Gastrointestinal Disorder Diagnosis and Drug Therapy Plan: A Case Study

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Words: 2769
Pages: 11
Subject: Nursing
Topics: Gastrointestinal Disorder

Assignment Question

I’m working on a nursing writing question and need the explanation and answer to help me learn. Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms, such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe a treatment that targets the cause rather than the symptom. Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Assignment, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan. This week, we will be reviewing Gastrointestinal and Hepatobiliary Disorders. You are to write a 1 page paper addressing the requirements written in your assignment. Please follow the directions given and review the grading rubric to ensure all questions have been addressed. Case: DC is a 46-year-old female who presents with a 24-hour history of RUQ pain. She states the pain started about 1 hour after a large dinner she had with her family. She has had nausea and on instance of vomiting before presentation. PMH: Vitals: HTN Temp: 98.8oF- Type II DM Wt: 202 lbs Gout Ht: 5’8” DVT – Caused by oral BCPs BP: 136/82 HR: 82 bpm Current Medications: Notable Labs: Lisinopril 10 mg daily WBC: 13,000/mm3 HCTZ 25 mg daily Total bilirubin: 0.8 mg/dL Allopurinol 100 mg daily Direct bilirubin: 0.6 mg/dL Multivitamin daily Alk Phos: 100 U/L AST: 45 U/L ALT: 30 U/L Allergies: Latex Codeine Amoxicillin PE: Eyes: EOMI HENT: Normal GI:bNondistended, minimal tenderness Skin:bWarm and dry Neuro: Alert and Oriented Psych:bAppropriate mood To Prepare: Review the case study assigned by your Instructor for this Assignment Reflect on the patient’s symptoms, medical history, and drugs currently prescribed. Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors, such as pregnancy, drugs, or a psychological disorder. Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. Write a 1-page paper that addresses the following: Explain your diagnosis for the patient, including your rationale for the diagnosis. Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples. Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area. Required Readings Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier. Chapter 64, “Drugs for Peptic Ulcer Disease” (pp. 589–597) Chapter 65, “Laxatives” (pp. 598–604) Chapter 66, “Other Gastrointestinal Drugs” (pp. 605–616) Chapter 80, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 723–743) Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., . . . Sanya, A. J. (2018) The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases Hepatology, 67(1), 328–357. Retrieved from https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/…This article details the diagnosis and management of nonalcoholic fatty liver disease. Review this article to gain an understanding of the underlying pathophysiology as well as the suggested pharmacotherapeutics that might be recommended to treat this disorder. https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/… NURS_6521_Week4_Assignment_Rubric NURS_6521_Week4_Assignment_Rubric Criteria Ratings Pts This criterion is linked to a Learning OutcomeExplain your diagnosis for the patient, including your rationale for the diagnosis. 25 to >22.25 pts Excellent The response accurately and clearly explains in detail the diagnosis for the patient, including an accurate and thorough rationale for the diagnosis that supports clinical judgment. 22.25 to >19.75 pts Good The response provides a basic explanation of 1-2 diagnoses for the patient, including an accurate rationale for the diagnosis that may support clinical judgment. 19.75 to >17.25 pts Fair The response inaccurately or vaguely explains the diagnosis for the patient, including an inaccurate or vague rationale for the diagnosis that may or may not support clinical judgment. 17.25 to >0 pts Poor The response inaccurately and vaguely explains the diagnosis for the patient, including an inaccurate and vague rationale for the diagnosis that does not support clinical judgment, or is missing. 25 pts This criterion is linked to a Learning OutcomeDescribe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. 30 to >26.7 pts Excellent The response accurately and completely describes in detail an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. 26.7 to >23.7 pts Good The response describes a basic explanation of the appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. 23.7 to >20.7 pts Fair The response inaccurately or vaguely describes an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. 20.7 to >0 pts Poor The response inaccurately and vaguely describes an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. 30 pts This criterion is linked to a Learning OutcomeJustify why you would recommend this drug therapy plan for this patient. Be specific and provide examples. 30 to >26.7 pts Excellent The response provides an accurate, clear, and detailed justification for the recommended drug therapy plan for this patient. … The response includes specific, accurate, and detailed examples that fully support the justification provided. 26.7 to >23.7 pts Good The response provides a basic justification for the recommended drug therapy plan for this patient. … The response includes only 1-2 examples that fully support the justification provided. 23.7 to >20.7 pts Fair The response provides an inaccurate or vague justification for the recommended drug therapy plan for this patient. … The response may include examples, which may inaccurately or vaguely support the justification provided. 20.7 to >0 pts Poor The response provides an inaccurate and vague justification for the recommended drug therapy plan for this patient, or is missing. … The response does not include examples that support the justification provided, or is missing. 30 pts This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. 5 to >4.45 pts Excellent Paragraphs and sentences follow writing standards for flow, continuity, and clarity. 4.45 to >3.95 pts Good Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. 3.95 to >3.45 pts Fair Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. 3.45 to >0 pts Poor Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. 5 pts This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5 to >4.45 pts Excellent Uses correct grammar, spelling, and punctuation with no errors 4.45 to >3.95 pts Good Contains a few (1–2) grammar, spelling, and punctuation errors 3.95 to >3.45 pts Fair Contains several (3–4) grammar, spelling, and punctuation errors 3.45 to >0 pts Poor Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding 5 pts This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. 5 to >4.45 pts Excellent Uses correct APA format with no errors 4.45 to >3.95 pts Good Contains a few (1–2) APA format errors 3.95 to >3.45 pts Fair Contains several (3–4) APA format errors 3.45 to >0 pts Poor Contains many (≥ 5) APA format errors 5 pts Total Points: 100

Answer

Introduction

Gastrointestinal (GI) and hepatobiliary disorders can present with similar symptoms, making it crucial for advanced practice nurses (APNs) to perform comprehensive assessments and formulate accurate diagnoses. This assignment revolves around a case study of a 46-year-old female patient named DC, who presents with right upper quadrant (RUQ) pain, nausea, and vomiting. The purpose of this paper is to provide a diagnosis for the patient, design an appropriate drug therapy plan, and justify the recommended treatment.

Diagnosis for the Patient

Based on the patient’s symptoms, medical history, and the findings from the case study, the likely diagnosis for DC is acute cholecystitis. Acute cholecystitis is characterized by inflammation of the gallbladder, often triggered by the obstruction of the cystic duct by gallstones (Mandaliya & Sahu, 2021). The patient’s RUQ pain, which began after a large dinner, and the associated nausea and vomiting are classic symptoms of this condition (McQuaid, 2020).

Furthermore, DC’s medical history includes hypertension (HTN), type II diabetes mellitus (DM), and obesity (202 lbs, BMI >30), all of which are risk factors for the development of gallstones and subsequent cholecystitis (Lammert et al., 2016). The patient’s medications, including lisinopril and hydrochlorothiazide, can also contribute to gallstone formation due to their potential to increase cholesterol levels (Mandaliya & Sahu, 2021). These factors collectively support the diagnosis of acute cholecystitis.

Appropriate Drug Therapy Plan

The treatment plan for DC, diagnosed with acute cholecystitis, involves both medical management and potential surgical intervention. Given her presentation and underlying conditions, the following drug therapy plan is recommended:

  1. NPO and Fluid Resuscitation: Initially, the patient should be kept nil per os (NPO) to rest the gallbladder. Intravenous (IV) fluids should be administered to maintain hydration and correct any electrolyte imbalances resulting from vomiting (Rosenthal & Burchum, 2021).
  2. Pain Management: Pain control is essential to alleviate RUQ pain. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, should be avoided due to their potential to exacerbate the condition. Instead, acetaminophen can be used for pain relief (McQuaid, 2020).
  3. Antibiotics: Empirical antibiotic therapy is indicated to combat infection in cases of acute cholecystitis. Ceftriaxone and metronidazole can be administered intravenously (Rosenthal & Burchum, 2021).
  4. Surgical Consultation: Considering DC’s comorbidities and severe symptoms, surgical consultation for cholecystectomy should be arranged. Laparoscopic cholecystectomy is the preferred surgical approach for uncomplicated cases (McQuaid, 2020).

Justification for the Drug Therapy Plan

The chosen drug therapy plan aligns with evidence-based practices for the management of acute cholecystitis. The rationale for each component is as follows:

  1. NPO and Fluid Resuscitation: Resting the gallbladder by fasting is essential to reduce inflammation and prevent further gallstone migration or blockage of the cystic duct. Fluid resuscitation is necessary to maintain hemodynamic stability and support renal function (Rosenthal & Burchum, 2021).
  2. Pain Management: Acetaminophen is a safe choice for pain management in patients with acute cholecystitis, as it does not pose the risk of aggravating the condition or causing bleeding (McQuaid, 2020).
  3. Antibiotics: Empirical antibiotic therapy is crucial to address the infection that often accompanies acute cholecystitis. Ceftriaxone and metronidazole provide coverage against the most common pathogens associated with this condition (Rosenthal & Burchum, 2021).
  4. Surgical Consultation: In cases of severe symptoms, complications, or failure to respond to medical management, cholecystectomy is indicated. Surgery is necessary to prevent recurrent attacks and the potential for complications like gangrene or perforation (McQuaid, 2020).

Impact of Gastrointestinal and Hepatobiliary Disorders

Gastrointestinal (GI) and hepatobiliary disorders have a significant impact on patients’ lives and healthcare systems. These disorders affect the structure and function of the GI tract and liver, leading to various symptoms and complications. Understanding the implications of these disorders is essential for healthcare providers, including advanced practice nurses (APNs), to provide timely and effective care.

Positive Impact on Awareness and Prevention

While GI and hepatobiliary disorders can be debilitating, they have a positive impact on raising awareness about the importance of a healthy lifestyle. Patients diagnosed with conditions like cholecystitis often become more conscious of their diet and lifestyle choices. This heightened awareness can lead to positive behavioral changes, such as adopting a low-fat diet and regular exercise, which can help prevent the recurrence of gallstone-related issues (Lammert et al., 2016).

Additionally, these disorders have led to advances in medical research and treatment options. New drugs and surgical techniques have emerged, improving the overall management of GI and hepatobiliary conditions. For instance, minimally invasive laparoscopic cholecystectomy has become the standard of care for gallbladder removal, offering quicker recovery times and reduced postoperative pain (McQuaid, 2020).

Negative Impact on Quality of Life

On the flip side, GI and hepatobiliary disorders can have a profoundly negative impact on patients’ quality of life. Symptoms such as abdominal pain, nausea, vomiting, and fatigue can be debilitating, making it challenging for individuals to carry out their daily activities. Patients may experience frequent hospitalizations, doctor visits, and a reduced ability to work or engage in social activities.

Patients with chronic GI disorders like irritable bowel syndrome (IBS) often struggle with unpredictable symptoms, impacting their emotional well-being. Anxiety and depression are common comorbidities in patients with chronic GI conditions, further diminishing their quality of life (Rosenthal & Burchum, 2021).

Potential Actions to Address the Challenges

To mitigate the negative impact of GI and hepatobiliary disorders, several potential actions can be taken:

  1. Patient Education: Providing patients with clear and comprehensive education about their condition, treatment options, and preventive measures can empower them to take an active role in managing their health. APNs can offer resources, such as pamphlets or online materials, to enhance patient understanding (Rosenthal & Burchum, 2021).
  2. Psychosocial Support: Recognizing the psychosocial impact of these disorders is essential. Healthcare providers should routinely screen for anxiety and depression in patients with chronic GI conditions and provide referrals to mental health professionals when needed. Support groups can also offer patients a sense of community and shared experiences (Rosenthal & Burchum, 2021).
  3. Advocacy for Research: APNs can advocate for increased funding and research into GI and hepatobiliary disorders. More research can lead to a better understanding of these conditions, improved diagnostic tools, and innovative treatment options.
  4. Promoting a Healthy Lifestyle: APNs can play a crucial role in promoting healthy lifestyles to prevent these disorders. They can educate patients on the importance of maintaining a balanced diet, regular exercise, and weight management to reduce the risk of developing GI and hepatobiliary issues (Lammert et al., 2018).

In conclusion, GI and hepatobiliary disorders have both positive and negative impacts on individuals and healthcare systems. While they raise awareness of the importance of a healthy lifestyle and drive medical advancements, they can significantly reduce patients’ quality of life. By implementing patient education, psychosocial support, advocacy for research, and lifestyle promotion, APNs can contribute to better patient outcomes and a healthier population.

References

Lammert, F., Gurusamy, K., Ko, C. W., Miquel, J. F., Méndez-Sánchez, N., Portincasa, P., … & van Erpecum, K. J. (2018). Gallstones. Nature Reviews Disease Primers, 2(1), 1-24.

Mandaliya, R., & Sahu, S. (2021). Cholecystitis. In StatPearls [Internet]. StatPearls Publishing.

McQuaid, K. R. (2020). Current Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy (3rd ed.). McGraw-Hill Education.

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2nd ed.). Elsevier.

FAQs

  1. FAQ: What are some common symptoms of gastrointestinal and hepatobiliary disorders, and why is it essential to diagnose them accurately?

    Answer: Common symptoms include abdominal pain, nausea, vomiting, and fatigue. Accurate diagnosis is crucial to provide appropriate treatment and prevent complications.

  2. FAQ: How do GI and hepatobiliary disorders impact a patient’s quality of life, and what measures can healthcare providers take to address these challenges?

    Answer: These disorders can significantly reduce a patient’s quality of life due to debilitating symptoms. Healthcare providers can offer patient education, psychosocial support, and lifestyle promotion to mitigate these challenges.

  3. FAQ: What role do advanced practice nurses (APNs) play in managing patients with GI and hepatobiliary disorders, and how can they empower patients to take control of their health?

    Answer: APNs are instrumental in providing comprehensive care, including patient education, psychosocial support, and advocacy for research. They empower patients by offering resources and promoting healthy lifestyles.

  4. FAQ: Are there any advancements in the treatment of GI and hepatobiliary disorders, and how do these advancements improve patient outcomes?

    Answer: Yes, there have been advancements such as minimally invasive surgeries. These advancements enhance patient outcomes by reducing recovery times and postoperative pain.

  5. FAQ: What is the significance of raising awareness about GI and hepatobiliary disorders, and how can individuals prevent these conditions through lifestyle modifications?

    Answer: Raising awareness is crucial to encourage early diagnosis and treatment. Lifestyle modifications, including a balanced diet, regular exercise, and weight management, can help prevent these disorders.