Your responses should be in a well-developed paragraph (300-350

Your responses should be in a well-developed paragraph (300-350 words) to each peer. Integrating an evidence-based resource that is different than the one you used for the initial post. Respectfully agree and disagree with your peers’ responses and explain your reasoning by Including your rationales in your explanation. The described expectations meet the passing level of 80%. Students are directed to review the Discussion Grading Rubric for criteria, which exceed expectations. APA format references , atleast 2 each. Response 1  What lifestyle modifications do you recommend for CF? It is crucial to educate and reassure CF. Perhaps if he understood how his choices affect the discomfort he is having, he would be more likely to adhere to the suggested treatment plan. Gastroesophageal reflux disease (GERD) can be prevented and cured by making straightforward lifestyle and dietary modifications (Cao et. al, 2019). First of all, I would recommend CF consider eliminating his nightly intake of wine as alcohol decreases lower esophageal sphincter (LES) tone; thus allowing for the contents of the stomach to flow back into the esophagus (Woo & Robinson, 2017). Additionally, eating smaller meals, and avoiding caffeine, chocolate, peppermint, and fatty foods can help prevent the acid reflux (Smith, 2018). Furthermore, I would inform CF that his choice to stop smoking was advantageous to his overall health. In relation to GERD, smoking inhibits the production of saliva causing a reduction of saliva in the mouth/throat; saliva helps to counteract the acidity of gastric secretions, thus avoiding smoking is best (Smith, 2018). Describe a rational drug choice for this patient. Be specific regarding what factors you would consider. Include pharmacokinetic and dynamic considerations for the pharmacological choices made. Also consider interactions and side effects. The entire class of proton pump inhibitors (PPI) are approved for treatment of GERD since they decrease gastric acid by over 90% (Woo & Robinson, 2017). Omeprazole (Prilosec) 20mg capsule by mouth once daily for a trial period of 4 weeks would be my rational drug choice for CF. Due to his age, negative physical exam, and the fact that he does not take daily medications, omeprazole would not interact with any current medications or put him at a concerning risk for osteoporosis. The benefits of omeprazole include rapid absorption of less than one hour and peak effect within 2 hours (Lexicomp, 2017). I would inform CF about common side effects such as dizziness, headaches, skin rash, constipation, diarrhea, flatulence, and nausea/vomiting (Lexicomp, 2017). What counseling points about this medication do you give CF? First of all, I would tell CF I wish to see him back in four weeks to discuss his potential experience with side effects, symptom relief including his being awakened at night with symptoms. Should he report his symptoms are controlled during the day and reappear before bed, I would consider adding either a second dose of omeprazole daily or an H2 receptor antagonist before bed (Woo & Robinson, 2017). It is important for CF to understand the efficiency of omeprazole is greatly decreased if not taken on an empty stomach (Lexicomp 2017). Adherence to taking PPI is crucial to attain the optimal gastric acid secretion; therefore, I would reinforce how important it is to stay consistent with his medication regimen (Smith, 2018). Responsec 2  Modifying lifestyle is the golden management strategy for GERD. Some of the lifestyle modification that could help CF reduce his frequency of GERD includes maintaining a healthy weight as more weight puts pressure on the abdomen causing acid to come out from the stomach to esophagus it is important to maintain a healthy BMI. Stopping smoking, drinking alcohol. Elevating the head of the bed to help him with the heart burn experienced at night using bed wedge decreases significantly the backing of acid from the stomach to esophagus (Johnson, 2016). To wait at least three hours before lying down or sleeping, chew food more slowly and thoroughly to help digest better. Stay away from foods that trigger acid reflux such as spicy foods, caffeine, chocolate high fat and fried foods (Joel E. Richter, 2009). Avoid tight fitting cloths in the waist and to be more physically active, to exercise and avoid sedentary lifestyle. Patients with GERD empirically treated with protein pump inhibitor are well managed with the medication without further diagnostic tests (Dalbir S. Sandhu, 2018). There are about four PPI that he can easily purchase over the counter. To improve the effectiveness and compliance of PPI it is important to tell the patient when to take the medication. Considering the fact that he is having symptoms of heart burn and had tried H2RA’s. There are some factors that ensures the effectiveness on the treatment such as how easily can the patient get the medication, how definite are we with the GERD diagnosis ruling our other causes, how the patient accepts the treatment and how they use their treatment in correct way (such as taking it 30 minutes prior to a meal. Factors that helps us chose the first line of treatment would be his knowledge regarding on how to take the medication and how he continuous to use it and his adherence to the lifestyle changes he is going to make. If his symptoms are not well managed with a PPI two timed daily dose, we consider adding H2RA (Dalbir S. Sandhu, 2018). When choosing PPI Lansoprazole is more effective than Omeprazole in reducing the acidity in the esophagus indicating different PPI affect the clearance of esophagus and esophageal sphincter differently (Janczewska I et al, 1998). Considering this and lansoprazole having a quick onset improves patients adhering to the treatment. The other thing to keep in mind is metabolism of pantoprazole CYP450 system making it safer (Bordin DS, 2010). We have to be cautious if we are using other drugs that interact with PPI such as clopidogrel it can decrease the effect of the blood thinner increasing the chance of heart attack. As long-term use of PPI can increase the chances of bone fracture, hypomagnesemia causing tremor, muscle pain and dysrhythmia, pneumonia and increase the risk of C-diff infection we have to be monitor for this side effects. CF need to be counseled on lifestyle change, using the medication correctly and as prescribed, looking out for the side effects and seek medical advice if symptoms worsen.  RUBRIC:   Discussion Question Rubric Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric. Note: The value of each of the criterion on this rubric represents a point range. (example: 17-0 points) Discussion Question Rubric – 100 PointsCriteriaExemplary Exceeds ExpectationsAdvanced Meets ExpectationsIntermediate Needs ImprovementNovice InadequateTotal PointsQuality of Initial PostProvides clear examples supported by course content and references. Cites three or more references, using at least one new scholarly resource that was not provided in the course materials. All instruction requirements noted. 40 pointsComponents are accurate and thoroughly represented, with explanations and application of knowledge to include evidence-based practice, ethics, theory, and/or role. Synthesizes course content using course materials and scholarly resources to support importantpoints. Meets all requirements within the discussion instructions. Cites two references. 35 pointsComponents are accurate and mostly represented primarily with definitions and summarization. Ideas may be overstated, with minimal contribution to the subject matter. Minimal application to evidence-based practice, theory, or role development. Synthesis of course content is present but missing depth and/or development. Is missing one component/requirement of the discussion instructions. Cites one reference, or references do not clearly support content. Most instruction requirements are noted. 31 pointsAbsent application to evidence-based practice, theory, or role development. Synthesis of course content is superficial. Demonstrates incomplete understanding of content and/or inadequate preparation. No references cited. Missing several instruction requirements. Submits post late. 27 points40Peer Response PostOffers both supportive and alternative viewpoints to the discussion, using two or more scholarly references per peer post. Post provides additional value to the conversation. All instruction requirements noted. 40 pointsEvidence of further synthesis of course content. Provides clarification and new information or insight related to the content of the peer’s post. Response is supported by course content and a minimum of one scholarly reference per each peer post. All instruction requirements noted. 35 pointsLacks clarification or new information. Scholarly reference supports the content in the peer post without adding new information or insight. Missing reference from one peer post. Partially followed instructions regarding number of reply posts. Most instruction requirements are noted. 31 pointsPost is primarily a summation of peer’s post without further synthesis of course content. Demonstrates incomplete understanding of content and/or inadequate preparation. Did not follow instructions regarding number of reply posts. Missing reference from peer posts. Missing several instruction requirements. Submits post late. 27 points40Frequency of DistributionInitial post and peer post(s) made on multiple separate days. All instruction requirements noted. 10 pointsInitial post and peer post(s) made on multiple separate days. 8 pointsMinimum of two post options (initial and/or peer) made on separate days. 7 pointsAll posts made on same day. Submission demonstrates inadequate preparation. No post submitted. 6 points10OrganizationWell-organized content with a clear and complex purpose statement and content argument. Writing is concise with a logical flow of ideas. 5 pointsOrganized content with an informative purpose statement, supportive content, and summary statement. Argument content is developed with minimal issues in content flow. 4 pointsPoor organization and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work. Purpose statement is noted. 3 pointsIllogical flow of ideas. Prose rambles. Purpose statement is unclear or missing. Demonstrates incomplete understanding of content and/or inadequate preparation. No purpose statement. Submits assignment late. 2 points5APA, Grammar, and SpellingCorrect APA formatting with no errors. The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately). Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions. There are no spelling, punctuation, or word-usage errors. 5 pointsCorrect and consistent APA formatting of references and cites all references used. No more than two unique APA errors. The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability. There are minimal to no grammar, punctuation, or word-usage errors. 4 pointsThree to four unique APA formatting errors. The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused. Multiple grammar, punctuation, or word usage errors. 3 pointsFive or more unique formatting errors or no attempt to format in APA. The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language). The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented. Grammar and punctuation are consistently incorrect. Spelling errors are numerous. Submits assignment late. 2 points5Total Points100

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