lin, age 83 was brought into the emergency department with upper gastrointestinal bleeding. She said she did not have any pain but "all of a sudden I coughed and then I started to choke up bright red blood" By the time she reached the hospital, the bleeding had stopped. Her blood test results showed no abnormalities in coagulation. Her red blood cell count was 3.5K/cmm (normal 4.00-5.20 K/cmm), but all other values were in the normal range. her blood pressure was 110/70 mmHg standing. In Ms. Lin's purse was a pack of cigarettes and in her wallet was a list of her prescription medications.
-spironolactone/HCTZ ,25mg/25mg: take in a.m. for hypertension
-sertraline (generic Zoloft) 25mg: take in a.m. for depression
-OTC nicotinic acid, 50mg: Take in p.m for high triglycerides "The other pills I take are in the bag that my daughter is bringing in. I can't remember just now what else I take- I feel so lightheaded!" Ms. Lin was given an IV infusion of normal saline. She was prepared for an endoscopic exam of her esophagus, stomach, and duodenum-an upper GI. A topical anesthetic was sprayed in the back of her throat, and she was given an IV sedative (propofol) to relax her and suppress her gag reflex. The gastroenterologist then threaded the endoscope into Ms. Lin's mouth, down her esophagus to her stomach and duodenum Pylorus and clean ulcer crater were spotted in the endoscope. There was no active bleeding or clot so the area was not treated. A biopsy was removed for further analysis. A photomicrograph of the gastric biopsy specimen high power shows inflammation and gram-negative bacteria.
4. What medications and self-medication behaviors can cause/aggravate her problem?
5. How will Ms. Lin's problem be treated?
4) Ms. Lin is infected with Helicobacter Pylori leading to cause Gastric ulcer.
Following medications and self medication behaviours can cause/ aggravate her problem. These are as follows:-
- Cigarette smoking increases the risk of infection with H.Pylori and reduces efficacy of antibiotic therapy.
- NSAID inhibit synthesis of prostaglandins in the stomach that are responsible for stimulating the synthesis of protective mucous.
- Alcohol, nicotinic acid, NSAID and low dose of asprin concurrently also increase the risk of gastric ulcer.
5) Ms. Lin's problem will be treated by eradicating H.Pylori infection which causes gastric ulcer.
- She needs to stop smoking, stop taking nicotinic acid, given IV Pantoprazole.
- To eradicate H.Pylori Infection, triple antibiotic regimen should be given. She must not drink alcohol during treatment.
- Combination of PPI pump and triple antibiotic regimen is known to eradicate H.pylori by 80%.
lin, age 83 was brought into the emergency department with upper gastrointestinal bleeding. She said she...
Luanne lin, age 83 was brought into the emergency department with upper gastrointestinal bleeding. She said she did not have any pain but "all of a sudden I coughed and then I started to choke up bright red blood" By the time she reached the hospital, the bleeding had stopped. Her blood test results showed no abnormalities in coagulation. Her red blood cell count was 3.5K/cmm (normal 4.00-5.20 K/cmm), but all other values were in the normal range. her blood...
You are working in a nearly empty small-town Emergency Department in the middle of the night when a young woman, a Ms. Harriman, comes in holding her abdomen and sobbing. She is doubled over in pain and says, “I think I have stomach or pancreatic cancer!” She moans and says she is nauseated and says, “I threw up blood at home! Hematemesis!” You and another intern nurse get her into a bed and draw the curtains. You hold a bedpan...
You are working in a nearly empty small-town Emergency Department in the middle of the night when a young woman, a Ms. Harriman, comes in holding her abdomen and sobbing. She is doubled over in pain and says, “I think I have stomach or pancreatic cancer!” She moans and says she is nauseated and says, “I threw up blood at home! Hematemesis!” You and another intern nurse get her into a bed and draw the curtains. You hold a bedpan...
NUR 254 Pediatric Case Study-Asthma-Student L.S. is a 7-year-old who has been brought to the emergency department (ED) by his mother. She immediately tells you he has a history of ED visits for his asthma. He uses an inhaler when he wheezes, but it ran out a month ago. She is a single parent and has 2 other children at home with a babysitter. Your assessment finds L.S. alert, oriented, and extremely anxious. His color is pale, and his nail...