A presumptive nursing diagnosis is at the center of nursing interventions; therefore, it is of utter importance to learn the process of analyzing diagnostic clues and symptoms (Herdman & Kamitsure, 2014). This paper aims to present three differential diagnoses for a patient who presents with nausea, vomiting, and diarrhea.
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Gastroenteritis is the first differential diagnosis for Judy. Regardless of the origin of gastroenteritis, its symptoms include, but are not limited to, persistent watery diarrhea, dehydration, vomiting, abdominal pain, and fatigue (Barrett & Fhoogartaigh, 2017). The woman’s symptoms are consistent with the disease. It can be argued that the patient’s complaint of weakness is a prodrome of the disease. The patient is hypotensive and tachycardiac, which are common symptoms of bacterial gastroenteritis since the condition is associated with dehydration (Barrett & Fhoogartaigh, 2017).
As for pathophysiology, the disease is conditioned by either “non-inflammatory infection in the upper small bowel of inflammatory infection in the colon” (Barrett & Fhoogartaigh, 2017, p. 683). Pathogens causing gastroenteritis to fall into three categories: bacteria, viruses, and parasites. Even though an infective agent is not always identified, a vast majority of diarrheal episodes are of a bacterial origin (Fhoogartaigh & Dance, 2013). To rule in the diagnosis, it is necessary to inquire about the patient about recent changes in her geographic locale. It has to do with the fact that foreign travel is associated with a heightened risk of important pathogens causing bacterial gastroenteritis (Humphries & Linscott, 2015). In addition, Judy should be asked about the recent consumption of seafood. There is a large body of empirical studies making a connection between seafood products and bacterial infections (Humphries & Linscott, 2015). Abdominal tenderness, sepsis, and sunken eyes are the components of the physical exam that can help to confirm the diagnosis. It has to do with the fact that the invasion of the intestinal mucosa and the production of a toxin by a pathogen leads to abdominal pains and severe dehydration (Fhoogartaigh & Dance, 2013).
It is expected that the patient has a recent history of antibiotic use. By virtue of reducing normal intestinal flora, antibiotics increase the risk of the disease. In addition to foreign travel, close contact with animals can also serve as a transmission channel for some bacterial agents associated with gastroenteritis (Barrett & Fhoogartaigh, 2017). The following diagnostic studies are recommended: stool studies, WBC count, and stool microscopy (Humphries & Linscott, 2015).
Acute appendicitis is the second differential diagnosis for the patient. The woman presents with diffuse abdominal pain, nausea, and vomiting. Although pain is not localized in the right flank, it is worth considering the diagnosis because this clinical aspect is present only in approximately fifty percent of patients (Petroianu, 2012). The condition is associated with numerous pathophysiologies none of which are unconditionally accepted by the medical community (Petroianu, 2012). An abdominal examination can help to confirm the diagnosis (Hogan-Quigley, Palm, & Bickley, 2012). The patient should be asked whether she experienced migrations of pain to the right lower quadrant because it is a common sign of the condition. The following findings of the physical exam can help to rule in the diagnosis: right lower quadrant pain, migration of pain, fever, pain before vomiting, rebound tenderness, and rectal tenderness (Petroianu, 2012).
Irritable Bowel Syndrome
Irritable bowel syndrome is the third differential diagnosis for the patient. The condition is associated with a wide range of symptoms such as diarrhea, abdominal pain, fatigue, and bloating (El-Salhy, 2012). Pathophysiological mechanisms of the condition are not clear. However, irritable bowel syndrome is associated with visceral hypersensitivity caused by immune activation, bacterial overgrowth, and serotonin dysregulation (Saha, 2014). To rule in the diagnosis, the patient should be asked about a family history of the condition. There is ample evidence pointing to a significant association between a history of irritable bowel syndrome and its incidence (El-Salhy, 2012). The woman should also be asked about a history of rectal bleeding. To confirm the diagnosis, the Rome criteria for diarrhea-predominant patients should be used because the patient is over 50 years and falls into the IBS-D category.
Medication for Gastroenteritis
PRIMARY CARE CLINIC
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KEISER UNIVERSITY SCHOOL OF NURSING
Patient Name: Judy Boer Birthdates: 2/4/1957
Name of Medication: Ciprofloxacin 500mg
SIG: Twice a day; orally; for three days (Barrett & Fhoogartaigh, 2017).
# dispensed: 6 Refills: none
It is important to improve the dietary awareness of Judy. The patient should be recommended to adhere to the requirements of safe food storage (Barrett & Fhoogartaigh, 2017). She should avoid the consumption of raw seafood and unpasteurized milk. The woman needs to increase her consumption of fluids due to dehydration; however, she should be advised against consuming caffeine since it is associated with the stimulation of bowel movements. Furthermore, it is also necessary to avoid fatty, greasy, and dairy products. Medications such as aspirin or ibuprofen are also not recommended during the recovery process (Humphries & Linscott, 2015). The follow-up should be scheduled in a week.
The paper has detailed three symptoms for the patient: gastroenteritis, acute appendicitis, and irritable bowel syndrome. The paper has also presented medication for gastroenteritis and discussed education for the woman.
Barrett, J., & Fhogartaigh, C. N. (2017). Bacterial gastroenteritis. Medicine, 45(11), 683-689.
El-Salhy, M. (2012). Irritable bowel syndrome: Diagnosis and pathogenesis. World Journal of Gastroenterology, 18(37), 5151-5163.
Fhoogartaigh, C. N., & Dance, D. (2013). Bacterial gastroenteritis. Medicine, 41(11), 693-699.
Herdman, T., & Kamitsuru, S. (2014). NANDA International: nursing diagnoses. Hoboken, NJ: John Wiley & Sons.
Hogan-Quigley, B., Palm, M. L., & Bickley, L. (2012). Bates’ nursing guide to physical examination and history taking. Philadelphia, PA: Lippincott, Williams, & Wilkins
Humphries, R. M., & Linscott, A. J. (2015). Laboratory diagnosis of bacterial gastroenteritis. Clinical Microbiology Reviews, 28(1), 3-31.
Petroianu, A. (2012). Diagnosis of acute appendicitis. International Journal of Surgery, 10(3), 115-119.
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Saha, L. (2014). Irritable bowel syndrome: Pathogenesis, diagnosis, treatment, and evidence-based medicine. World Journal of Gastroenterology, 20(22), 6759-6773.