Sample Answer for NURS 6521 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 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Title: NURS 6521 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
The patient in the case study presents with nausea, vomiting, and diarrhea. He has a drug abuse history and likely Hepatitis C. The current drug therapy includes Synthroid, Nifedipine, and Prednisone. The purpose of this assignment is to discuss the diagnosis and appropriate pharmacotherapy for the patient.
Diagnosis
Hepatitis C infection is the presumptive diagnosis. This is a liver inflammation caused by Hepatitis C virus (HCV). It is spread through sexual intercourse with infected persons, sharing personal items, and sharing drug-injection equipment (Ghany et al., 2020). Most infected persons are asymptomatic. Symptomatic cases present symptoms like fatigue, fever, reduced appetite, nausea, vomiting, abdominal discomfort, pale feces, dark urine, myalgia, and jaundice (Jin, 2020). Therefore, Hepatitis C is the primary diagnosis because of the positive symptoms of nausea, vomiting, and diarrhea and the client’s history of drug abuse and Hepatitis C infection.
Appropriate Drug Therapy
The recommended drug therapy will include a combination of Ombitasvir/paritaprevir/ritonavir (Technivie) for 12 weeks to treat Hepatitis C infection. Technivie is indicated for HCV infection in patients without cirrhosis. Ombitasvir inhibits HCV NS5A, which is needed for Hepatitis C viral replication. Paritaprevir inhibits NS3/4A serine protease required for proteolytic cleavage of the HCV-encoded polyprotein into mature forms (Wu et al., 2019). Ritonavir is a protease inhibitor that elevates paritaprevir serum levels. Nifedipine would be reduced to 10 mg and Prednisone to 5 mg since they are associated with GI side effects.
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Conclusion
The patient’s nausea, vomiting, and diarrhea symptoms are consistent with Hepatitis C infection. Besides, the history of Hepatitis C and drug abuse make HCV infection the likely diagnosis. A combination of Ombitasvir/paritaprevir/ritonavir will be recommended to treat the HCV infection,
References
Ghany, M. G., Morgan, T. R., & AASLD‐IDSA hepatitis C guidance panel. (2020). Hepatitis C guidance 2019 update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America recommendations for testing, managing, and treating hepatitis C virus infection. Hepatology, 71(2), 686–721. https://doi.org/10.1002/hep.31060
Jin, J. (2020). Screening for Hepatitis C Virus Infection. JAMA, 323(10), 1008-1008. doi:10.1001/jama.2020.1761
Wu, J., Huang, P., Fan, H., Tian, T., Xia, X., Fu, Z., … & Zhang, Y. (2019). Effectiveness of ombitasvir/paritaprevir/ritonavir, dasabuvir for HCV in HIV/HCV coinfected subjects: a comprehensive analysis. Virology journal, 16(1), 1–10.
A Sample Answer 2 For the Assignment: NURS 6521 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Title: NURS 6521 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
A Sample Answer 3 For the Assignment: NURS 6521 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Title: NURS 6521 Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
In the provided case study, the 46-year-old female patient presents with a 24-hour history of RUQ pain. The patient claims that the pain started approximately an hour after consuming a large dinner with her family. Associated symptoms include nausea and vomiting. The patient also has a history of type 2 DM, HTN, Gout, Obesity, and DVT. The patient is currently on a multivitamin, allopurinol, HCTZ, and lisinopril, with latex, codeine, and amoxicillin allergy. The purpose of this discussion is to examine the patient and come up with the most appropriate diagnosis and treatment plan based on the provided patient factors.
The patient presents with RUQ pain, nausea, and vomiting, elevated white blood cells, elevated bilirubin levels, and elevated aspartate levels, which indicated possibilities of acute calculous cholecystitis. This disorder is characterized by inflammation of the gallbladder (Pisano et al., 2020). Studies show that acute cholecystitis normally presents with upper right quadrant abdominal pain which usually occurs after a large or fatty, just like for the case of the patient in the provided case study (Arockia Singh & Anish Kumar, 2019). The diagnostic criteria for this disorder require a blood test with elevated WBC, positive for the patient. Additional tests include imaging studies such as abdominal ultrasound and CT to identify stones in the gall bladder.
Antibiotic therapy is the most effective treatment plan for patients with acute calculous cholecystitis. Microbial culture of a sample of the bile is however needed to identify the causative bacterial organism for the right choice of antibiotic to use. Since the patient is allergic to amoxicillin, an alternative regimen like third-generation cephalosporins in combination with metronidazole is considered the most appropriate supportive initial treatment for this patient (Pisano et al., 2020). As such, the patient treatment plan will include: Ceftriaxone 1 g IV daily for 5 days, and Metronidazole 1 g IV loading dose then 500 mg IV q6h. Nausea can be managed using an antiemetic like ondansetron, whereas Tylenol can be considered for the management of the associated pain (Fu et al., 2021). Surgical interventions are considered in case of worsening symptoms even after the administration of initial therapy.
References
Arockia Singh, M. D. S., & Anish Kumar, M. P. (2019). Diagnosis and management of acute acalculous cholecystitis in an outpatient: a case report. International Surgery Journal, 6(5), 1777. https://doi.org/10.18203/2349-2902.isj20191906
Fu, Y., Pang, L., Dai, W., Wu, S., & Kong, J. (2021). Advances in the study of acute acalculous cholecystitis: a comprehensive review. Digestive Diseases. DOI: 10.1159/000520025
Pisano, M., Allievi, N., Gurusamy, K., Borzellino, G., Cimbanassi, S., Boerna, D., … & Ansaloni, L. (2020). 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World journal of emergency surgery, 15(1), 1-26. https://doi.org/10.1186/s13017-020-00336-x