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.

To Prepare
  • Review the case study assigned,
  • 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.

ASSIGNED 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:

  • Synthroid 100 mcg daily
  • Nifedipine 30 mg daily
  • Prednisone 10 mg daily

THE QUESTION

  • 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.

READING REQUIREMENT

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/10.1002/hep.29367

 

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.


EXCELLENT

GOOD

Poor

Explain your diagnosis for the patient, including your rationale for the diagnosis.

23 (23%) – 25 (25%)

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.

20 (20%) – 22 (22%)

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.

18 (18%) – 19 (19%)

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.

0 (0%) – 17 (17%)

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.

Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

27 (27%) – 30 (30%)

The response accurately and completely describes in detail an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

24 (24%) – 26 (26%)

The response describes a basic explanation of the appropriate drug therapy plan based on the patient’s history, diagno

READING REQUIREMENT

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/10.1002/hep.29367

 

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.


EXCELLENT

GOOD

Poor

Explain your diagnosis for the patient, including your rationale for the diagnosis.

23 (23%) – 25 (25%)

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.

20 (20%) – 22 (22%)

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.

18 (18%) – 19 (19%)

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.

0 (0%) – 17 (17%)

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.

Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

27 (27%) – 30 (30%)

The response accurately and completely describes in detail an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

24 (24%) – 26 (26%)

The response describes a basic explanation of the appropriate drug therapy plan based on the patient’s history, diagno

1The symptoms present in patients experiencing gastrointestinal (GI) conditions are often non-specific, and it is important for care providers to conduct an extensive assessment to identify the underlying cause of the presentations (Kumar & Gupta, 2018). This process is further complicated by the fact that GI manifestations can occur on the background of diseases involving other systems. 

2

The case gives a patient queasiness, regurgitating, and looseness of the bowels, which are vague gastrointestinal manifestations. The patient has an affirmed history of illicit drug use and suspected hepatitis C. 

Nevertheless, the last option must be set as an analysis following a polymerase chain response (PCR) that recognizes HCV RNA in the serum. 

2

In this way, in light of the medication history, the patient is suspected to encounter intricacies from the use of prednisone. 

1

The general principles applied to minimize the side effects from oral glucocorticoids include a reassessment of their use and necessity for the patient, reducing the duration of use, and providing mucosal protective agents such as bismuth subsalicylate (Gupta & Garg, 2017). These agents help in coating areas of ulcerations or erosion and preventing further damage from gastric acid. In the case of this patient bismuth subsalicylate will be selected agent as it also contributes to stimulating the secretion of mucus, prostaglandin, and bicarbonate. Patient education will also be provided, and include information on diet and different products that should be avoided while taking prednisone. Spicy and fried foods are not recommended, and smoking and alcohol should also be avoided as they irritate the gastric mucosa. The patient has a history of drug abuse, which makes education on abstaining from alcohol important as this can lead to ulcers, and gastric perforation, which is life threatening. The preliminary diagnosis of the patient is gastritis on the background of prednisone use. This is a glucocorticoid, which affects the gastric mucosa through inhibition of prostaglandins. The drug bismuth subsalicylate was prescribed due to its mucosal protective properties (Gupta & Garg, 2017). Other recommendations such as patient dietary education were also stated as certain food products can also affect the state of the mucosa and cause the existing manifestations to persist or lead to more life threatening situations.

Sources

INCLUDED SOURCES

· Institutional database (2)

100%

· Top sources

· 1

Student paper

88%

· 2


Student paper

12%

High Match – 96%

Student paper

The symptoms present in patients experiencing gastrointestinal (GI) conditions are often non-specific, and it is important for care providers to condu

1The symptoms present in patients experiencing gastrointestinal (GI) conditions are often non-specific, and it is important for care providers to conduct an extensive assessment to identify the underlying cause of the presentations (Kumar & Gupta, 2018). This process is further complicated by the fact that GI manifestations can occur on the background of diseases involving other systems. 

2

The case gives a patient queasiness, regurgitating, and looseness of the bowels, which are vague gastrointestinal manifestations. The patient has an affirmed history of illicit drug use and suspected hepatitis C. 

Nevertheless, the last option must be set as an analysis following a polymerase chain response (PCR) that recognizes HCV RNA in the serum. 

2

In this way, in light of the medication history, the patient is suspected to encounter intricacies from the use of prednisone. 

1

The general principles applied to minimize the side effects from oral glucocorticoids include a reassessment of their use and necessity for the patient, reducing the duration of use, and providing mucosal protective agents such as bismuth subsalicylate (Gupta & Garg, 2017). These agents help in coating areas of ulcerations or erosion and preventing further damage from gastric acid. In the case of this patient bismuth subsalicylate will be selected agent as it also contributes to stimulating the secretion of mucus, prostaglandin, and bicarbonate. Patient education will also be provided, and include information on diet and different products that should be avoided while taking prednisone. Spicy and fried foods are not recommended, and smoking and alcohol should also be avoided as they irritate the gastric mucosa. The patient has a history of drug abuse, which makes education on abstaining from alcohol important as this can lead to ulcers, and gastric perforation, which is life threatening. The preliminary diagnosis of the patient is gastritis on the background of prednisone use. This is a glucocorticoid, which affects the gastric mucosa through inhibition of prostaglandins. The drug bismuth subsalicylate was prescribed due to its mucosal protective properties (Gupta & Garg, 2017). Other recommendations such as patient dietary education were also stated as certain food products can also affect the state of the mucosa and cause the existing manifestations to persist or lead to more life threatening situations.

Sources

INCLUDED SOURCES

· Institutional database (2)

100%

· Top sources

· 1

Student paper

88%

· 2


Student paper

12%

High Match – 96%

Student paper

The symptoms present in patients experiencing gastrointestinal (GI) conditions are often non-specific, and it is important for care providers to condu