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Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

The case study describes client HL having nausea/vomiting and diarrhea complaints. HL admits to using illicit drugs and had a likely Hepatitis C infection. His current medications are Nifedipine 30 mg, Synthroid 100 mcg, and Prednisone 10 mg. This paper will discuss the client’s diagnosis and the pharmacological treatment plan.

Assessment and Diagnosis

To correctly diagnose HL, advance practitioner must do a detailed physical examination and complete history for the diagnosis of the health conditions .Most GI disorders has the same presentation symptoms and many other diseases may mimic Gastrointestinal disorder. Also, questions about onset and duration of the symptoms should be asked to determine if the symptoms are caused by the home medications or another underlining cause. The APRN, focus will be on finding the cause while treating the presenting symptoms. Diagnostic tools will include lab work to diagnose Hepatitis C, stool test for C-Diff, urinalysis for drug test, and imaging test such as ultrasound to assess liver problems. Due to the presenting symptoms, I will give a primary diagnosis of the condition as acute gastroenteritis.

Hepatitis C is the most likely diagnosis for HL. Hepatitis C is characterized by liver inflammation from infection by Hepatitis C virus (HCV). The HCV is an RNA virus found in blood and is spread parenterally (Manns et al., 2017). Most HCV infections are caused by exposure to infected blood through unsafe injections, recycling syringes for drug users, transfusion of unscreened blood, unsafe health care practices, and unsafe sexual practices (Ghany et al., 2019). Acute symptomatic persons exhibit malaise, anorexia, nausea, vomiting, jaundice, abdominal discomfort, myalgia, pale feces, and dark urine (Ghany et al., 2019). HL presents with nausea and vomiting, which are consistent with Hepatitis C. The patient abuses illicit drugs and had a Hepatitis C infection, increasing the risk of developing Hepatitis C.

Drug Therapy Plan

The treatment plan for HL will include a combination of Elbasvir/Grazoprevir for 12 weeks. The Elbasvir/Grazoprevir combination is used for patients who have never been on Hepatitis C treatment in the presence or absence of asymptomatic cirrhosis (Panel et al., 2018). It is also used for patients having stage 4/5chronic kidney disease.

Conclusion

HL has a diagnosis of Hepatitis C based on symptoms of nausea and vomiting and a history of using illicit drugs and HCV infection. HCV transmission occurs when one is exposed to contaminated blood from unsafe injections and transfusion. The treatment will include a combination of Elbasvir/Grazoprevir.

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References

Ghany, M. G., Marks, K. M., Morgan, T. R., Wyles, D. L., Aronsohn, A. I., Bhattacharya, D., … & Gordon, S. C. (2019). Hepatitis C guidance 2019 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection. Hepatology71(2), 686-721. https://doi.org/10.1002/hep.31060

Manns, M. P., Buti, M., Gane, E. D., Pawlotsky, J. M., Razavi, H., Terrault, N., & Younossi, Z. (2017). Hepatitis C virus infection. Nature reviews Disease primers3(1), 1-19. https://doi.org/10.1038/nrdp.2017.6

Panel, A. I. H. G. (2018). Hepatitis C guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America67(10), 1477. https://doi.org/10.1093/cid/ciy585

The patient in the case study presents with nausea, vomiting, and diarrhea. He has a drug abuse history and likely Hepatitis C. The current drug therapy includes Synthroid, Nifedipine, and Prednisone. The purpose of this assignment is to discuss the diagnosis and appropriate pharmacotherapy for the patient.

Diagnosis

Hepatitis C infection is the presumptive diagnosis. This is a liver inflammation caused by Hepatitis C virus (HCV). It is spread through sexual intercourse with infected persons, sharing personal items, and sharing drug-injection equipment (Ghany et al., 2020). Most infected persons are asymptomatic. Symptomatic cases present symptoms like fatigue, fever, reduced appetite, nausea, vomiting, abdominal discomfort, pale feces, dark urine, myalgia, and jaundice (Jin, 2020). Therefore, Hepatitis C is the primary diagnosis because of the positive symptoms of nausea, vomiting, and diarrhea and the client’s history of drug abuse and Hepatitis C infection.

Appropriate Drug Therapy

The recommended drug therapy will include a combination of Ombitasvir/paritaprevir/ritonavir (Technivie) for 12 weeks to treat Hepatitis C infection. Technivie is indicated for HCV infection in patients without cirrhosis. Ombitasvir inhibits HCV NS5A, which is needed for Hepatitis C viral replication. Paritaprevir inhibits NS3/4A serine protease required for proteolytic cleavage of the HCV-encoded polyprotein into mature forms (Wu et al., 2019). Ritonavir is a protease inhibitor that elevates paritaprevir serum levels. Nifedipine would be reduced to 10 mg and Prednisone to 5 mg since they are associated with GI side effects.

Conclusion

The patient’s nausea, vomiting, and diarrhea symptoms are consistent with Hepatitis C infection. Besides, the history of Hepatitis C and drug abuse make HCV infection the likely diagnosis. A combination of Ombitasvir/paritaprevir/ritonavir will be recommended to treat the HCV infection,

 

 

References

Ghany, M. G., Morgan, T. R., & AASLD‐IDSA hepatitis C guidance panel. (2020). Hepatitis C guidance 2019 update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America recommendations for testing, managing, and treating hepatitis C virus infection. Hepatology71(2), 686–721. https://doi.org/10.1002/hep.31060

Jin, J. (2020). Screening for Hepatitis C Virus Infection. JAMA323(10), 1008-1008. doi:10.1001/jama.2020.1761

Wu, J., Huang, P., Fan, H., Tian, T., Xia, X., Fu, Z., … & Zhang, Y. (2019). Effectiveness of ombitasvir/paritaprevir/ritonavir, dasabuvir for HCV in HIV/HCV coinfected subjects: a comprehensive analysis. Virology journal16(1), 1–10.

Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms, such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe a treatment that targets the cause rather than the symptom.

Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Assignment, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.

Resources

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare:

  • Review the case study assigned by your Instructor for this Assignment
  • Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.
  • Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors, such as pregnancy, drugs, or a psychological disorder.
  • Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

By Day 7 of Week 4

Write a 1-page paper that addresses the following:

  • Explain your diagnosis for the patient, including your rationale for the diagnosis.
  • Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
  • Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center offers an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm

Rubric

NURS_6521_Week4_Assignment_Rubric
NURS_6521_Week4_Assignment_Rubric
Criteria Ratings Pts

Explain your diagnosis for the patient, including your rationale for the diagnosis.

25 to >22.25 pts

Excellent
The response accurately and clearly explains in detail the diagnosis for the patient, including an accurate and thorough rationale for the diagnosis that supports clinical judgment.

22.25 to >19.75 pts

Good
The response provides a basic explanation of 1-2 diagnoses for the patient, including an accurate rationale for the diagnosis that may support clinical judgment.

19.75 to >17.25 pts

Fair
The response inaccurately or vaguely explains the diagnosis for the patient, including an inaccurate or vague rationale for the diagnosis that may or may not support clinical judgment.

17.25 to >0 pts

Poor
The response inaccurately and vaguely explains the diagnosis for the patient, including an inaccurate and vague rationale for the diagnosis that does not support clinical judgment, or is missing.
25 pts

Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

30 to >26.7 pts

Excellent
The response accurately and completely describes in detail an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

26.7 to >23.7 pts

Good
The response describes a basic explanation of the appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

23.7 to >20.7 pts

Fair
The response inaccurately or vaguely describes an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

20.7 to >0 pts

Poor
The response inaccurately and vaguely describes an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
30 pts

Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

30 to >26.7 pts

Excellent
The response provides an accurate, clear, and detailed justification for the recommended drug therapy plan for this patient. … The response includes specific, accurate, and detailed examples that fully support the justification provided.

26.7 to >23.7 pts

Good
The response provides a basic justification for the recommended drug therapy plan for this patient. … The response includes only 1-2 examples that fully support the justification provided.

23.7 to >20.7 pts

Fair
The response provides an inaccurate or vague justification for the recommended drug therapy plan for this patient. … The response may include examples, which may inaccurately or vaguely support the justification provided.

20.7 to >0 pts

Poor
The response provides an inaccurate and vague justification for the recommended drug therapy plan for this patient, or is missing. … The response does not include examples that support the justification provided, or is missing.
30 pts

Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.

5 to >4.45 pts

Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

4.45 to >3.95 pts

Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

3.95 to >3.45 pts

Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

3.45 to >0 pts

Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.
5 pts

Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

5 to >4.45 pts

Excellent
Uses correct grammar, spelling, and punctuation with no errors

4.45 to >3.95 pts

Good
Contains a few (1–2) grammar, spelling, and punctuation errors

3.95 to >3.45 pts

Fair
Contains several (3–4) grammar, spelling, and punctuation errors

3.45 to >0 pts

Poor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5 pts

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.

5 to >4.45 pts

Excellent
Uses correct APA format with no errors

4.45 to >3.95 pts

Good
Contains a few (1–2) APA format errors

3.95 to >3.45 pts

Fair
Contains several (3–4) APA format errors

3.45 to >0 pts

Poor
Contains many (≥ 5) APA format errors
5 pts
Total Points: 100