The nurse has implemented a care plan for an adult client with ...

[Frost2351]

The nurse has implemented a care plan for an adult client with gastroesophegeal reflux disorder (GERD). On the next clinic visit, which statement by the client indicates adherence to the plan of care?
 
  A) Spandex camisoles are worth heartburn.
  B) I have switched from margaritas to wine.
  C) I've lost 6 pounds because I eat every 3 hours and never before bed.
  D) I take a TUMS with the ranitidine to make it work better.

Question 2

An adult client with a BMI of 39 who smokes 1 pack of cigarettes per day is admitted to the hospital with chest pressure.
 
  After myocardial infarction is ruled out, the client is diagnosed with erosive esophagitis through upper GI endoscopy. The client is now refusing all medications and states I'm not getting hooked on any pills. What would the nurse recommend for the multidisciplinary collaborative plan?
  Select all that apply.
  A) Assess the client's readiness for change in smoking cessation and weight loss.
  B) Interview the client and spouse for a 24-hour recall of usual food content, intake, and meal times.
  C) Enlist the client's son to elevate the foot of the client's bed at home 6 inches.
  D) Offer the client a surgical consult to reduce the necessity of medication.
  E) Omit the pharmacist notification of the Multidisciplinary Team meeting about the client.

[qytan]

Answer to Question 1

Answer: C
Appropriate client outcomes are freedom from pain and knowledge of lifestyle changes to manage GERD. Weight loss, small, frequent meals, and avoiding lying down within 3 hours of eating indicate correct management. Although the client knows tight-fitting spandex camisoles can worsen GERD, she is not willing to stop wearing them. Changing from margaritas to wine will not improve GERD. Antacids like TUMS should be avoided within 1 hour before or after an H2-receptor blocker like ranitidine.

Answer to Question 2

Answer: A, B

Weight loss and smoking cessation will improve the symptoms of GERD. Determining food types, amounts, and times of consumption can help the client avoid foods that stimulate acid production and avoid eating prior to lying down. The head of the bed should be elevated and the team should recommend this to the client rather than enlisting the client's son. A surgical consult should come from the primary provider and will not necessarily reduce the need for medication. The pharmacist should be included in the Multidisciplinary Team meeting to give input to strategies to improve the client's receptivity to medication therapy.

[Frost2351]

Excellent

[chjcharjto14]

TYSM