DIGESTIVE srstEM 227 a PRACTICAL APPLICATION | This excise wi mats you cwore of infomation, abbreviations, ond medica termlolegy typaly found no getroenterology polents chr ‘eo the following chant note and then anewer the questions that follow. PATIENT: Schmit, Thomas C. Dare: 06/10/2007 0B: 05/29/72 AGE: 35 SEX: Male INSURANCE: Physcare Health Insurance ‘al sign: T968F hi Rie Br: 132786 Hee 2" We 226 ‘Alergles: Zest (snope)—anglotensin converting enzyme (ACE ifr that he took fr hypertension {Chie Complaint: Du, aching paln end buming sensation In the epigatnui, Poss (heartoum) an sour ceructation (belching. ‘Subjective: 38 y/o white male co dl, aching pain in stomach and back. He states that hes experiencing Increased epsodes of “heartbum and belching” which occur “two to thes hours efter meals and uring te ‘ight? He describes foursmonth hiory of “heatbur,” wich last for several dys but is weleved by eat ing,“ stops for a ceupe of weeks, but lt abways tums.” Patient was lagnosed with HTN dx years ago,22 CHAPTER EIGHT = He ls taking Catapres cloning 0.4 mag par day with apparent good canto. Paint ic 2amaker with «i | tory of 1 PPD for 18 years. Denies use of NSAIDs or regular alcohol corumption But drinks tw to four cups (of cotlee and two clas dally, He denies recent try of back ry. ‘General Appearance: Appears uneaty and tense; n apparent dlucomfat as indicated by facial expression (orimace) Lungs: CTA Heart: Regular rte and rhythm, no mucmus, gallop, oF rubs ‘And: Tenderness in the elgasicare, gly, bowel sounds In all 4 quadrants, no masies or Bverspleen ‘enlargement MS: Welldeveloped musculature of upper body Neuro: No recent history of back jury, no kegulrtes ofthe spine Shin: Sight fusing of cheeks and redness ofthe nose, overall suntan of body a “Assessments Peptic ucer date (PUD) 1. Patients treted for H. pl due to postive results of culture. Treatment regimen incudes two antblotes ‘and a prton-pump Inhibitor (PP. Instruct the patent to tae the folowing medleatons PO; Blain (lar. ‘thromycn) 500 mg bid + amsiclln 1 bid + Prlasec (omeprazole) 20 mg bid for 10 days. Inform ‘tent thatthe cure ate ranges from 70% to 9094, not 100 %, because of patent fare to adhere to ‘regimen. Encourage patient to take the medlestion as ordered forthe total of 10 days 2. Inform patient ofthe three compllcatons ofan lcer—leeding, obstuction, and perforation. Bleeding ‘eur when the acid or ulcer breaks a blood vest. Obstruction ozurs when te cer blocks the path ‘food tying to leave the stomach. A perforation occurs when ulcer burrows Urough stomach ting. Instruct patent to Immediately report any signs of bleeding, sich a back tary stool or the passing of ‘or vomiting of biod to his physclan Also to report sudden welght ls or severe pan Inthe epigastre are of the abdomen. 3. Stress importance of smoking cesaton and consequences the patent continues. Provide patent with Information to contact te local smog cessaion program through American Heart Asocation. 4. Educate the patient that ulcers are the end resuit of an Imbalance Between dgesve enzymes cid, and pain in the stomach and the mucosal ining ofthe duodenum caused by several factor a bacterial Infection by H. pylon overuse of NSAIDs, overuse of cafleine or alohek: smoking: or the formation of \gastrinomas, tumors ofthe aci-producig cll ofthe stoach that Increase acd output. 5 Discus wth the pallent that ulcers aren caused by spicy foods or ses but are aggravated by them. ‘Aso, mk canna cue an uce. Mik provide rie ref fuer pln by coating the stomach fining. Mil ‘an also mula the stomach to produce more ac and dgesve ces, which may aggravate ulcers. Sg upp acangutar enon ined tn mab ae nor {py tars bap pecans the Sonac door The cogs al pete ne bir ‘cer eta he by ues et colnet tt bdo ea of pars wescee tr poet eg tee Bop Hao eston 6 eins testes te gid ana of agree py opener pot wht ware on eseoe ‘ced ibaa etary whe snc soccer ey aSevmmmainee: bt taper eter