Case study:
This we will look at GI and hepatobiliary disorders. We will be completing a one-page assignment that is due by day 7 (Sunday). Please use the following case study for the assignment:
Week 4 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 with her family. She has had nausea and one 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
DETAILS:
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.
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.
(AS A NURSE PRACTITONER- PROVIDER)
RUBRIC:
NURS_6521_Week4_Assignment_Rubric
NURS_6521_Week4_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeExplain your diagnosis for the patient, including your rationale for the diagnosis.
25 to >22.25 pts
Excellent
The response accurately and clearly explains in detail the diagnosis for the patient, including an accurate and thorough rationale for the diagnosis that supports clinical judgment.
22.25 to >19.75 pts
Good
The response provides a basic explanation of 1-2 diagnoses for the patient, including an accurate rationale for the diagnosis that may support clinical judgment.
19.75 to >17.25 pts
NURS_6521 Diagnosis and Drug Therapy for a Patient with Right Upper Quadrant Pain
Based on the information provided, my diagnosis for this 46-year-old female patient presenting with right upper quadrant (RUQ) pain is cholecystitis, or gallbladder inflammation. Her symptoms of RUQ pain one hour after a large meal, along with nausea and vomiting, are classic signs of cholecystitis (Mayo Clinic, 2022). Her medical history of hypertension, diabetes, gout, and previous DVT also put her at higher risk for developing gallbladder issues like cholecystitis (MedlinePlus, 2021).
For drug therapy, I would continue the patient’s current medications of lisinopril, HCTZ, and allopurinol, as these are appropriately managing her hypertension, diabetes, and gout. To treat the cholecystitis, I would prescribe a short course of oral ciprofloxacin 500mg twice daily for 7 days (Uptodate, 2023). Ciprofloxacin is a fluoroquinolone antibiotic recommended as first-line treatment for mild to moderate cholecystitis by international guidelines (EASL, 2022). This antibiotic therapy aims to reduce inflammation and infection in the gallbladder. I would also recommend a low-fat diet and increased fluid intake during the treatment period to rest the gallbladder (Mayo Clinic, 2022).
Prescribing ciprofloxacin is appropriate for this patient given her diagnosis of cholecystitis, need for antibiotic therapy, and lack of contraindications based on her medical history. Ciprofloxacin directly addresses the underlying infection and inflammation causing her symptoms. A short course of oral antibiotics allows for outpatient treatment while effectively managing her condition. Continuing her current medications also safely maintains control of her other medical conditions. This individualized drug therapy plan is justified and tailored specifically for this 46-year-old female patient presenting with RUQ pain.
Mayo Clinic. (2022, March 22). Cholecystitis. Retrieved November 15, 2022, from https://www.mayoclinic.org/diseases-conditions/cholecystitis/symptoms-causes/syc-20363862
MedlinePlus. (2021, December 3). Gallbladder disease risk factors. U.S National Library of Medicine. Retrieved November 15, 2022, from https://medlineplus.gov/gallbladderdiseaseriskfactors.html
Uptodate. (2023, January). Treatment of acute cholecystitis in adults. Retrieved November 15, 2022, from https://www.uptodate.com/contents/treatment-of-acute-cholecystitis-in-adults
EASL Clinical Practice Guidelines: Management of cholestatic liver diseases. (2022). Journal of Hepatology, 76(1), 12–49. https://doi.org/10.1016/j.jhep.2021.09.005
