St Thomas University Week 5 Bile Duct Blockage and Infection Response

• Katia Gedeon

Module 5 Discussion Weekly Clinical Experience

•            KJ is a 68-year-old female that visits the clinic complaining of intermittent, burning, epigastric pain for the past two weeks. The discomfort occurs once a day, about two to three hours after eating. Hunger and heavy, fatty foods aggravate the discomfort, while milk, antacids, and other foods relieve it. When it is at its extreme, the pain is at 7/10, and when it is at its diminished, the pain is at 0/10 in severity. Sometimes, the pain is accompanied by nausea. There are no signs of constipation or diarrhea, and the patient’s stool color, appetite, or weight, or have not changed. She has, however, vomited once, with a sour, yellowish, and non-bloody fluid.

Challenges and Success

           Throughout the week, both problems and successes were encountered. Under many circumstances, I was able to care for a variety of patients and make various diagnoses. The difficulties were related to complex circumstances that I had never encountered before in my work. Patients had to wait for the preceptor and other nurse practitioners because of these circumstances. Patients received poor quality care and services were delayed as a result of this. However, there were several triumphs, one of which was collaborating with my preceptor. The preceptor was able to assist me in improving my knowledge and skills in inpatient care for a variety of patients with various ailments. I was able to care for a variety of patients and make various diagnoses. Thus, I grew in my practice as I can now provide care to most patients on my own.

Patient Assessment, Plan of Care, Differential Diagnosis, and Health Promotion Intervention
Patient assessment of the symptoms is essential to determine the diagnosis and the care plan. The patient’s signs and symptoms include epigastric pain that increases when the patient takes fatty and heavy foods and when hungry, vomiting, and nausea showing that she has biliary colic or cholecystitis (K80.66) (Thomas, 2019). This is also proven by the physical examination that showed epigastric tenderness and positive murphy signs. The plan of care includes both pharmaceutical and non-pharmaceutical methods. The patient has been prescribed pain relievers such as ibuprofen and nonsteroidal anti-inflammatory drugs (NSAIDs). However, with this form of treatment the stones may fail to disappear or appear after some years (Thomas, 2019). Laparoscopic surgery or cholecystectomy is the most effective form of treatment where the gall bladder is removed (Thomas, 2019). Open surgery may also be used in more complex conditions. Other forms of treatment include dietary or nutritional changes where the foods that increase the pain are avoided with increased consumption of more fluids.

           Differential diagnoses include gastritis (K29. 70) due to signs and symptoms including nausea, epigastric pain, vomiting, and taking NSAIDs for a long time (Johnson, 2017). The pain in gastritis is, however, mild than what the patient is feeling. Peptic ulcer disease (K27. 9) is another likely diagnosis due to epigastric pain that is exacerbated by heavy and fatty foods and relieved by antacids (Johnson, 2017). The other differential diagnosis is Functional dyspepsia (K30) due to stomach pain, pain relieved by mediations and some meals, and nausea after meals (Johnson, 2017). However, the condition is non-ulcer. Health promotion intervention includes patient education on avoiding smoking, alcohol, and fatty foods, and encouraging non-alcoholic and non-acidic fluids and fiber consumption.   

Lessons Learnt 

           There were some crucial lessons learned during the week. I was able to comprehend the significance of educating patients in the delivery of care. The majority of the clients I educated, particularly on compliance with medication and other forms of treatment, had better patient outcomes, which made me realize the value of education to the patients. Another lesson learned was the value of effective communication and coordination in the delivery of care. The majority of the clients needed interprofessional collaboration between providers thrown in for good measure. It is critical for practitioners to communicate effectively in order to offer high-quality and safe care. Furthermore, for the care plan to operate and be followed, effective communication between both the care provider and the client is necessary.

References

Johnson, J. (2017). Ten causes of epigastric pain. Retrieved from https://www.medicalnewstoday.com/articles/study-finds-link-between-chronic-pain-and-  disrupted-eating#Chronic-pain-management (Links to an external site.)

Thomas, D. J. (2019). Gallbladder and pancreatic disorders. In L. Dunphy, J. Winland-Brown, B.Porter, & D. Thomas (Eds.), Primary care: The art and science of advanced practice nursing – an interprofessional approach (5th ed., pp. 603-612). Philadelphia, PA: F. A.      Davis