Gastroesophageal Reflux Disease

Mrs. Robinson is a 66-year-old female who presented to the emergency department with wheezing, difficulty breathing, right-sided chest pain with deep inspiration, nausea, and vomiting. She stated that she was in her usual state of health until she awoke at 3:00 a.m. with wheezing and was not able to go pack to sleep. She was nauseas and vomited a small amount of green blood-stained emesis. A chest x-ray was done and showed an infiltrate in the right anterior lung base with chronic pleural effusion. Mrs. Robinson's medical history includes asthma, gastroesophageal reflux disease (GERD) for the past 3 years, and reoccurring pneumonia. She weighs 170 lbs. with a BMI of 29.2. She was started on albuterol (Ventolin) nebulizer treatments and levofloxacin (Levaquin) intravenously in the emergency department. 

Mrs. Robinson was admitted to the medical unit with a diagnosis of pneumonia due to recurrent aspiration related to the GERD. She remained on the levofloxacin (Levaquin) for infection and was prescribed lansoprazole (Prevacid) and ranitidine (Zantac) to prevent reflux.

1. Explain some of the contributing factors to Mrs. Robinson's GERD.

2. If untreated, what are some of the possible complications of GERD?

3. Discuss the medications that Mrs. Robinson is taking and how they work to reduce the symptoms of reflux. Why are antacids not used to manage GERD?

4. What are some of the foods and medications that may precipitate an episode of reflux esophagitis? 

5. How does Mrs. Robinson's weight affect reflux, and what recommendations should you make?