Discussion Questions Part One:
1. What are the pertinent positives and negatives on examination related to his presenting problem?
Respiration Rate = 16 and unlabored; skin pale without rash, Sclera pale with no icterus, Good lung expansion, lungs clear to auscultation and percussion, Moderate epigastric tenderness without rebound or guarding, Stool guaiac positive,
2. What is your differential diagnosis a this time?
At this time the differential diagnosis is Peptic Ulcer Disease, Gastritis, Anemia, Gastric Carcinoma
3. What laboratory studies should be obtained at this time?
At this time, an upper endoscopy need to be performed in order to check for the inflammation of the stomach lining as well as taking a biopsy for laboratory analysis(Vieth, Neumann, & Falkeis, 2014).
Blood tests also need to be performed which will involve checking for blood cell count to diagnose Anemia, testing for the infection of H. pylori as well as the presence of pernicious anemia(Vieth et al., 2014).
Fecal occult blood test is also another laboratory test that needs to be performed at this time in order to check for the presence of blood in the stool which will aid in diagnosis of the condition the patient is suffering from(Vieth et al., 2014).
Discussion Questions Part Two:
1. Based on these findings, what are the diagnoses for this patient?
Based in the presented findings, this patient is suffering from Gastritis
2. How should this patient be managed?
Tom is suffering from Gastritis which has been made worse by his alcoholic nature. Management of Gastritis mostly depends on its cause. In this case, the cause of Tom’s Gastritis is due to his alcoholic nature. Tom is a known alcoholic. Therefore, Pressure should be put on him to stop drinking since it’s the first step when managing gastritis. In addition to stopping drinking both medical and nursing management should be used to manage Tom.
In medical management of Tim, antibiotic therapy should be administered so as to kill H. pylori which are also a causative organism for Gastritis. Acid blocking medications commonly referred to as the proton pump inhibitors should also be administered to the patient. These medications blocks those cells which create the stomach acid. This in turn helps in reducing the production of the stomach acid. Some of these drugs includes; Prevacid, Nexium and Prilosec. These drugs even though they are useful in reducing the gastric acid, their long term use should be discouraged. Long term use of these drugs has been greatly associated with an increase risk to spine, hip as well as wrist fracture(Han et al., 2011).
Acid reducing medications should also be administered to the patient. These medications help in reducing the amount of acid that is being in contact with the gastric wall. This reduces incidences of cell erosion discomfort by the patient. Some of the acid reducing medication includes Zantac and Pepcid. When these medications lower the amount of acid in the stomach, they relieve pain as well as allow the stomach lining to heal. Antacids have also been commonly used as a form of medicine for reliving gastritis(Han et al., 2011).
Nursing management on this patient should focus on reducing anxiety of the patient through the use of calm approach in which all the procedures and medical interventions are explained. The nurse should also give advice on the proper diet that the patient should have in order to reduce signs and symptoms. The nurse should also promote fluid balance on the patient and check for any signs of dehydration as well as electrolyte imbalance. The nurse should also check for any signs of hemorrhage and low hemoglobin levels. In case the patient exhibit signs of low hemoglobin levels, the patient should be transfused. Medication for pain relief should also be administered accordingly(Parker & Hyrkas, 2011).
References
Han, S., Han, U.,Atinkaya, C., Osmanoglu, G., Cavuşoǧlu, T., &Dikmen, E. (2011). Management of gastrostomy to prevent perforation in acute severe corrosive esophagitis and gastritis: An experimental study. Turkish Journal of Gastroenterology, 22(2), 117–121.
Parker, S., & Hyrkas, K. (2011).Priorities in nursing management.Journal of Nursing Management, 19(5), 567–571.
Vieth, M., Neumann, H., &Falkeis, C. (2014). The diagnosis of gastritis.Diagnostic Histopathology.
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