Feb 23, 2024 NURS 6521 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
NURS 6521 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders NURS 6521 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Gastrointestinal problems are a common occurrence in nursing and healthcare. Nurses and other healthcare providers utilize interventions such as comprehensive patient assessment to develop accurate diagnoses and care plans. The treatment of gastrointestinal disorders require the use of evidence-based interventions and guidelines to improve outcomes. Therefore, this essay examines a case study of a 46-year-old female that has presented to the clinic with complaints of right upper quadrant pain for the last 24 hours. The patient developed the problem an hour after having a large dinner with her family. She reported nausea and vomiting before the onset of pain. The essay develops the patient’s diagnosis and treatment plan that would aid recovery. Diagnosis The most probable diagnosis for the patient is biliary colic. Biliary colic is a pain in the abdomen that arises from stones in the bile duct or cystic duct of the biliary tree. Patients develop the pain after eating a large fatty mean. The meal causes gallbladder contraction (Hapca et al., 2021; Makutonin et al., 2023). Patients often describe the pain as constant and not colicky. Prolonged obstruction results in cholangitis or cholecystitis. The accompanying symptoms associated with the biliary colic include right upper quadrant pain, nausea, and vomiting (Sigmon et al., 2023). The patient in the case study also has risk factors that predispose her to biliary colic such as being overweight. There is also the elevation of white blood cells, which may indicate the risk of cholangitis or cholecystitis if responsive interventions are not implemented. Liver enzymes such as direct bilirubin, GGT, ALP, ALT, and AST may or may not be elevated in biliary colic (Doherty et al., 2022). Appropriate Drug Therapy An appropriate treatment for the patient in the case study is ursodeoxycholic acid. Ursodeoxycholic acid is the drug of choice that helps in dissolving gallstones in patients with biliary colic. The additional interventions include restricting fat intake and administration of analgesics and antiemetics for nausea and vomiting. The study by Pizza et al., (2020) found that Ursodeoxycholic acid significantly reduces incidence of cholelithiasis, cholecystitis among patients with biliary obstruction, hence prescribing the patient in the case study. Struggling to Meet Your Deadline? Get your assignment on NURS 6521 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders done on time by medical experts. Don’t wait – ORDER NOW! Meet my deadline Conclusion In summary, the most likely diagnosis for the patient is biliary colic. Biliary colic arises from the obstruction at the biliary tree. The presenting symptoms and risk factors align with those seen in patients with biliary colic. An effective treatment would be prescribing her Ursodeoxycholic acid. References 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), Article 3. https://doi.org/10.3390/medicina58030388 Hapca, S., Ramsay, G., Murchie, P., & Ahmed, I. (2021). Biliary colic. BMJ, 374, n2085. https://doi.org/10.1136/bmj.n2085 Makutonin, M., Moghatederi, A., Newton, S., Ma, Y., & Meltzer, A. C. (2023). Biliary colic in the emergency department: A state-wide analysis of one-year costs and clinical outcomes. Surgery Open Science, 12, 9–13. https://doi.org/10.1016/j.sopen.2023.02.002 Pizza, F., D’Antonio, D., Lucido, F. S., Tolone, S., Del Genio, G., Dell’Isola, C., Docimo, L., & Gambardella, C. (2020). The Role of Ursodeoxycholic Acid (UDCA) in Cholelithiasis Management After One Anastomosis Gastric Bypass (OAGB) for Morbid Obesity: Results of a Monocentric Randomized Controlled Trial. Obesity Surgery, 30(11), 4315–4324. https://doi.org/10.1007/s11695-020-04801-z Sigmon, D. F., Dayal, N., & Meseeha, M. (2023). Biliary Colic. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430772/ 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. Case Study This paper NURS 6521 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders is an examination of HL’s case study. HL has come to the clinic with symptoms that include nausea, diarrhea and vomiting. The patient also has a history of drug abuse as well as possible hepatitis C. He is currently on drugs that include synthroid 100 mcg daily, nifedipine 30 mg daily and prenidsone 10 mg daily. The case study does not provide any additional information on comprehensive history and examination that was obtained from the client. Therefore, based on the given information, I will diagnose the client with gastroenteritis. Gastroenteritis is a disease of the gastrointestinal system that arises from inflammation and infection of the digestive tract. Patients with gastroenteritis often experience symptoms that include vomiting, diarrhea, and abdominal cramps. The factor that may have contributed to gastroenteritis in the case study is the use of prednisone. Prednisone undergoes metabolism in the liver. Its use is associated with the adverse effect of compromising the normal hepatic function. As a result, there was a decline in his immune status predisposing him to a rise in the hepatitis C virus (Sunkara et al., 2019). The client also has a history of drug abuse, which may have compromised the liver functioning. The compromised liver functioning and immunity may have led to hepatitis C, hence, the development of gastric symptoms that include diarrhea, vomiting and nausea (Walker et al., 2018). The drug therapy that I will consider for HL is systematic withdrawal of prednisone. I would reduce the dosage of prednisone slowly to prevent the risk of adverse effects of abrupt withdrawal. I would also prescribe the patient an antiemetic such as ondasetron, as it is associated with minimal or no sedation. I will continue with the other medications. I will also educate HL about the risks of over-the-counter medications and drug abuse (Rohde & Domm, 2018). References Rohde, E., & Domm, E. (2018). Nurses’ clinical reasoning practices that support safe medication administration: An integrative review of the literature. Journal of Clinical Nursing, 27(3–4), e402–e411. https://doi.org/10.1111/jocn.14077 Sunkara, T., Rawla, P., Yarlagadda, K. S., & Gaduputi, V. (2019). Eosinophilic gastroenteritis: Diagnosis and clinical perspectives. Clinical and Experimental Gastroenterology, 12, 239–253. https://doi.org/10.2147/CEG.S173130 Walker, M. M., Potter, M., & Talley, N. J. (2018). Eosinophilic gastroenteritis and other eosinophilic gut diseases distal to the oesophagus. The Lancet Gastroenterology & Hepatology, 3(4), 271–280. https://doi.org/10.1016/S2468-1253(18)30005-0 Photo Credit: Getty Images/iStockphoto Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of NURS 6521 Assignment Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders 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. Click here to ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: NURS 6521 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders 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. NURS 6521 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders 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. Appropriate Drug Therapy Plan In the management of biliary colic several drugs could be used together in order to bring about a therapeutic impact to the patient. This will consist of medication that offer pain relief as that is one of the clinical manifestations that the patient presents with and drugs that dissolve the gallstones to treat the cause of the condition (IBM Micromedex, 2019). To manage the pain acetaminophen together with a low dose opioid can be used. The acetaminophen can be given at a dose of 500mg and the opioid such as codeine at a dose of 8 mg both to be taken orally per required need can be prescribed. Also an antispasmodic agent can be used such as hyoscine butylbromide taken orally prescribed at 20mg four times daily that can reduce spasms and relieve pain. Additionally, to dissolve the gall stones ursodeoxycholic acid (UDCA) to be taken orally at a dose of 300mg three times daily is used. The patient should also continue with her previously prescribed medication to deal with her other (IBM Micromedex, 2019). 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). All papers submitted must use this formatting. Pharmacotherapy For Gastrointestinal and Hepatobiliary Disorders The patient in the case study presents with nausea, vomiting, and diarrhea. He has a drug abuse history and likely Hepatitis C. The current drug therapy includes Synthroid, Nifedipine, and Prednisone. The purpose of this assignment is to discuss the diagnosis and appropriate pharmacotherapy for the patient. Diagnosis Hepatitis C infection is the presumptive diagnosis. This is a liver inflammation caused by Hepatitis C virus (HCV). It is spread through sexual intercourse with infected persons, sharing personal items, and sharing drug-injection equipment (Ghany et al., 2020). Most infected persons are asymptomatic. Symptomatic cases present symptoms like fatigue, fever, reduced appetite, nausea, vomiting, abdominal discomfort, pale feces, dark urine, myalgia, and jaundice (Jin, 2020). Therefore, Hepatitis C is the primary diagnosis because of the positive symptoms of nausea, vomiting, and diarrhea and the client’s history of drug abuse and Hepatitis C infection. Appropriate Drug Therapy The recommended drug therapy will include a combination of Ombitasvir/paritaprevir/ritonavir (Technivie) for 12 weeks to treat Hepatitis C infection. Technivie is indicated for HCV infection in patients without cirrhosis. Ombitasvir inhibits HCV NS5A, which is needed for Hepatitis C viral replication. Paritaprevir inhibits NS3/4A serine protease required for proteolytic cleavage of the HCV-encoded polyprotein into mature forms (Wu et al., 2019). Ritonavir is a protease inhibitor that elevates paritaprevir serum levels. Nifedipine would be reduced to 10 mg and Prednisone to 5 mg since they are associated with GI side effects. Conclusion The patient’s nausea, vomiting, and diarrhea symptoms are consistent with Hepatitis C infection. Besides, the history of Hepatitis C and drug abuse make HCV infection the likely diagnosis. A combination of Ombitasvir/paritaprevir/ritonavir will be recommended to treat the HCV infection, References Ghany, M. G., Morgan, T. R., & AASLD‐IDSA hepatitis C guidance panel. (2020). Hepatitis C guidance 2019 update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America recommendations for testing, managing, and treating hepatitis C virus infection. Hepatology, 71(2), 686–721. https://doi.org/10.1002/hep.31060 Jin, J. (2020). Screening for Hepatitis C Virus Infection. JAMA, 323(10), 1008-1008. doi:10.1001/jama.2020.1761 Wu, J., Huang, P., Fan, H., Tian, T., Xia, X., Fu, Z., … & Zhang, Y. (2019). Effectiveness of ombitasvir/paritaprevir/ritonavir, dasabuvir for HCV in HIV/HCV coinfected subjects: a comprehensive analysis. Virology journal, 16(1), 1–10. Submission and Grading Information To submit your completed Assignment for review and grading, do the following: Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name. Click the Week 4 Assignment Rubric to review the Grading Criteria for the Assignment. Click the Week 4 Assignment link. You will also be able to “View Rubric” for grading criteria from this area. Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click Open. If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database. Click on the Submit button to complete your submission. NURS 6521 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Abdominal infections could be associated with a wide range of clinical features, including abdominal pain, nausea, vomiting, and diarrhea. In that regard, therefore, it would be easy to confuse one diagnosis over the other. This essay considers a patient HL case study presented with nausea, vomiting, diarrhea, the diagnosis made, and the treatment options are taken. Diagnosis Hepatitis C is a possible diagnosis for HL. This condition would appear asymptomatic, but when symptoms occur, they could be mild or even severe. HL symptoms, including nausea, vomiting, and diarrhea, are prevalent with hepatitis C infection. This condition could be caused by viruses, bacteria, or parasitic infections. The infection can also be found in contaminated food or water, while chemical agents have also been shown to be causative. The diagnosis can be made using tests that include serologic assays, which measure the levels of antibodies that are generated, and the molecular assays which would detect the presence of HCV RNA (Chalasani et al., 2018). Appropriate Drug Therapy Plan In this case study, the therapeutic options recommendable include Hepatitis C pegylated interferon-α (IFN-α), administered weekly. Additionally, the patient is put on a daily dose of ribavirin for about 24 to 48 weeks. The combination is effective in clearing the HCV genotypes, especially 2 and 3 infections. The patient should also be put on food therapy. It is recommended that eating a frequent balanced diet possibly prevents nausea and vomiting associated with the disease. The balanced diet should be composed of cereals, whole grains, vegetables, and even fruits. There should also be a moderate to high protein diet to heal the infected liver tissue (Venugopal et al., 2018). The patient should also avoid certain drugs like aminoglycoside antibiotics, sedatives, and acetaminophen, which are considered hepatotoxic in high doses. Appropriate use of the proper diagnostic approaches forms the basis of diagnosis, which informs the kind of intervention to be taken. Viruses, bacteria, and chemical agents can cause HCV. The condition can be treated using pegylated interferon-α (IFN-α) and ribavirin. References Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., … Sanyal, A. J. (2018). The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology, 67(1), 328–357. https://doi.org/10.1002/hep.29367 Venugopal, V., Padmanabhan, P., Raja, R., & Dixit, N. M. (2018). Modelling how responsiveness to interferon improves interferon-free treatment of hepatitis C virus infection. PLoS Computational Biology, 14(7), e1006335. https://doi.org/10.1371/journal.pcbi.1006335 Grading Criteria To access your rubric: Week 4 Assignment Rubric Check Your Assignment Draft for Authenticity To check your Assignment draft for authenticity: Submit your Week 4 Assignment draft and review the originality report. Submit Your Assignment by Day 7 of Week 4 To participate in this Assignment: Week 4 Assignment What’s Coming Up in Module 4? Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images In the next module, you will examine types of drugs prescribed to patients with endocrine disorders, such as diabetes, and you will consider the impact of patient factors on the effects of these drugs. Next Week To go to the next week: Module 4 Module 3: Gastrointestinal and Hepatobiliary Systems Symptoms of various gastrointestinal (GI) and hepatobiliary disorders often overlap, making diagnosis and treatment challenging. For example, symptoms such as vomiting, constipation, and bloating are non-specific and could also be the result of underlying medical history or current prescription drug use. As an advanced practice nurse, you could be potentially responsible for providing care to a patient who may present with non-specific symptoms related to the gastrointestinal and hepatobiliary systems. How would you proceed to care for this patient? What type of drug therapy might you recommend, not knowing current medical history or prescription drug use? Are there certain drugs you should avoid in ensuring a drug-drug interaction does not occur? These are the types of questions that may guide you in your role as an advanced practice nurse. What’s Happening This Module? Module 3: Gastrointestinal and Hepatobiliary Systems is a 1-week module, Week 4 of the course. In this module, you will examine diagnoses for patients with potential GI and hepatobiliary disorders. You also develop a drug therapy plan based on patient history and diagnosis. Week 4: Gastrointestinal and Hepatobiliary Disorders As an advanced practice nurse, you will likely encounter patients who will present with symptoms affecting the gastrointestinal (GI) tract. Of special note, is the consideration that most symptoms concerning the GI tract are non-specific and therefore, diagnosing diagnoses of the GI tract require thoughtful and careful investigation. Similarly, hepatobiliary disorders may also mirror many of the signs and symptoms that patients present when suffering from GI disorders. How might you tease out the specific signs and symptoms between these potential disorders and body systems? What drug therapy plans will best address these disorders for your patients? This week, you examine GI and hepatobiliary disorders. You will review a patient case study and consider those factors in recommending and prescribing a drug therapy plan fo your patient. Learning Objectives Students will: Evaluate diagnoses for patients with gastrointestinal and hepatobiliary disorders Justify drug therapy plans based on patient history and diagnosis Learning Resources
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