NR 603 Week 3 Collaboration Cafe_Client Case 2 Anjali Patel

Consider the client’s primary diagnosis alongside their HPI and physical exam findings. How does the client’s medical history complicate and guide the diagnostic process, and what strategies should the FNP use to avoid diagnostic errors? Explain your rationale. Anjali’s primary diagnosis is cholecystitis. Her HPI indicated nausea, vomiting and diarrhea, right upper quadrant abdominal pain that radiates to her mid back, along with a fever, and loss of appetite. Her physical exam showed tenderness in the right upper quadrant, a positive Murphy’s sign, fever, and tachycardia. Her labs showed an elevated white blood cell count, and elevated liver functions. Her ultrasound showed gallbladder wall thickening, distention and gallstones. All these finding support a diagnosis of cholecystitis. It is important to rely on diagnostic criteria especially in outpatient settings where there are limited resources available. To diagnose Pancreatitis, the patient must have 2 of the 3 criteria: epigastric pain radiating to the back, elevated amylase/lipase greater than 3 times the upper limit of normal, and a CT scan or ultrasound results consistent with pancreatitis (Beij et al., 2025). Cholecystitis is diagnosed by the presence of fever, elevated WBCs, right upper quadrant abdominal pain, and positive Murphy’s sign. Cholecystitis pain is often triggered by eating a fatty meal and radiates. It is important for the NP to obtain a thorough history from the patient and obtain the appropriate labs and imaging to help avoid diagnostic errors. In a clinic setting with limited resources an Ultrasound in conjunction with a CBC, CMP and lipase would be the most accessible and appropriate diagnostic tools for this patient. The patient’s recent right total knee arthroscopy complicates the patient’s diagnosis as an elevated white count could be attributed to post operative infection. The patient’s abdominal pain and lack of appetite could be indicative of post-operative ileus. Compare and contrast the management of each assigned diagnosis, including similarities and differences in pharmacologic and non-pharmacologic treatment, client education, referral, and follow-up care. Consider how the client’s unique past medical history and social history impact care decisions Management of cholecystitis in the outpatient setting requires the patient to have stable vital signs with no fever and no evidence of obstruction. The patient should be given broad spectrum antibiotics, levofloxacin and metronidazole, along with good pain control with NSAIDs or opioids, antiemetics, and strict dietary guidelines for a low-fat diet. An urgent referral to general surgery is also indicated for removal of the gallbladder (Mencarini et al., 2024). Outpatient management of pancreatitis should include a clear liquid diet with gradual return to a low-fat diet as tolerated, pain control and good