NU 665 Week 3 Assignment 2: iHuman Simulation

Sample Answer for NU 665 Week 3 Assignment 2: iHuman Simulation

Assessment

1. Peptic Ulcer Disease (PUD) ICD10:K27.9 – is primarily caused by Helicobacter pylori but additional causes such as NSAIDs have also been implicated. Rare causes include stress, chemotherapy, zollinger-ellison syndrome, viral infections, and radiation therapy (Narayanan, Reddy & Marsicano, 2018). Its mechanism is an imbalance between destructive factors and the protective gastric mucosa. Damage to the protective mucosa by the aforementioned factors increases susceptibility to acidity with progressive inflammation and gastric metaplasia. Patients often report abdominal pain, abdominal fullness/bloating, weight loss, melena stool, hematemesis, nausea, and vomiting (Kamada et al., 2021).  Consistent with the patient’s symptoms, the pain localizes to the epigastrium, may be associated with meals, develops gradually, is episodic with relief periods and may be associated with symptoms of nausea, heartburn, and indigestion.
2. Acute alcoholic pancreatitis ICD10:K85.20 – describes a necro-inflammatory condition which results from the destruction of exocrine cells by inflammatory cells which is primarily characterized by elevated levels of lipase (Mederos et al., 2021). It has been associated with chronic alcohol consumption and a major cause of GI-related hospitalizations. Clinically, patients will report abdominal pain, anorexia, nausea, and vomiting. Although physical exam may be unremarkable, findings may include; jaundice, guarding, and tenderness (Mederos et al., 2021). In contrast, the abdominal pain radiates to the back, is poorly localized, and is acute.
3. Gastric Neoplasm ICD10:C16.9 – its risk has been associated with the consumption of cured/smoked foods, diet low in vitamin C & vitamin A, drinking contaminated water, salt-preserved food, a high BMI, GERD, smoking, and high calorie diets (Waldum & Fossmark, 2021). Symptoms often appear in the advanced stages of the disease with patients reporting nausea, fatigue, early satiety, unintentional weight loss, abdominal pain, hematemesis, dyspepsia, and dysphagia. Physical exam may reveal enlarged nodes with conjunctival pallor, acanthosis nigricans, and seborrheic keratosis (Waldum & Fossmark, 2021). Compared to the pain in PUD, the pain in gastric neoplasm radiates to the back, is more generalized, and is not related to meals hence, can occur at any time.
4. Gastritis ICD10:K29.70 – gastritis is primarily characterized by gastric mucosa inflammation which can be caused by stress, medications, trauma, uremia, corrosive agents, radiation, or even viral infections (Waldum & Fossmark, 2021). Its mechanism relates to a disruption in the mucosal barrier, a decrease in the secretion of gastric mucus and blood flow. Although patients also report epigastric pain, the pain has an acute onset with nausea, vomiting, and dyspepsia that resolves independently (Waldum & Fossmark, 2021).

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Final Diagnosis: Peptic Ulcer Disease (PUD)

Management Plan

Pharmacology

o   Omeprazole 40 mg PO BID

o   Amoxicillin 1gm PO BID

o   Clarithromycin 500mg PO BID

Non-Pharmacology

o   Discuss considerations for smoking cessation and initiate the patient on nicotine patch

o   Stop the patient’s NSAIDs and advice patient to only take OTC with input from a primary care provider.

o   Recommend the patient to stop alcohol consumption.

• Discuss considerations for weight loss for a healthier BMI.

Diagnostics

• No additional tests needed in this visit

Consults/Referrals

• Refer patient to a dietician for dietary counselling, assessment, and further management

Patient Education

• Adequate management of PUD requires the identification and avoidance of factors likely to worsen or trigger the ulcer. In this case, you must avoid the consumption of caffeine, NSAIDs, aspirin, alcohol, and tobacco (Kamada et al., 2021).
• Stress also worsens PUD therefore, you should learn and practice effective stress management techniques such as
• PUD management includes standard triple therapy with clarithromycin, amoxicillin, and omeprazole, which is taken twice daily as a single dose for 14 days (Kamada et al., 2021).

Follow Up

• To return for follow-up in 14 days
• Should you experience vomiting blood, coffee ground vomitus, or stool with bright-red blood, seek emergent care immediately

References

Kamada, T., Satoh, K., Itoh, T., Ito, M., Iwamoto, J., Okimoto, T., & Koike, K. (2021). Evidence-based clinical practice guidelines for peptic ulcer disease 2020. Journal of gastroenterology, 56, 303-322.

Mederos, M. A., Reber, H. A., & Girgis, M. D. (2021). Acute pancreatitis: a review. Jama, 325(4), 382-390.

Narayanan, M., Reddy, K. M., & Marsicano, E. (2018). Peptic ulcer disease and Helicobacter pylori infection. Missouri medicine, 115(3), 219.

Waldum, H., & Fossmark, R. (2021). Gastritis, gastric polyps and gastric cancer. International Journal of Molecular Sciences, 22(12), 6548.