Gastrointestinal Disorders
Nausea, vomiting, and diarrhea are challenging symptoms to diagnose as they can be caused by various medications, viruses, bacteria, and environmental factors. In this case, HL presents with nausea, vomiting, and diarrhea, and he has a history of drug abuse, possible hepatitis C, and is currently taking Synthroid (Levothyroxine) 100mcg, nifedipine (Procardia) 30mg, and prednisone (Prednisone) 10mg.
Based on the provided information, acute gastroenteritis is a likely diagnosis. However, as the patient’s healthcare provider, the first step would be to obtain a thorough history. Important questions would include when the symptoms started, recent drug use, presence of visible blood in the stool, consumption of new foods or shared meals with others who also became sick, duration of symptoms, presence of headache along with nausea and vomiting, and timing of nausea, vomiting, and diarrhea in relation to meals. According to Arcangelo, Peterson, Wilbur, and Reinhold (2017), the combination of headache, diarrhea, nausea, and vomiting is suggestive of viral gastroenteritis (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Friesma, De Boer, Duizer, Kortbeek, Notermans, et al. (2012) explain that norovirus is a common cause of gastroenteritis, which is usually self-limiting and resolves within a week (Friesma, De Boer, Duizer, Kortbeek, Notermans et al., 2012). NURS 6521 Week 7 Advanced Pharmacology
Treatment
Since gastroenteritis is a self-limiting condition, the primary treatment plan would focus on rest and adequate hydration. It is recommended to consume clear liquids and avoid sugary drinks like soda. Carson and Mudd (2016) highlight that sugar can worsen diarrhea by increasing water movement in the intestines and causing hypernatremia (Carson & Mudd, 2016). Drinks containing electrolytes such as Gatorade and Pedialyte are preferable. Antiemetic medication can be prescribed to help alleviate nausea and facilitate fluid intake. Considering the possibility of hepatitis C and potential liver injury, ondansetron (Zofran) 4mg PO would be an appropriate choice (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). The dosing of phenothiazines should be adjusted in the presence of liver dysfunction, and caution should be exercised due to the patient’s history of recent drug abuse, which could lead to CNS depression (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Zinc lozenges can be used to potentially reduce the duration of illness, and probiotics can help restore a healthy gastrointestinal bacterial balance (Carson & Mudd, 2017). The patient should be informed that if the symptoms persist or worsen, or if hydration becomes difficult, further testing, laboratory workup, imaging studies, and intravenous fluids may be necessary to identify the underlying cause. Diagnosing and treating patients with nausea, vomiting, and diarrhea can be challenging, but a comprehensive patient history, careful medication review, and appropriate questioning can help the healthcare provider develop an effective treatment plan. NURS 6521 Week 7 Advanced Pharmacolog.
References
Arcangelo, A., Peterson, A., Wilbur, V., & Reinhold, J. (Eds.) (2017). Pharmacotherapeutics for advanced practice: A practical approach. (4th Ed.). Ambler, PA: Lippincott Williams & Wilkins.
Carson, A., Mudd, S., & Madati, J. (2016). Clinical Practice Guideline for the Treatment of Pediatric Acute Gastroenteritis in the Outpatient Setting. Journal of Pediatric Healthcare, 30(6), 610-616. doi:10.1016/j.pedhc.2016.04.012
Friesma, M., De Boer, R., Duizer, E., Kortbeek, M., Notermans, W., Smeulders, A., . . . Van Dyuhoven, Y. (2012). Aetiology of acute gastroenteritis in adults requiring hospitalization in the netherlands. Epidemiology and Infection, 140(10), 1780-6. doi:http://dx.doi.org.ep.waldenulibrary.org/10.1017/S0950268811002652
