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.
Full Answer Section
The patient's medical history is significant for hyperlipidemia and hypertension. He is currently taking atorvastatin and lisinopril. He denies any history of alcohol abuse or tobacco use.
On physical examination, the patient's abdomen is soft and non-distended. There is mild tenderness in the upper right quadrant of his abdomen. The patient's vital signs are all within normal limits.
Differential Diagnosis
The differential diagnosis for the patient's symptoms includes:
- Gallbladder disease
- Cholecystitis
- Choledocholithiasis
- Pancreatitis
- Peptic ulcer disease
- Gastroesophageal reflux disease (GERD)
- Non-alcoholic fatty liver disease (NAFLD)
Diagnostic Testing
The following diagnostic tests may be ordered to help determine the underlying cause of the patient's symptoms:
- Complete blood count (CBC)
- Basic metabolic panel (BMP)
- Liver function tests (LFTs)
- Abdominal ultrasound
- Endoscopic retrograde cholangiopancreatography (ERCP)
Drug Therapy Plan
The specific drug therapy plan for the patient will depend on the underlying cause of his symptoms. However, some general principles of drug therapy for GI/hepatobiliary disorders include:
- Treat the underlying cause of the disorder. This may involve using antibiotics to treat an infection, using proton pump inhibitors (PPIs) to treat GERD, or using ursodeoxycholic acid to treat gallstone disease.
- Manage symptoms. This may involve using over-the-counter pain medications, such as ibuprofen or acetaminophen, or using prescription pain medications, such as opioids or tramadol.
- Prevent complications. This may involve using antiemetics to prevent nausea and vomiting, or using pancreatic enzymes to prevent pancreatitis attacks.
Example Drug Therapy Plan
If the patient is diagnosed with cholecystitis, the following drug therapy plan may be recommended:
- Antibiotics: Antibiotics may be prescribed to treat any infection that is present. Common antibiotics used to treat cholecystitis include ciprofloxacin, levofloxacin, and piperacillin/tazobactam.
- Pain medication: Pain medication may be prescribed to manage the patient's pain. Common pain medications used to treat cholecystitis include ibuprofen, acetaminophen, and tramadol.
- Ursodiol: Ursodiol may be prescribed to dissolve small gallstones and prevent the formation of new gallstones.
- Cholecystectomy: If the patient has recurrent cholecystitis or if the gallstones are too large to dissolve with medication, cholecystectomy (gallbladder removal surgery) may be recommended.
Conclusion
Advanced practice nurses play an important role in the diagnosis and management of GI/hepatobiliary disorders. By carefully evaluating patients and designing appropriate drug therapy plans, advanced practice nurses can help patients to achieve optimal outcomes.
Additional Considerations
In addition to the drug therapy plan outlined above, there are a number of other things that the advanced practice nurse can do to support the patient:
- Educate the patient about their condition and treatment plan. This includes explaining the importance of taking medications as prescribed, following a healthy diet, and avoiding triggers for their symptoms.
- Provide emotional support. GI/hepatobiliary disorders can be physically and emotionally challenging. The advanced practice nurse can provide support to the patient and their family by listening to their concerns and offering guidance and resources.
Coordinate care with other healthcare professionals. The advanced practice nurse may need to collaborate with other healthcare professionals, such as physicians, dietitians, and social workers, to provide comprehensive care to the patient.
Sample Answer
Case Study
A 65-year-old male patient presents to the clinic with a chief complaint of abdominal pain and cramping. He reports that the pain is located in the upper right quadrant of his abdomen and has been present for the past few weeks. The pain is worse after eating fatty foods and is often accompanied by nausea and bloating. The patient also reports that he has lost 10 pounds in the past month.