Nurse Patient Diagnosis. PICOT Question
A 57-year-old female presents for follow-up. She weighs 233 pounds. She has a history of hypertension,
hyperlipidemia, and osteoarthritis. She has been experiencing reflux-type symptoms frequently for the
past 4 weeks. She has used over-the-counter antacids, which have been quite effective in alleviating her
Upon review of her history, it is noted that she has a family history of osteoporosis, with 2 first-degree
female relatives suffering vertebral fractures by the age of 65. She was seen in the office about 3 weeks
ago with an apparent sinus infection, for which she was prescribed a cephalosporin. Further questioning
of the patient reveals no weight loss, dysphagia, odynophagia, or other alarm symptoms.
Physical examination is within normal limits. The patient’s blood pressure is noted to be well controlled,
and results of her most recent blood chemistries demonstrate normal blood sugar, renal function, and
The patient expresses frustration regarding her frequent reflux and requests a prescription for “the
purple pill”. She says she is tired of having to take antacids so frequently, and would just like to take a
pill every day which would stop the heartburn.
In this case, a conservative approach is optimal, and before committing the patient to long-term
pharmacologic therapy for reflux symptoms and presumed GERD, it would be appropriate to try nonpharmacologic methods. The patient is now on 150mg of ranitidine (H2 receptor antagonist).
You are the nurse conducting an exam on 2/4 for his next follow up appointment. Include a
complete health history, physical examination, medication education, and three health
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