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Discussion #2
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 practitioneràquestions, 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:
•
•
”ake 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?
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4. Are Mr. Bergeràsymptoms 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?
Use APA 6th Edition Format and support your work
with at least 3 peer-reviewed references within 5 years
of publication. All paragraphs need to be cited
properly. All responses must be in a narrative
(paragraph) format. Be sure to include references
based on APA guidelines.
For this discussion, you are not required to respond to
your peers. Responses must be supported by peerreviewed references, and in APA 6th ed format.

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