Is Heartburn Dangerous? IntroductionKenji Oshima (called KO) is a 58-year-old man who has not been to the doctor’s office for many years. He hasn’t had a physical exam by a healthcare provider in over 15 years, which is not uncommon for men of his age. He has had insurance provided by his employer, but he hasn’t used it because he hasn’t been sick. Unfortunately, over the last 8 months this has changed. In this period, KO inexplicably lost almost 20 pounds, and he just didn’t feel very well.
He frequently become short of breath and nauseated, which was followed by frightening episodes where he became almost feverish and sweaty. He finally decided, with pressure from his wife and daughter, that he needed a full checkup.The history and physical exam (H&P) is a critical tool in the initial evaluation of the healthcare needs of the patient. If the healthcare provider asks the patient the right questions and pays close attention to their answers, the patient will often tell the provider what is wrong with them. There is no substitute for the relationship between patient and healthcare provider.
The complete H&P is just as important a tool as x-rays, magnetic resonance imaging (MRIs), lab work, and the multitude of other advanced technological studies available to modern medicine. This case follows KO through his first visit with his new primary care provider.After KO filled out a medical history questionnaire in the waiting area, it didn’t take too long for him to be called back to an examination room. The medical assistant took KO’s vital signs (blood pressure, temperature, heart rate, and respiratory rate) and measured his height and weight, and then ushered him into a small examination room.
KO was given a gown to wear and instructed to disrobe completely under the gown, and then to have a seat on the exam table.Ms. Young, advanced registered nurse practitioner (ARNP), introduced herself as the nurse practitioner who would be asking KO many questions in addition to those on the questionnaire. She said she would also be performing the physical portion of his exam. Miss Young noticed that KO’s father had died of gastric cancer at the age of 64.When KO asked if he wasn’t supposed to see a doctor rather than a nurse practitioner, Ms. Young explained her role in the family practice medical group, something she explained regularly to new patients. KO wasn’t that familiar with the changes in healthcare and the types of providers that were practicing these days.
He admitted that he was nervous about the appointment in general and meant no disrespect, but he was curious about Ms. Young’s qualifications and her educational background. Seeing KO’s apprehension, Ms. Young encouraged him to ask questions about anything that he felt would put his mind at ease.It is critical to develop a rapport with a new patient that is built on mutual respect and trust.
This is the foundation that allows a healthcare provider to ask for and collect sensitive information that patients are sometimes unwilling to discuss even with close family members. In this same way, the study of anatomy and physiology is an important educational foundation to which aspiring healthcare providers must commit themselves. Without a solid foundation, the obligation to lifelong learning that all professions within the healthcare field advocate is a hollow oath. KO’s unexplained weight loss, palpable right upper quadrant pain, history of stomach pain made worse by eating, and persistent heartburn were concerning.
The nausea could be associated with heartburn, but periodic hot flashes and shortness of breath were out of context with these mostly gastrointestinal symptoms. Ms. Young thought they were all related, but she thought a referral to a specialist was the correct intervention for this patient. She did not feel comfortable formulating a treatment plan without more information than her H&P had provided. KO’s Japanese heritage and the fact that his father had died from complications of gastric cancer made the decision to refer KO to a specialist simple.
The gastroenterologist, a specialist of the gastrointestinal system, would want several baseline labs prior to seeing KO in his or her office. Ms. Young discussed her plan with KO, as she would need his consent to make these arrangements and she wanted to make sure that he understood why she was referring him to a specialist. KO was disappointed and more than a little frightened, but he understood Ms. Young’s rationale.
She discussed her concerns about his family history of gastric cancer, and that his symptoms were beyond her scope of practice to diagnose and treat. She would be happy to continue to see him as a primary care provider nonetheless. KO signed the consent form and was to report to the local clinical laboratory with the list of his lab results that the specialist required for their first visit. Ms. Young recalls her Anatomy & Physiology (A&P) course that initially inspired her to pursue an advanced degree after her Associate of Science in Nursing (ASN). She saw how she began by learning about the smallest building blocks of life and worked her way through increasingly more complex organizational levels of the human body.
Define the six levels of organization of the body.
Describe each level and explain how it is related to the next higher level.
Explain the eleven major organs systems in the body. Anatomical position is assumed when using directional terms to describe, document, and discuss the findings of the examination of different regions of the body.
Describe how the body is situated in anatomical position and why it is considered important. Ms. Young is concerned about KO’s heartburn symptoms and stomach pain because of the history of gastric cancer in his immediate family. For that reason, she has referred him to a gastroenterologist for a more focused work-up.
(a) Describe the location and subdivisions of the ventral cavity and
(b) the dorsal cavity.
(c) Describe which cavity or cavities the endoscopic device, which looks like a long hose, must travel through to get from the mouth to the stomach.
Less than 20% plagiarism.
