The needs of patients aged 12 to 18 are the same and different. A case study of an Adolescent Patient with GERD.

Gastroesophageal Reflux Disease (GERD) is a frequent gastrointestinal condition of both adults and children. With GERD, the acid in the stomach backs up, irritating and causing pain in the stomach, and leads to regurgitation and heartburn. Lifestyle issues like poor nutrition, late meals and stress during adolescence, could play a role in the onset of symptoms (Shaqran et al., 2023). Case study of a 16-year-old female (Emily Smith) will be used to discuss a persistent case of heartburn and reflux symptoms that could be a manifestation of GERD. The use of pharmacological, nonpharmacological, and lifestyle modifications are included and evidence-based practice and national treatment guidelines support.

Patient Assessment

Subjective Findings

Emily Smith, a 16-year-old woman, comes to the primary care clinic with a two-month history of getting heartburn often. She has a burning sensation in her chest, which worsens after eating big meals and spicy food. Symptoms are primarily at night, and at times while sleeping. Emily also mentions that she has a foul taste in her mouth, and that it is worse when lying flat. She won’t eat, has lost weight, vomited or has abdominal pain. Pharmacy purchases of antacids will not be 100% effective. She consumes a lot of junk food, drinks carbonated beverages and frequently eats late at night. She also talks about moderate school and extracurricular activities stress.

Objective Findings

Emily’s blood pressure (BP) is 110/70 mmHg, her heart rate is 72 beats per minute, her respiratory (breathing) rate is 16 breaths per minute, her body temperature is 98.4°F, and her BMI is 23 kg/m². Physical examination is normal. No hepatosplenomegaly, soft and non-tender abdomen, bowel sounds are normal.

Diagnosis

Primary Diagnosis

Emily is diagnosed with Gastroesophageal Reflux Disease (GERD). Her history of recurrent heartburn, sour taste in the mouth which is worsened by lying down and some improvement on antacid support corroborates this diagnosis.

Pharmacological Treatment

First-Line Considerations

Proton pump inhibitors (PPIs) and antacids would be the first drugs to use in treating Emily’s GERD. Examples of common PPIs are Omeprazole and Lansoprazole. As explained by Bucan et al. (2025 these drugs decrease the production of hydrochloric acid in the stomach and facilitate the mucosa’s healing, which decreases the reflux symptoms. The other treatment is histamine-2 receptor antagonists such as Famotidine that lower acid production and are recommended for mild or intermittent symptoms. Short-term, symptomatic relief may continue to be provided using antacids, e.g., calcium carbonate.

Rationale

PPIs are believed to be most effective at treating GERD symptoms, as they are known to prevent stomach acid from coming up for longer and to heal the esophagus. PPIs should be used for people who have reflux symptoms more than twice a week, according to the American College of Gastroenterology. Consider H2 receptor antagonist if symptoms occur at night or if not severe. Antacids only work in the short term and are not recommended as a first line treatment for long term management (Katz et al., 2022).

Nonpharmacological Treatment

Dietary Changes

Emily shouldn’t eat or drink things that may trigger GERD symptoms including:

Spicy foods
Fried and fatty foods
Carbonated beverages
Caffeine
Chocolate
Citrus products
Tomato-based foods

The lower esophageal sphincter relaxes or produces too much stomach acid in the presence of these foods, and this makes reflux symptoms worse.

She should try to eat more of:

Fruits and vegetables
Whole grains
Lean proteins
Water

Physical Activity

Regularly moderate amounts of exercise should be encouraged as exercise can aid digestion, lower stress levels and help maintain a healthy weight. Strongly, though, exercise after eating is not recommended as it can aggravate reflux symptoms.

Weight Management

Emily’s BMI is within the normal range, but being a healthy weight is important as being overweight will cause pressure on the tummy, which can cause reflux. Participation in school sports and healthy eating can help stave off future weight-related problems.

Lifestyle Modifications

Eating Habits

Emily should:

Cut back on quantity and up on the number of meals.

Avoid overeating
Avoid eating within 2 – 3 hours before going to bed.
Reduce late-night snacking

Eating large meals raises the pressure in the stomach, thus making acid reflux possible.

Posture

Emily should refrain from lying on her back right after she eats and raise the head of her bed about 6-8 inches so that it’s more difficult to reflux during her sleep.

Stress Management

Stress can worsen GI symptoms, such as GERD. Emily discusses the stress she has at school and in extracurriculars that is not so bad. Some stress management techniques are:

Relaxation techniques
Deep breathing exercises
Yoga
Time management skills
Adequate sleep
Advise against writing and paying attention to the symptoms

To relieve reflux symptoms and enhance quality of life, stress reduction can be helpful.

Evidence-Based Practice Support

In general, evidence-based studies have demonstrated excellent efficacy in reducing GERD symptoms and to heal esophagitis in adolescent GERD patients taking PPIs. Dietary changes and behavioral factors are also helpful in decreasing reflux symptoms and episodes, which are supported by the research. Along with lifestyle changes, the American College of Gastroenterology (ACG) suggests that if lifestyle changes are not enough to manage GERD, then acid suppression therapy is the best treatment. Also significant in the adolescent population are triggers and dietary counseling, as per the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition.

Conclusion

Emily is frequently having heartburn (acid reflux), her mouth doesn’t taste good and is worse when lying down, which are all classic symptoms of GERD. Treatment is pharmacological and nonpharmacological and effective management is through both. Proton pump inhibitors and H2 receptor antagonists can help to decrease the gastric acid secretion and alleviate symptoms. Other lifestyle changes are also beneficial: Avoid trigger foods, smaller portions, sitting up straight after eating and reducing stress. Based on evidence, national guidelines and combined interventions, the interventions are recommended to be combined in order to maximize the effectiveness of the interventions and prevent complication arising from GERD.

References

Bucan, J. I., Braut, T., Krsek, A., Sotosek, V., & Baticic, L. (2025). Updates in Gastroesophageal Reflux Disease Management: From Proton Pump Inhibitors to Dietary and Lifestyle Modifications. Gastrointestinal Disorders, 7(2), 33. https://doi.org/10.3390/gidisord7020033

Katz, P. O., Dunbar, K. B., Schnoll-Sussman, F. H., Greer, K. B., Yadlapati, R., & Spechler, S. J. (2022). ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease. American Journal of Gastroenterology, 117(1), 27–56. https://doi.org/10.14309/ajg.0000000000001538

Shaqran, T. M., Ismaeel, M. M., Alnuaman, A. A., Al Ahmad, F. A., Albalawi, G. A., Almubarak, J. N., AlHarbi, R. S., Alaqidi, R. S., AlAli, Y. A., Alfawaz, K. S., & Daghriri, A. A. (2023). Epidemiology, Causes, and Management of Gastro-oesophagal Reflux Disease: A Systematic Review. Cureus. https://doi.org/10.7759/cureus.47420

CLICK HERE TO ORDER A PLAGIARISM FREE PAPER

The media for this assignment provides patient case study options for you to select from. Review the case that best fits your major and then complete the Gastrointestinal Case study.

You are expected to include three evidence-based practice articles to support your work. Additionally, you will need to include the national guidelines for any treatment plans/options. All papers must conform to the most recent APA standards.

Turnitin plagiarism checker is enabled for this assignment.

Gastrointestinal Case Study

Instructions

In this document, you will find four patients you are seeing for GI issues today on your busy clinic and hospitalist schedule. Select the patient that best fits your major, review the case details for that patient, and answer the questions provided. You are expected to include three evidence-based practice articles to support your work. Additionally, you will need to include the national guidelines for any treatment plans/options. All papers must conform to the most recent APA standards.

Select one of the following patients for this case study:

WH, FNP, Pediatrics

Patient: Emily Smith

Age: 16 years old

Visit Type: Primary Care Clinic

Chief Complaint: “I’ve been having a lot of heartburn lately.”

Subjective:

HPI: Emily Smith is a 16-year-old female presenting to the primary care clinic with complaints of frequent heartburn over the past two months. She reports experiencing a burning sensation in her chest, especially after eating large meals or spicy foods. The discomfort often occurs in the evenings and sometimes wakes her up at night. She occasionally feels a sour taste in her mouth and has noticed that her symptoms worsen when she lies down. Emily denies any difficulty swallowing, weight loss, vomiting, or abdominal pain. She has been taking over-the-counter antacids with some relief but is concerned about the persistence of her symptoms.

ROS:

General: Denies fever, fatigue, or weight loss.
Cardiovascular: Denies chest pain, palpitations, or edema.
Respiratory: Denies shortness of breath, cough, or wheezing.
Gastrointestinal: Reports frequent heartburn and sour taste in her mouth. Denies nausea, vomiting, diarrhea, or constipation.
Genitourinary: Denies dysuria, hematuria, or frequency.
Neurological: Denies headaches, dizziness, or syncope.
Musculoskeletal: Denies joint pain or muscle weakness.
Endocrine: Denies polyuria, polydipsia, or heat/cold intolerance.
Psychiatric: Denies anxiety or depression.

Past Medical History:

History of asthma, well-controlled with albuterol PRN
Seasonal allergies

Surgical History:

None

Family History:

Father: Alive, age 45, history of GERD and hypertension
Mother: Alive, age 43, history of asthma and seasonal allergies
Siblings: One younger brother, healthy

Social History:

Occupation: High school student
Marital Status: Single
Tobacco Use: Denies
Alcohol Use: Denies
Illicit Drug Use: Denies
Diet: Reports a diet high in fast food and carbonated beverages. Frequently eats late at night.
Exercise: Participates in school sports, moderate physical activity.
Stress Levels: Reports moderate stress related to school and extracurricular activities.

Sexual History:

Not sexually active

Medications:

Albuterol inhaler PRN
Over-the-counter antacids as needed

Allergies:

None

Objective:

Vital Signs:

Blood Pressure: 110/70 mmHg
Heart Rate: 72 bpm
Respiratory Rate: 16 breaths/min
Temperature: 98.4°F
BMI: 23 kg/m²

Physical Exam:

General: Well-nourished, well-appearing adolescent female in no acute distress
Cardiovascular: S1 and S2 normal. No murmurs, rubs, or gallops. No peripheral edema.
Respiratory: Lungs clear to auscultation bilaterally. No wheezes, rales, or rhonchi.
Gastrointestinal: Abdomen soft, non-tender, no hepatosplenomegaly. Bowel sounds normal.
Neurological: Alert and oriented x3. Cranial nerves II-XII intact. No focal deficits.
Musculoskeletal: Full range of motion in all extremities. No joint swelling or tenderness.
Skin: No rashes or lesions.

Assessment:

Gastroesophageal Reflux Disease (GERD)

Questions to Answer

Please review the instructions in your assignment for information on how you are expected to organize your answers.

What pharmacological treatments would you consider for Emily’s GERD? Explain your rationale for choosing each medication.
What nonpharmacological treatments would you recommend helping manage Emily’s symptoms? Provide specific strategies and explain how they can help.
What lifestyle modifications would you suggest to Emily to prevent GERD symptoms?

Pharmacological Treatment:

First-line considerations:
Rationale:

Nonpharmacological Treatment:

Dietary changes:
Physical activity:
Weight management:

Lifestyle Modifications:

Eating habits:
Posture:
Stress management:

Adult Geri Primary Care

Patient: Mary Thompson

Age: 78 years old

Visit Type: Primary Care Clinic

Chief Complaint: “I’ve been having a lot of heartburn and acid reflux.”

Subjective:

HPI: Mary Thompson is a 78-year-old female presenting to the primary care clinic with complaints of frequent heartburn and acid reflux over the past three months. She reports experiencing a burning sensation in her chest, especially after meals, and a sour taste in her mouth. The symptoms are worse at night and often wake her up. She has been taking over-the-counter antacids with partial relief. Mary is concerned because her symptoms are persistent despite dietary modifications.

ROS:

General: Reports fatigue and occasional dizziness.
Cardiovascular: Reports occasional palpitations and mild, non-exertional chest discomfort. Denies edema.
Respiratory: Denies shortness of breath or cough.
Gastrointestinal: Reports frequent heartburn, acid reflux, and occasional nausea. Denies vomiting, weight loss, or changes in bowel habits.
Genitourinary: Reports nocturia (2–3 times per night). Denies dysuria or hematuria.
Neurological: Reports occasional dizziness. Denies headaches or syncope.
Musculoskeletal: Reports chronic low back pain and stiffness in the mornings.
Endocrine: Denies polyuria, polydipsia, or heat/cold intolerance.
Psychiatric: Reports mild anxiety related to her symptoms. Denies depression.

Past Medical History:

Hypertension
Type 2 Diabetes Mellitus
Osteoarthritis
Chronic Kidney Disease Stage 3
Atrial Fibrillation (on anticoagulation)
Hyperlipidemia
GERD (recent onset)

Surgical History:

Total knee replacement (age 70)
Hysterectomy (age 55)

Family History:

Father: Deceased at age 80, history of hypertension and myocardial infarction
Mother: Deceased at age 85, history of type 2 diabetes
Siblings: One sister, age 75, with hypertension

Social History:

Occupation: Retired teacher
Marital Status: Widowed
Tobacco Use: None
Alcohol Use: Occasional wine (1–2 glasses/week)
Illicit Drug Use: Denies
Diet: Reports a balanced diet, avoids spicy foods due to reflux
Exercise: Walks daily, limited by back pain

Sexual History:

Not sexually active

Medications:

Lisinopril 20 mg daily
Metformin 1000 mg twice daily
Atorvastatin 40 mg daily
Warfarin 5 mg daily (INR 2–3)
Metoprolol 50 mg twice daily
Amlodipine 5 mg daily
Acetaminophen 500 mg as needed for pain
Over-the-counter antacids as needed for heartburn

Allergies:

Penicillin (rash)

Objective:

Vital Signs:

Blood Pressure: 140/85 mmHg
Heart Rate: 80 bpm, irregularly irregular
Respiratory Rate: 18 breaths/min
Temperature: 98.6°F
BMI: 26 kg/m²

Physical Exam:

General: Well-nourished, elderly female in no acute distress
Cardiovascular: Irregularly irregular heart rhythm. S1 and S2 are normal. No murmurs, rubs, or gallops. No peripheral edema.
Respiratory: Lungs clear to auscultation bilaterally. No wheezes, rales, or rhonchi.
Gastrointestinal: Abdomen soft, non-tender, no hepatosplenomegaly. Mild epigastric tenderness. Bowel sounds normal.
Neurological: Alert and oriented x3. Cranial nerves II-XII intact. No focal deficits.
Musculoskeletal: Mild tenderness in the lumbar region. Full range of motion in all extremities. No joint swelling or deformities.
Skin: No rashes or lesions.

Lab Results:

CBC: Mild anemia
BMP: Elevated creatinine consistent with CKD Stage 3, otherwise normal electrolytes
LFTs: Normal
HbA1c:2%

Assessment:

Gastroesophageal Reflux Disease (GERD)
Hypertension
Type 2 Diabetes Mellitus
Osteoarthritis
Chronic Kidney Disease Stage 3
Atrial Fibrillation
Hyperlipidemia

Plan:

Questions to Answer

Please review the instructions in your assignment for information on how you are expected to organize your answers.

What pharmacological treatments would you consider for Mary’s GERD? Explain your rationale for choosing each medication, especially considering her comorbidities and polypharmacy.
What potential drug interactions and side effects should you be aware of when prescribing medications for Mary?
What nonpharmacological treatments and lifestyle modifications would you recommend to help manage Mary’s GERD symptoms?
How would you address Mary’s mild anxiety related to her GERD symptoms?

Pharmacological Treatment:

First-line considerations:
Rationale:

Potential Drug Interactions and Side Effects:

Interactions:
Side Effects:

Nonpharmacological Treatment and Lifestyle Modifications:

Dietary changes:
Eating habits:
Posture:
Weight management:

Addressing Anxiety:

Nonpharmacological:
Pharmacological:

Acute Care

Patient: Emily Smith

Age: 18 years old

Visit Type: Emergency Department

Chief Complaint: “I have severe abdominal pain and haven’t been able to pass stool.”

Subjective:

HPI: Emily Smith is an 18-year-old female presenting to the emergency department with complaints of severe abdominal pain for the past 24 hours. The pain started diffuse and crampy but has become more localized to the lower abdomen. She reports nausea and vomiting and has not been able to pass stool or gas since the pain began. Emily describes the pain as 8/10 in intensity and notes that it worsens with movement. She denies any history of similar episodes, fever, or recent abdominal trauma.

ROS:

General: Reports fatigue and significant discomfort.
Cardiovascular: Denies chest pain, palpitations, or edema.
Respiratory: Denies shortness of breath, cough, or wheezing.
Gastrointestinal: Reports severe abdominal pain, nausea, vomiting, and absence of bowel movements and flatus. Denies hematemesis or melena.
Genitourinary: Denies dysuria, hematuria, or frequency.
Neurological: Denies headaches, dizziness, or syncope.
Musculoskeletal: Denies joint pain or muscle weakness.
Endocrine: Denies polyuria, polydipsia, or heat/cold intolerance.
Psychiatric: Denies anxiety or depression but appears distressed due to pain.

Past Medical History:

History of asthma, well-controlled with albuterol PRN
Seasonal allergies

Surgical History:

None

Family History:

Father: Alive, age 45, history of hypertension
Mother: Alive, age 43, history of asthma and seasonal allergies
Siblings: One younger brother, healthy

Social History:

Occupation: High school student
Marital Status: Single
Tobacco Use: Denies
Alcohol Use: Denies
Illicit Drug Use: Denies
Diet: Reports a diet high in fast food and low in fiber.
Exercise: Participates in school sports, moderate physical activity.

Sexual History:

Not sexually active

Medications:

Albuterol inhaler PRN

Allergies:

None

Objective:

Vital Signs:

Blood Pressure: 115/75 mmHg
Heart Rate: 92 bpm
Respiratory Rate: 20 breaths/min
Temperature: 99.2°F
SpO2: 98% on room air
BMI: 23 kg/m²

Physical Exam:

General: Appears in significant distress, lying still to avoid exacerbating pain.
Cardiovascular: S1 and S2 are normal. No murmurs, rubs, or gallops. No peripheral edema.
Respiratory: Lungs clear to auscultation bilaterally. No wheezes, rales, or rhonchi.
Gastrointestinal: Abdomen distended with hypoactive bowel sounds. Significant tenderness to palpation in the lower abdomen, with guarding and rebound tenderness. No palpable masses. Percussion reveals tympany.
Neurological: Alert and oriented x3. Cranial nerves II-XII intact. No focal deficits.
Musculoskeletal: Full range of motion in all extremities. No joint swelling or tenderness.
Skin: No rashes or lesions.

Lab Results:

CBC: Elevated white blood cell count
BMP: Electrolytes within normal limits
LFTs: Normal
Amylase/Lipase: Normal

Imaging:

Abdominal X-ray: Multiple air-fluid levels and dilated loops of bowel suggestive of bowel obstruction
CT Abdomen and Pelvis: Confirms mechanical bowel obstruction with a transition point in the distal small intestine. No signs of bowel perforation or ischemia.

Assessment:

Bowel Obstruction

Plan:

Questions to Answer

Please review the instructions in your assignment for information on how you are expected to organize your answers.

What pharmacological treatments would you consider for Emily’s bowel obstruction? Explain your rationale for choosing each medication.
What nonpharmacological treatments would you recommend helping manage Emily’s symptoms? Provide specific strategies and explain how they can help.
What lifestyle modifications would you suggest to Emily to prevent symptoms returning?

Pharmacological Treatment:

Pain management:
Antiemetics:
Antibiotics:

Nonpharmacological Treatment:

PSYCH
Patient: Emily Smith

Age: 16 years old

Visit Type: Psychiatric Mental Health NP Office

Chief Complaint: “I’ve been having a lot of heartburn lately.”

Subjective:

HPI: Emily Smith is a 16-year-old female presenting to the psychiatric mental health NP office with complaints of frequent heartburn over the past two months. She reports experiencing a burning sensation in her chest, especially after eating large meals or spicy foods. The discomfort often occurs in the evenings and sometimes wakes her up at night. She occasionally feels a sour taste in her mouth and has noticed that her symptoms worsen when she lies down. Emily denies any difficulty swallowing, weight loss, vomiting, or abdominal pain. She has been taking over-the-counter antacids with some relief but is concerned about the persistence of her symptoms. Emily also reports that her heartburn is increasing her anxiety, as she is worried it might be something serious.

ROS:

General: Denies fever, fatigue, or weight loss.
Cardiovascular: Denies chest pain, palpitations, or edema.
Respiratory: Denies shortness of breath, cough, or wheezing.
Gastrointestinal: Reports frequent heartburn and sour taste in her mouth. Denies nausea, vomiting, diarrhea, or constipation.
Genitourinary: Denies dysuria, hematuria, or frequency.
Neurological: Denies headaches, dizziness, or syncope.
Musculoskeletal: Denies joint pain or muscle weakness.
Endocrine: Denies polyuria, polydipsia, or heat/cold intolerance.
Psychiatric: Reports increased anxiety related to her heartburn Denies depression, hallucinations, or suicidal ideation.

Past Medical History:

History of asthma, well-controlled with albuterol PRN
Seasonal allergies

Surgical History:

None

Family History:

Father: Alive, age 45, history of GERD and hypertension
Mother: Alive, age 43, history of asthma and seasonal allergies
Siblings: One younger brother, healthy

Social History:

Occupation: High school student
Marital Status: Single
Tobacco Use: Denies
Alcohol Use: Denies
Illicit Drug Use: Denies
Diet: Reports a diet high in fast food and carbonated beverages. Frequently eats late at night.
Exercise: Participates in school sports, moderate physical activity.
Stress Levels: Reports moderate stress related to school and extracurricular activities.

Sexual History:

Not sexually active

Medications:

Albuterol inhaler PRN
Over-the-counter antacids as needed

Allergies:

None

Objective:

Vital Signs:

Blood Pressure: 110/70 mmHg
Heart Rate: 72 bpm
Respiratory Rate: 16 breaths/min
Temperature: 98.4°F
BMI: 23 kg/m²

Physical Exam:

General: Well-nourished, well-appearing adolescent female in no acute distress
Cardiovascular: S1 and S2 are normal. No murmurs, rubs, or gallops. No peripheral edema.
Respiratory: Lungs clear to auscultation bilaterally. No wheezes, rales, or rhonchi.
Gastrointestinal: Abdomen soft, non-tender, no hepatosplenomegaly. Bowel sounds normal.
Neurological: Alert and oriented x3. Cranial nerves II-XII intact. No focal deficits.
Musculoskeletal: Full range of motion in all extremities. No joint swelling or tenderness.
Skin: No rashes or lesions.

Assessment:

Gastroesophageal Reflux Disease (GERD) 2. Anxiety exacerbated by GERD symptoms

Plan:

Questions to Answer

Please review the instructions in your assignment for information on how you are expected to organize your answers.

What pharmacological treatments would you consider for Emily’s GERD? Explain your rationale for choosing each medication.
How would you address Emily’s anxiety related to her GERD symptoms? What nonpharmacological and pharmacological options would you consider?
What nonpharmacological treatments would you recommend helping manage Emily’s GERD symptoms? Provide specific strategies and explain how they can help.
What lifestyle modifications would you suggest to Emily to prevent GERD symptoms?

Pharmacological Treatment:

First-line considerations:
Rationale:

Addressing Anxiety:

Nonpharmacological:
Pharmacological:

Nonpharmacological Treatment for GERD:

Dietary changes:
Physical activity:
Weight management:
Eating habits:
Posture:

Lifestyle Modifications:

Stress management: