Assignment Evidence-Based Clinical Intervention: A Case of Diarrhea

Assignment Evidence-Based Clinical Intervention: A Case of Diarrhea

A Sample Answer For the Assignment: Assignment Evidence-Based Clinical Intervention: A Case of Diarrhea

Title: Assignment Evidence-Based Clinical Intervention: A Case of Diarrhea

Assignment Evidence-Based Clinical Intervention  A Case of Diarrhea

The primary medical diagnosis for the patient is diarrhea. Diarrhea is defined as the sudden onset of increased bowel movements with more than three loose stools of more than 200 grams in a day (Lacy, 2016). It is categorized into acute diarrhea if it lasts for less than 14 days, and chronic or persistent diarrhea if it lasts for more than 14 days. Traveler’s diarrhea is defined by the situation in which an individual acquired the symptoms and in most cases is caused by consumption of contaminated food and water (Schweitzer, Singh, Rupali & Libman, 2019). Diarrhea is mostly a symptom of infection by a pathogen, namely a bacteria, virus, or parasite, which are spread mainly by contaminated water.

Symptoms of diarrhea include increased frequency of bowel movements, increased fluid content of stools, abdominal cramps, intestinal rumbling, abdominal distention, loss of appetite, and thirst (Schweitzer et al., 2019). The patient also complains of painful contractions of the anus with ineffective straining during defecation (Schertzer & Garmel, 2018). On examination. Patients also present with dehydration.

The patient, in this case, presented with symptoms of increased bowel movements, frequent loose stools for two days, and vomiting. The passage of frequent loose stools started after he had traveled to another country. The patient also reports of weight loss, fatigue, loss of appetite, and a dull and diffuse abdominal pain. On physical examination, there are increased bowel sounds in all four quadrants, and the abdomen is tender on palpation.

Onset: Patient reports that the symptoms began two days ago. Location: Reports pain on the abdomen. Duration: Symptoms have lasted for two days. Characteristics: Describes pain as dull and diffuse. Aggravating factors: Reports no aggravating factors. Relieving factors: Reports Loperamide partly relieves diarrhea. Treatment: OTC Loperamide to alleviate diarrhea.

Commonly Affected Age-Group: Children below the age of 5 years are at the highest risk and the most affected by diarrhea. Children less than two years mostly have viral diarrhea from infection by Rotavirus and Adenovirus (Schertzer & Garmel, 2018). Very young children are at a high risk of secondary dehydration and nutrient malabsorption. The severity, duration, and prognosis of diarrhea in children are highly determined by the child’s age and nutritional status (Schertzer & Garmel, 2018). As a result, very young children are usually at risk for severe life-threatening diarrhea.

Concomitant States Associated With Diarrhea

Diarrhea is associated with dehydration which manifests with hypotension, dry mucous membranes, poor skin turgor, and sunken eyes (Schertzer & Garmel, 2018). Dehydration is the major cause of morbidity and mortality, especially in children having diarrhea. High-grade fever is usually present in diarrhea caused by a bacterial infection and low-grade fever in viral infections (Schweitzer et al., 2019). Metabolic acidosis as a result of the loss of electrolytes through diarrhea.

Pathophysiology of Diarrhea

Diarrhea occurs when there is a reversal of the normal absorption of water and electrolytes in the body to increased secretion. There are three types of diarrhea, namely secretory, osmotic, and mixed diarrhea (DuPont, 2014). Secretory diarrhea is also referred to as high-volume diarrhea, and it commonly occurs from bacterial infection of the gastrointestinal system. It results from an increase in production and secretion of water and electrolytes by the intestinal mucosa into the intestinal lumen (DuPont, 2014). In a bacterial

infection, the enteric pathogens invade the epithelium of the GI and produce enterotoxins that stimulate secretion. The pathogens also trigger the production of cytokines that attract inflammatory agents which increase secretion in the gut. Osmotic diarrhea results when water is drawn into the intestines through osmotic pressure of unabsorbed food particles, and as a result slowing the water reabsorption process (Acree & Davis, 2017). In osmotic diarrhea, stool output is usually not massive, and it is proportional to the amount of non-absorbable food consumed (Schweitzer et al., 2019). Mixed diarrhea results from increased peristalsis and a combination of increased secretion of water and electrolytes and a decreased absorption in the large intestine.

Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: Assignment Evidence-Based Clinical Intervention: A Case of Diarrhea

Differential Diagnosis

Food poisoning: This is an acute illness that occurs from consumption of water or food that is contaminated by pathogens, namely bacteria, viruses, parasites, or chemicals. The most common causative pathogens are E.coli, C.perfingens, S.aureus, Salmonella, and Norovirus (Acree & Davis, 2017). Clinical presentations depend on the colonizing pathogen. Food poisoning manifests with increased bowel movements lasting less than two weeks with loose stools having blood or mucus. Other symptoms include abdominal pain, vomiting, fever, headache, abdominal bloating, and reactive arthritis (DuPont, 2014). Severe cases of food poisoning, present with neurologic, renal, and hepatic involvement and may lead to disability or death (Acree & Davis, 2017). In food poisoning, the patient usually has a history of consumption of raw seafood, canned foods, undercooked meat, or deli meat. Food poisoning is a possible diagnosis as per the patient’s symptoms of frequent loose stools, vomiting, and abdominal pain. Negative findings include fever, headache, bloody or mucoid stools, and joint pain.

Shigellosis: This is a type of food poisoning that is spread through the fecal-oral route. It occurs when there is an infection with a Shigella species. The populations at high risk of shigellosis include international travelers, children in daycares, homosexual men, people in custodial institutions, and people living in crowded conditions with poor sanitation (Schertzer & Garmel, 2018). Early symptoms of Shigellosis include severe abdominal cramps which have a sudden onset, vomiting, loss of appetite, high-grade fever, the passage of large-volume watery stools and seizures. The symptoms are followed by painful contractions of the anus, abdominal pain, urgency to defecate with fecal incontinence and passage of small-volume mucoid and bloody stools (Schertzer & Garmel, 2018). Physical examination findings in patients with Shigellosis include high body temperature, tachycardia, tachypnea, tenderness on the central and lower abdomen and signs of dehydration (Acree & Davis, 2017). Positive findings, in this case, include passing loose stool, vomiting, and loss of appetite, abdominal pain and tenderness, and history of travel. Negative findings include fever, fecal incontinence, tachycardia, tachypnea, and signs of dehydration.

Non-infective gastroenteritis: Gastroenteritis (GE) refers to inflammation of the stomach and intestines lining. Most cases of GE are infectious, although it can occur after ingestion of chemical toxins and drugs (DuPont, 2014). GE is acquired from the consumption of contaminated food and water or through the fecal-oral route. Symptoms of non-infectious G.E include nausea, vomiting, low-grade fever, fatigue, myalgia, loss of appetite, and abdominal discomfort (Lacy, 2016). The patient also reports increased bowel movements with the passage of frequent non-bloody and watery stools lasting for 1-4 days and is often self-limiting (DuPont, 2014). Physical examination findings include hyperactive bowel sounds, abdominal distension, tenderness, and guarding (Lacy, 2016). Non-infectious G.E is a likely diagnosis as per the patient’s symptoms of frequent loose stools, fatigue, abdominal pain, vomiting, and loss of appetite. Negative findings include low-grade fever, myalgia, and guarding.

Rehydration is recommended in the management of moderate diarrhea with fluids containing glucose, sodium, bicarbonate, chloride, and potassium ions. In severe diarrhea, intravenous fluid therapy with Ringer’s lactate solution is the most preferred treatment (Shane et al., 2017).

Antidiarrheal agents can be used in patients with mild to moderate diarrhea to promote comfort. Nevertheless, antidiarrheal agents are not recommended in cases of high fever, bloody diarrhea, high fever, systemic toxicity and should be stopped in patients with worsening diarrhea despite therapy (Riddle et al., 2017). Bismuth subsalicylate is strongly recommended for Traveler’s diarrhea because of its anti-inflammatory and antibacterial effects, and evidence shows that it improves symptoms in Traveler’s diarrhea (Riddle et al., 2017). Loperamide is also strongly recommended as monotherapy in moderate travelers’ diarrhea.

Antibiotic therapy is not indicated for acute diarrhea cases but can be considered in the empiric treatment of patients presenting with fever, bloody stools, and tenesmus and people who have traveled internationally with temperatures of more than 38.5 or have signs of sepsis (Shane et al., 2017). Antibiotics of choice for adults include fluoroquinolones such as ciprofloxacin, ofloxacin, levofloxacin, and norfloxacin for 5–7 days. Antibiotics may be used to treat moderate Traveler’s diarrhea with the strongest evidence recommending the use of Fluoroquinolones and Azithromycin (Riddle et al., 2017). Rifaximin is also recommended, but there is no reliable evidence supporting its use (Shane et al., 2017). However, there is a gradual increase in multidrug-resistant bacteria that is associated with antibiotic use in prophylactic therapy, and in treatment of travelers’ diarrhea.

Expected Outcomes

Treatment with an antidiarrheal agent such as Bismuth subsalicylate will help relieve abdominal pain and diarrhea with a return to regular bowel movements. It is expected that adequate intake of fluids containing carbohydrates and electrolytes will restore lost energy and electrolytes and rehydrate the body.

Algorithms

The first step is classifying diarrhea as mild, moderate, and severe. Mild diarrhea is tolerable, does not cause distress or interfere with daily activities (Schweitzer et al., 2019). Treatment of mild diarrhea may include Loperamide or Bismuth subsalicylate. Moderate diarrhea is distressing and interferes with daily activities. Treatment may consist of Loperamide alone or loperamide with an adjunct antibiotic (DuPont, 2014). Severe diarrhea causes incapacitation and prevents daily activities. The stool should be assessed for the presence of blood to classify diarrhea as Dysentery or non-dysentery (Schweitzer et al., 2019). Treatment must include an antibiotic, and Loperamide may be used as an adjunct. Microbiologic testing should be done in severe diarrhea.

SOAP NOTE

Subjective: Patient present with a history of passing frequent loose stool for two days. Reports fatigue, vomiting, loss of appetite, weight loss, diffuse, dull abdominal pain, and mild low back pain. Has taken Loperamide to relieve diarrhea. Denies fever, muscle weakness, bloating, flatulence, or history of diarrhea or constipation.

Objective: Temp 98.48 F, BP 120/74, Pulse 86, Resp 18, BMI 32.7. Hyperactive bowel sounds. Abdominal tenderness. No palpable masses, or hepatosplenomegaly. No guarding and rebound tenderness noted.

A: Traveler’s diarrhea.

P: Loperamide 4mg PO initially, then 2 mg after each subsequent loose stool. Health education on handwashing, drinking boiled or treated water, and thorough washing of fruits and vegetables before consumption. Advise on adequate intake of fluids to promote rehydration. Follow-up after three days in the outpatient clinic to evaluate the progress of treatment

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource