NSG6005Week 4 assignment 1
Because TJ has unremarkable lab work and vital signs that are within normal limits, differential
diagnoses can be narrowed significantly. Because of his history of bleeding ulcer and multiple
...
NSG6005Week 4 assignment 1
Because TJ has unremarkable lab work and vital signs that are within normal limits, differential
diagnoses can be narrowed significantly. Because of his history of bleeding ulcer and multiple
risk factors (over age 50, NSAID use, tobacco and alcohol use), and the lack of relief using
Zantac, differential diagnoses are peptic ulcer disease (PUD), h. pylori infection, erosive
esophagitis, or gastro esophageal reflux disease (GERD). The American College of
Gastroenterology (ACG) recommend that patients with active or past history of PUD or on longterm NSAID therapy be tested and treated for h. pylori infection (Chey, Leontiadis, Howden, &
Moss, 2017). Endoscopy may be ordered and is the preferred diagnostic test for PUD and
erosive esophagitis according to the ACG.
As previously mentioned, TJ has multiple risk factors that are possibly contributing to his
symptoms. He is over age 50, uses NSAIDS daily to treat his osteoarthritis, he smokes tobacco,
and drinks alcohol. TJ should be instructed to discontinue the OTC Zantac and NSAIDS.
Selective NSAID treatment for TJ’s osteoarthritis will reduce potential for future recurrence of
ulcers (Chou, McDonough, Nakamoto, & Griffin, 2016), and ACG recommendations for
treatment of PUD and h. pylori are followed, which are 10-14 days of bismuth quadruple therapy
(bismuth, proton pump inhibitor [PPI], tetracycline, and a nitro imidazole) (Chey, Leontiadis,
Howden, & Moss, 2017).
Pylera (metronidazole/tetracycline/bismuth subsalicylate) 125mg/125mg/140mg by
mouth every six hours for 10 days (Chey, Leontiadis, Howden, & Moss, 2017). Prilosec
(omeprazole) 20mg by mouth every 12 hours for 10 days (take with 10 oz. water) (Chey,
Leontiadis, Howden, & Moss, 2017). Celebrex (celecoxib) 200mg by mouth every day (Chou,
McDonagh, Nakamoto, & Griffin, 2016). Recommend smoking cessation and offer Nicodermpatch on 21/14/7 mg regimen and provide community support group information. Follow up
visit 4 weeks after completion of Pylera and Prilosec to test for successful eradication of h. pylori
and possible follow up endoscopy to verify healing of ulcerations (Chey, Leontiadis, Howden, &
Moss, 2017). TJ should also receive patient education to stress the importance of compliance
with medication regimen and follow up to minimize potential for recurrence and evaluate
effectiveness of treatment.
References
Chey, W. D., Leontiadis, G. I., Howden, C. W., & Moss, S. F. (2017). ACG Clinical Guideline:
Treatment of Helicobacter Pylori Infection. The American Journal of
Gastroenterology,112(2), 212-239. doi:10.1038/ajg.2016.563
Chou, R., McDonagh, M. S., Nakamoto, E., & Griffin, J. (2016). Analgesics for Osteoarthritis:
An Update of the 2006 Comparative Effectiveness Review [Internet]. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/22091473
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