The clinical experience for this week encompassed disease management of abdominal and endocrine problems in older adults.
The clinical experience for this week encompassed disease management of abdominal and endocrine problems in older adults. As a nurse, I took part in evaluating and managing patients with such conditions. A major challenge I encountered was accurately assessing and interpreting symptoms in the elderly, as they may present with atypical manifestations of the disease (Abudu-Birresborn et al., 2019). On the other hand, through the help of my preceptors and colleagues, I managed to navigate these challenges and, in the process, gained a lot of experience in the provision of adequate and compassionate care for this group of patients. I not only started with the right body language but also exercised patience and showed proper respect.
This week, I met an elderly patient who was complaining of abdominal pain, lethargy, and unplanned weight loss. The 69-year-old African American male patient reported that his abdominal pain started 2 days ago and had progressively increased in the right upper quadrant, associated with general weakness and nausea. His past medical history was significant for hypertension and diabetes type 2, both of which were well-controlled with medications and lifestyle modifications. He reported that his father, who died 8 years ago of a stroke, had been known to have a symptomatic single giant gallstone for a decade preceding his death. He reported occasional consumption of alcohol, denying the use of tobacco or any illicit drugs.
On initial evaluation, the patient was febrile, but hemodynamically stable. His current vital signs include a temp of 98.6oF, RR of 18/min, HR of 89/min, BP of 118/72 mmHg, SpO2 of 96%, BMI of 20.4, and pain of 4/10. He was jaundiced, and this along with pale stools indicated a problem with liver function or biliary obstruction (Osagiede et al., 2019). The abdominal exam revealed RUQ tenderness. The gallbladder was palpable, with a positive Murphy’s sign. All the other physical exams were insignificant. Lab tests showed an erythrocyte sedimentation rate of 60mm in 1h, a C-reactive protein of 48mg/dL, and a WBC count of 17,000/mm3. All the other blood tests that were ordered were normal. Diagnostic imaging (ultrasound, MRI) was ordered to evaluate liver and biliary system.
Based on the presentation and physical exam findings, the core differential diagnoses that we considered included gallstones, hepatitis, and pancreatitis. In this case, the likelihood of gallstone disease was strongly suggested, with the presentation of right upper quadrant pain, jaundice, and pale stools (Chhoda, Mukewar & Mahadev, 2021). This condition is often observed in older adult patients and is in line with the patient’s symptoms. Our plan of care included medications to dissolve gallstones; pain-relieving treatment by means of analgesics; nutrition assessment, as well as support, to address undesirable weight loss; and consulting with a gastroenterologist for further assessment and treatment. The health promotion measure that we addressed with the patient was the need to maintain a balanced diet and an active lifestyle to ensure no recurrence of the stones or other biliary diseases.
In summary, the clinical experience for this week was challenging, yet rewarding. Despite the challenges I encountered, I learned about the critical role of adequate assessment and differential diagnosis in older patients with complaints of abdominal and endocrine disorders. I also learned about the need to work with interdisciplinary teams to ensure that the patient receives comprehensive care.
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