GI CASE STUDY

READING MATERIALS:

• Woo, T. M., & Robinson, M. V. (2020). Pharmacotherapeutics for advanced practice nurse prescribers (5th ed.) Philadelphia, PA: F.A. Davis Company.
  • Chapter 7: Nutrition and Nutraceuticals
  • Chapter 8: Herbal Therapy and Cannabis
  • Chapter 17: Drugs Affecting the Gastrointestinal System
  • Chapter 36: Gastroesophageal Reflux and Peptic Ulcer Disease

Joshua George is a 42-year-old white man presenting with a 2-month history of intermittent mid-epigastric pain. The pain sometimes wakes him up at night and seems to get better after he eats a meal. J.G. informs you that his doctor told him that he had an infection in his stomach 6 months ago. He never followed up and has been taking over-the-counter antacids and histamine receptor antagonists (H2Ras) for 2 weeks without relief. He takes no other medications. He is concerned because the pain is continuing. He has no other significant history except he is a 20 pack-year smoker and he drinks 5 cups of coffee a day. He eats late at night and goes to bed about 30 minutes after dinner. He is allergic to penicillin.

Diagnosis: Peptic Ulcer Disease

1. List specific goals for treatment for J.G.
2. What drug therapy would you prescribe for J.G.? Please provide your rationales.
3. What are the parameters for monitoring success of the therapy?
4. Discuss specific patient education based on the prescribed therapy.
5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
6. What would be the choice for second-line therapy?
7. What over-the-counter and/or alternative medications would be appropriate for J.G.?
8. What lifestyle changes would you recommend to J.G.?
9. Describe one or two drug–drug or drug–food interaction for the selected agent.

read the case study below and answer accordingly put a citation to each answer.

Gastroenteritis

Baby K., age 14 months, has vomiting and diarrhea and is crying continuously because of what appears to be severe abdominal pain. The suspected cause is gastroenteritis attributable to Staphylococcus aureus from milk custard that had not been properly stored.

1. Briefly describe how S. aureus in the custard could cause vomiting and diarrhea.

2. Describe the fluid and electrolyte imbalances that can be expected in Baby K.

3. Describe the signs of dehydration that can be expected in a child.

Peptic Ulcer and Peritonitis

Ms. X., age 76, has been admitted to the emergency department with severe generalized abdominal pain and vomiting. No significant findings were immediately evident to indicate a cause. Six hours later, Ms. X.’ s blood pressure began to drop, and her pulse was rapid but thready. Exploratory abdominal surgery revealed a perforated gastric ulcer and peritonitis.

1. Describe the process by which an ulcer develops.

2. Suggest several possible factors contributing to ulcer formation.

3. Explain why peptic ulcer may not be diagnosed in an early stage of development.