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Such symptoms as diarrhea, nausea, and vomiting can signify a wide variety of disorders and problems. Therefore, a patient presenting with these complaints may be difficult to diagnose, because the causes of these issues may vary significantly. In the discussed case, the patient, HL, comes to the clinic with the three mentioned above symptoms, while also taking other medications and possibly having Hepatitis C. The assessment of the patient should include several tests to rule out or confirm this judgment. Diagnostics should also evaluate the validity of such differential diagnoses as bacterial or virus infection, gastroenteritis, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and other gastrointestinal and hepatobiliary conditions.
The patient’s history and current complaint can provide a nurse with some information about potential causes and issues. HL reports experiencing vomiting, diarrhea, and nausea. HL also possibly has Hepatitis C, although the diagnosis is not confirmed. The history of drug abuse is also significant while considering the patient’s health. The prescription drugs such as Synthroid, Nifedipine, and Prednisone provide some background on the patient’s conditions as well. First of all, Synthroid is usually used in patients with unbalanced thyroid production (“Synthroid,” 2018). Second, Nifedipine is a calcium channel blocker utilized for hypertension, angina, and pregnancy-related problems (“Nifedipine,” 2018). Finally, Prednisone is an anti-inflammatory drug that is prescribed to treat many conditions, including allergies, psoriasis, and ulcerative colitis (“Prednisone,” 2018). The patient may have breathing problems, allergies, or angina. Moreover, if HL is pregnant, then these prescriptions could also be understandable.
The lack of information about the patient does not allow one to establish one diagnosis. However, a nurse can make some possible suggestions and create a list of necessary tests. At first, the patient’s current use of substances has to be evaluated. Then, a blood test and a stool culture test can be requested to see whether the patient has an infection. These diagnostics may help rule out or confirm acute gastroenteritis – an infection characterized by watery diarrhea, vomiting, fever, and nausea (Humphries & Linscott, 2015). It can be acquired by consuming poorly prepared food or liquids.
Another possible diagnosis is an inflammatory bowel disease (IBD) such as ulcerative colitis, which causes exudative diarrhea (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). In this case, the assessment of standard biomarkers can help support the diagnosis (Tontini, Vecchi, Pastorelli, Neurath, & Neumann, 2015). The symptoms may also be a sign of irritable bowel syndrome (IBS), which can be confirmed or excluded by analyzing the patient’s family history and other symptoms (Chey, Kurlander, & Eswaran, 2015). Finally, one should consider the patient history of drug abuse and possible pregnancy as affecting factors. If HL is pregnant, then diarrhea and vomiting can be a result of hormonal changes. Finally, Wurcel, Merchant, Clark, and Stone (2015) note that withdrawal from some illicit drugs can cause the described symptoms as well. Thus, diagnostic tests and a physical examination are vital in establishing the correct diagnosis.
After the diagnosis is confirmed, the nurse can develop a personal plan for treating the cause of the condition. However, to lower the impact of the symptoms on the patient’s health, one can prescribe some medications. If the patient has Hepatitis C, antiviral medications should be prescribed (AASLD/IDSA HCV Guidance Panel, 2015). To manage diarrhea, one can suggest antidiarrheal agents; however, some of their effects can exacerbate the condition, especially if HL has an infection (Arcangelo et al., 2017). Otherwise, the patient should be advised to drink enough fluids, avoid symptoms-inducing foods, and follow a strict hygienic routine.
Additional information about the patient is required to establish and support a diagnosis. Thus, diagnostic tests of blood and stool are necessary to assess such potential issues as acute gastroenteritis, bacterial infection, IBS, or IBD. Drug abuse and pregnancy should also be considered because they can exacerbate the symptoms or cause hormonal imbalance. The patient’s treatment should include hydration, a healthy diet, the reassessment of current medications, and antidiarrheal agents.
AASLD/IDSA HCV Guidance Panel. (2015). Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus. Hepatology, 62(3), 932-954.
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Chey, W. D., Kurlander, J., & Eswaran, S. (2015). Irritable bowel syndrome: A clinical review. JAMA, 313(9), 949-958.
Humphries, R. M., & Linscott, A. J. (2015). Laboratory diagnosis of bacterial gastroenteritis. Clinical Microbiology Reviews, 28(1), 3-31.
Nifedipine. (2018). Web.
Prednisone. (2018). Web.
Synthroid. (2018). Web.
Tontini, G. E., Vecchi, M., Pastorelli, L., Neurath, M. F., & Neumann, H. (2015). Differential diagnosis in inflammatory bowel disease colitis: State of the art and future perspectives. World Journal of Gastroenterology: WJG, 21(1), 21-46.
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Wurcel, A. G., Merchant, E. A., Clark, R. P., & Stone, D. R. (2015). Emerging and Underrecognized complications of illicit drug use. Clinical Infectious Diseases, 61(12), 1840-1849.