Case Analysis Tool Worksheet <\/p>\n
Student’s Name: Case ID: Mol_AQ_19<\/p>\n
I. Epidemiology\/Patient Profile <\/p>\n
Mr. Rodriguez is a 39-year-old uninsured male who recently moved to the U.S. from the Dominican Republic. He works as a farm laborer and only speaks Spanish.<\/p>\n
II. Prioritized Cues from History and PE. <\/p>\n
Tier 1 Tier 2 Tier 3<\/p>\n
Chronic progressive worsening epigastric pain for about a year<\/p>\n
Father had high blood pressure and mother had diabetes<\/p>\n
No chronic medical condition<\/p>\n
Eating or drinking makes it better or worse<\/p>\n
He has no health insurance<\/p>\n
Never been hospitalized or had any surgery<\/p>\n
Eating spicy foods sometimes makes it worse<\/p>\n
No weight loss, fevers, chills, or night sweats<\/p>\n
Immigrant from Dominican Republic<\/p>\n
Drinks alcohol occasionally<\/p>\n
Previous smoker (quit 6 months ago)<\/p>\n
Takes traditional herbal teas<\/p>\n
Takes Ibuprofen (NSAIDs) for pain most days<\/p>\n
Denies dysphagia, regurgitation<\/p>\n
Denies hematemesis, hematochezia, or melena stools<\/p>\n
Denies, nausea, vomiting, anorexia, early satiety, diarrhea, or constipation.<\/p>\n
Epigastric tenderness on deep palpation without rebound tenderness or guarding<\/p>\n
III. Problem Statement <\/p>\n
Mr. Rodriguez is a 39-year-old Latino immigrant from the Dominican Republic who presents with chronic progressively worsening epigastric pain. He denies other symptoms such as nausea, vomiting, hematemesis, hematochezia, and melena. He quit smoking 6 months ago and consumes 3 to 4 beers per week. Take occasional NSAIDs and traditional herbal teas.<\/p>\n
IV. Differential Diagnosis <\/p>\n
Leading dx: Gastritis<\/p>\n
History Finding(s) Physical Exam Finding(s) <\/p>\n
Chronic progressive worsening epigastric pain for about a year<\/p>\n
Epigastric tenderness on deep palpation without rebound tenderness or guarding<\/p>\n
Eating or drinking makes it better or worse<\/p>\n
Eating spicy foods sometimes makes it worse<\/p>\n
Takes Ibuprofen (NSAIDs) for pain most days<\/p>\n
Denies hematemesis, hematochezia, or melena stools<\/p>\n
Denies dysphagia, regurgitation<\/p>\n
Drinks alcohol occasionally<\/p>\n
Previous smoker (quit 6 months ago)<\/p>\n
Takes traditional herbal teas<\/p>\n
Alternative dx: Peptic Ulcer Disease<\/p>\n
History Finding(s) Physical Exam Finding(s) <\/p>\n
Chronic progressive worsening epigastric pain for about a year<\/p>\n
Epigastric tenderness on deep palpation without rebound tenderness or guarding<\/p>\n
Eating or drinking sometimes makes it better<\/p>\n
Eating spicy foods sometimes makes it worse<\/p>\n
Takes Ibuprofen (NSAIDs) for pain most days<\/p>\n
Denies hematemesis, hematochezia, or melena stools<\/p>\n
Denies dysphagia, regurgitation<\/p>\n
Drinks alcohol occasionally<\/p>\n
Previous smoker (quit 6 months ago)<\/p>\n
Takes traditional herbal teas<\/p>\n
Alternative dx: Gastroesophageal Reflux Disease<\/p>\n
History Finding(s) Physical Exam Finding(s) <\/p>\n
Chronic progressive worsening epigastric pain for about a year<\/p>\n
Epigastric tenderness on deep palpation without rebound tenderness or guarding<\/p>\n
Eating or drinking sometimes makes it worse<\/p>\n
Eating spicy foods sometimes makes it worse<\/p>\n
Drinks alcohol occasionally<\/p>\n
Previous smoker (quit 6 months ago)<\/p>\n
Takes traditional herbal teas<\/p>\n
V. Explanation of Diagnostic Plan and Treatment Plan in prioritized order: <\/p>\n
Diagnostic Plan Rationale <\/p>\n
Proton Pump Inhibitor Test<\/p>\n
A trial of prescription PPI to see if it reduces the symptoms. Diagnosis of GERD can be made if PPI is effective (Dunphy et al., 2019).<\/p>\n
Serum Test for H. pylori antibodies<\/p>\n
This is used to confirm evidence of past infections with H. pylori<\/p>\n
Urea Breath Test<\/p>\n
Accurately detects active infection with H. pylori but it is more expensive than the serologic test and requires that patients stop taking their medications for about two weeks prior to performing the test<\/p>\n
Stool H. pylori antigen testing<\/p>\n
This is more accurate than antibody testing. Although less expensive than the urea breath test, it is however more expensive than the serology test and is less convenient.<\/p>\n
Fecal Occult Blood Testing<\/p>\n
To rule out gastric bleeding (McCance & Huether, 2019).<\/p>\n
Upper endoscopy<\/p>\n
Endoscopy is the most accurate diagnostic test for peptic ulcer disease. The sensitivity of upper endoscopy in the detection of gastroduodenal lesions is approximately 90 percent but varies based on the location of the ulcer and the experience of the endoscopist. It is only indicated for patients older than 60 years or those with alarm symptoms (hematemesis, hematochezia, iron deficiency anemia among other symptoms) or for those who have been taking medications without any improvement.<\/p>\n
Treatment Plan Rationale<\/p>\n
Encourage patient to stop taking NSAIDs unless medically indicated<\/p>\n
NSAIDs can injure the gastric and duodenal mucosa leading to considerable morbidity and mortality<\/p>\n
Advice patient to avoid alcohol, coffee, and other caffeinated beverages <\/p>\n
They tend to stimulate acid secretion and may worsen the symptoms<\/p>\n
Advice patient to continue abstinence from smoking<\/p>\n
Smoking decreases vascularity to the gastric mucosal cells which can result in poor healing after an injury which is worsened using NSAIDs and H. pylori infection<\/p>\n
Empiric treatment: 1. PPI (Esomeprazole 40 mg daily) 2. Antacids<\/p>\n
This is the first-line therapy and should be used only if the patient is symptomatic and usually as needed. 1. The PPIs inhibit the parietal cell hydrogenpotassium adenosine triphosphate (ATPase) which mediates the secretion of hydrogen ions. They have been known to heal about 90% of ulcers but there is a danger of the prevention of absorption of Vit B12 and Iron. 2. The Antacids are used mainly for symptomatic relieve as they rapidly neutralize acid and are less expensive and easily tolerated.<\/p>\n
Triple therapy for H. pylori infection (10 \u2013 14 days): 1. PPI (Esomeprazole\/Nexium 40mg) once daily 2. Amoxicillin 1 g twice daily 3. Clarithromycin 500 mg twice daily<\/p>\n
This treatment is the initial treatment especially in patients with suspected or diagnosed H. pylori infection with the need for the eradication of the infection.<\/p>\n
Follow-up in 2 weeks<\/p>\n
This is important if symptoms have recurred or persisted<\/p>\n
Referral to GI for upper endoscopy<\/p>\n
This is required if after treatment there is still no improvement or there has been a progression of symptoms.<\/p>\n
Referral for Surgery<\/p>\n
This may only be indicated as a last option when there is brisk bleeding of about 6 \u2013 8 units of blood within a 24-hour period or in case of recurrent bleeding, perforation, obstruction of the gastric outlet and refusal of a benign ulcer to heal despite treatment.<\/p>\n
I have adhered to the honor system: Yes <\/p>\n
Student’s signature<\/p>\n
References<\/p>\n
Cash, J., Glass, C., & Mullen, J. (2021). Family practice guidelines. (5th Ed). Springer Publishing Company. <\/p>\n
Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D. (2019). Primary Care, The Art, and Science of Advanced Practice Nursing – An Interprofessional Approach. Davis Plus.\u00a0 ISBN 9780803667181<\/p>\n
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.<\/p>\n
Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D. (2019). Primary Care, The Art, and Science of Advanced Practice Nursing – An Interprofessional Approach. Davis Plus.\u00a0 ISBN 9780803667181<\/p>\n
Cash, J. & Glass, C. (2020). Family Practice Guidelines. Fifth Edition. Springer Publishing. ISBN 9780826153418<\/p>\n
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.<\/p>\n
Chen, M. J., Chen, C. C., Chen, Y. N., Chen, C. C., Fang, Y. J., Lin, J. T., … & Taiwan Gastrointestinal Disease Helicobacter Consortium. (2018). Systematic review with meta-analysis: concomitant therapy vs. triple therapy for the first-line treatment of Helicobacter pylori infection.\u00a0Official journal of the American College of Gastroenterology| ACG,\u00a0113(10), 1444-1457.<\/p>\n","protected":false},"excerpt":{"rendered":"
Case Analysis Tool Worksheet Student’s Name: Case ID: Mol_AQ_19 I. Epidemiology\/Patient Profile Mr. Rodriguez is a 39-year-old uninsured male who recently moved to the U.S. from the Dominican Republic. He works as a farm laborer and only speaks Spanish. II. Prioritized Cues from History and PE. Tier 1 Tier 2 Tier 3 Chronic progressive worsening […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[10],"class_list":["post-106715","post","type-post","status-publish","format-standard","hentry","category-research-paper-writing","tag-writing"],"_links":{"self":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/posts\/106715","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/comments?post=106715"}],"version-history":[{"count":0,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/posts\/106715\/revisions"}],"wp:attachment":[{"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/media?parent=106715"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/categories?post=106715"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/papersspot.com\/blog\/wp-json\/wp\/v2\/tags?post=106715"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}