NURS 6521 Week 4 EmmaGarcia Pharmacotherapy For Gastrointestinal And Hepatobiliary Disorders Example
Week 4 Case Study
Hi everyone-
I hope everyone had a good week! This week we will be looking at GI disorders. We have a paper that will be due.
Please use the following case for your assignment:
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
Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Based on the provided case study, the patient, DC, appears to be presenting with acute cholecystitis. The sudden onset of the right upper quadrant (RUQ) pain occurring approximately one hour after a large dinner is indicative of gallbladder inflammation. The gallbladder is located in the RUQ, and cholecystitis often manifests as sharp or colicky pain in this region (Rosenthal & Burchum, 2021). Additionally, DC reports experiencing nausea and vomiting, which are common symptoms associated with cholecystitis, particularly when biliary colic occurs due to gallstone obstruction.
DC possesses several risk factors that further support the diagnosis of acute cholecystitis. Being a 46-year-old female, she is more prone to gallbladder-related issues. Her weight of 202 lbs and height of 5’8″ indicate obesity, which is associated with an increased risk of gallstone formation. Furthermore, her medical history reveals a diagnosis of hypertension, type II diabetes mellitus (DM), and a previous deep vein thrombosis (DVT) caused by oral contraceptive pills (BCPs). While the latter is unrelated to the current symptoms, hypertension and type II DM can contribute to the overall clinical picture.
Considering the diagnosis of acute cholecystitis, an appropriate drug therapy plan for DC would involve pain management, administration of antibiotics, and symptom relief. Pain can be managed using nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. However, due to DC’s comorbidities of hypertension and type II DM, acetaminophen may be a safer choice, as it does not significantly affect blood pressure or glucose levels. Conversely, NSAIDs can potentially interfere with antihypertensive medications and have adverse effects on blood pressure.
The next aspect of the drug therapy plan involves antibiotic treatment. Acute cholecystitis involves inflammation and infection of the gallbladder (Gallaher & Charles, 2022). Therefore, an appropriate antibiotic regimen should be prescribed. A combination of a third-generation cephalosporin, such as ceftriaxone, and metronidazole would be suitable. This combination provides broad-spectrum coverage against gram-negative organisms commonly found in biliary infections and anaerobic bacteria. Additionally, symptom relief for DC’s nausea and vomiting can be achieved through the use of antiemetics. Ondansetron, a well-tolerated antiemetic, can be considered to alleviate these symptoms and improve the patient’s overall comfort.
References
Gallaher, J. R., & Charles, A. (2022). Acute cholecystitis: A review. JAMA, 327(10), 965-975. https://doi.org/10.1001/jama.2022.2350
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.