| Course | NUR-7072 Adult Primary Care Part II |
|---|---|
| Module | Module 2 |
| Paper type | Case paper: gastrointestinal care |
| Length | About 1,030 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7072 Module 2
Late Dinners and Heartburn: Testing First, Then Treating Reflux in Primary Care
Student Name
M.S. in Nursing, Family Nurse Practitioner, Thomas Edison State University
NUR-7072: Adult Primary Care Part II
Mentor Name
Month Day, Year
Late Dinners and Heartburn: Testing First, Then Treating Reflux in Primary Care
The Patient
Tomás Reyes, an invented 47-year-old restaurant manager, has had heartburn for about a year, now three or four nights a week, with sour fluid rising into his throat when he lies down. He also has a gnawing burning in the upper abdomen on some afternoons. He eats his main meal around 11 p.m. after closing and goes to bed within an hour. He drinks three cups of coffee a day and two glasses of wine on his nights off and uses ibuprofen for back pain on several days each week. He does not smoke. He has had no trouble swallowing, pain with swallowing, vomiting, black stools, weight loss or anemia. His body mass index is 31, with central obesity, and his abdominal examination is normal apart from mild epigastric tenderness.
Checking for Alarm Features
Katz et al. (2022) recommend that people whose main symptoms are typical heartburn and regurgitation, without warning signs, be given an eight-week empiric trial of a proton pump inhibitor taken once daily before a meal. Alarm features, including difficulty or pain with swallowing, gastrointestinal bleeding, anemia, weight loss and recurrent vomiting, call for endoscopy instead. The guideline also suggests screening endoscopy for Barrett's esophagus in people with chronic, frequent reflux plus three or more risk factors, such as male sex, age over 50, white race, central obesity, a smoking history or a close relative with Barrett's esophagus or esophageal cancer. Mr. Reyes has no alarm features and does not meet the screening criteria.
Why Test for H. pylori
His afternoon epigastric burning and regular ibuprofen use suggest dyspepsia and possible ulcer risk as well as reflux. Chey et al. (2017) recommend testing for Helicobacter pylori in patients under 60 with uninvestigated dyspepsia and no alarm features, in anyone with active or past peptic ulcer disease and in patients taking long-term low-dose aspirin or starting long-term nonsteroidal anti-inflammatory drugs, among other groups. They advise using either a stool antigen test or a urea breath test and holding proton pump inhibitors for two weeks beforehand, because acid suppression can cause false-negative results. Since Mr. Reyes had not yet started a PPI, a stool antigen test was collected before treatment began.
Treatment if Positive
Chey and colleagues recommend bismuth quadruple therapy, given for 10 to 14 days and made up of a proton pump inhibitor, bismuth, metronidazole and tetracycline, as a first-line option, particularly for patients with previous macrolide exposure. Clarithromycin-based triple therapy is reserved for areas where clarithromycin resistance is known to be low and for patients without prior macrolide use. All treated patients should have a test of cure no sooner than four weeks after the antibiotics end, with proton pump inhibitors held for one to two weeks before testing.
How Safe Are PPIs?
Many patients have heard that proton pump inhibitors cause dementia, kidney disease, fractures or pneumonia, associations drawn largely from observational studies. Moayyedi et al. (2019) tested these concerns in a randomized trial in which 17,598 patients with stable cardiovascular disease received pantoprazole 40 mg daily or placebo for a median of about three years. Pantoprazole did not increase pneumonia, fractures, chronic kidney disease, dementia, diabetes, cancer or death. The only possible difference was a small increase in enteric infections. The authors concluded that pantoprazole is safe for long-term use when indicated.
| Source | Key point | Application to Mr. Reyes |
|---|---|---|
| Katz et al. (2022) | Eight-week PPI trial for classic symptoms without alarm features | Omeprazole before breakfast for eight weeks |
| Chey et al. (2017) | Test for H. pylori in dyspepsia before PPI; bismuth quadruple therapy | Stool antigen collected first |
| Moayyedi et al. (2019) | Pantoprazole for three years did not raise feared harms | Reassurance with a taper plan |
Plan
His stool antigen was negative. He began omeprazole 20 mg each morning, 30 minutes to an hour ahead of breakfast, for an eight-week trial. He agreed to move his main meal to a 5 p.m. break and keep a light snack after closing, to wait at least three hours after eating before lying down and to put blocks under the legs at the head of his bed, which the guideline supports for nighttime symptoms. Weight loss was discussed as one of the most effective lifestyle measures for reflux. Rather than banning foods, we agreed he would notice whether coffee or wine worsened his symptoms. Ibuprofen was replaced with acetaminophen and heat for his back.
Ibuprofen and the Stomach
Regular ibuprofen irritates the stomach lining and raises the risk of ulcers and bleeding, and it can worsen reflux symptoms. Stopping it removes a cause rather than masking it. If his back pain needs more than acetaminophen and heat, a topical diclofenac gel used for a short time is a gentler option, and the back pain itself deserves its own assessment at a later visit.
Tapering and Follow-Up
Katz and colleagues advise trying to stop the proton pump inhibitor in patients whose symptoms resolve after the trial and who have no erosive disease or Barrett's esophagus, because many need it only on demand or not at all. Mr. Reyes will return in eight weeks. If his symptoms have resolved, we will taper to every other day and then stop, using on-demand doses if needed. If symptoms persist on daily therapy, the next steps are twice-daily dosing for a short period and referral for endoscopy and further testing.
Work and Cultural Context
Restaurant work makes regular meals hard, and family meals around food are central to his life. The plan aimed to keep those meals while shifting their timing and size.
Limits
The COMPASS trial enrolled older patients with cardiovascular disease, and its three-year follow-up cannot rule out harms that take longer to appear. Stool antigen testing can miss some infections. The patient is invented.
Conclusion
Katz and colleagues supported an eight-week PPI trial for classic reflux without alarm features, Chey and colleagues guided testing for H. pylori before acid suppression and Moayyedi and colleagues showed that long-term pantoprazole did not cause the harms patients fear. Testing first, treating with omeprazole and meal changes and planning a taper give Mr. Reyes relief without lifelong medication by default.
References
Chey, W. D., Leontiadis, G. I., Howden, C. W., & Moss, S. F. (2017). ACG clinical guideline: Treatment of Helicobacter pylori infection. American Journal of Gastroenterology, 112(2), 212-239. https://doi.org/10.1038/ajg.2016.563
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
Moayyedi, P., Eikelboom, J. W., Bosch, J., Connolly, S. J., Dyal, L., Shestakovska, O., Leong, D., Anand, S. S., Störk, S., Branch, K. R. H., Bhatt, D. L., Verhamme, P. B., O'Donnell, M., Maggioni, A. P., Lonn, E. M., Piegas, L. S., Ertl, G., Keltai, M., Bruns, N. C., . . . Yusuf, S. (2019). Safety of proton pump inhibitors based on a large, multi-year, randomized trial of patients receiving rivaroxaban or aspirin. Gastroenterology, 157(3), 682-691. https://doi.org/10.1053/j.gastro.2019.05.056
NUR 7072 Module 2 instructions, in plain terms
Gastrointestinal care is among the systems TESU's catalog lists for NUR-7072, and because no syllabus is posted, this second paper is modeled as a reflux and dyspepsia case. Present an adult with upper gastrointestinal symptoms, screen explicitly for alarm features and Barrett's screening criteria and decide whether an empiric trial or endoscopy is appropriate. Explain when and how to test for H. pylori, including holding acid suppression, and name first-line treatment if positive. Start therapy with correct timing, give lifestyle advice tied to the patient's routine, address medication safety with evidence and plan a taper. Some sections focus on irritable bowel syndrome or constipation instead. Ask whether a differential diagnosis table is expected.
How this NUR 7072 Module 2 example is built
Tomás Reyes, an invented 47-year-old restaurant manager, has nighttime heartburn, regurgitation and afternoon epigastric burning, along with regular ibuprofen use. Alarm features and Barrett's screening criteria are checked and found absent. A stool antigen test for H. pylori is collected before any acid suppression, and bismuth quadruple therapy is described in case it is positive. The ACG guidelines and the COMPASS trial are compared in a table. Omeprazole before breakfast, meal timing changes, head-of-bed elevation, a switch from ibuprofen, a taper plan, cultural context, limits and a conclusion follow. Stopping ibuprofen, which treats a cause of his symptoms, gets its own section.
Where the marks sit in the NUR 7072 Module 2 rubric
Reflux papers earn high marks when alarm features are listed and ruled out explicitly and when the decision between an empiric trial and endoscopy follows the guideline. Readers look for H. pylori testing in the right patients, done before acid suppression, and for first-line eradication therapy with a test of cure. Correct PPI timing, lifestyle advice tied to the patient's actual schedule and removal of contributing drugs such as ibuprofen show careful management. Counseling on safety with randomized evidence, and a plan to taper rather than continue by default, shows thoughtful prescribing. Removing a contributing drug, rather than adding acid suppression on top of it, shows careful reasoning. Planning how to stop the drug, not only how to start it, shows good stewardship of long-term medication.
NUR 7072 Module 2 help: mistakes that cost marks
Reflux papers often start a PPI without checking for alarm features or testing for H. pylori. List the alarm features and say which are absent, test before acid suppression when the patient has dyspepsia or ulcer risk and know the first-line eradication regimen. Teach correct PPI timing, link lifestyle advice to the patient's routine and remove drugs that harm the stomach. Address safety concerns with trial evidence and plan to taper after eight weeks. Pass along the assignment and the patient's symptoms to receive a free first draft. Check the patient's medication list for drugs that worsen reflux or injure the stomach. State how you will judge the trial and your next step if symptoms remain.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 7072 Module 2 questions, answered
Where can I find a free NUR 7072 Module 2 sample paper?
The reflux and H. pylori case paper, from alarm features to a PPI taper, is reproduced here.
What are alarm features in reflux disease?
Trouble or pain swallowing, bleeding, anemia, weight loss and recurrent vomiting, which call for endoscopy.
How long is an empiric PPI trial?
Katz and colleagues recommend eight weeks of once-daily therapy before a meal.
Why hold a PPI before H. pylori testing?
Acid suppression can cause false-negative breath and stool tests, so Chey and colleagues advise stopping it two weeks before.
Are long-term PPIs dangerous?
In Moayyedi and colleagues' trial, three years of pantoprazole did not increase pneumonia, fractures, kidney disease or dementia.