Description
Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms, such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe a treatment that targets the cause rather than the symptom.
Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Assignment, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.
This week, we will be reviewing Gastrointestinal and Hepatobiliary Disorders. You are to write a 1 page paper addressing the requirements written in your assignment. Please follow the directions given and review the grading rubric to ensure all questions have been addressed.
Case:
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 she had with her family. She has had nausea and on 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
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.
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.
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
Required Readings
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Chapter 64, “Drugs for Peptic Ulcer Disease” (pp. 589–597)
Chapter 65, “Laxatives” (pp. 598–604)
Chapter 66, “Other Gastrointestinal Drugs” (pp. 605–616)
Chapter 80, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 723–743)
Chalasani, N., Younossi, Z., Lavine, J. E., Charlton, M., Cusi, K., Rinella, M., . . . Sanya, A. J. (2018) The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases Hepatology, 67(1), 328–357. Retrieved from https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/…This article details the diagnosis and management of nonalcoholic fatty liver disease. Review this article to gain an understanding of the underlying pathophysiology as well as the suggested pharmacotherapeutics that might be recommended to treat this disorder. https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/…
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
Fair
The response inaccurately or vaguely explains the diagnosis for the patient, including an inaccurate or vague rationale for the diagnosis that may or may not support clinical judgment.
17.25 to >0 pts
Poor
The response inaccurately and vaguely explains the diagnosis for the patient, including an inaccurate and vague rationale for the diagnosis that does not support clinical judgment, or is missing.
25 pts
This criterion is linked to a Learning OutcomeDescribe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
30 to >26.7 pts
Excellent
The response accurately and completely describes in detail an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
26.7 to >23.7 pts
Good
The response describes a basic explanation of the appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
23.7 to >20.7 pts
Fair
The response inaccurately or vaguely describes an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
20.7 to >0 pts
Poor
The response inaccurately and vaguely describes an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
30 pts
This criterion is linked to a Learning OutcomeJustify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.
30 to >26.7 pts
Excellent
The response provides an accurate, clear, and detailed justification for the recommended drug therapy plan for this patient. … The response includes specific, accurate, and detailed examples that fully support the justification provided.
26.7 to >23.7 pts
Good
The response provides a basic justification for the recommended drug therapy plan for this patient. … The response includes only 1-2 examples that fully support the justification provided.
23.7 to >20.7 pts
Fair
The response provides an inaccurate or vague justification for the recommended drug therapy plan for this patient. … The response may include examples, which may inaccurately or vaguely support the justification provided.
20.7 to >0 pts
Poor
The response provides an inaccurate and vague justification for the recommended drug therapy plan for this patient, or is missing. … The response does not include examples that support the justification provided, or is missing.
30 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.
5 to >4.45 pts
Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
4.45 to >3.95 pts
Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
3.95 to >3.45 pts
Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
3.45 to >0 pts
Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
5 to >4.45 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors
4.45 to >3.95 pts
Good
Contains a few (1–2) grammar, spelling, and punctuation errors
3.95 to >3.45 pts
Fair
Contains several (3–4) grammar, spelling, and punctuation errors
3.45 to >0 pts
Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.
5 to >4.45 pts
Excellent
Uses correct APA format with no errors
4.45 to >3.95 pts
Good
Contains a few (1–2) APA format errors
3.95 to >3.45 pts
Fair
Contains several (3–4) APA format errors
3.45 to >0 pts
Poor
Contains many (≥ 5) APA format errors
5 pts
Total Points: 100
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Asthma and Stepwise
Management
Student’s Name:
Walden University:
Due Date:
Long-term Controls for Asthma
• Asthma is a chronic condition caused by
inflammation of the airways.
• Long-term controls for the condition include antiinflammatories mainly glucocorticoids (Rosenthal &
Burchum, 2017).
• Anti-inflammatories suppresses inflammation,
reduce bronchial hyper-reactivity and mucus
production.
• Glucocorticoids impact on patients include speaking
difficulty, retarded growth in children, bone loss, risk
of cataracts glaucoma.
Quick Relief Controls for Asthma
• Bronchodilators are options used for quick relief and
symptomatic relief (Montano et al., 2020).
• Core bronchodilators used in asthma treatment
include beta-agonists and anticholinergics.
• Their mode of action mainly comprises histamine
suppression, increasing ciliary motility to induce
bronchodilation (Rosenthal & Burchum, 2017).
• Some of the bronchodilators’ adverse impacts
include tachycardia, angina, chest pain among others.
Stepwise Treatment and Management
• The stepwise treatment approach is an asthma
treatment plan whereby the doses are gradually
increased and reduced at interval to achieve stability
(Cazzola et al., 2021).
• The approach to treatment aims to gain control of
asthma among patients mainly through reducing
impairment and reducing risk.
• Stepwise treatment mainly suppresses inflammations
and prevents exacerbation through dosage alterations.
Stepwise Treatment and Management of
Asthma
Steps
Care and Medication
Step one
SABA PRN
Step two
Low-dose ICS
Step three
Low-dose ICS and LABA
Step four
Medium dose ICS and LABA
Step five
High dose ICS and LABA
Step six
High dose ICS, LABA and corticosteroids
The treatment is to be stepped up or down
based on the patient’s assessment across the
various steps.
Stepwise Management in Maintaining
Asthma Control
• The core benefit of the stepwise approach in asthma
treatment is that it enables gaining and maintaining
control of the disease (Papi et al., 2020).
• Stepwise management helps in pharmacological risk
and side effects control in the asthma treatment.
• Reassessment of therapy in every patient’s visit
reinforces the disease and intervention control.
• Stepwise treatment also allows for stepping up or
down of treatment thus controlling the disease.
Conclusion
• Asthma is a chronic respiratory disease caused by
inflammation of the airways.
• Core pharmacological options for the disease include
bronchodilators and anti-inflammatories.
• Bronchodilators and anti-inflammatories have
adverse impacts on patients.
• The stepwise treatment approach offers a means for
reducing impairments and risk in asthma treatment.
References
• Cazzola, M., Matera, M. G., Rogliani, P., Calzetta,
L., & Ora, J. (2021). Step-up and step-down
approaches in the treatment of asthma. Expert
Review of Respiratory Medicine, 15(9), 1159-1168.
• Montaño, L. M., Flores-Soto, E., Sommer, B., SolísChagoyán, H., & Perusquía, M. (2020). Androgens
are effective bronchodilators with anti-inflammatory
properties: A potential alternative for asthma therapy.
Steroids, 153, 108509.
References (Cont.…)
• Papi, A., Blasi, F., Canonica, G. W., Morandi, L.,
Richeldi, L., & Rossi, A. (2020). Treatment strategies
for asthma: reshaping the concept of asthma
management. Allergy, Asthma & Clinical
Immunology, 16, 1-11.
• Rosenthal, L. D., & Burchum, J. (2017). Lehne’s
Pharmacotherapeutics for Advanced Practice
Providers-E-Book. Elsevier Health Sciences.
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