Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is curren
Case study assigned.
Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:
- Synthroid 100 mcg daily
- Nifedipine 30 mg daily
- Prednisone 10 mg daily
- Flagyl 500 mg TID
- Metronidazole 250 mg daily
Vitals:
Temp: 98.8oF
Wt: 155 lbs
Ht: 5’7”
BP: 136/82
HR: 90 bpm
PE:
Eyes: EOMI
HENT: Normal
GI: Nondistended, minimal tenderness
Skin: Warm and dry
Neuro: Alert and Oriented
Psych: Appropriate mood
- Introduction
- Explain your diagnosis for the patient, including your rationale for the diagnosis. What labs would you order?
- Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. Discuss each of the patient’s medications. Create an updated drug therapy plan.
- How might you evaluate specific signs and symptoms between these potential disorders and body systems? What drug therapy plans will best address these disorders for your patients?
- Justify why you would recommend this drug therapy plan for the patient. Be specific and provide examples. Use and cite at least 4 sources for written assignments.
- conclusions
TOPIC: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Case study assigned.
Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:
· Synthroid 100 mcg daily
· Nifedipine 30 mg daily
· Prednisone 10 mg daily
· Flagyl 500 mg TID
· Metronidazole 250 mg daily
Vitals:
Temp: 98.8oF
Wt: 155 lbs
Ht: 5’7”
BP: 136/82
HR: 90 bpm
PE:
Eyes: EOMI
HENT: Normal
GI: Nondistended, minimal tenderness
Skin: Warm and dry
Neuro: Alert and Oriented
Psych: Appropriate mood
1. Introduction
2. Explain your diagnosis for the patient, including your rationale for the diagnosis. What labs would you order?
3. Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. Discuss each of the patient’s medications. Create an updated drug therapy plan.
4. How might you evaluate specific signs and symptoms between these potential disorders and body systems? What drug therapy plans will best address these disorders for your patients?
5. Justify why you would recommend this drug therapy plan for the patient. Be specific and provide examples. Use and cite at least 4 sources for written assignments.
6. conclusions
RUBRIC FOR GRADING
Explain your diagnosis for the patient, including your rationale for the diagnosis. = 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.
This criterion is linked to a Learning OutcomeDescribe an appropriate drug therapy plan based on the patient's history, diagnosis, and drugs currently prescribed. = The response accurately and completely describes in detail 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. = The response provides an accurate, clear, and detailed justification for the recommended drug therapy plan for this patient. … The response includes specific, accurate, and detailed examples that fully support the justification provided.
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. = Paragraphs and sentences follow writing standards for flow, continuity, and clarity .
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation. = Uses correct grammar, spelling, and punctuation with no errors.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list. = Uses correct APA format with no errors
,
Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and
diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking
the following prescription drugs:
Synthroid 100 mcg daily
Nifedipine 30 mg daily
Prednisone 10 mg daily
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.
Based on information given, and the patient exhibiting symptoms of nausea, vomiting,
and diarrhea, a diagnosis of some form of a stomach virus also medically termed acute
gastroenteritis. Acute gastritis is a sudden inflammation or swelling in the lining of the stomach.
Symptoms can also cause abdominal pain, coupled with nausea, vomiting and fever may also
occur with these symptoms (Diskin, 2017). How the illness begins, spreads from contact to
contact with someone that may have already has been affected or eating contaminated food.
To alleviate the present symptoms and have the patient in the most comfortable care as
possible, a treatment protocol would consist of rehydration via saline fluids from loss of
vomiting and diarrhea. As a provider giving medical assistance, staff must always be cognizant
of reducing symptoms while preventing further complications (Arcangelo & Peterson, 2013).
In being aware of the patient’s current medications and previous drug history, drug
therapy and treatment plan would be consisting of non-habit-forming medications such as
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Phenergan and Zofran. Imodium A-D will also be prescribed to assist with diaherra. Patient will
be advised and instructed to be placed on a liquid diet which will consists of clear liquids,
electrolytes such Gatorade and Powerade will be strongly encouraged. Food recommendations
such as clear liquid broth, Jell-O, and Saltine crackers will also be recommended. Since the
patient is may also have Hep-C, additional testing may also be explored to test the patient’s liver
and conduct Hepatis C testing to see if the patient is at risk. During treatment of patient HL,
further and additional inquires would be asked to see why patient is taking Prednisone and what
is the patient taking this medication for? Prednisone side effects generally includes upset
stomach (Huether & McCance, 2017), but discontinuance of the medication would not be
encouraged, but a tapering of decreasing dosage would begin.
References
Arcangelo, P. V., & Peterson, A. M. (2013). Pharmacotherapeutics for Advanced Practice: A
Practical Approach (3rd ed.). Ambler, PA: Lippincott Williams &
Diskin, A. (2017, February 10). Emergent Treatment of Gastroenteritis. Medscape. Retrieved
from https://emedicine.medscape.com/article/775277-overview
Huether, S. E., & McCance, K. L. (2017). Understanding Pathophysiology (6th ed.). St. Louis,
Mo: Mosby
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Review of Case Study:
Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and
diarrhea. The patient has a history of drug abuse, and possible Hepatitis C. HL is currently taking
the following prescription drugs: It is essential to complete a thorough health history and
examination before diagnosing HL. There are several necessary questions related to HL’s
medication list that should ask:
• Duration and reason for the Prednisone?
• Recent recreational drug use?
• Duration of the symptoms/ weightloss?
• Description and number of the stools/emesis per day?
• Synthroid 100 mcg daily
• Nifedipine 30 mg daily
• Prednisone 10 mg daily
History of Present Illness and Medical History
Patient presents with symptoms of diarrhea, nausea, and vomiting. Learning from HL’s
medical history, HL appears to have some possible chronic conditions based on his current
medications; Synthroid 100 mg daily, Nifedipine 30mg daily, and prednisone 10mg daily.
Synthroid is a hormone replacement that is used to treat hypothyroidism, thyroid
cancer and goiter (Drugs.com, 2017). Synthroid can have adverse effects if not taken correctly or
if misused, thorough assessment and review of patients understanding of medication regimen is
needed. Diarrhea is a common side effect of Synthroid. N/V are classified as severe/adverse
reaction and should be reported the health practitioner immediately (Drugs.com, 2017). Healthy
adults age 50 years or less with a weight of 70kg or more; initial dose of 100-125 mcg/day be
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taken for a few months. HL’s medical history and chronicity of the hepatitis could warrant
decreasing the current dose of Synthroid. Thyroid levels should be checked every 6-8 weeks
(Drugs.com, 2017). No warnings were identified with the use of Synthroid and Hepatitis C upon
review.
Nifedipine is a calcium channel blocker that is used to treat hypertension and chest
pain (angina). There are no warnings with Hepatitis C and the use of calcium channel blockers.
Initial dose recommended 30-60mg orally (Drugs.com, 2017). Nifedipine has also been linked to
several instances of clinically apparent acute liver injury, and dosing should be decreased for
patients with any chronic illness involving the liver and function. HL’s dose is appropriate for
treatment and current health status (Drugs.com, 2017).
Prednisone is a corticosteroid that prevents the release of substances in the body that
causes inflammation it also suppresses the immune system (Drugs.com.2017). Prednisone treats
many different conditions such as allergic disorders, skin conditions, ulcerative colitis, arthritis,
lupus, psoriasis, or breathing disorders. Prednisone should be taken with care if you have a
thyroid issue, and I recommend discontinuing this medication. Side effect of prednisone is
pancreatitis, which presents with severe pain in your upper stomach, nausea, and vomiting.
Prednisone often prescribed for HCV patients who are unresponsive to NSAIDs or have
advanced liver disease, such as cirrhosis, and in those who have contraindications to their use
(nephrotoxicity); short-term, low-dose prednisone (5 to 10 mg) is usually prescribed. Nifedipine
will increase the level or effect of prednisone (Drugs.com, 2017).
Assessment and Diagnostics
A comprehensive history and physical examination are required to create a full picture of
any underlining issues that is causing the patient’s symptoms. Medication reconciliation is
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needed to be conducted for potential drug interactions. Also, the diagnostic workup is required
for further evaluation. Drug Screen test, Urinalysis, abdominal ultrasound, Blood tests such as
liver panel, CBC, CMP, TSH, Hepatitis C RNA test, genotype test, an antibody test for HCV will
be ordered to determine the cause of the symptoms. Imaging of the GI tract for abnormalities
should be considered for thorough examination and ROS.
Primary Diagnosis: Hepatitis C Virus
Hepatitis C is an acute liver infection caused by a virus that usually results from infected
person-to-person contact of blood and bodily fluids, sexual intercourse or sharing of needles
associated with illicit drug/substance abuse (Arcangelo & Peterson, 2013) . classifications can be
acute or chronic (Arcangelo & Peterson, 2013). HCV is progressive, and in most cases,
symptoms are asymptomatic but may present significant problems. It is often undiagnosed due to
the symptoms present as a flu-like illness. Usually, elevated liver enzymes and a positive
antibody test for HCV (anti-HCV) mean that an individual has hepatitis C. Symptoms include
fatigue, mild fever, muscle and joint aches, nausea, vomiting, loss of appetite, vague abdominal
pain, and sometimes diarrhea. Diarrhea develops during acute hepatitis C. Although this initial
phase of infection causes no symptoms at all, approximately 20 to 30 percent of people notice
symptoms about 1 to 3 months after contracting the virus (Centers for Disease Control and
Prevention, 2016). From the data collected, the patient has a history drug abuse, the current
medications such as prednisone and presenting symptoms may suggest the diagnosis of Acute
Hepatitis C.
Differential Diagnosis
• Drug Dependence and Abuse: The signs and symptoms displayed by a person
depend on what substances the person has abused. Symptoms may include altered mental status,
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CNS suppression, nausea, vomiting, diarrhea, anxiety, hallucinations, chest pain, and abdominal
pain. Most patients with substance abuse commonly exhibit behavioral symptoms that can cause
harm to self or others and requires an emergent medical intervention(Arcangelo & Peterson,
2013). Referral to dependence counselor or addiction specialist is warranted to rule out acute
relapse.
• Gastroenteritis is irritation/inflammation of the stomach and intestines caused by
food contaminated with bacteria, viruses, parasites, or toxins. Symptoms may include cramping,
nausea, vomiting, or diarrhea. The illness usually spreads easily from contact with a sick person
or eating or drinking contaminated food or beverages also will spread the disease. Most
otherwise healthy patients recover in a few days by drinking plenty of fluids and resting.
Antibiotics treat gastroenteritis caused by bacteria or some parasites. In most cases, nausea,
vomiting, and diarrhea will resolve within 24 to 48 hours (Arcangelo & Peterson, 2013).
-Offering the patient an antiemetic would be an appropriate intervention and may provide
comfort.
Plan and Treatment Recommendations
According to the American Association for the Study of Liver Diseases and the Infectious
Diseases Society of America (2016), the recommendations for treatment and management per
HCV Guidelines:
Regular laboratory monitoring every four to six weeks for six months to 12 months is
also recommended to determine spontaneous clearance of HCV infection versus persistence of
infection (Drugs.com, 2017).
HL’s symptomology and presentation it is my belief the patient can be classified as genotype
1a (without cirrhosis) (Drugs.com, 2017). Guidelines for the diagnosis and management of HCV
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infection were originally released jointly by the American Association for the Study of Liver
Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) in 2016 and are
updated on a continuous basis, following availability of new medications or release of major
treatment trials. Regimen selection for patients with genotype 1 infection should take into
account the efficacy, duration, and adverse reactions, potential drug interactions, the patient's
history of prior treatment, and the stage of fibrosis before selecting the best medication to treat
(Arcangelo & Peterson, 2013)
References:
Arcangelo, V. P., & Peterson, A. M. (2013). Pharmacotherapeutics for Advanced Practice: A
practical approach. Ambler, PA: Lippincott Williams and Wilkins.
American Association for the Study of Liver Diseases and the Infectious Diseases Society of
America (2016). Management of Acute HCV Infection. Retrieved July 9, 2018 from
http://www.hcvguidelines.org/unique-populations/acute-infection
Centers for Disease Control and Prevention (2016). Hepatitis C FAQs for the Public.
Retrieved July 9, 2018 from https://www.cdc.gov/hepatitis/hcv/cfaq.htm
http://symptoms.webmd.com/default.htm#conditionView
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Hypertension if left without treatment can causes nausea and vomiting as presenting
symptoms. This nausea and vomiting can also be a sign of a heart attack a comprehensive lab
work-up to ensure there is no damage to the heart must be complete for the visit to be thorough
in diagnosing and treatment. Multiple or continuous blood pressure measurements should be
ordered if they could be responsible for the symptoms.
Arcangelo, V. P., & Peterson, A. M. (2013). Pharmacotherapeutics for Advanced Practice: A
practical approach. Ambler, PA: Lippincott Williams and Wilkins.
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Adenike B.docx by Adenike Balogun
Submission date: 20-Jun-2023 01:38PM (UTC-0500) Submission ID: 2119832881 File name: Adenike_B.docx (25.11K) Word count: 967 Character count: 5095
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19% SIMILARITY INDEX
6% INTERNET SOURCES
0% PUBLICATIONS
15% STUDENT PAPERS
1 6%
2 5%
3 2%
4 2%
5 2%
6 1%
7 1%
Exclude quotes On
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Adenike B.docx ORIGINALITY REPORT
PRIMARY SOURCES
Submitted to Marquette University Student Paper
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This is what I put together myself. It has 19% similarity when I submitted it to Turn-in.
Rationale for diagnosis
The clinical manifestations of gastroenteritis are diarrhea, vomiting, dysuria, abdominal pain, and infection. Patient HL has symptoms of nausea, vomiting and diarrhea. Although HL has history of drug abuse and hepatitis C. The neuro and psych assessment show normal results that means he is not undergoing drug abuse again. The Synthroid 100 mcg daily is probably for the patient's hypothyroid problem. Symptoms of the patient does not support hypothyroidism. Nausea and vomiting can be a sign of high blood pressure, but the patient's BP is 136/82mmhg which is within normal range. So, the nausea, vomiting and diarrhea might be cause by Gastroenteritis. The patient's symptoms are most likely due to a gastrointestinal infection, possibly viral, and the prednisone is exacerbating the symptoms. The patient's history of drug abuse and possible hepatitis C are also risk factors for GI infections.
The labs that I would order would include a CBC, CMP, stool culture, and stool ova and parasites. I would also order a viral panel, including tests for norovirus, rotavirus, and adenovirus. A liver panel and an antibody test for hepatitis C would be the diagnostic tests that would be ordered to confirm this diagnosis in the laboratory. If the results of these tests came back positive, the patient would be given antiviral medicine in order to treat the condition. A complete blood count (CBC) would be ordered to evaluate for anemia, which can be a complication of GI bleeding. A comprehensive metabolic panel (CMP) would be ordered to assess for electrolyte abnormalities, which can occur with vomiting and diarrhea. A stool culture would be ordered to identify the causative organism of the infection. Stool ova and parasites would be ordered to rule out parasitic infections, which are common in developing countries but can also occur in developed countries. The viral panel would be ordered to identify the specific virus causing the infection. The norovirus is a common cause of viral gastroenteritis and is often responsible for outbreaks of vomiting and diarrhea. The rotavirus is the most common cause of severe diarrhea in young children and can also cause vomiting. The adenovirus is another virus that can cause gastroenteritis, although it is less common than the norovirus and rotavirus.
Appropriate Drug Therapy
The patient's current medication regimen does not appear to be related to the symptoms. The patient is taking Synthroid for hypothyroidism, Nifedipine for hypertension, Prednisone for an unknown reason, Flagyl for an unknown reason, and Metronidazole for an unknown reason. I would recommend discontinuing the Flagyl and Metronidazole, as they are not likely to be helpful for the current symptoms. I would also recommend discontinuing the Prednisone, as it is likely exacerbating the symptoms. The patient should continue taking the Synthroid and Nifedipine. For the current symptoms, I would recommend a trial of an antiemetic such as ondansetron (Zofran) and loperamide (Imodium) for diarrhea. If the symptoms improve with this regimen, no further treatment may be necessary. If the symptoms do not improve, or if the patient develops a fever, I would recommend admission to the hospital for IV fluids and further testing. Ondansetron is a medication that is used to treat nausea and vomiting. It is typically used in cancer patients who are undergoing chemotherapy. Loperamide is a medication that is used to treat diarrhea. It works by slowing down the movement of the intestine, which allows the body to absorb more water from the stool.
Recommend Drug Therapy
I would recommend this drug therapy plan for the patient because it is likely to help with the symptoms of nausea, vomiting, and diarrhea. Ondansetron is a medication that is used to treat nausea and vomiting. It is typically used in cancer patients who are undergoing chemotherapy. Loperamide is a medication that is used to treat diarrhea. It works by slowing down the movement of the intestine, which allows the body to absorb more water from the stool.
The patient is likely experiencing these symptoms due to their history of drug abuse and possible Hepatitis C. The medication that they are currently taking, Flagyl and Metronidazole, are antibiotic that is used to treat bacterial infections. However, it can also cause nausea, vomiting, and diarrhea as side effects. The other medications that the patient is taking, such as Synthroid, nifedipine, and prednisone, are not likely to be the cause of the symptoms. However, they may be contributing to the severity of the symptoms.
The recommended drug therapy plan is likely to help the patient with their symptoms. Ondansetron is a medication that is used to treat nausea and vomiting. It is typically used in cancer patients who are undergoing chemotherapy. However, it can also be effective in treating nausea and vomiting caused by other conditions, such as drug abuse. Loperamide is a medication that is used to treat diarrhea. It works by slowing down the movement of the intestine, which allows the body to absorb more water from the stool. This can help to reduce the severity of diarrhea.
References
Egerton-Warburton,
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