Gastrointestinal DisordersPaper details:week 6 Discussion Advanced Practice Care of Adults Across the Life Span (NURS 6531N 20
To prepare:
Review this weeks media presentation 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.
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 Discussion1. consider potential diagnoses for the patients in the following case studies
2.an explanation of the differential diagnosis for the patient in the case study that you selected. 3.Describe the role the patient history and physical exam played in the diagnosis. 4.Then suggest potential treatment options based on your patient diagnosisCase study
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
Resources
Week 6 Learning ResourcesThis page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this weeks assigned Learning Resources. To access select media resources please use the media players below.Required ResourcesReadings
Buttaro T. M. Trybulski J. Polgar Bailey P. & Sandberg-Cook J. (2013). Primary care: A collaborative practice (4th ed.). St. Louis MO: Mosby. Part 12 Evaluation and Management of Gastrointestinal Disorders (pp. 612722)This part examines the pathophysiology and clinical presentation of several GI disorders. It also describes diagnostic criteria differential diagnosis and management methods for GI disorders.
Part 20 Evaluation and Management of Infectious Disease Chapter 234 Infectious Diarrhea (pp. 12631271)This chapter describes characteristics of three types of infectious diarrhea and identifies the pathophysiology clinical presentation treatment options and possible causes of the disorder.
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Building a Health HistorySince the first meeting with any patient sets the tone for a successful patient provider collaboration and partnership I would ensure the clinical atmosphere was physically unencumbered and with a comfortable atmosphere. My client is a 76-year-old African-American male with disabilities living in an urban setting. I would first introduce myself with an extended hand and ask my patient how he would like to be addressed (Ball J. W. Dains J. E. Flynn J. A. Solomon B. S. & Stewart R. W. 2015). As an active listener and in consideration of my patients age gender and ethnicity I would formulate my questions in a respectful nonjudgmental and open-ended manner. I would begin with the patients explanation as to the reason for his visit or his chief complaint. I would then gather the patients current and past medical history family history psychological history social history review of systems and then physical examination (Sullivan D. D. 2012).Explanation of Techniques UtilizedIt is important that there are no physical obstacles between the patient and me for the purpose of good eye contact and so he will know that I am actively listening to his concerns. A comfortable and uncluttered atmosphere will help the patient to relax and feel at ease (Ball J. W. Dains J. E. Flynn J. A. Solomon B. S. & Stewart R. W. 2015). The formulation of my questions would give my patient the latitude and room for explanation.Risk Assessment Instruments Their Justify the ApplicabilityThe risk assessment tools that I would utilize are the TACE assessment tool and the geriatric functional assessment tool (functional impairment gait instability cognitive impairment and major depressive illness). The TACE questionnaire will give me an indication of what additional labs I will need to order and additional patient education to be completed (Ball J. W. Dains J. E. Flynn J. A. Solomon B. S. & Stewart R. W. 2015). Since my patient is in the geriatric age group he is at increased risk for physical and cognitive impairment. Approximately 75% of persons over the age of 75 have decreased functional impairment and are at greater risk for falls injury illness hospitalization and nursing home placement. Although cognitive impairment for age 65 and older is roughly only about 3% cognitive testing it should not be ruled out because this often goes undiagnosed and must be ruled out and patients with suspected cognitive impairment should be screened for delirium and depression (University of Michigan Medical School 2003).Provide At Least Five Targeted Questions
1.Do you live with
2.How often do you forget to take your medication
3.How has this problem effected your everyday life
4.How often do you leave your home weekly
5.Are there stairs in your home
6.How many times have you fallen in the last 12 months
7.Do you have close family or friends
8.What other concerns do you have ReferencesBall J. W. Dains J. E. Flynn J. A. Solomon B. S. & Stewart R. W. (2015). Seidels guide tophysical examination (8th ed.). St. Louis MO: Elsevier Mosby.Sullivan D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia PA: F. A. Davis.University of Michigan Medical School. (2003). Geriatric functional assessment. Retrieved fromhttp://www.med.umich.edu/lrc/coursepages/m1/HGD/GeriatricFunctionalAssess.pdf

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