week 4 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders/NURS 6521

week 4 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders/NURS 6521

week 4 Assignment: Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders/NURS 6521

Write a drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed. Please include an introduction and summary. Instructions and case scenario attached

 Advanced Pharmacology

The case portrays DC, a 46-year-old woman with RUQ pain for the past 24 hours. The onset of the pain was roughly an hour after having a large family dinner. She also experienced nausea and one episode of vomiting before presenting. On physical exam, she has a non-distended abdomen with minimal tenderness. Lab results include a high WBC of 13,000/mm3 and Direct bilirubin at 0.6 mg/dL. The purpose of this paper is to discuss the likely diagnosis and treatment plan.

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Diagnosis for the Patient

Acute cholecystitis is the likely primary diagnosis for this case. This is an inflammation of the gall bladder caused mainly by gallstones. The diagnostic criteria for Acute cholecystitis include: Constant pain in the RUQ for more than 12 hours, usually triggered by a large meal or fatty meal; Tenderness in the RUQ with or without Murphy’s sign or palpable mass; Inflammatory response signified by fever, high WBC count, or elevated C-reactive protein (Gallaher & Charles, 2022). Other GI symptoms include nausea, vomiting, flatulence, and belching. Patients with acute cholecystitis often have mild jaundice with elevated serum bilirubin levels due to inflammation and edema around the biliary tract (Bridges et al., 2018). Acute cholecystitis is the diagnosis for this patient owing to positive pertinent symptoms like RUQ pain precipitated by a large meal, nausea, vomiting, abdominal tenderness, high WBC count, and high direct bilirubin levels.

Drug Therapy Plan

The drug therapy will include analgesics, IV antibiotics, and antiemetics. Antibiotic therapy will include Piperacillin/tazobactam (Zosyn) 4.5 g IV four times daily. It is one of the antibiotics recommended by the Sanford Guide for treating cholecystitis (Mou et al., 2019). Meperidine 50 mg IM every four hours PRN will be the analgesic of choice for pain control. Promethazine 12.5 mg every 6 hours PRN will be prescribed for nausea and vomiting.

Conclusion

The patient meets the diagnostic criteria for Acute cholecystitis, including RUQ pain, abdominal tenderness, and inflammatory response (high WBC count). Nausea, vomiting, and a high bilirubin level are also consistent with Acute cholecystitis. Treatment will include IV Piperacillin/tazobactam, IM Meperidine, and IV Promethazine.

References

Bridges, F., Gibbs, J., Melamed, J., Cussatti, E., & White, S. (2018). Clinically diagnosed cholecystitis: a case series. Journal of surgical case reports, 2018(2), rjy031. https://doi.org/10.1093/jscr/rjy031

Gallaher, J. R., & Charles, A. (2022). Acute Cholecystitis: A Review. JAMA, 327(10), 965-975. doi:10.1001/jama.2022.2350

Mou, D., Tesfasilassie, T., Hirji, S., & Ashley, S. W. (2019). Advances in the management of acute cholecystitis. Annals of gastroenterological surgery, 3(3), 247-253. https://doi.org/10.1002/ags3.12240