Peer Response: Unit 5, Due Sunday by 11:59 pm CT
PUD and Anemia
Read the SOAP notes constructed by your course colleagues.
Review the ‘P’s posted by your peers from your advanced practice nursing role perspective – educator, leader or practitioner. From your advanced practice mindset reflect on a discussion you would like to have with two of your course colleagues about their ‘P’.
Post a response individually to each of them that expresses your advanced practice nursing role perspective of their ‘P’.
Use scholarly resources relevant to your advanced practice nursing role to support the key elements of the peer discussions you construct. [For example – if you are a nurse educator (clinical or academic) what are your thoughts about the patient education provided in the ‘P’, or do you want to comment on the fact that a peer put N/A for educational, etc.?’; if you a nurse leader what are your thoughts about the risk profile or cost effectiveness of the ‘P’, or adherence to the Patient Bill of Rights, etc.?; if you are a nurse practitioner did your peer develop a ‘P’ that aligns with EBP/CPG guidelines and/or the foundational basic sciences, etc.?
Please be sure to validate your opinions and ideas with citations and references in APA format.
PLEASE USE UPDATED REFERENCEES FOR BOTH PEERS I WILL PROVIDE THEIR POST BELOW
PEER#1 AND PEER#2
Collapse SubdiscussionNwakaego Ude
TuesdayAug 10 at 1:23am
This is a case of a 62-year-old white female who has been reported for demonstrating signs of dementia. Patient is a former supervisor and a fellow FNP. Patient reports a gnawing pain in her stomach. If she does eat, she reports getting ‘full’ very quickly. She reports feeling mildly nauseous for the last few weeks. Patient sustained a fall injury about 9 months ago from a ladder. She shattered some teeth and developed an infection.
Laboratory tests were taken and revealed hemoglobin of 8 and hematocrit of 24.
The patient will be examined about the start of the pain, if eating helps or hurts it, medical history, NSAIDs, salicylates, corticosteroids use, and family history of H. pylori, Gi bleeds, caffeine, and alcohol use. More information will aid in determining if the ulcer is gastric or duodenal. This patient’s predominant impression is PUD, with a potential GI bleed and anemia. H. Pylori is the most common cause of peptic ulcer disease. pylori or stress affects around 30-40% of the population in the United States, with about 5% of these individuals experiencing a GI bleed or perforation (Arcangelo & Peterson, 2017). H. Pyloric breaks down urea into ammonia and carbon dioxide, which is harmful to one’s health and can have a bad impact on one’s mental state. (Arcangelo & Peterson, 2017). When the stomach lining and mucosal protection are damaged, gastric acid production is reduced, resulting in PUD (Arcangelo & Peterson, 2017). GI bleeds, such as perforation or penetration, can occur because of PUD, as this patient is suffering acute, epigastric, and gnawing pain in her stomach, as well as nausea and sensations of fullness (Arcangelo & Peterson, 2017). Anemia, early satiety, and lab tests such as endoscopy with biopsy, Gi series, blood test, CT scan abdomen with contrast, and H testing are all severe symptoms. serology or urea breath test for Helicobacter pylori
Therapeutics: If this patient tested positive for Helicobacter pylori, antibiotics such as amoxicillin or clarithromycin will first be prescribed. pylori and acid suppression medication, such as histamine-2 receptor antagonists like famotidine or PPIs like omeprazole, for four weeks, if induced by NSAIDs or eight weeks if not (Arcangelo & Peterson, 2017). Due to blood loss, consider beginning the patient on an iron replacement as well. Pepto-Bismol can also be used alongside antibiotics or PPIs.
Headaches, diarrhea, and constipation are all adverse effects of PPIs, as well as fractures and infections (Arcangelo & Peterson, 2017). It is crucial to notice the deteriorating performance of the kidneys in older people and how this interacts with antacids; thus, avoid taking antacids with other medications since they will interfere with absorption (Arcangelo & Peterson, 2017). Patients should also be taught that black tarry stool is expected when taking the iron pills, and to use PPIs with caution since they might induce bone fractures (Arcangelo & Peterson, 2017). NSAIDs, cigarette smoking, and foods that cause PUD, such as spicy meals, caffeine, and alcohol, should be avoided, as well as PUD mitigation measures (Arcangelo & Peterson, 2017).
Consultation/Collaboration: Refer to gastroenterologist for follow up and neurologist for dementia.
Arcangelo, V. & Peterson, A. (2017). Pharmacotherapeutics for advanced practice: A practical approach. 4th Ed. Philadelphia: Wolters Kluwer
WednesdayAug 11 at 11:19pm
Subjective: The patient is a 62-year-old white female brought in by her family. The patient’s family voices concerns about early-stage dementia. The family states patient complains of gnawing stomach pain, poor appetite, getting full quickly during meals, and mild nausea for a few weeks. The family states nine months ago, the patient fell from a ladder and sustained severe oral injuries that included shattering of teeth and developing an infection. The patient is currently under the care of an oral surgeon for these issues. The patient has been absent from work and seemed off her game by those who know her, including me.
Objective: HGB 8 and HCT 24 obtained from urgent care.
Assessment: Peptic ulcer disease with actively bleeding ulcer/s causing anemia.
Therapeutics: I will first obtain the patients’ medical history, vital signs and perform a physical exam. Laboratory tests will include a Complete Blood Count, Hemoccult stool, blood cultures (patient developed an infection), and H. Pylori breath test. An endoscopy will be performed to examine the patient’s upper digestive system for ulcers. If the patient cannot tolerate the endoscopy, a barium swallow will be performed. A barium swallow is a series of X-rays of the upper digestive system that creates images of the esophagus, stomach, and small intestine; during the X-ray, the patient will swallow a white liquid (containing barium) that coats your digestive tract and makes an ulcer more visible (Mayo Clinic, 2020). Her treatment plan will include an antibiotic (Amoxil, Biaxin, Flagyl, Levofloxacin) for two weeks, a proton pump inhibitor (Protonix), and a bismuth subsalicylate if needed. To treat her anemic episode, I will offer the patient a blood transfusion, and if refused, I will order an iron infusion. Oral iron supplements can further damage the patient’s stomach lining. A follow-up endoscopy will be performed to check the progress of healing.
· Educational: Patient and family will be educated on the importance of medication compliance. The patient will be advised to avoid spicy and acidic foods. Recent changes such as falls and not being able to work are both stressful events. The patient will be educated on ways to decrease stress. Stress relief exercises include yoga, deep breathing, meditation, and keeping a journal (Mayo Clinic, 2021). The family should also rearrange items in her home that will prevent falls and have adequate lighting.
· Consultation: I would consult a neurologist to clarify rather or not the patient has dementia. I would schedule the consult for a month or two to be sure the patient has recovered from her anemic episode.
Mayo Clinic. (2020, August). Peptic ulcer. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/diagnosis-treatment/drc-20354229
Mayo Clinic. (2021, March). Stress management. Retrieved from Mayo Clinic: https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress-relievers/art-20047257
PUD and Anemia
Peer Response: Unit 5, Due Sunday by 11:59 pm CT
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