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Gastroesophageal reflux disease (GERD).

Scenario 1: Peptic Ulcer
A 65-year-old female comes to the clinic with a complaint of abdominal pain in the epigastric area. The pain has been persistent for two weeks. The pain described as burning, non-radiating and worse after meals. Denies N&V, weight loss or obvious bleeding. She admits to frequent belching with bloating.
PMH: seasonal allergies with Chronic Sinusitis, positive for osteoarthritis,
Meds: Claritin 10 mg po daily, ibuprofen 400-600 mg po prn pain
Family Hx-non contributary
Social history: Separated recently pending divorce; stressful situation with trying to manage two homes. Works as a Legal Assistant at a local law firm. She has 35 PPY of smoking, drinks 1-2 glasses of wine a day, and 6-7 cups of coffee per day. She denies illicit drug use, vaping or unprotected sexual encounters.
Breath test in the office revealed + urease.
The healthcare provider suspects the client has peptic ulcer disease.

  1. Explain what contributed to the development from this patient’s history of PUD?
  2. What is the pathophysiology of PUD/ formation of peptic ulcers?

Scenario 2: Gastroesophageal Reflux Disease (GERD)
A 44-year-old morbidly obese female comes to the clinic complaining of “burning in my chest and a funny taste in my mouth”. The symptoms have been present for years but patient states she had been treating the symptoms with antacid tablets which helped until the last 4 or 5 weeks. She never saw a healthcare provider for that. She says the symptoms get worse at night when she is lying down and has had to sleep with 2 pillows. She says she has started coughing at night which has been interfering with her sleep. She denies palpitations, shortness of breath, or nausea.
PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid obesity (BMI 48 kg/m2)
FH:non contributary
Medications: Lisinopril 10 mg po qd, Bentyl 10 mg po, ibuprofen 800 mg po q 6 hr prn
SH: 20 PPY of smoking, ETOH rarely, denies vaping
Diagnoses: Gastroesophageal reflux disease (GERD).

  1. If the client asks what causes GERD how would you explain this as a provider?

Scenario 3: Upper GI Bleed
A 64-year-old male presents the clinic with complaints of passing dark, tarry, stools. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some mid epigastric pain for several weeks and has been taking OTC antacids. The most likely diagnosis is upper GI bleed which won’t be confirmed until further endoscopic procedures are performed.

  1. What are the variables here that contribute to an upper GI bleed?

Scenario 4: Diverticulitis
A 54-year-old schoolteacher is seeing your today for complaints of passing bright red blood when she had a bowel movement this morning. She stated the first episode occurred last week. The episode today was accompanied by nausea, sweating, and weakness. She states she has had some LLQ pain for several weeks but described it as “coming and going”. She says she has had a fever and abdominal cramps that have worsened this morning.
Diagnosis is lower GI bleed secondary to diverticulitis.

  1. What can cause diverticulitis in the lower GI tract?

Sample Solution

vey and can incite related topics with a broader perspective. Finally, the most important objectives are to base the business decisions on unbiased information and compare results for providing a well-based conclusion for your target survey population. One of the most common real life examples is that governments make considerable use of surveys to get informed of the conditions of their populations in terms of employment and unemployment, income and expenditure, housing conditions, education, nutrition, health, travel patterns, and many other subjects. They also conduct surveys of organisations such as manufacturers, retail outlets, farms, schools, and hospitals. Local governments equally make use of surveys for local planning purposes. Generally, surveys are also used in many other sciences such as sociology, political science, education and public health, [see 3, Kalton 1983] This report will include a description of statistical techniques that are associated with a survey sampling, typical outputs generated by each of them and some explanations on how to interpret those outputs. Last but not least, some real life examples will be addressed and a critical evaluation of the topic will be analysed. How to select a good sample size To begin with, there are several ways to choose a sample size. First of all, it should be bore in mind that the experience of the conductor plays a major role in the determination of a sample size when there are items readily available or convenient to collect. However, there are more scientific ways to estimate a sample size. For instance, the experimenter could use a target for the power of the statistical test to be applied once the same is collected or he/she could use a confidence level which determines how accurate a result will turn out with lower chances of error. The requirement of a good sample is that the estimation should be based on these scientific forms and the means. One of those ways is using the standard error of the sample mean, that achievement with the corresponding formula: σ/√n , where n is the sample size and the σ2 the corresponding variance In addition to this, we express the 95% of the confidence interval with the form: (x̅-2σ/√n, x̅+2σ/√n), where x̅ is the sample mean with a Normal Distribution and defined using the Central Limit Theorem. Therefore, if we wish to have a confidence interval that is W units in width, we should calculate: n = 16σ2/W2. This means that the smaller in range we need the interval to be then the bigger the size of the sample. For exam

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