Gastrointestinal and Hepatobiliary DisorderDC 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 one 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 moodExplain 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 Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier. BUY A PLAGIARISM FREE PAPER HEREChapter 64, “Drugs for Peptic Ulcer Disease” (pp. 589–597) 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.2936 Gastrointestinal and Hepatobiliary Disorder Acute pancreatitis is a sudden inflammation of the pancreas. The main symptom is severe abdominal pain that radiates to the back. Other symptoms include nausea, vomiting, fever, and rapid heartbeat. If left untreated, acute pancreatitis can lead to serious complications, such as organ failure and death. Early diagnosis and treatment are essential to prevent these complications (Lee et al.,2019). Acute pancreatitis is most often caused by a virus, but it can also be caused by chemicals or food toxins. The most common cause of acute pancreatitis in adults is alcoholism, followed by gallstones and gastritis. This paper is based on a case study of a 46-year-old woman who reported to the clinic complaining of RUQ pain, nausea, and vomiting that began about an hour after a substantial supper with her family. The purpose of this paper is to describe the patient’s diagnosis and the best treatment approach. Diagnoses Based on the patient’s complaints of nausea and vomiting, as well as her history of RUQ pain, she undoubtedly has acute pancreatitis. The levels of liver enzymes such as AST and bilirubin commonly rise with this condition (Leppäniemi et al.,2019). The patient’s direct bilirubin level was.6mg/ml and ALT level was 45 U/L, indicating acute pancreatitis. Her amylase levels were also high, indicating pancreatic inflammation. Furthermore, the patient’s gout history and use of allopurinol increases the risk of severe pancreatitis. BUY A PLAGIARISM FREE PAPER HERETreatment There are no definitive treatments for acute pancreatitis. Treatment is aimed at supporting the patient through the acute phase of the disease. This may involve hospitalization, intravenous hydration, pain relief, and supportive care. In some cases, aggressive supportive care may be required, including total parenteral nutrition and mechanical ventilation. Assuming there is no contraindication, the treatment plan would involve continuing the client on her hypertensive medication such as HCTZ, and lisinopril 10mg, adding anti-emetic such as ondansetron to control nausea and vomiting, and ibuprofen for pain. Allopurinol, on the other hand, should be discontinued and substituted with another antigout medication since it might induce or aggravate pancreatitis by raising uric acid levels (Ghasemi et al.,2021). Antibiotics are widely indicated in situations of infection. Due to the patient’s WBC of 13,000/mm3, which indicates the presence of infection, an antibiotic such as ceftriaxone should be added. BUY A PLAGIARISM FREE PAPER HERE
I chose to include ibuprofen, an NSAID, since it has been shown to be effective in managing pain and inflammation associated with acute pancreatitis; unlike narcotic analgesics, it does not suppress breathing. Acetaminophen is another possible option, although excessive use may cause liver damage and is hence not recommended in this situation. Ondansetron, on the other hand, is worth included in the treatment regimen due to its effectiveness in managing nausea and vomiting. Other anti-emetic drugs, such as chlorperazine, cause drowsiness and are thus not a viable option for the patient. Ceftriaxone is typically well tolerated and has minimal side effects (Genchanok et al.,2019). References Lee, P. J., & Papachristou, G. I. (2019). New insights into acute pancreatitis. Nature Reviews Gastroenterology & Hepatology, 16(8), 479-496. Leppäniemi, A., Tolonen, M., Tarasconi, A., Segovia-Lohse, H., Gamberini, E., Kirkpatrick, A. W., … & Catena, F. (2019). 2019 WSES guidelines for the management of severe acute pancreatitis. World journal of emergency surgery, 14(1), 1-20. Ghasemi, A. (2021). Uric acid‐induced pancreatic β-cell dysfunction. BMC Endocrine Disorders, 21(1), 1-5. Genchanok, Y., Tolu, S. S., Wang, H., & Arora, S. (2019). Agranulocytosis from outpatient antimicrobial treatment with ceftriaxone: a case report. The Permanente Journal, 23. |