Assignment Question

I’m working on a nursing writing question and need the explanation and answer to help me learn. Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of 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. This week, we will be reviewing Gastrointestinal and Hepatobiliary Disorders. You are to write a 1 page paper addressing the requirements written in your assignment. Please follow the directions given and review the grading rubric to ensure all questions have been addressed. Case: 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 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. 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. Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area. Required Readings Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier. Chapter 64, “Drugs for Peptic Ulcer Disease” (pp. 589–597) Chapter 65, “Laxatives” (pp. 598–604) Chapter 66, “Other Gastrointestinal Drugs” (pp. 605–616) Chapter 80, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 723–743) Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., . . . Sanya, 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. Retrieved from https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/…This article details the diagnosis and management of nonalcoholic fatty liver disease. Review this article to gain an understanding of the underlying pathophysiology as well as the suggested pharmacotherapeutics that might be recommended to treat this disorder. https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/… 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 Fair The response inaccurately or vaguely explains the diagnosis for the patient, including an inaccurate or vague rationale for the diagnosis that may or may not support clinical judgment. 17.25 to >0 pts Poor The response inaccurately and vaguely explains the diagnosis for the patient, including an inaccurate and vague rationale for the diagnosis that does not support clinical judgment, or is missing. 25 pts This criterion is linked to a Learning OutcomeDescribe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. 30 to >26.7 pts Excellent The response accurately and completely describes in detail an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. 26.7 to >23.7 pts Good The response describes a basic explanation of the appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. 23.7 to >20.7 pts Fair The response inaccurately or vaguely describes an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. 20.7 to >0 pts Poor The response inaccurately and vaguely describes an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. 30 pts This criterion is linked to a Learning OutcomeJustify why you would recommend this drug therapy plan for this patient. Be specific and provide examples. 30 to >26.7 pts Excellent 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. 26.7 to >23.7 pts Good The response provides a basic justification for the recommended drug therapy plan for this patient. … The response includes only 1-2 examples that fully support the justification provided. 23.7 to >20.7 pts Fair The response provides an inaccurate or vague justification for the recommended drug therapy plan for this patient. … The response may include examples, which may inaccurately or vaguely support the justification provided. 20.7 to >0 pts Poor The response provides an inaccurate and vague justification for the recommended drug therapy plan for this patient, or is missing. … The response does not include examples that support the justification provided, or is missing. 30 pts This criterion is linked to a Learning OutcomeWritten 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. 5 to >4.45 pts Excellent Paragraphs and sentences follow writing standards for flow, continuity, and clarity. 4.45 to >3.95 pts Good Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. 3.95 to >3.45 pts Fair Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. 3.45 to >0 pts Poor Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. 5 pts This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation 5 to >4.45 pts Excellent Uses correct grammar, spelling, and punctuation with no errors 4.45 to >3.95 pts Good Contains a few (1–2) grammar, spelling, and punctuation errors 3.95 to >3.45 pts Fair Contains several (3–4) grammar, spelling, and punctuation errors 3.45 to >0 pts Poor Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding 5 pts This criterion is linked to a Learning OutcomeWritten 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. 5 to >4.45 pts Excellent Uses correct APA format with no errors 4.45 to >3.95 pts Good Contains a few (1–2) APA format errors 3.95 to >3.45 pts Fair Contains several (3–4) APA format errors 3.45 to >0 pts Poor Contains many (≥ 5) APA format errors 5 pts Total Points: 100

Answer

Introduction

Cholecystitis is an inflammatory condition of the gallbladder that can be acute or chronic. It typically presents with symptoms such as right upper quadrant (RUQ) pain, nausea, vomiting, and fever. Prompt diagnosis and appropriate drug therapy are essential for managing cholecystitis effectively.

Diagnosis and Rationale

To diagnose cholecystitis, healthcare providers often utilize a combination of clinical evaluation, laboratory tests, and imaging studies. Key diagnostic steps include:

• Clinical Assessment: The patient’s history and physical examination play a crucial role in identifying cholecystitis. RUQ pain, especially after a fatty meal, is a hallmark symptom. Patients may also exhibit tenderness upon palpation of the RUQ.
• Laboratory Tests: Blood tests, including a complete blood count (CBC) and liver function tests, can aid in the diagnosis. Elevated white blood cell count (WBC) and liver enzyme levels may indicate inflammation and gallbladder dysfunction.
• Imaging Studies: Imaging modalities like ultrasound are commonly used to visualize the gallbladder. Ultrasound can reveal gallstones, gallbladder wall thickening, and signs of inflammation.
• HIDA Scan: A hepatobiliary iminodiacetic acid (HIDA) scan may be performed to assess gallbladder function. This nuclear medicine test can help confirm the diagnosis if other imaging results are inconclusive.

Once the diagnosis of cholecystitis is established, the focus shifts to managing symptoms and addressing the underlying cause.

Appropriate Drug Therapy Plan

• Pain Management: As mentioned earlier, acetaminophen is a suitable choice for managing RUQ pain associated with cholecystitis. It provides effective pain relief without the gastrointestinal side effects seen with NSAIDs (Rosenthal & Burchum, 2021).
• Nausea and Vomiting Control: Ondansetron is a commonly prescribed antiemetic for patients experiencing nausea and vomiting. Its mechanism of action involves blocking serotonin receptors in the central nervous system, providing relief from these distressing symptoms (Rosenthal & Burchum, 2021).
• Gallbladder Function Management: Statins like atorvastatin can be considered to manage cholesterol levels in the bile. High cholesterol in bile can contribute to the formation of gallstones, a risk factor for cholecystitis. Statins help lower cholesterol levels in the body, which may indirectly reduce the risk of gallstone formation (Rosenthal & Burchum, 2021).
• Antibiotics: In cases of acute cholecystitis, where infection is suspected or confirmed, antibiotics are typically prescribed. Broad-spectrum antibiotics like ciprofloxacin and metronidazole may be used to cover a range of potential pathogens (Rosenthal & Burchum, 2021).

Patient Care and Lifestyle Recommendations

In addition to drug therapy, patient care plays a crucial role in managing cholecystitis. Healthcare providers often provide the following guidance:

• Dietary Modifications: Patients are advised to follow a low-fat diet to reduce the workload on the gallbladder. Avoiding fatty and fried foods can help prevent further attacks of cholecystitis.
• Hydration: Adequate hydration is important for overall health and can help prevent the formation of gallstones.
• Surgical Consultation: In many cases, especially when symptoms are severe or recurrent, surgical removal of the gallbladder (cholecystectomy) may be recommended. This procedure is typically performed laparoscopically and can provide long-term relief from cholecystitis.
• Follow-Up: Patients should follow up with their healthcare provider for regular monitoring and to assess the effectiveness of treatment. Lifestyle modifications and medication adjustments may be necessary over time.
• Pain Management: Over-the-counter pain relievers like acetaminophen can be used as needed to manage pain between healthcare provider visits.

In conclusion, the comprehensive management of cholecystitis involves timely diagnosis, appropriate drug therapy, and patient care. Acetaminophen and ondansetron are valuable tools in managing pain and nausea, while statins may help reduce the risk of gallstone formation. A multidisciplinary approach, including lifestyle modifications and surgical consultation when necessary, ensures the best outcomes for patients with cholecystitis. Early intervention and adherence to medical advice can help prevent complications and improve the overall quality of life for individuals with this condition.

References

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

FAQs

1. What are the common symptoms associated with cholecystitis?
   • This question focuses on understanding the typical clinical presentation of cholecystitis.
2. How is cholecystitis diagnosed, and what diagnostic methods are commonly used?
   • This question delves into the diagnostic process for cholecystitis, including clinical assessment and imaging studies.
3. What are the recommended drug therapies for managing cholecystitis symptoms?
   • This question addresses the pharmacological interventions used to alleviate pain, nausea, and other symptoms associated with cholecystitis.
4. What lifestyle modifications are advised for individuals with cholecystitis?
   • This question explores the dietary and lifestyle changes recommended to manage cholecystitis and prevent symptom recurrence.
5. When is surgical consultation typically recommended for cholecystitis, and what is the surgical procedure involved?
   • This question provides information on the circumstances under which surgical removal of the gallbladder may be necessary and the surgical approach used.