NURS 6521 Week 7 Discussion: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Sample Answer for NURS 6521 Week 7 Discussion: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Included After Question

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.

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.

By Day 7 of Week 4

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.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name.
Click the Week 4 Assignment Rubric to review the Grading Criteria for the Assignment.
Click the Week 4 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
Click on the Submit button to complete your submission.

A Sample Answer For the Assignment: NURS 6521 Week 7 Discussion: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Title: NURS 6521 Week 7 Discussion: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

The case study concerns a 46-year-old female with reports of RUQ pain for the past 24 hours. The pain began an hour after having a large dinner. She also experienced nausea and one vomiting episode prior to the presentation. The purpose of this paper is to discuss the likely diagnosis and treatment plan.

Diagnosis

The likely diagnosis for this patient is Acute cholecystitis. This is a gallbladder inflammation that progresses over hours due to a gallstone obstructing the cystic duct. Gallaher & Charles (2022) explain that the classic presentation of Acute cholecystitis includes acute RUQ pain, fever, nausea, and vomiting associated with eating and physical exam findings of RUQ tenderness. Acute cholecystitis manifests with a high WBC count indicating inflammation (Bridges et al., 2018). In addition, serum levels of aspartate aminotransferase, alkaline phosphatase, and lactate dehydrogenase may be increased, pointing to abnormalities in liver function in persons with severe biliary obstruction (Doherty et al., 2022). Direct and indirect serum bilirubin levels are also increased. Acute cholecystitis is the selected diagnosis owing to postprandial RUQ pain, nausea, vomiting, mild abdominal tenderness, high WBC, and elevated Bilirubin levels.

Drug Therapy

Drug therapy will include antibiotics with IV Ceftriaxone 2 g once daily and IV metronidazole 500 mg every 8 hours. These antibiotics have adequate coverage against the most common pathogens (Gallaher & Charles, 2022). An antiemetic like Prochlorperazine IV 2.5 mg every 4 hours will be administered to alleviate nausea and prevent fluid and electrolyte disorders caused by vomiting. Oxycodone/acetaminophen 1 tablet orally every 6 hours will be prescribed for pain control.

Conclusion

Positive findings of postprandial RUQ pain, nausea, vomiting, mild abdominal tenderness, high WBC, and elevated Bilirubin levels indicate likely Acute cholecystitis. When a gallstone impacts the cystic duct and continuously obstructs it, it results in acute inflammation causing cholecystitis. Drug therapy will include antibiotics with Ceftriaxone and Metronidazole, antiemetic with Prochlorperazine, and Oxycodone/acetaminophen for pain relief.

References

Bridges, F., Gibbs, J., Melamed, J., Cussatti, E., & White, S. (2018). Clinically diagnosed cholecystitis: a case series. Journal of surgical case reports, 2018(2), rjy031. https://doi.org/10.1093/jscr/rjy031

Doherty, G., Manktelow, M., Skelly, B., Gillespie, P., Bjourson, A. J., & Watterson, S. (2022). The Need for Standardizing Diagnosis, Treatment and Clinical Care of Cholecystitis and Biliary Colic in Gallbladder Disease. Medicina, 58(3), 388. https://doi.org/10.3390/medicina58030388

Gallaher, J. R., & Charles, A. (2022). Acute Cholecystitis: A Review. JAMA, 327(10), 965–975. https://doi.org/10.1001/jama.2022.2350

Week 7 discussion

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 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 Discussion, 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.

Consider the following case study:

Patient HL comes into the clinic with the following
symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug
abuse and possible Hepatitis C. HL is currently taking the following
prescription drugs:

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A Sample Answer 2 For the Assignment: NURS 6521 Week 7 Discussion: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Title: NURS 6521 Week 7 Discussion: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Gastrointestinal problems are a common occurrence in nursing and healthcare. Nurses and other healthcare providers utilize interventions such as comprehensive patient assessment to develop accurate diagnoses and care plans. The treatment of gastrointestinal disorders require the use of evidence-based interventions and guidelines to improve outcomes. Therefore, this essay examines a case study of a 46-year-old female that has presented to the clinic with complaints of right upper quadrant pain for the last 24 hours. The patient developed the problem an hour after having a large dinner with her family. She reported nausea and vomiting before the onset of pain. The essay develops the patient’s diagnosis and treatment plan that would aid recovery.

Diagnosis

The most probable diagnosis for the patient is biliary colic. Biliary colic is a pain in the abdomen that arises from stones in the bile duct or cystic duct of the biliary tree. Patients develop the pain after eating a large fatty mean. The meal causes gallbladder contraction (Hapca et al., 2021; Makutonin et al., 2023). Patients often describe the pain as constant and not colicky. Prolonged obstruction results in cholangitis or cholecystitis. The accompanying symptoms associated with the biliary colic include right upper quadrant pain, nausea, and vomiting (Sigmon et al., 2023). The patient in the case study also has risk factors that predispose her to biliary colic such as being overweight. There is also the elevation of white blood cells, which may indicate the risk of cholangitis or cholecystitis if responsive interventions are not implemented. Liver enzymes such as direct bilirubin, GGT, ALP, ALT, and AST may or may not be elevated in biliary colic (Doherty et al., 2022).

Appropriate Drug Therapy

An appropriate treatment for the patient in the case study is ursodeoxycholic acid. Ursodeoxycholic acid is the drug of choice that helps in dissolving gallstones in patients with biliary colic. The additional interventions include restricting fat intake and administration of analgesics and antiemetics for nausea and vomiting. The study by Pizza et al., (2020) found that Ursodeoxycholic acid significantly reduces incidence of cholelithiasis, cholecystitis among patients with biliary obstruction, hence prescribing the patient in the case study.

Conclusion

In summary, the most likely diagnosis for the patient is biliary colic. Biliary colic arises from the obstruction at the biliary tree. The presenting symptoms and risk factors align with those seen in patients with biliary colic. An effective treatment would be prescribing her Ursodeoxycholic acid.

References

Doherty, G., Manktelow, M., Skelly, B., Gillespie, P., Bjourson, A. J., & Watterson, S. (2022). The Need for Standardizing Diagnosis, Treatment and Clinical Care of Cholecystitis and Biliary Colic in Gallbladder Disease. Medicina, 58(3), Article 3. https://doi.org/10.3390/medicina58030388

Hapca, S., Ramsay, G., Murchie, P., & Ahmed, I. (2021). Biliary colic. BMJ, 374, n2085. https://doi.org/10.1136/bmj.n2085

Makutonin, M., Moghatederi, A., Newton, S., Ma, Y., & Meltzer, A. C. (2023). Biliary colic in the emergency department: A state-wide analysis of one-year costs and clinical outcomes. Surgery Open Science, 12, 9–13. https://doi.org/10.1016/j.sopen.2023.02.002

Pizza, F., D’Antonio, D., Lucido, F. S., Tolone, S., Del Genio, G., Dell’Isola, C., Docimo, L., & Gambardella, C. (2020). The Role of Ursodeoxycholic Acid (UDCA) in Cholelithiasis Management After One Anastomosis Gastric Bypass (OAGB) for Morbid Obesity: Results of a Monocentric Randomized Controlled Trial. Obesity Surgery, 30(11), 4315–4324. https://doi.org/10.1007/s11695-020-04801-z

Sigmon, D. F., Dayal, N., & Meseeha, M. (2023). Biliary Colic. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430772/

A Sample Answer 3 For the Assignment: NURS 6521 Week 7 Discussion: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Title: NURS 6521 Week 7 Discussion: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Abdominal infections could be associated with a wide range of clinical features, including abdominal pain, nausea, vomiting, and diarrhea. In that regard, therefore, it would be easy to confuse one diagnosis over the other. This essay considers a patient HL case study presented with nausea, vomiting, diarrhea, the diagnosis made, and the treatment options are taken.

Diagnosis

Hepatitis C is a possible diagnosis for HL. This condition would appear asymptomatic, but when symptoms occur, they could be mild or even severe. HL symptoms, including nausea, vomiting, and diarrhea, are prevalent with hepatitis C infection. This condition could be caused by viruses, bacteria, or parasitic infections. The infection can also be found in contaminated food or water, while chemical agents have also been shown to be causative. The diagnosis can be made using tests that include serologic assays, which measure the levels of antibodies that are generated, and the molecular assays which would detect the presence of HCV RNA (Chalasani et al., 2018).

Appropriate Drug Therapy Plan

In this case study, the therapeutic options recommendable include Hepatitis C pegylated interferon-α (IFN-α), administered weekly. Additionally, the patient is put on a daily dose of ribavirin for about 24 to 48 weeks. The combination is effective in clearing the HCV genotypes, especially 2 and 3 infections. The patient should also be put on food therapy. It is recommended that eating a frequent balanced diet possibly prevents nausea and vomiting associated with the disease. The balanced diet should be composed of cereals, whole grains, vegetables, and even fruits. There should also be a moderate to high protein diet to heal the infected liver tissue (Venugopal et al., 2018). The patient should also avoid certain drugs like aminoglycoside antibiotics, sedatives, and acetaminophen, which are considered hepatotoxic in high doses.

Appropriate use of the proper diagnostic approaches forms the basis of diagnosis, which informs the kind of intervention to be taken. Viruses, bacteria, and chemical agents can cause HCV. The condition can be treated using pegylated interferon-α (IFN-α) and ribavirin.

References

Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., … Sanyal, 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. https://doi.org/10.1002/hep.29367

Venugopal, V., Padmanabhan, P., Raja, R., & Dixit, N. M. (2018). Modelling how responsiveness to interferon improves interferon-free treatment of hepatitis C virus infection. PLoS Computational Biology, 14(7), e1006335. https://doi.org/10.1371/journal.pcbi.1006335

DISCUSSION RUBRIC

NURS 6521 Week 7 Discussion Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Grading Rubric Guidelines

Performance Category	10	9	8	4	0
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic decisions.	Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions Evaluates literature resources to develop a comprehensive analysis or synthesis. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion	Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions. Evaluates information from source(s) to develop a coherent analysis or synthesis. Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis. Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion. Demonstrates little or no understanding of the topic.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) without any interpretation/evaluation. The posting uses information that is not valid, relevant, or reliable	No evidence of the use of scholarly inquiry to inform or change professional or academic decisions. Information is not valid, relevant, or reliable
Performance Category	10	9	8	4	0
Application of Course Knowledge – Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources; Applies concepts to personal experience in the professional setting and or relevant application to real life.	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources. Applies concepts to personal experience in their professional setting and or relevant application to real life Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content	Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson. Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life Does not demonstrate a solid understanding of the principles and concepts presented in the lesson	Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post. Posts are superficial and do not reflect an understanding of the lesson content Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life	Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category	5	4	3	2	0
Interactive Dialogue Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. *(5 points possible per graded thread)*	Exceeds minimum post requirements Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days. Replies to a post posed by faculty and to a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days Replies to a question posed by a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Meets expectations of 2 posts on 2 different days. The main post is not made by the Wednesday deadline Does not reply to a question posed by a peer or faculty	Has only one post for the week Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments	Does not post to the thread No connections are made to the topic
	Minus 1 Point	Minus 2 Point	Minus 3 Point	Minus 4 Point	Minus 5 Point
Grammar, Syntax, APA Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition	2-3 errors in APA format. Written responses have 2-3 grammatical, spelling, and punctuation errors. Writing style is generally clear, focused, and facilitates communication.	4-5 errors in APA format. Writing responses have 4-5 grammatical, spelling and punctuation errors. Writing style is somewhat focused.	6-7 errors in APA format. Writing responses have 6-7 grammatical, spelling and punctuation errors. Writing style is slightly focused making discussion difficult to understand.	8-10 errors in APA format. Writing responses have 8-10 grammatical, spelling and punctuation errors. Writing style is not focused, making discussion difficult to understand.	Post contains greater than 10 errors in APA format. Written responses have more than 10 grammatical, spelling and punctuation errors. Writing style does not facilitate communication. The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
	0 points lost				-5 points lost
Total Participation Requirements *per discussion thread*	The student answers the threaded discussion question or topic on one day and posts a second response on another day.				The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement *per discussion thread*	The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.				The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.