NR 576 Week 5 Assignment; iHuman Virtual Patient Attempt 3359692 - Mark Griffin

History Notecard by Colleen Dunn on case Mark Griffin Use this worksheet to organize your thoughts before developing a differential diagnosis list. 1. Indicate key symptoms (Sx) you have identified from the history. Start with the patient's reason(s) for the encounter and add additional symptoms obtained from further questioning. 2. Characterize the attributes of each symptom using "OLDCARTS". Capture the details in the appropriate column and row. 3. Review your findings and consider possible diagnoses that may correlate with these symptoms. (Remember to consider the patient's age and risk factors.) Use your ideas to help guide your physical examination in the next section of the case. Sx Sx Sx =weird S HPI =stomach =nausea/indigestion bowel =vom pain movements Onset a couple couple months ago a couple a c of months months mo ago ago Location abdominal abdomen stool pain Duration all all the time a couple of a c the time- days black of better and bm's worse periods- better with food for short time Characteristics burning, burning black stools clear aching for 2 black days, went away Relieving food food unknown unk Timing antacids constant, one time- one / self limiting Treatments lim Severity between 2 resolved res and 6 on 1/10 Attempt: 3359692 Report generated on 11/28/2024, 7:31:19 PM America/New_York Management Plan by Colleen Dunn on case Mark Griffin Plan: treatment for H Pylori and PUD Start the patient on quadruple therapy to eradicate H Pylori which includes a PPI for 6 weeks. The patient will be started on "bismuth-containing quadruple therapy with a PPI, bismuth, tetracycline and a nitroimidazole (metronidazole or tinidazole) for 14 days or PPI, clarithromycin, amoxicillin, and a nitroimidazole for 14 days is the preferred as first line treatment" (Narayanan et al 2019). Start: Amoxicillin 500 mg one by mouth twice a day x 10 days Clarithromycin 500 mg one by mouth twice a day x 10 days Pantoprazole 20 mg by mouth twice a day x 10 days then once a day for 4 weeks. Bismuth subcitrate (Pepto-Bismol) 262 mg orally four times daily for 14 days Acetaminophen 650 mg every 4-6 hours as needed for pain-do not exceed 4000 gm. Stop aspirin, NSAIDS, tums, smoking. Refer to gastroenterology: EGD for biopsy Education on stopping smoking. Education on alcohol, NSAIDS, and aspirin-bleeding-discontinue. Education on diet and avoidance of fatty foods, caffeine, chocolate, alcohol. Encourage hydration. Education on s/s that warrant emergency evaluation. Call or seek evaluation for s/s of allergy development. Report vomiting, nausea, constipation. Consider probiotic. Repeat labs 4 weeks after treatment. Follow-up 4 weeks. Reference Dunphy, L.M., Winland-Brown, J. E., Porter, B.O. & Thomas, D.J. (2022). Primary care: The art and science of advanced practice nursing - An interprofessional approach. (6th ed.). F.A. Davis. Helicobacter Pylori, (2024). Family Practice Notebook. https://fpnotebook.com/GI/ID/HlcbctrPylr.htm Narayanan, M., Reddy, K. M., & Marsicano, E. (2019). Peptic Ulcer Disease and Helicobacter pylori infection. Missouri medicine, 115(3), 219–224. Attempt: 3359692 Report generated on 11/28/2024, 7:31:19 PM America/New_York Social History Category Data entered by Colleen Dunn Social History drinks