Gastrointestinal Case Study

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According to the Nursing administration journal, use evidence-based practice that health care practitioners utilize to provide health care to their patients. The EBP approach allows practitioners to use current research studies to provide care. At the same time, it is an approach that reduces the variation and the cost of health care. Also, Evidence-Based Research provides problem-solving techniques that combine different medical practices from various literature delivered (Reynolds, 2019). Therefore, in this paper, we aim to integrate evidence-based research into the treatment of intermittent mid-epigastric patients.

According to J.G., the most likely diagnosis regarding him is a white man who is 42- years old would be Peptic ulcer disease (PUD). His condition is reported to only improve after meals, thus a common infection of Helicobacter pylori. The infection could only worsen after his initial diagnosis, which he took lightly. Now that J.G. is undergoing intermittent, taking large portions of caffeine in coffee and smoking, it triggers his pain.

J.G.s Specific Goals of Treatment

One primary specific goal would ensure that a healthcare practitioner would work on pain management and relief. Also, ensure that the ulcers do not reoccur, especially as regularly as they do.

What drug therapy would you prescribe for J.G.? Please provide your rationale.

Since the patient is allergic to penicillin, the available treatment suitable for him would be the administration of Clarithromycin triple therapy due to the H pylori infection.

Omeprazole 20mg BID

Amoxicillin 1g BID

Clarithromycin 500mg BID

The medicine indicated above should be taken for 14 days. Intake of two antibiotics hastens recovery and pain management. The availability of acid suppressions in the treatment eradicates the bacteria in the body while providing relief to the patient.

What are the parameters for monitoring the success of the therapy?

Regular monitoring of the urine to check on the acid levels helps to determine the patient’s recovery process.

Discuss specific patient education based on the prescribed therapy.

The patient should be careful with the intake of foods they take. Ensure that he takes foods with minimal acids and is thorough with every diagnosis he gets. The problem could not have escalated if he had taken precautions about the diagnosis he took six months ago.

List one or two adverse reactions for the selected agent that would cause you to change therapy.

Pseudomembranous colitis is one of the significant adverse reactions of amoxicillin. However, according to research, it only happens to 1-2% of the patients. Amoxicillin also causes antibiotic-related diseases like allergic reactions, skin rash, vomiting, and diarrhea.

What would be the choice for second-line therapy?

Bismuth quadruple therapy for 14 days as follows:

Omeprazole 20mg BID

Bismuth subsalicylate 300 mg QID

Tetracycline 500mg QID

Metronidazole 500mg QID

What would over-the-counter and alternative medications be appropriate for J.G.?

Some over-the-counter medicines that help reduce the acid include PPIs and H2 blockers.

PPIs: Pantoprazole 40mg OD

H2 blockers: Famotidine 20mg OD

What lifestyle changes would you recommend to J.G.?

• A smoking history may constantly affect J.G.s ulcers; therefore, he should avoid smoking to reduce the constant discomfort.
• Coffee triggers acids in the stomach which leads to corrosion the stomach.
• Another recommendation would be to avoid eating minutes before sleeping. Eating 3 hours before sleeping allows food digestion within the body.
• Healthy traits require eating healthy and maintaining body fitness through exercise.

Describe one or two drug–or drug–food interactions for the selected agent.

• Antiplatelet, clopidogrel, ad PPIs help reduce the risk of cardiovascular attacks among patients.
• Alcohol and PPIs increase the chances of headaches, nausea, and dizziness.

Reference

Reynolds, S.S. (2019) “Mock nursing research and evidence‐based Practice conference to support learning in pre‐licensure nursing students,” Worldviews on Evidence-Based Nursing, 16(6), pp. 498–500. Available at: https://doi.org/10.1111/wvn.12412.

Gastrointestinal Case Study

Value: 100 points

Due: Create your initial post by Day 3 and reply to at least two of your classmates by Day 7.

Grading Category: Discussions

Initial Post

Answer the following questions in three well-developed paragraphs (450–500 words) using APA formatting, integrating two evidence-based resources to include clinical practice guidelines as well as the course textbook.

Overview: Gastrointestinal Case Study

Joshua George is a 42-year-old white man presenting with a 2-month history of intermittent mid-epigastric pain. The pain sometimes wakes him up at night and seems to get better after he eats a meal. J.G. informs you that his doctor told him that he had an infection in his stomach 6 months ago. He never followed up and has been taking over-the-counter antacids and histamine receptor antagonists (H2Ras) for 2 weeks without relief. He takes no other medications. He is concerned because the pain is continuing. He has no other significant history except he is a 20 pack-year smoker and he drinks 5 cups of coffee a day. He eats late at night and goes to bed about 30 minutes after dinner. He is allergic to penicillin.

Diagnosis: Peptic Ulcer Disease

1. List specific goals for treatment for J.G.
2. What drug therapy would you prescribe for J.G.? Please provide your rationales.
3. What are the parameters for monitoring success of the therapy?
4. Discuss specific patient education based on the prescribed therapy.
5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
6. What would be the choice for second-line therapy?
7. What over-the-counter and/or alternative medications would be appropriate for J.G.?
8. What lifestyle changes would you recommend to J.G.?
9. Describe one or two drug–drug or drug–food interaction for the selected agent.