Nursing

After making your observations of the patient this week, and after reading about and researching the conditions covered in this module, you will now put it all together in a report.

Instructions
In at least 375 words, or 1.5 double-spaced pages, prepare a case report that addresses the following:

Based on the case study provided, respond to the following questions:
Identify and differentiate the symptoms from the signs in this patient.
Did you find any remarkable detail in the personal and social history of our patient that can help to make the diagnosis?
What results do you expect to find in the tests ordered?
What are some future complications the patient is at risk of developing?
What organs are included in the upper digestive system? Mention and explain at least three other conditions of the upper digestive system that may be a cause of digestive bleeding.
What specific sign on the physical exam is characteristic of upper digestive system bleeding?
What organs are included in the lower digestive system? What are some causes of lower digestive system hemorrhages, and how do you differentiate them from upper digestive system hemorrhages?
According to the patient’s previous medical history, it is possible that he has cirrhosis of the liver? Why? Can cirrhosis of the liver be a cause of upper digestive bleeding? What is the prognosis? Explain.
Are there any specific risk factors of diseases of the gallbladder or pancreas? If so, why, and what is the prognosis?
All references must be cited using APA Style format. Please refer to the CCCOnline APA Citation Toolkit.

Personal Information

Name: Mr. Christopher Franklin

Age: 60 years old

Gender: Male

Description

Mr. Franklin is a 60-year-old patient with a history of a thrombotic cerebrovascular accident two years ago. After the stroke he started with seizure attacks. He has been suffering from hypertension for the last ten years and ulcerative colitis since last year. He currently takes lisinopril, hydrochlorothiazide, aspirin, carbamazepine, and a low dose of prednisone.

Mr. Franklin has been suffering from epigastric pain, sensation of fullness, and occasional nausea for the last six months. This time, he was brought to the ER because, while he was talking to his son, he had a dizzy spell and fell to the floor. He is conscious and is complaining of severe epigastric pain. He began with mild abdominal pain two days after he started taking a new cycle of prednisone for his colitis, around seven days ago. The pain increases when he eats or drinks something. He is also complaining of suffering from pyrosis, malaise, and dizziness, and he has noticed that his feces are dark.

The patient was a heavy alcohol drinker until he had the stroke. He is a cigarette smoker since he was 20 years old. His mother suffered from Alzheimer’s disease and died of colon cancer, and his father died of cirrhosis of the liver.

On physical examination we found:

Remarkable Signs on Physical Exam by Regions

Abdomen: Pain on palpation on epigastric region
SOMA: Right hemiplegia and hyperreflexia
Remarkable Signs on Physical Exam by Systems

Integumentary system: Pallor, diaphoresis, coldness
Cardiovascular system: Tachycardia. Blood pressure 70/50 mmHg. Radial pulse 110.
Digestive system: Tenderness of epigastric region. Rectal exam showed melena.
Neurologic system: The patient is conscious and well oriented to time, place, and person. Right hemiplegia and hyperreflexia.
Lab Tests

Complete blood count (CBC)
Metabolic panel
Lipid panel
Abdominal CT scan
Esophagogastroduodenoscopy
Main Diagnosis

Upper digestive bleeding due to drug-induced gastritis
Hypovolemic shock
Acute anemia
Other Diagnoses

Stabilized thrombotic cerebrovascular accident
Epilepsy
Essential hypertension
Ulcerative colitis
Supporting Material

Mr. Franklin’s diagnoses of multiple digestive disorders has severely and acutely impacted his quality of life. If you’ve ever had a stomach ache, or even just mild bloating, you can appreciate how important a healthy digestive system is to your health and happiness. Similarly, living with neurological disorders can be confounding and scary to patients. In this module, you will explore disorders related to these two systems and take a deeper look at Mr. Franklin’s conditions

ANSWER

1. The symptoms differ from the signs in the patient that, from tests, several of his organs are expected to show objective evidence of disease.
2. Details from the personal and social history of the patient can help deduce that the patient is at risk of developing cancer from heredity as well as cirrhosis due to heavy drinking.
3. The results expected from the tests ordered are the presence of lower digestive system hemorrhages, upper digestive system hemorrhages, and cirrhosis of the liver.
4. Future risks include pancreatic cancer, liver disease, cancer of the colon, esophagus or stomach, hepatocellular carcinoma, and death.
5. Conditions of the upper digestive system, which include mouth, pharynx, esophagus, stomach, and duodenum organs that may cause digestive bleeding are such as hemorrhoids, peptic ulcers, tears or inflammation of the esophagus, diverticulosis and diverticulitis, cancer of the colon, esophagus, or stomach, ulcers colitis, Crohn’s diseases, and colonic polyps.
6. A specific sign on the physical exam that is a characteristic of upper digestive bleeding is upper GI bleeding that occurs with vomiting fresh blood, dark altered blood, and black tarry stools.
7. Organs in the lower digestive system include the small intestines, which comprise the duodenum, jejunum, and ileum, and large intestine, which include the cecum, colon, rectum, and anus. Causes of lower digestive system hemorrhages are diverticular disease, inflammatory bowel disease, tumors, colon polyps, hemorrhoids, anal fissures, and proctitis (Kollef 1997). They can be differentiated from upper digestive hemorrhages through the regions they occur. If bleeding occurs in the esophagus, stomach, or duodenum, it is considered to be upper bleeding, while if it occurs in the small intestine, large intestine, and rectum of the anus, then it is lower building.
8. It is possible that the patient has cirrhosis of the liver because of his prior heavy alcohol consumption. Cirrhosis can cause upper digestive bleeding from a variety of lesions that arise from portal hypertension like gastroesophageal varices and portal hypertensive gastropathy, among other lesions (Biecker 2013). The prognosis is a 15% likely development of hepatocellular carcinoma or 80% to 90% development and death due to liver disease.
9. Risk factors of diseases of the gallbladder or pancreas include heavy alcohol consumption, cigarette smoking, obesity, and pancreatitis. The prognosis is a high chance of acute pancreatitis or pancreatic cancer (Fernandez 1994).

References

Biecker Erwin, “Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension,” International Scholarly Research Notices, vol. 2013, Article ID 541836, 20 pages, 2013. https://doi.org/10.1155/2013/541836

Fernandez, E., La Vecchia, C., D’Avanzo, B., Negri, E., & Franceschi, S. (1994). Family history and the risk of the liver, gallbladder, and pancreatic cancer. Cancer Epidemiology and Prevention Biomarkers, 3(3), 209-212.

Kollef, M. H., O’Brien, J. D., Zuckerman, G. R., & Shannon, W. (1997). BLEED: a classification tool to predict outcomes in patients with acute upper and lower gastrointestinal hemorrhage. Critical care medicine, 25(7), 1125-1132.