ST Thomas University Advance FNP Clinical Discussion

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Katia Gedeon

Module 4 Discussion Weekly Experience

A 68-year-old female visits the office complaining of intermittent, burning, epigastric pain for the past two weeks. The pain is felt once daily about two to three hours after meals. The pain is exacerbated by hunger and heavy, fatty, food and is alleviated by antacids, milk, and other foods. The severity is 7/10 at its highest and 0/10 when it has diminished and is sometimes accompanied by nausea. The patient does not have diarrhea or constipation and there are no changes in appetite or weight or color of the stool. However, she has vomited once with the vomit being yellowish, sour, and non-bloody fluid.

Challenges and Success

During the week there were both challenges and successes faced. One of the main successes was working with my preceptor. The preceptor was able to help me improve my knowledge and skills in patient care for different types of patients with different conditions. I was able to attend to different patients and make different diagnoses. Challenges were associated with complex conditions which I had not faced in any part of my practice. These conditions required patients to wait for the preceptor and other registered nurses. This compromised care as the patients received low-quality care and delays in services. Seeing patients suffering from chronic conditions such as cancer, diabetes, and kidney problems was also a challenge as it made me feel sad for them.

Patient Assessment, Plan of Care, Differential Diagnoses, and Health Promotion Intervention

For the case, it was essential to assess the patient to make the right diagnosis and provide a proper plan of care. Based on the signs and symptoms including epigastric pain exacerbated by hunger and heavy, fatty food, nausea and vomiting accompanying the pain, and physical exam showing positive murphy sign and epigastric tenderness, the likely diagnosis is biliary colic or cholecystitis (K80.66) (Hapca, 2021). These signs and symptoms led to the diagnosis of biliary colic which requires a plan of care that is pharmaceutical or non-pharmaceutical. The patient is given nonsteroidal anti-inflammatory drugs (NSAIDs) and pain relievers but the stones fail to disappear or reaper after some years (Sigmon et al., 2021). The main form of treatment is cholecystectomy or laparoscopic surgery where the gallbladder is removed (Hapca et al., 2021). Open surgery may also be recommended if the pain continues and hospital admission would be required for the patient (Hapca et al., 2021). Non-pharmaceutical treatment includes dietary changes where the aggravating foods are avoided (Sigmon et al.., 2021). Weight management is also important and this might require regular exercise by the patient (Hapca et al., 2021).

Differential diagnoses include peptic ulcer disease (K27. 9) due to the burning, epigastric pain that comes two to three hours after meals, pain is relieved by antacids and exacerbated by fatty foods, and history of NSAID use (de Virgilio & Grigorian, 2019). Another differential diagnosis is gastritis (K29. 70) due to epigastric pain, nausea, vomiting, and taking of NSAIDs, but with mild pain (de Virgilio & Grigorian, 2019). Functional dyspepsia (K30) which is non-ulcer and is associated with pain in the stomach, nausea after meals, and pain relieved by some meals and medication is another differential diagnosis (de Virgilio & Grigorian, 2019). However, diagnosis is after a thorough patient assessment and examination. Health promotion intervention for the condition includes patient education, especially on dietary changes where food with more fiber and fluids is encouraged (Hapca et al., 2021).

Lessons Learnt

During the week, there were some important lessons. First, I was able to understand the importance of patient education in care provision. Most of the patients I educated especially on adherence to therapy had better patient outcomes and this made me understand the need and importance of patient education (Sigmon et al., 2021). Another lesson was the importance of collaboration and effective communication in care provision. Most of the patients required collaboration between physicians and nurses and in other cases, it included social workers and pharmacists. Communication between these providers is important to ensure that care is safe and of high quality. Moreover, effective communication is also required between the care provider and the patient for the care plan to work and be followed effectively.

References

de Virgilio, C. & Grigorian, A. (2019). Severe epigastric pain with nausea and vomiting. Surgery, 227-237. doi:10.1007/978-3-030-05387-1_20 (Links to an external site.)

Hapca, S., Ramsay, G., Murchie, P. & Ahmed, I. (2021). Biliary colic, BMJ, 374 doi:https://doi.org/10.1136/bmj.n2085 (Links to an external site.)

Sigmon, D. F., Dayal, N. & Meseeha, M. (2021). Biliary Colic. StatPearls Publishing.https://www.ncbi.nlm.nih.gov/books/NBK430772/