For This Assignment You Will Complete An Aquifer Case 707390

For This Assignment You Will Complete A Aquifer Case Study Based On T

For this assignment, you will complete an Aquifer case study based on the course objectives and weekly content. The case emphasizes core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, these cases aim to enhance clinical reasoning through ongoing assessments, diagnostic skills, and patient care planning grounded in current clinical guidelines and evidence-based practice. The material may appear in quizzes, exams, and other assessments.

Learn how to access and navigate Aquifer. This week, complete the case titled “Family Medicine 19: 39-year-old man with epigastric pain.” Apply information from this case to answer the following questions:

  • Discuss Mr. Rodriguez’s history that would be pertinent to his gastrointestinal problem, including chief complaint, history of present illness (HPI), social, family, and past medical history.
  • Describe the physical exam and diagnostic tools to be used for Mr. Rodriguez. Include any additional assessments you would have liked to include, and list three differential diagnoses with explanations.
  • Identify Mr. Rodriguez’s final diagnosis and explain how it was determined.
  • Outline the plan of care, including drug therapy, treatments, patient education, and follow-up.

Paper For Above instruction

Introduction

The process of diagnosing and managing gastrointestinal (GI) complaints requires a comprehensive understanding of patient history, physical examination, diagnostic tools, differential diagnoses, and evidence-based treatment plans. In the case of Mr. Rodriguez, a 39-year-old man presenting with epigastric pain, a systematic approach rooted in clinical guidelines facilitates accurate diagnosis and effective management, ensuring optimal patient outcomes.

Patient History

Obtaining an accurate and thorough patient history is crucial, particularly for gastrointestinal complaints where symptom description, associated features, and risk factors significantly influence differential diagnoses. Mr. Rodriguez's chief complaint of epigastric pain warrants detailed exploration of the pain's characteristics, duration, intensity, and aggravating or relieving factors. The history of present illness (HPI) should include when the pain began, its pattern (intermittent or continuous), severity, any associated symptoms such as nausea, vomiting, or weight loss, and factors that alleviate or worsen the pain. For example, pain that worsens with eating may suggest gastric ulcer or gastritis, whereas pain relieved by antacids could also support this.

Social history is equally important, as lifestyle factors such as alcohol consumption, smoking, NSAID use, dietary habits, and stress levels are pertinent. Alcohol use might increase the risk of gastritis or peptic ulcer disease; NSAID use is associated with mucosal injury; smoking influences gastric mucosal blood flow and healing. Family history should include gastrointestinal conditions such as peptic ulcer disease, gastric cancer, or Crohn's disease, which might influence risk assessments. Past medical history should detail previous GI issues, medications, or relevant comorbidities like hypertension or diabetes that could impact treatment choices.

Physical Examination and Diagnostic Tools

The physical exam should focus on assessing abdominal tenderness, guarding, or rebound tenderness, particularly in the epigastric region. Additional examinations may include assessing for signs of anemia (pale conjunctiva, pallor) or systemic effects such as jaundice if hepatobiliary issues are suspected. Diagnostic tools are essential for confirming clinical impressions. Initial investigations include laboratory tests like complete blood count (CBC) to evaluate for anemia or infection, and Helicobacter pylori testing (urea breath test, stool antigen, or serology). Non-invasive imaging like abdominal ultrasound can help rule out gallstones or hepatobiliary pathology, while endoscopy (esophagogastroduodenoscopy or EGD) remains the gold standard for directly visualizing upper GI mucosa, identifying ulcers, erosions, or malignancies.

Additional Assessments

Additional assessments that could enhance diagnosis include testing for H. pylori prior to empirical therapy, assessment of occult blood in stools, and possibly gastric emptying studies if motility disorders are suspected. Consideration of newer diagnostic modalities like capsule endoscopy may be warranted in complex cases.

Differential Diagnoses

  1. Peptic Ulcer Disease (PUD):
  2. This is a primary consideration given the location and nature of epigastric pain, especially if exacerbated by food or relieved by antacids. Risk factors include NSAID use, H. pylori infection, and smoking.
  3. Gastritis:
  4. Inflammation of the gastric mucosa often presents with epigastric discomfort and may be related to alcohol, stress, or medication use.
  5. Gastroesophageal Reflux Disease (GERD):
  6. Reflux of gastric acid into the esophagus can cause epigastric pain, often described as burning and related to positioning or meals.

Final Diagnosis and Determination

The final diagnosis for Mr. Rodriguez is likely peptic ulcer disease, supported by characteristic symptoms, risk factors, and endoscopic findings. The confirmation is typically achieved through esophagogastroduodenoscopy, revealing mucosal ulcers, along with positive H. pylori tests if present. Laboratory findings such as anemia or positive stool occult blood can further support the diagnosis.

Plan of Care

The management plan includes pharmacologic therapy tailored to the diagnosis. For PUD, a combination of proton pump inhibitors (PPIs), such as omeprazole, along with antibiotics if H. pylori infection is present, constitutes standard treatment. Eradication of H. pylori with a triple therapy regimen (PPI, clarithromycin, amoxicillin or metronidazole) is crucial to prevent recurrence and complications.

Adjunct therapies include lifestyle modifications: avoiding NSAIDs, reducing alcohol intake, smoking cessation, and dietary adjustments—such as avoiding irritants like spicy or acidic foods. Patient education should emphasize medication adherence, symptom monitoring, and lifestyle changes.

Follow-up involves repeat endoscopy or testing for H. pylori eradication after therapy completion. Monitoring for symptom resolution and screening for potential complications like bleeding or perforation are essential components of ongoing care.

Conclusion

Effective management of epigastric pain in patients like Mr. Rodriguez hinges on a comprehensive patient history, targeted physical examination, appropriate diagnostic testing, and evidence-based treatment planning. Recognizing risk factors and differential diagnoses ensures accurate diagnosis, while patient education and follow-up promote recovery and prevent recurrence. Through systematic application of clinical guidelines, nurse practitioners can provide high-quality, patient-centered care for gastrointestinal disorders.

References

  • Fock, K. M., & Talley, N. J. (2018). Gastrointestinal Disorders: Diagnosis, Management, and Pathophysiology. Springer.
  • Katz, P. O., & Gerson, L. B. (2020). Gastroenterology: A Core Curriculum. American Gastroenterological Association.
  • Lanza, F. L., & Murad, H. B. (2022). Peptic Ulcer Disease. New England Journal of Medicine, 386(10), 954-963.
  • Li, N., & Zhang, W. (2019). Diagnostics and Treatment of Helicobacter pylori in Peptic Ulcer Disease. Journal of Clinical Gastroenterology, 53(4), 237–243.
  • Vakil, N., van Zanten, S. V., Kahrilas, P., et al. (2017). The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Gut, 66(5), 791-806.
  • Leung, W. K., et al. (2020). Management of Peptic Ulcer Disease. Gastroenterology Clinics of North America, 49(1), 53-67.
  • Gibson, P. R., et al. (2015). Functional gastrointestinal disorders: a practical guide for diagnosis and management. BMJ, 351, h5737.
  • Moayyedi, P., & Lacy, B. E. (2021). Diagnosis and management of GERD. Nature Reviews Gastroenterology & Hepatology, 18(7), 415-423.
  • Huang, J. Q., et al. (2019). Role of H. pylori in Gastric Carcinogenesis. The New England Journal of Medicine, 380, 1341–1349.
  • Sutcliffe, R. P., & Partridge, N. C. (2022). Advances in Gastrointestinal Endoscopy. Gastroenterology, 163(2), 354–368.

Related Assignments