Posted: July 20th, 2023

DC is a 46-year-old female who presents with a 24-hour history of RUQ pain

Case study:
This we will look at GI and hepatobiliary disorders. We will be completing a one-page assignment that is due by day 7 (Sunday). Please use the following case study for the assignment:

Week 4 Assignment
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 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 mood
DETAILS:
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.
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.
(AS A NURSE PRACTITONER- PROVIDER)
RUBRIC:
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

Diagnosis:
Based on DC’s presentation of RUQ pain after a large meal, along with nausea and vomiting, and her medical history, the most likely diagnosis is acute cholecystitis. Acute cholecystitis is an inflammation of the gallbladder caused by the obstruction of the cystic duct by a gallstone. Patients often present with RUQ pain, nausea, vomiting, and fever. DC’s medical history of type II diabetes, hypertension, and obesity are all risk factors for the development of gallstones and cholecystitis.

Drug Therapy Plan:
The initial drug therapy plan for DC should include pain control and antiemetics. For pain control, acetaminophen is a good option as it is safe for patients with liver disease, which DC may have based on her elevated liver enzymes. NSAIDs should be avoided due to their potential to exacerbate gastritis or cause bleeding in patients with peptic ulcer disease. As DC has a history of allergies to codeine and amoxicillin, an opioid analgesic and penicillin-based antibiotics should be avoided. For antiemetics, metoclopramide or ondansetron can be used to alleviate DC’s nausea and vomiting.

Justification:
Acetaminophen is a safe and effective pain reliever that does not affect blood clotting or cause gastric irritation, making it a good option for DC. Metoclopramide or ondansetron are appropriate antiemetics as they work on different receptors in the gastrointestinal tract to alleviate nausea and vomiting. They also do not have the side effects of sedation or extrapyramidal symptoms seen with other antiemetics such as promethazine. Finally, avoiding opioids and penicillin-based antibiotics is important to prevent any potential allergic reactions or adverse effects in DC.

In conclusion, DC’s presentation and medical history suggest acute cholecystitis as the most likely diagnosis. An initial drug therapy plan that includes acetaminophen for pain control and metoclopramide or ondansetron for antiemetics is appropriate. This plan was chosen based on DC’s medical history, diagnosis, and current medications to provide safe and effective symptom relief.

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