SNAPPS Written Assignment

Student Name: John Doe Course: NR511: Differential Diagnosis and Primary Care Practicum Instructor: Dr. Jane Smith Date: August 5, 2024

1. Summarize

• Case Summary: A 45-year-old male presented with a chief complaint of intermittent chest pain and discomfort after meals, especially when lying down. The patient described the pain as a burning sensation in the chest that occasionally radiated to the neck. His medical history is significant for obesity, hypertension, and a sedentary lifestyle. The patient denies any history of smoking or alcohol use.

2. Narrow the Differential

• Differential Diagnoses Considered:
  1. Gastroesophageal Reflux Disease (GERD)
  2. Peptic Ulcer Disease
  3. Angina Pectoris
  4. Esophageal Spasm
• Based on the clinical presentation and history, GERD was the most likely diagnosis, with peptic ulcer disease and esophageal spasm as other potential considerations. Angina was deemed less likely due to the patient’s lack of typical cardiac risk factors and the nature of the pain being associated with meals and body position.

3. Analyze the Differential

• Analysis of GERD: The patient’s symptoms of burning chest pain after meals, exacerbated by lying down, strongly suggest GERD. The absence of alarm features such as weight loss, persistent vomiting, or dysphagia further supports this diagnosis.
• Analysis of Peptic Ulcer Disease: While the patient’s symptoms could indicate peptic ulcer disease, the lack of epigastric pain and the nature of the burning sensation being more consistent with reflux made this a secondary consideration.
• Analysis of Angina: The patient’s symptoms were not typical of angina, as there was no exertional component, and the pain was related to food intake and position.
• Analysis of Esophageal Spasm: Although esophageal spasm can present with chest pain, the patient’s history and symptom pattern made GERD more likely.

4. Probe Preceptor

• Questions Asked: I inquired about the potential need for diagnostic tests, such as an upper endoscopy or esophageal pH monitoring, to confirm the diagnosis of GERD. I also asked about the role of lifestyle modifications versus medication as first-line treatment. My preceptor confirmed that while lifestyle changes should be initiated, empiric treatment with a proton pump inhibitor (PPI) would be appropriate given the patient’s symptoms and history.

5. Plan Management

• Management Plan: The patient was advised to implement lifestyle modifications, including weight loss, elevating the head of the bed, and avoiding late meals or trigger foods such as spicy dishes and caffeine. A prescription for omeprazole, a proton pump inhibitor, was provided to manage the symptoms. The patient was also educated on the potential side effects of long-term PPI use and the importance of follow-up if symptoms persist or worsen.

6. Self-Directed Learning Issue

• Identified Learning Issue: During my oral presentation, I recognized a gap in my understanding of the long-term management of GERD, particularly concerning the risks associated with prolonged PPI use and the strategies for tapering off these medications once symptoms are controlled.
• Significance of the Issue: This issue is significant because it directly impacts patient safety and the effectiveness of GERD management. Understanding when and how to safely discontinue PPIs, while ensuring the patient does not experience a relapse of symptoms, is crucial in providing high-quality care.
• Steps to Address the Issue: To address this learning issue, I plan to review current clinical guidelines on the management of GERD, focusing on the role of PPIs. I will also research alternative treatments and lifestyle modifications that can help maintain symptom control without long-term medication dependence. Additionally, I will seek advice from my preceptor on real-world strategies for managing patients who require long-term therapy.

7. Reflection

• Learning Experience Reflection: This case provided valuable insights into the management of GERD and highlighted the importance of considering both immediate and long-term treatment strategies. I realized the necessity of balancing symptom control with minimizing potential side effects of chronic medication use. Going forward, I will approach similar cases with a more comprehensive view of both short-term relief and long-term management, ensuring that patient education and follow-up are integral parts of the care plan.