nurs6531 week 6 discussion latest 2017 december

Week 6 discussion

Diagnosing Gastrointestinal Disorders

In primary care settings, patients often present with
abdominal pain. Although this is frequently a sign of a gastrointestinal (GI)
disorder, abdominal pain could also be the result of other systemic disorders,
making this type of pain difficult to assess. While abdominal pain is most
common, many other GI symptoms also overlap multiple disorders, further
increasing the difficulty in diagnosing and treating patients. This makes
provider-patient communication essential. You must be able to formulate
questions that will prompt the patient to provide the necessary information, as
this will guide your assessment and diagnosis. For this Discussion, consider
potential diagnoses for the patients in the following case studies.

Case Study 1:

A 49-year-old man presents to the office complaining of
vague abdominal discomfort over the past few days. He states he does not feel
like eating and has not moved his bowels for the last 2 days. His patient
medical history includes an appendectomy at age 22 and borderline hypertension,
which he is trying to control with diet and exercise. He takes no medications
and has no known allergies. Positive physical exam findings include a
temperature of 99.9 degrees Fahrenheit, heart rate of 98, respiratory rate of
24, and blood pressure of 150/72. The abdominal exam reveals abdominal
distention, diminished bowel sounds, and lower left quadrant tenderness without
rebound.

Case Study 2:

A 40 year-old female presents to the office with the chief
complaint of diarrhea. She has been having recurrent episodes of abdominal
pain, diarrhea, and rectal bleeding. She has lost 9 pounds in the last month.
She takes no medications, but is allergic to penicillin. She describes her life as stressful, but
manageable. The physical exam reveals a pale middle- aged female in no acute
distress. Her weight is 140 pounds (down from 154 at her last visit over a year
ago), blood pressure of 94/60 sitting and 86/50 standing, heart rate of 96 and
regular without postural changes, respiratory rate of 18, and O2 saturation
99%. Further physical examination reveals:

Skin: w/d, no acute lesions or rashes

Eyes: sclera clear, conj pale

Ears: no acute changes

Nose: no erythema or sinus tenderness

Mouth: membranes pale, some slight painful ulcerations,
right buccal mucosa, tongue beefy red, teeth good repair

Neck: supple, no thyroid enlargement or tenderness, no
lymphadenopathy

Cardio: S1 S2 regular, no S3 S4 or murmur

Lungs: CTA w/o rales, wheezes, or rhonchi

Abdomen: scaphoid, BS hyperactive, generalized tenderness,
rectal +occult bloo

Case Study 3:

A 52-year-old male presents to the office for a routine physical.
The review of symptoms reveals anorexia, heartburn, and weight loss over the
past 6 months. The heartburn is long standing, occurring most days during the
week. He takes TUMS or Rolaids to relieve the discomfort. The patient describes
occasional use of ibuprofen for back pain, but denies other medications
including herbals. He has no known allergies. He was adopted so does not know
his family history. Social history reveals that, although he stopped smoking
ten years ago, he smoked for 20 years. He occasionally consumes alcohol on the
weekends only. The only positive physical exam finding for this patient was
slight epigastric tenderness. The remainder of his exam was negative and the
rectal exam was negative for blood.

To prepare:

Review this week’s media presentations and Part 12 of the
Buttaro et al. text in the Learning Resources.

Select one of the three case studies listed above. Reflect
on the provided patient information including history and physical exams.

Think about a differential diagnosis. Consider the role the
patient history and physical exam played in diagnosis.

Reflect on potential treatment options based on your
diagnosis.

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