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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Differentiate between typical, atypical, and complicated symptoms of GERD

  • Recommend appropriate lifestyle modifications and pharmacotherapy interventions for patients with GERD

  • Formulate a monitoring plan to assess the effectiveness and safety of pharmacotherapy for GERD

  • Educate patients on appropriate lifestyle modifications and drug therapy issues, including adherence, adverse effects, and drug interactions

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PATIENT PRESENTATION

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Chief Complaint

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"I have burning in my chest when I am in my recliner after supper watching the evening news."

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History of Present Illness

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Gertie Burns is a 67-year-old woman who presents to her primary care provider complaining of burning sensation in chest every morning before breakfast and evening after supper. She has also noticed persistent cough and hoarseness develop in the last 2 years. She has had similar symptoms in the distant past but did not pay close attention while busy working multiple shifts as a registered nurse (RN). The burning pain had improved with weight loss, resulting from diet and exercise, when Gertie was in her fifties. However, after retirement, she gained her weight back with her new sedentary lifestyle and diet consisting of deep-fried Cajun meals. She has been self-treating her symptoms with Tums and drinking more milk to relieve the burning. The Tums has been working some but not to her satisfaction. She eats dinner around 5:30 pm, so it can be finished by the time the news comes on every evening at 6 pm. She is inquiring if she should purchase Tagamet since she saw a commercial on television about it treating stomach acid.

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Past Medical History

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HTN × 16 years

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Osteoarthritis × 9 years

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Osteoporosis × 3 months

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Onychomycosis of the left big toe × 4 weeks

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Impaired renal function

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Constipation

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Seasonal allergies

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Family History

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Father had stroke and died at age 74. Mother died of cancer at age 83. Patient has one sister who is 71 and has osteoporosis.

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Social History

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GB is an African American woman originally from Louisiana. She is married and lives with her husband of 47 years who is a smoker (smoked 1 ppd × 40 years). She and her husband have three daughters, aged 47, 45, and 40. She is a retired RN and works as a volunteer at a local hospital.

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Tobacco/Alcohol/Substance Use

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Social drinker; (−) tobacco or illicit drug use

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Allergies/Intolerances/Adverse Drug Events

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NKDA

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Medications (Current)

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MOM 30 mL PO q 24 h PRN constipation

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Alendronate 70 mg PO weekly

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Nifedipine XL 30 mg PO q 24 h

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