NSG 6101 Week 3 Gastrointestinal Discussion

Mr. Rodriquez’s History That Would Be Pertinent to His Gastrointestinal Problem

The case study is about Mr. Cesar Rodriguez, a 39-year-old male who recently moved to the U.S. from the Dominican Republic. Mr. Rodriguez is uninsured, and he is on his first clinic visit. He has had a chief complaint of worsening abdominal pain over the past months. He states that the pain occurs in the epigastric area. The client mentions that the abdominal pain started about a year ago. It used to occur a few times a week but now occurs daily. Eating and drinking sometimes alleviate or worsen the pain, and spicy foods also worsen it. In the HPI, it would be important to know the characteristics of the pain, that is, if it is sharp, dull, colicky, or aching (Govender et al., 2021). Besides, knowing if the pain is constant or radiating is vital. The measures the patient has taken to ease the pain, including medications and non-pharmacological interventions, are also crucial to know and their impact in alleviating the pain. Furthermore, the severity of the abdominal pain on a pain scale is essential.

Essential information in the past medical history includes the patient’s chronic illnesses and history of GI disorders. It is vital to know the patient’s current medications with the dose and frequency. The patient mentions that he takes Ibuprofen most days of the week, which is associated with gastritis. In the family history, the patient reports his father had a history of hypertension and his mother diabetes. Vital information in the social history includes dietary habits, smoking, alcohol use, substance use, and exercise patterns (Govender et al., 2021). Mr. Rodriguez reports smoking a few cigarettes daily but stopped six months ago. However, he takes 3-4 beers per week, which may increase the risk of stomach ulcers.

Physical Exam and Diagnostic Tools to Be Used For Mr. Rodriguez

Physical exams that should be included for Mr. Rodriguez include a detailed abdominal exam with inspection, auscultation, percussion, and palpation. Diagnostic tests proposed for this patient include H. pylori with IgG serologic test, urea breath test, or stool antigen test. The Urea breath test has the advantage of accurately detecting active H. pylori infection. In addition, an endoscopy is indicated if the patient presents with alarming symptoms. A fecal occult blood test (FOBT) has also been used to assess stool samples for occult blood, usually caused by gastritis, peptic ulcers, and inflammatory bowel disease (Govender et al., 2021). I recommend a complete blood count (CBC) to assess if the patient has an underlying inflammation or infection and rule out low RBC, usually caused by anemia.

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Differential Diagnoses

Peptic ulcer disease (PUD) secondary to H. pylori infection: The clinical manifestations of PUD include epigastric tenderness, nausea, vomiting, and dyspepsia. Epigastric pain is a positive symptom in the patient (Narayanan et al., 2018). In addition, the patient had a positive H. pylori IgG serology IgG test indicating that the epigastric symptoms have been caused by H. pylori infection.

Gastritis: Gastritis is characterized by epigastric burning pain associated with food and worsens in the supine position and epigastric tenderness with no rebound tenderness (Narayanan et al., 2018). The patient has epigastric pain that sometimes worsens with food making gastritis a differential diagnosis.

Dyspepsia: Dyspepsia is the most common upper GI symptom. It is characterized by epigastric pain, abdominal fullness, discomfort, burning, nausea, vomiting, early satiety, and belching (Medić et al., 2021). The patient reports epigastric pain making this a differential diagnosis.

Plan of Care

The drug therapy for Mr. Rodriguez will include the Quadruple therapy for H. Pylori infection. This will include 10-14 days of quadruple therapy with a proton pump inhibitor (PPI), bismuth, tetracycline, and nitroimidazole (Manu et al., 2021). The medications will include:

Esomeprazole 40 mg PO qid

Bismuth 525 mg PO qid

Metronidazole 500 mg PO qid

Tetracycline 500 mg PO qid

Patient education: The patient will be educated on medication compliance and completing the dose to eliminate the H.pylori infection. He will be advised to avoid unnecessary NSAID use and use acetaminophen when possible. In addition, he will be advised to avoid alcohol consumption when he is in treatment. This is because taking alcohol with Metronidazole causes unpleasant side effects like nausea, vomiting, and hot flushes.

Follow-up: Mr. Rodriguez is scheduled for a follow-up visit after one month. He will be assessed for improvement of symptoms. If there is no improvement in symptoms, an endoscopy will be indicated. It is recommended in patients on a PPI, antibiotics, or bismuth for endoscopic testing for H. pylori.

NSG 6101 Week 3 Gastrointestinal Discussion References

Govender, I., Rangiah, S., Bongongo, T., & Mahuma, P. (2021). A Primary Care Approach to Abdominal Pain in Adults. South African family practice: official journal of the South African Academy of Family Practice/Primary Care, 63(1), e1–e5. https://doi.org/10.4102/safp.v63i1.5280

Manu, P., Rogozea, L. M., Sandor, V., & Dumitraşcu, D. L. (2021). Pharmacological Management of Peptic Ulcer: A Century of Expert Opinions in Cecil Textbook of Medicine. American Journal of Therapeutics, 28(5), e552–e559. https://doi.org/10.1097/MJT.0000000000001439

Medić, B., Babić, Ž., Banić, M., & Ljubičić, L. (2021). MODERN APPROACH TO DYSPEPSIA. Acta Clinica Croatica, 60(4), 731–738. https://doi.org/10.20471/acc.2021.60.04.21

Narayanan, M., Reddy, K. M., & Marsicano, E. (2018). Peptic Ulcer Disease and Helicobacter pylori infection. Missouri medicine, 115(3), 219–224.

This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned.

To support your work with evidence bases references. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite sources in your responses to other classmates. In addition you must respond to your professor if applicable. Complete your participation for this assignment by the end of the week.

For this assignment, you will complete a Aquifer case study based on the course objectives and weekly content. Aquifer cases emphasize core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the Aquifer case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

The Aquifer assignments are highly interactive and a dynamic way to enhance your learning. Material from the Aquifer cases may be present in the quizzes, the midterm exam, and the final exam.

Learn how to access and navigate Aquifer.

This week, complete the Aquifer case titled “Family Medicine 19: 39-year-old man with epigastric pain”

Apply information from the Aquifer Case Study to answer the following discussion questions:

Discuss the Mr. Rodriquez’s history that would be pertinent to his gastrointestinal problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.

Describe the physical exam and diagnostic tools to be used for Mr. Rodriguez. Are there any additional you would have liked to be included that were not?

Please list 3 differential diagnoses for Mr. Rodriguez and explain why you chose them. What was your final diagnosis and how did you make the determination?

What plan of care will Mr. Rodriquez be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?