1. Provide a bulleted list of your learning points from the clinical case you analyzed this
week and the salient features of what you have envisioned for patient education in your
care plan. List key points about the patient’s presenting diagnoses, how you determined
these, what diagnostic tests you ordered to confirm your diagnoses, and, most importantly,
what you learned about patient education for gastrointestinal system based on your
research.
Week 3: Gastroenterology Clinical Case
HPI
A 60-year-old Italian male presents with acute abdominal pain. He is a retired
schoolteacher and still does some teaching on the side. He is complaining of acute onset of
umbilical pain that started last evening after eating. He is experiencing a gnawing hunger
pain in the umbilical area. The pain is more diffuse now and he feels nauseous, but there
is no vomiting. He believes he had fever last night because he felt very warm and sweaty.
His symptoms subsided after he sat up for a few hours on a chair, but he is not sure how it
went away.
The patient has been having these symptoms for the past 24 hours. He has had similar
symptoms in the past, but it was not as bad as this. The pace of illness was worse last
night and is much better now. In the past, the symptoms would last only an hour or two and
resolve spontaneously.
In terms of severity, the pain experienced last night, during the “attack,” was a ten.
Today, it is a seven. He was awake last night and the pain has been bothering him for the
past 24 hours. Last night, the pain was more localized in the periumbilical region. It is
more diffuse now. The pain does not radiate to the back; it is mainly generalized in the
abdomen now and less intense from what it was last night.
He has also been having some heartburn-like symptoms for the past two weeks. The symptoms
increased after eating. The heartburn would resolve spontaneously within a few hours and
sometimes it was relieved after he took some OTC antacids. The patient thinks he is having
a heart attack. The worsening of his symptoms has made him seek medical care today.
PMH
The patient is being treated for hypercholesterolemia, hypertension, and gout. He goes to
his primary care provider every three to four months for a routine checkup. The patient had
“stomach” problems as a young man but he is not sure of the diagnosis that was
back then, but nothing else. He had an appendectomy 20 years ago, without any
complications. He has been using a lot of non steroidal anti-inflammatory drugs (NSAIDs) to
control his gout symptoms. Besides these, the patient has had no significant illnesses.
The patient states that he has always had a “queasy stomach” and has had no other workups
to date for the problem. He knows that he has some type of heartburn problem, but is
treating it with only over-the-counter medications and has had no further investigations.
ROS
Intermittent heartburn symptoms for a few weeks, nausea. No vomiting. No blood in the
stool.
MEDICATIONS
Indocin 50 mg Q 6 hours PRN gout symptoms Zocor 20 mg QD
Propranolol 50mg BID
The patient is not compliant with the prescribed regimen because he is concerned about the
side effects of the medication. However, he seems to be over using Indocin as he has been
experiencing symptoms of gout for the past one month.
He is also trying alternative therapy such as, Saint John’s wort because he thinks he is
suffering from depression. He has been taking three capsules three times a day since last
month, but has not noted any difference in his symptoms.
ALLERGIES/REACTIONS
He has no known drug allergies.
SOCIAL HISTORY
He is a retired schoolteacher and still does some teaching on the side. He is living off a
state teachers’ pension. His wife continues to work in a local grocery store. They are
getting by but do not always have enough money to go traveling. He has a master’s degree in
education. Together, they make $50,000.00 per year. The patient has access to a primary
care provider and sees him three to four times per year. He has a health insurance coverage
including prescription cover.
His wife has osteoarthritis of both knees and hips. This limits her ability to be active.
The patient would like to be more active but he is having problems with gout recently. Both
husband and wife would like to be more active but don’t know if that will be possible,
considering the pain that they are in. They have two grown-up children—a son and a
daughter—living outside the home, both alive and well.
This patient is very concerned about his symptoms and wondering whether he is having a
heart attack, because his father died at the same age. His wife is equally concerned. The
patient feels that he has had a good life and does not want it to end early. He does not
have any undue stress and is hoping that something can be done to treat him. He feels that
the medical community should be able to cure him. He does not feel the need to change his
lifestyle to be healthier.
His support systems include his wife and some of the people that he used to work with, in
the school district. He still meets them occasionally. He is not suffering from social
isolation and would like to somehow become more involved in the community, because he
thinks it may help him cure his symptoms of depression.
Though the patient gets anxious very easily, he does not like to show it. He walks one or
two days per week. He knows he needs to do more, but his pain is a detriment. He likes to
go and meet his primary care provider, but sees it more as a social event.
HABITS
Smoking: Non-smoker
Alcohol: He drinks wine every night, sometimes to excess (4 to 5 glasses) Substance abuse:
Denies use of drugs
DIET HABITS
His wife tries to make a healthy meal at home, but he finds himself eating fast food
frequently.
FAMILY HISTORY
He has two older brothers. They are alive, but both have high blood pressure and high
cholesterol. They developed these medical problems in their early fifties. There is a
significant family history of gout throughout.
The patient does not have any specific hobbies but likes to work around the house. The
patient is originally from United States. He and his wife live in a residential community.
There are some resources at their disposal along with community support groups, but they
don’t access everything. Overall, the community is safe in terms of crime.
PHYSICAL EXAMINATION
Vital Signs: BP right arm sitting 175/70; T: 99 po; P: 64 regular; R: 18 and non-labored
HEENT: Within normal limits
Lymph Nodes: None palpated Lungs: Clear to auscultation Heart: RRR without murmur Carotids:
No bruits
Abdomen: + BS in all quadrants. Resonant to percussion throughout. Sharp pain with
palpation at the epigastric region, radiating to the back. No HSM. No peritoneal signs.
Rectum: Stool light brown and heme negative Genital/Pelvic: Not examined
Extremities, Including Pulses: 2+ pulses throughout, not edema Neurologic: Not examined
Lab Results/ Radiological Studies/ EKG Interpretation
CBC: within normal limits LFTs: within normal limits
H. pylori: Positive
Amylase & Lipase: within normal limits Radiological Studies
Abdominal ultrasound: Gall bladder and liver are normal EKG Interpretation
EKG: Normal sinus rhythm
Grading Criteria Maximum Points
Review provided a bulleted list of learning points from the clinical case and the salient
features of patient education. 4
Included key points about patient’s presenting diagnoses, how learner arrived at each
diagnosis, and the rationale behind suggesting the diagnostic tests. 4
Listed learner’s understanding of patient education for gastrointestinal care gathered from
research. 4
Total 12
PLACE THIS ORDER OR A SIMILAR ORDER WITH NURSING TERM PAPERS TODAY AND GET AN AMAZING DISCOUNT
