NR 603 Week 3 Collaboration Cafe_Client Case 2 Anjali Patel s Case Study on Cholecystitis vs PUD

localized guarding, RUQ tenderness, slightly diminished bowel sounds, and mild fever and tachycardia. Additionally, the patient presents with the hallmark finding in acute cholecystitis, which is pain during inhalation and palpation of the gallbladder, known as a positive Murphy’s sign (Jones, et al., 2025). The only pertinent medical history for Ms. Patel appears to be the recent right total knee arthroplasty. This recent surgical history adds to the patient’s complexity, as post- op complications and infection must be investigated and ruled out. If infection is present, the FNP will need to perform further diagnostics to decipher whether the source is a post-op complication or related to other differentials. Strategies to avoid diagnostic errors include performing a thorough history and physical examination, use of evidence- based clinical practice guidelines, judicious use of diagnostic tools including labs and imaging, and consulting mentors or members of the interdisciplinary team when appropriate. Utilization of these strategies during the clinical decision- making process can help guide good practice and follow standardized evidence-based methods while intergrading appropriate resources. 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. Cholecystitis: Management of acute cholecystitis depends upon disease severity. Mild cases like Ms. Patel may be treated conservatively on an outpatient bases with a combination of nonpharmacologic and pharmacologic treatments. Interventions should initially consist of dietary modifications (low fat, high fiber), antiemetics and non-opioid analgesia (Jones, et al., 2025). Patients who are treated outpatient should be educated for signs of advancing disease requiring intervention including worsening pain, fever, or jaundice. Additional education includes dietary modifications, use of a food journal to identify triggers and dosing for medications. A referral to GI for biliary evaluation, and a nutritionist for dietary modifications is warranted. Patients managed on an outpatient bases should be scheduled to follow up with their provider within one week, or call sooner if symptoms do not resolve. More severe cases require hospitalization, bowel rest, IV fluid resuscitation, broad spectrum antibiotics, opioid analgesia, and prompt surgical intervention (Jones, et al., 2025). Severe cases of acute cholecystitis should be referred to surgery immediately as evidence demonstrates that early surgical intervention reduces postoperative morbidity and mortality compared to delayed intervention for inpatient cases (Jones, et al., 2025). Patients should follow up with their surgeon one week after discharge and should be educated to monitor for localized and systemic signs of infection. PUD: Pharmacological management of PUD differs greatly from cholecystitis and may include triple antibiotic therapy for H. pylori positive cases and long-term therapy with Jones, M., Santos, G., Patel, P., & O’Rourke, M. (2025, July 6). Acute cholecystitis. In StatPearls. [Internet]. StatPearls Publishing. Retrieved September 14, 2025 from https://www.ncbi.nlm.nih.gov/books/NBK459171/ Malik, T., Gnanapandithan, K., & Singh, K. (2023, June 5). Peptic ulcer disease. In StatPearls. [Internet]. StatPearls Publishing. Retrieved September 14, 2025 from https:// www.ncbi.nlm.nih.gov/books/NBK534792/