Introduction
Patients’ history and presenting symptoms are important in proper diagnoses and management of gastrointestinal conditions. Therefore, nurse practitioners (NP) must obtain a comprehensive history from all patients, which aids in making the correct diagnoses when combined with physical examination results.
Rationale and Explanation for Diagnosis
In the case study, the patient does not show signs that match inflammatory disorders. The side effects of prednisone that relate to the gut trigger nausea, vomiting and diarrhea. Synthroid 100mcg is a synthetic compound that mimics the action of thyroxin hormone. Levothyroxine is effective in improving thyroid hormone release by the thyroid glands thereby alleviating hypothyroidism (Arcangelo & Peterson, 2011). Nifedipine, a calcium channel blocker, is effective in the management of hypertension and angina. Continuous use of nifedipine causes unwanted effects like nausea, sweating, heartburn and a general feeling of illness.
The absence of inflammation signs rules out inflammatory conditions of the digestive system particularly inflammatory gastroenteritis subtype. Therefore, the patient’s diagnosis is likely to be non-inflammatory gastroenteritis because of the symptoms present. Non-inflammatory gastroenteritis often presents with nausea, vomiting and diarrhea. This condition has many causes ranging from adverse drug effects and food poisoning to bacteria and viruses (Porter & Kaplan, 2011).
Drug Therapy Plan for the Patient
The patient’s drug abuse history predisposes him to hepatitis due to the likelihood of sharing injection with other drug users (Starr & Raines, 2011). Therefore, it is possible that the patient exhibits a derangement of serum electrolyte levels as well as electrolyte imbalance because of the involvement of the liver. Consequently, liver function tests are important in monitoring liver functions because of the suspicion of hepatitis.
The nurse practitioner must carry out rehydration therapy to counter fluid loss due to vomiting and diarrhea. Management of diarrhea is vital in chronic cases as it poses a danger of fluid and electrolyte loss, which is fatal. Crystalloid fluid therapy replaces potassium ions in hypokalemia and sodium ions in hyponatremia (Smeltzer, Bare, Hinkle & Cheever, 2010). Additional intervention measures involve the administration of oral rehydration salts.
The NP should administer anti-diarrheal drugs such as loperamide 4mg (a chewable tablet) after the first loose stool followed by a maintenance dose of 2mg after the subsequent loose stool. The administration of diphenoxylate 2.5 to 5mg three to four times a day as a tablet or syrup slows down gastric motility.
The administration of antibacterials is useful in diarrhea attributable to bacterial infections (Porter & Kaplan, 2011). The use of probiotics, for example, Lactobacillus in yoghurt that contains active cultures is safe and may relieve some of the symptoms. Helicobacter pylori is one of the main causes of diarrhea. However, the patient is on prednisone, which suppresses body inflammatory responses and masks any indications of inflammation.
Following the confirmation of H. pylori infection by breath tests, antibiotics such as tetracycline or amoxicillin (in combination with clarithromycin) and a proton pump inhibitor like lansoprazole can treat Helicobacter pylori infection. The NP can manage cryptosporidiosis by the oral administration of 500 mg nitazoxanide twice a day. This regimen is effective in patients with suppressed immune system, which is the case in patient HL because of the intake of prednisone. The NP can administer chlorpromazine orally at a dose of 10 to 25mg four times a day to manage nausea and prevent vomiting (Özdemir et al., 2014).
The NP can manage the patient’s condition based on the current prescription by altering the drug dosages. Lowering the dosage of a single drug may help reduce the synergistic nature of the individual drug side effects. For example, lowering nifedipine dosage from 30mg to 20mg may give the patient relief from nausea, diarrhea and vomiting. Another alternative is to substitute one of the drugs with an alternative that causes fewer gastric irritations.
Conclusion
Irritation of the stomach mucosa leads to the alteration of the normal flora of the stomach thereby producing gastrointestinal system dysfunction, which leads to the manifestation of various symptoms in the patient.
References
Arcangelo, V. P., & Peterson, A. M. (2011). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins. Web.
Özdemir, H. H., Bulut, S., Berilgen, M. S., Kapan, O., Balduz, M. & Demir, C. F. (2014). Resistant cyclic vomiting syndrome successfully responding to chlorpromazine. Acta Medica (Hradec Králové), 57(1), 28–29. Web.
Porter, R. S. & Kaplan, J. L. (2011). The Merck manual of diagnosis and therapy (19th ed.). White Station, NJ: Merck Sharp & Dohme Corp. Web.
Smeltzer, S. C., Bare, B., Hinkle, J. L., & Cheever, K., H. (2010). Brunner and Suddarth textbook of medical surgical nursing (12th ed.). Philadelphia, PA: Lippincott Williams and Wilkins. Web.
Starr, S., & Raines, D. (2011). Cirrhosis: Diagnosis, management, and prevention. American Family Physician, 84(12), 1353–1359. Web.