NURS 6521 Week 4 EmmaGarcia Pharmacotherapy For Gastrointestinal And Hepatobiliary Disorders

NURS 6521 Week 4 EmmaGarcia Pharmacotherapy For Gastrointestinal And Hepatobiliary Disorders Example

Week 4 Case Study

Hi everyone-

I hope everyone had a good week! This week we will be looking at GI disorders. We have a paper that will be due.

Please use the following case for your assignment:

DC is a 46-year-old female who presents with a 24-hour history of RUQ pain. She states the pain started about 1 hour after a large dinner she had with her family. She has had nausea and on instance of vomiting before presentation.

PMH:	Vitals:
HTN	Temp: 98.8oF
Type II DM	Wt: 202 lbs
Gout	Ht: 5’8”
DVT – Caused by oral BCPs	BP: 136/82
	HR: 82 bpm

Current Medications:	Notable Labs:
Lisinopril 10 mg daily	WBC: 13,000/mm3
HCTZ 25 mg daily	Total bilirubin: 0.8 mg/dL
Allopurinol 100 mg daily	Direct bilirubin: 0.6 mg/dL
Multivitamin daily	Alk Phos: 100 U/L
	AST: 45 U/L
	ALT: 30 U/L

Allergies:

Latex
Codeine
Amoxicillin

PE:

Eyes: EOMI
HENT: Normal
GI:bNondistended, minimal tenderness
Skin:bWarm and dry
Neuro: Alert and Oriented
Psych:bAppropriate mood

Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Based on the provided case study, the patient, DC, appears to be presenting with acute cholecystitis. The sudden onset of the right upper quadrant (RUQ) pain occurring approximately one hour after a large dinner is indicative of gallbladder inflammation. The gallbladder is located in the RUQ, and cholecystitis often manifests as sharp or colicky pain in this region (Rosenthal & Burchum, 2021). Additionally, DC reports experiencing nausea and vomiting, which are common symptoms associated with cholecystitis, particularly when biliary colic occurs due to gallstone obstruction.

DC possesses several risk factors that further support the diagnosis of acute cholecystitis. Being a 46-year-old female, she is more prone to gallbladder-related issues. Her weight of 202 lbs and height of 5’8″ indicate obesity, which is associated with an increased risk of gallstone formation. Furthermore, her medical history reveals a diagnosis of hypertension, type II diabetes mellitus (DM), and a previous deep vein thrombosis (DVT) caused by oral contraceptive pills (BCPs). While the latter is unrelated to the current symptoms, hypertension and type II DM can contribute to the overall clinical picture.

Considering the diagnosis of acute cholecystitis, an appropriate drug therapy plan for DC would involve pain management, administration of antibiotics, and symptom relief. Pain can be managed using nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. However, due to DC’s comorbidities of hypertension and type II DM, acetaminophen may be a safer choice, as it does not significantly affect blood pressure or glucose levels. Conversely, NSAIDs can potentially interfere with antihypertensive medications and have adverse effects on blood pressure.

The next aspect of the drug therapy plan involves antibiotic treatment. Acute cholecystitis involves inflammation and infection of the gallbladder (Gallaher & Charles, 2022). Therefore, an appropriate antibiotic regimen should be prescribed. A combination of a third-generation cephalosporin, such as ceftriaxone, and metronidazole would be suitable. This combination provides broad-spectrum coverage against gram-negative organisms commonly found in biliary infections and anaerobic bacteria. Additionally, symptom relief for DC’s nausea and vomiting can be achieved through the use of antiemetics. Ondansetron, a well-tolerated antiemetic, can be considered to alleviate these symptoms and improve the patient’s overall comfort.

References

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

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Case Study: Gastroenteritis

HL is a patient who presents with nausea, vomiting, and diarrhea with a history of drug abuse and possible Hepatitis C. This paper aims to highlight the differential diagnosis based on the patient’s presenting complaint, describe the recommended drug therapy, and justify its use for this patient.

Differential Diagnoses

The primary diagnosis is gastroenteritis. Differential diagnoses include food poisoning and bowel obstruction. Gastroenteritis is a viral, bacterial, or parasitic infection of the intestines that presents with the above presentation in addition to abdominal pain and is highly contagious (Maslennikov et al., 2021). The main causative agents are viruses, including noroviruses and rotavirus, transmitted through ingestion or coming into contact with contaminated food and water. Using prednisone, which suppresses the immune system, means an increased predisposition to infections. In addition to the patient’s presenting complaint, this means that gastroenteritis is the primary diagnosis.

Drug Therapy Plan

Gastroenteritis is often self-limiting, and the patient is encouraged to stay hydrated and rest. In this patient, I would recommend antiemetic drugs such as ondansetron (Riddle, 2018). In addition, I would recommend loperamide or bismuth subsalicylate. After finding out the reason for the use of prednisone, I would slowly taper off the drug and eventually discontinue it. The patient can continue using both Synthroid and nifedipine.

Justification For Drug Therapy

Antiemetics are critical in minimizing vomiting and consequent fluid loss. Ondansetron is my preferred drug of choice due to its limited sedative properties compared to other antiemetics, such as promethazine (Rosenthal & Burchum, 2021). Antidiarrheals such as loperamide and bismuth subsalicylate help address diarrhea, significantly contributing to fluid loss. Tapering off the prednisone and eventually discontinuing it is crucial in this patient. Corticosteroids such as prednisone, when used over long durations of time, significantly impact the liver. These drugs often increase the risk of developing or worsening nonalcoholic fatty liver disease. This is particularly risky in this patient with possible hepatitis C. Nifedipine and Synthroid have minimal to no impact on the liver and can be continued.

Conclusion

The patient’s presenting complaints paint a picture of gastroenteritis. Despite the condition being mostly self-limiting, prescribing antiemetics and antidiarrheals is important to minimize fluid loss. Discontinuing drugs such as prednisone, which have a significant impact on the liver in such a patient, is essential to minimize the risk of nonalcoholic fatty liver disease.