GI Case Study:

Chief complaint: “I have recurrent H. Pylori infection”. 

HPI: M.C. a 46-year-old Hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has PMH of dyspepsia, and GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms. 

PMH: 

H. Pylori infection gastritis

Diabetes Mellitus, type 2

Surgeries: None

Allergies: NKDA

Vaccination History: Up-to-date

Social history:

High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.

Family history:

Both parents are alive. Father has history of DM type 2, Tinea Pedis. Mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis. 

ROS:

Constitutional: Negative for fever. Negative for chills. 

Respiratory: No Shortness of breath. No Orthopnea. 

Cardiovascular: No edema. No palpitations. 

Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal

Assessment:

Primary Diagnosis: Recurrent H. Pylori infection gastritis

Secondary Diagnoses: Dyspepsia

Differential Diagnosis: Peptic Ulcer Disease

Previous medication plan: two months ago and failed.

1. Clarithromycin      500 mg po BID for 2 weeks
2. Omeprazole      40 mg po BID for 2 weeks and then po daily.
3. Cipro      500 mg po BID for 2 weeks

Plan: Tests

Pt had EGD done 2 weeks ago that showed H. Pylori positive gastritis in biopsy results. 

Urea breath test 8 weeks after treatment with H. Pylori medications. Pt needs to stop PPI’s 2 weeks prior to Urea Breath test. 

Labs: No new labs are needed.  

Referrals: may refer based on effect of medication therapy given for 2 weeks.

Follow up: return to office in 8 weeks to reevaluate symptoms.

QUESTIONS

1. As a future nurse practitioner, it is important that you determine the medications used for recurrent H. Pylori infection. 

2. Please discuss new therapy guidelines for H. Pylori treatment, and provide patient education.

Below is the website for the American Academy of Gastroenterology Clinical Guidelines (ACG) for the updated H. Pylori therapy. Feel free to consult other peer-reviewed articles within 5 years of publication.

http://gi.org/wp-content/uploads/2017/02/ACGManagementofHpyloriGuideline2017.pdf

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Chief complaint: “I have recurrent H. Pylori infection”. 

HPI: M.C. a 46-year-old Hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has PMH of dyspepsia, and GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms. 

PMH: 

H. Pylori infection gastritis

Diabetes Mellitus, type 2

Surgeries: None

Allergies: NKDA

Vaccination History: Up-to-date

Social history:

High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.

Family history:

Both parents are alive. Father has history of DM type 2, Tinea Pedis. Mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis. 

ROS:

Constitutional: Negative for fever. Negative for chills. 

Respiratory: No Shortness of breath. No Orthopnea. 

Cardiovascular: No edema. No palpitations. 

Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal

Assessment:

Primary Diagnosis: Recurrent H. Pylori infection gastritis

Secondary Diagnoses: Dyspepsia

Differential Diagnosis: Peptic Ulcer Disease

Previous medication plan: two months ago and failed.

1. Clarithromycin      500 mg po BID for 2 weeks
2. Omeprazole      40 mg po BID for 2 weeks and then po daily.
3. Cipro      500 mg po BID for 2 weeks

Plan: Tests

Pt had EGD done 2 weeks ago that showed H. Pylori positive gastritis in biopsy results. 

Urea breath test 8 weeks after treatment with H. Pylori medications. Pt needs to stop PPI’s 2 weeks prior to Urea Breath test. 

Labs: No new labs are needed.  

Referrals: may refer based on effect of medication therapy given for 2 weeks.

Follow up: return to office in 8 weeks to reevaluate symptoms.

Questions:

As  NP, it is important that you determine the medications used for recurrent H. Pylori infection. 

Please discuss new therapy guidelines for H. Pylori treatment, and provide patient education.

Below is the website for the American Academy of Gastroenterology Clinical Guidelines (ACG) for the updated H. Pylori therapy. 

http://gi.org/wp-content/uploads/2017/02/ACGManagementofHpyloriGuideline2017.pdf

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The following job is another student post to wish i have to react. Please add some other information about the topic. do not repeat the same as the student already did. remember APA. and less than 20 % of similarity.  

A patient is admitted with renal calculi.

1. What symptoms will the patient manifest if he is experiencing renal colic?

• A patient experiencing renal colic will mainly have pain. The type of pain felt with renal colic is “colicky” as the stone blocks the outflow and stretches the ureter. This pain is reflected in the flank of the side being affected (Grossman & Porth, 2014). This pain may also radiate to the lower abdomen/bladder region and nausea and vomiting may also accompany renal colic.

1. How will the nurse best manage the renal colic?

• The best way to manage renal colic is to first alleviate the pain and any other accompanying symptom as this can cause extreme anxiety in the patient. Antibiotic treatment may also be implemented. Once pain is relieved and the stone has passed, all efforts should be made to ensure it does not happen again. Also ensuring an adequate fluid intake can help prevent the recurrence (Grossman & Porth, 2014).

1. The nurse is straining the urine for presence of stones that the patient may have passed. What is the importance of this nursing action?

•  It is of extreme importance to strain the urine to identify the chemical components of the stone. This dictates the course to follow, what dietary changes need to be made, what medication needs to be prescribed, long-term measures to avoid new stone formation, and it helps also to identify any underlying cause (Grossman & Porth, 2014).

Reference

Grossman, S. C., & Porth, C. (2014). Porth’s pathophysiology: concepts of altered health states. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

 Please react to this student post. remember references and plarigarism

Descending Spinal Tract

• Corticospinal, reticulospinal, and vestibulospinal
• Sends impulses from the brain to muscle groups
• Control muscle tone, posture, and motor movements
• Efferent

1. Ascending Spinal Tract
2. Spinothalamic and spinocerebellar
3. Sends sensory signals to accomplish complex tasks
4. Ascending tracts recognize exact stimulus and location
5. Contains fibers that discriminate rough from light touch, temperature and pain
6. Afferent

• If the spinal cord is completely severed, then complete loss of function below the point if injury is expected (Ball, Dains, Flynn, Solomon & Stewart, 2015).
• The nervous system is a group of nerves and neurons that transmit messages to different parts of the body. It is in charge of coordinating and controlling the body (Ball et al., 2015). The nervous system is divided into the central and the peripheral nervous system, further subdivided into autonomic, sympathetic and parasympathetic. The central nervous system is comprised of the brain. The peripheral nervous systems is comprised of the cranial and spinal nerves and the ascending and descending pathways (Ball et al., 2015). With all parts functioning properly the nervous system is able to receive and identify stimuli, control voluntary and involuntary body functions (Ball et al., 2015).
• The three major units of the brain are the cerebrum, the cerebellum and the brainstem (Ball et al., 2015).
• The difference between the ascending and descending tracts is that the ascending is sensory (afferent) because it delivers information to the brain and the descending tract delivers motor (efferent) information to the periphery (Ball et al., 2015)
• The pituitary gland regulates metabolic processes and controls growth, lactation, and vasoconstriction through hormonal regulation (Ball et al., 2015).
• The fourth cranial nerve is called trochlear and it is in charge of the downward and inward movement of the eye (Ball et al., 2015).
• Risk factors for cerebrovascular accidents include hypertension, obesity, sedentary lifestyle, smoking, stress, high cholesterol/triglycerides/lipoproteins, congenital conditions and family history of cerebrovascular accidents (Ball et al., 2015).
• The 5.07 monofilament test is used to test sensation in different parts of the foot in patients suffering from diabetes mellitus or peripheral neuropathy (Ball et al., 2015).  
• The 0 to 4+ scale is used to grade the response when testing the reflex. 0 indicates no response and 4+ indicates hyperactive reflex (Ball et al., 2015).
• Older adults may be taking medication for other conditions that can affect their balance, mental status and coordination and it is important know this in order to rule out whether a symptom is due to a side effect or a cause for concern (Ball et al., 2015).
• Meningitis that occurs during the first year may cause epilepsy later on in life, also any infection in the first year of life can impair brain functioning and development (Ball et al., 2015).
• Peripheral neuropathy is a loss of motor and sensory function due to diabetes mellitus, vitamin B12 deficiency, Lyme disease, HIV infection, poor blood circulation and altered lipid metabolism. In this case the cause of EI’s neuropathy is Diabetes Mellitus due to the elevated A1c (Ball et al., 2015).
• Objective data in peripheral neuropathy include reduced sensation in the foot, inability to feel sharp touch, diminished distal pulses, unable to stand on toes or heels, skin ulcers in extremities that are often not felt by the patient and decreased sensation below the knees (Ball et al., 2015).
• The best technique to assess for peripheral neuropathy is the 5.07 monofilament test because it assesses sensation in different areas of the foot (Ball et al., 2015).

Reference  

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidels guide to physical examination. St. Louis, MI: Elsevier Mosby.

  The following is another student post to wish i have to react. It should contain 3 paragraphs. please be small. 3 references and less than 20 % similarity. 

Chapter 11

Patient Centered Care

In patient centered care, nurses and other medical professionals take care of patients and their families in valuable and meaningful ways to get the best results and hence characterized by several principles. The first characteristic of patient centered care is the exploration of the disease and illness experience (Masters, 2018). By exploring how the patient and his family feels about the disease or illness in question, it is possible to develop appropriate measures for dealing with it. Believes, perceptions and attitudes about a disease are vital determinants of how a patient responds to treatment against a disease.

The second characteristic of patient centered care is that it is understanding the whole person. A nurse ought to understand a patient including their physical and emotional attributes that affect treatment (Masters, 2018). This allow him to respond to their needs in appropriate methods. The third characteristic is that patient centered care in culturally appropriate. The culture of the patient should be put into consideration in developing the care process. By respecting diversity, patient centered care ensure that healthcare is delivered in a manner that the patient understand hence increasing chances of recuperation.

Patient centered care should also be based on teamwork and collaboration. There is a need for development of measures to promote collaboration among healthcare staff working with patients (Masters, 2018). Collaboration and teamwork eliminate errors, and presents the best solutions in patient care.

Patient Education

The first step to providing patient education is understanding their cultural backgrounds. Patient centered-care include culturally appropriate education (APA., 2009). Educations should be done in the language they most understand with minimum use of medical jargon. Secondly, the nurse should understand the patient’s family background. Members of the family should be included during patient education as they provide support during the recuperation process.

The third consideration to make is in regard to what the patient and his family members already know about management of the disease. Including members of the family in patient education increase the chances that it will be followed (Haley et al., 2017). While it is not necessary to repeat what the patient already knows, confirmations should be done to ensure their knowledge is accurate.

The use of visual aids is also necessary during the education of this patient. Charts, pictures, PowerPoint and even videos if possible should be included in the education. The nurse should take advantage of technology and provide videos and other material to reinforce the teaching (APA., 2009). Moreover, the nurse can demonstrate certain procedures using available items and other people available.

Evaluating the Effectiveness of Patient Education

To evaluate the effectiveness of the education in the scenario, several methods can be used. First, the nurse should ask the patient to restate the instructions given (Haley et al., 2017). For example, the patient can be asked to restate the drug regime in their own words. The patients should also be presented with questions to help identify areas where reinforcement teaching may be needed.

The nurse should also evaluate the patient and his family for attitude towards the teachings provided. To evaluate for attitude, the nurse should ask the patient and his family how they are going to incorporate the information in their daily routines (Haley et al., 2017). For example, one can ask the patient how they will incorporate their drug taking regime in their daily schedules.

The last method of evaluation will involve looking at the outcomes of the education provided. During clinical visits, the nurse will ask whether the patient has been able to follow the education provided (APA., 2009). Also, the outcomes of treatment including the effectiveness of management of the condition will be examined.

References

APA. (2009). Publication Manual. American Psychological Association (APA) (6th ed.). ISBN: 978-1-4338-0561-5

Haley, B., Heo, S., Wright, P., Barone, C., Rettiganti, M. R., & Anders, M. (2017). Relationships among active listening, self-awareness, empathy, and patient-centered care in associate and baccalaureate degree nursing students. NursingPlus Open, 3, 11-16.

Masters, K. (2018). Role development in professional nursing practice. Jones & Bartlett Learning.