehealth Act, 2018). 

Conclusion

As nurse practitioners, we can adhere to these regulations while also advocating for the advancement of the advanced practice registered nurse’s role in healthcare. Another opportunity for advocacy lies in the use of telehealth to improve access to care in rural areas. By providing exceptional care and demonstrating the knowledge and skills needed to practice independently, we can emulate the need to expand the scope of practice for nurse practitioners.