Sample Answer for PHARMACOTHERAPY FOR GASTROINTESTINAL AND HEPATOBILIARY DISORDERS NURS 6512 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.
RESOURCES
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Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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 Links to an external site.). All papers submitted must use this formatting.
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A Sample Answer For the Assignment: PHARMACOTHERAPY FOR GASTROINTESTINAL AND HEPATOBILIARY DISORDERS NURS 6512
Title: PHARMACOTHERAPY FOR GASTROINTESTINAL AND HEPATOBILIARY DISORDERS NURS 6512
The case study depicts a 46-year-old female patient with a chief complaint of RUQ pain for the last 24 hours. The RUQ pain began an hour after dinner, and she had nausea and vomiting x1 before the pain started. The abdomen is non-distended but has mild tenderness. Lab results revealed a high WBC count and Direct bilirubin. The purpose of this paper is to discuss the patient’s diagnosis and treatment plan.
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 2 For the Assignment: PHARMACOTHERAPY FOR GASTROINTESTINAL AND HEPATOBILIARY DISORDERS NURS 6512
Title: PHARMACOTHERAPY FOR GASTROINTESTINAL AND HEPATOBILIARY DISORDERS NURS 6512
Diagnosis
Hepatitis A is the identified diagnosis for this case. It is caused by the hepatitis A virus (HAV) transmitted via the fecal-oral route through person-to-person contact and ingesting contaminated food or water. The classical presentation in adults includes anorexia, RUQ pain, jaundice, and hyperbilirubinemia (Abutaleb & Kottilil, 2020). Hepatitis A is the presumptive diagnosis based on pertinent positive symptoms of nausea, vomiting, RUQ pain, abdominal tenderness, and high direct bilirubin levels. Besides, an elevated WBC count indicates an underlying infection.
Drug Therapy Plan
Treatment of Hepatitis A is usually supportive. I would recommend Acetaminophen 500 mg per oral twice daily to relieve pain. Pain relief is important to promote quality patient care in the acute phase of Hepatitis A (Ntouva et al., 2019). In addition, I would recommend Metoclopramide 10 mg PRN. Metoclopramide is an antiemetic and will be important to alleviate nausea and vomiting. In addition, inactivated Hepatitis A vaccine will be administered for active immunization against diseases associated with HAV (Ntouva et al., 2019).
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Conclusion
The patient presented with symptoms consistent with Hepatitis A, such as nausea, RUQ pain, mild abdominal tenderness, hyperbilirubinemia, and an elevated WBC count. Hepatitis A could be due to transmission of HAV from contaminated food or water. The treatment plan will include supportive measures such as pain control and alleviating nausea and vomiting using an analgesic and antiemetic.
References
Abutaleb, A., & Kottilil, S. (2020). Hepatitis A: Epidemiology, Natural History, Unusual Clinical Manifestations, and Prevention. Gastroenterology clinics of North America, 49(2), 191–199. https://doi.org/10.1016/j.gtc.2020.01.002
Ntouva, A., Sibal, B., Balogun, K., Mandal, S., & Harding, N. (2019). Hepatitis A in primary care: working in partnership for diagnosis, management, and prevention of outbreaks. The British journal of general practice : the journal of the Royal College of General Practitioners, 69(687), 521–522. https://doi.org/10.3399/bjgp19X705965
A Sample Answer 3 For the Assignment: PHARMACOTHERAPY FOR GASTROINTESTINAL AND HEPATOBILIARY DISORDERS NURS 6512
Title: PHARMACOTHERAPY FOR GASTROINTESTINAL AND HEPATOBILIARY DISORDERS NURS 6512
The case concerns HL, with nausea, vomiting, and diarrhea. The patient has a history of illicit drug use and a possible Hepatitis C infection. The current drug therapy includes Synthroid 100 mcg, Nifedipine 30 mg, and Prednisone 10 mg. The purpose of this paper is to discuss the diagnosis and drug therapy for this patient.
Diagnosis
The patient’s symptoms and medical history are consistent with Hepatitis C, which is caused by Hepatitis C virus (HCV). HCV is transmitted parenterally through contaminated blood from sharing and recycling syringes among drug users, unsafe sexual practices, and unsafe health practices like transfusing unscreened blood (Lazarus et al., 2020). The clinical manifestations of Hepatitis C include nausea, vomiting, anorexia, non-specific upper abdominal discomfort, jaundice, and malaise (Kouroumalis & Voumvouraki, 2022). However, some patients are asymptomatic. Hepatitis C is the presumptive diagnosis owing to the patient’s positive GI symptoms of nausea, vomiting, and diarrhea. In addition, the patient has a history of illicit drug use, which puts him at risk of contracting HCV and a history of Hepatitis C infection.
Drug Therapy Plan
Treatment guidelines for Hepatitis C recommend treatment with antiviral drugs following the initial diagnosis of the condition. Effective direct-acting antiviral drugs (DAAs) are recommended for hepatitis C to lower the chances of progressing to chronic infection. The patient’s treatment plan will include Ledipasvir/sofosbuvir (Harvoni) 1 tablet (90 mg/400 mg) orally once daily for 8 weeks (Chung et al., 2018). The oral combination of Ledipasvir and Sofosbuvir is used to treat adults with chronic hepatitis C, with or without cirrhosis.
Conclusion
Hepatitis C is the presumptive diagnosis for this patient based on the presence of GI symptoms like nausea, vomiting, and diarrhea. The patient may have contracted HCV from sharing syringes, or it could be a chronic infection considering the history of possible Hepatitis C. Treatment will be a combination of Ledipasvir and Sofosbuvir, which is recommended for chronic Hepatitis C.
References
Chung, R. T., Ghany, M. G., Kim, A. Y., Marks, K. M., Naggie, S., Vargas, H. E.,Aronsohn, A.I., Bhattacharya, D., Broder, T., Falade-Nwulia, O.O.,& Fontana, R. J. (2018). Hepatitis C guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection. Clinical Infectious Diseases. DOI: 10.1093/cid/ciy585
Kouroumalis, E., & Voumvouraki, A. (2022). Hepatitis C virus: A critical approach to who really needs treatment. World journal of hepatology, 14(1), 1–44. https://doi.org/10.4254/wjh.v14.i1.1
Lazarus, J. V., Roel, E., & Elsharkawy, A. M. (2020). Hepatitis C Virus Epidemiology and the Impact of Interferon-Free Hepatitis C Virus Therapy. Cold Spring Harbor perspectives in medicine, 10(3), a036913. https://doi.org/10.1101/cshperspect.a036913