Name: Gary

Age: 32

Gender: male

Other details: Family history of cancer


Visit 1/June


Gary was seen by the nurse practitioner with complaints of abdominal burning and cramping, abdominal pain and inability to eat for a few weeks, but incidentally resolved as of the appointment. The nurse practitioner prescribed Zantac and set up a complete physician exam for the next month


Visit 2 /July

During this visit the patient gave a history of chewing tobacco and heavy coffee intake, occasional abdominal pain and increased in stool frequency. Rafael also indicated a family history that his mother was diagnosed with colon cancer at the age of 55. The nurse practitioner changed the medication regimen from Zantac to Protonix and ordered an upper GI series with contrast to rule out gastritis or an ulcer. The negative test results were provided to the primary care physician, who never saw the patient or reviewed the patient’s chart.


visit 3/August

The patient was seen by the nurse practitioner a month later, when he reported that his symptoms were improved on Protonix, but he continued to have problems with eating. The nurse practitioner continued with a diagnosis of gastritis and gave instructions to call with any concerns and scheduled a follow-up visit in six months.


visit 4/December

Gary returned and reported worsening stomach cramps and burning to the nurse practitioner. The nurse practitioner then changed the medication to Prevacid, continued with a diagnosis of gastritis and arranged for an appointment with a gastroenterologist for a possible esophagogastroduodenoscopy in July.


visit 5/January

Gary returned for an appointment with the MD, complaining of increasing pain and loose stools. The appointment for a GI consult was moved up after a discussion with the physician, but Rafael went to an emergency room before the scheduled visit. A work-up at the hospital, which included an abdominal CT scan and colonoscopy, resulted in a diagnosis of near obstruction of the right side of the colon by a Stage IV tumor and metastasis to the peritoneum and lymph nodes.


Immediate surgery was performed, followed by chemotherapy, and more. Rafael died about two years later.




  1. 1. Identify the defendants and the areas of negligence in this case.
  3. 2.Given the patient’s symptoms listed above, provide a comprehensive differential diagnoses list (ONLY a list).
  5. 3. Reflect on this case and what you would have done differently as an advanced practice registered nurse.
  7. 4. Review the risks that NPs face associated with practice identified in Buppert (2021) p. 299 and identify which of these apply to the case. What strategies might have reduced the risk of the outcome presented in this case? Refer to Buppert (2021) Chapter 8: Risk Management.
  9. 5. What do you think the verdict was and why?



  • Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones and Bartlett Publishers.


  • J oel, L. A. (2018). Advanced practice nursing: Essentials for role development (4th ed). F. A. Davis Company.





Identify defendant. Use of legal standards when analyzing potential medical malpractice: duty, breach of duty, causation, damages and negligence.


Scholarly discussion of standard of care of the practice issues relevant to the case. If applicable differential diagnosis.


Demonstrates synthesis of legal issues as they apply to personal professional practice.


Support prediction of case verdict with sound logic thread grounded by legal concepts.


Professional Application: Major elements of the paper are supported by evidence-based articles/guidelines.


Technical aspects of paper: Grammar, spelling, Intelligible, Quality of writing/organization of paper; and use of APA. Easy to follow clear quality and organization of paper


Remember to use APA format, including a cover sheet and a reference list.

The paper should be about three to five pages in length.





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