How to write a nursing paper on Epigastric Pain Case Studies (Solved)
How to write a nursing paper on Epigastric Pain Case Studies (Solved)
- What is GERD and what causes it?
Gastroesophageal reflux disease (GERD) is a disorder of the digestive system that involves the regurgitation of the stomach contents into the esophagus. Reflux of these contents causes a painful, burning sensation in the middle chest that can move up into the neck (National Health Institute, 2020). There are many causes of GERD but all revolve around the weakness of the lower esophageal sphincter that normally prevents the backflow of the stomach contents. Too much pressure on the abdomen like during pregnancy can lead to heartburn. The disease can also be caused by a Hiatal hernia whereby the upper part of the stomach bulges into the diaphragm getting in the way of normal food intake (National Health Institute, 2020). The use of medications like NSAIDS, TCAs, benzodiazepines, and calcium channel blockers can cause or worsen the symptoms of GERD.
- What is PUD and what causes it?
Peptic ulcer disease (PUD) is a condition in which sores or ulcers develop in the stomach or the duodenum. These ulcers develop as a result of a damaged protective stomach layer that provides a cushion against pepsin and gastric acid secretions. The predominant causes of PUD are Helicobacter pylori infection and continuous use of nonsteroidal anti-inflammatory drugs (NSAIDS) (Malik et al., 2020). H pylori bacteria infects the stomach and sticks to the mucus layer causing inflammation and eventual destruction of the protective barrier. There are other infections like Crohn’s disease, cytomegalovirus, and chronic renal failure that can cause PUD.
1a) Identify two (2) additional questions that were not asked in the case study and should have been?
“have you observed any changes in your eating habits?”
“Is the pain associated with any other symptoms or made worse by exertion and relieved by rest?”
1b) Explain your rationale for asking these two additional questions.
These two questions can be used to find out more information about the patient’s pain. For instance, asking about a change in eating habits like intake of particular food substances could highlight conditions like PUD or GERD. Asking about associated symptoms and relive of the pain during resting could guide the provider in examining other systems like the respiratory system that could detect conditions like asthma.
1c) Describe what the two (2) additional questions might reveal about the patient’s health.
A change in the patient’s eating habits may indicate a worsening condition that could eventually be due to ulcers or GERD. The questions will guide the examiner in assessing symptoms like weight loss or weight gain due to a change in eating habits. The question on associated characteristics like the relief of the pain on rest may indicate problems with the heart or the respiratory system. Patients with conditions like asthma can present with such kind of pain.
2a) Explain the reason the provider examined each system.
Examination of Mr. Rodriguez involved taking vital signs and assessment of HEENT, respiratory, cardiovascular, abdomen, skin, and extremities. Examination of these systems was necessary to identify other symptoms that could be consistent with the patient’s condition. Obtaining this information was important in guiding focused examination and diagnosis of the patient. Additionally, examination of all body systems is important to detect other medical problems that the patient might not be aware of, yet alarming.
2b) Describe how the exam findings would be abnormal based on the information in this case.
Examination of Mr. Rodriguez revealed minimal epigastric tenderness on deep palpation without rebound tenderness or guarding. The epigastric pain is probably a result of ulcers in the stomach or duodenum secondary to infection. The pain could also be a result of acid reflux to the lower part of the esophagus.
2c) Describe the normal findings for each system.
The first part of the exam focused on vital signs that revealed the following results: Temperature is 36.9 C (98.5 F), Pulse is 78 beats/minute, regular, Respiratory rate is 16 breaths/minute, Blood pressure is 123/72 mmHg, and Body mass index is 24.8 kg/m 2. HEENT assessment revealed no conjunctival pallor, significant dental abnormalities, and the oropharynx had no lesions. The neck was supple with no masses or thyromegaly. Assessment of the cardiovascular system revealed a regular heart rate and rhythm and no murmurs, rubs, or gallops. There were bilaterally clear lung sounds with no wheezes, rales, or rhonchi. Assessment of the skin revealed no jaundice while the lower extremities were warm, well-perfused with no clubbing or edema.
Identify the various diagnostic instruments you would need to use to examine this patient.
blood pressure machine, thermometer, stethoscope, tongue depressor, otoscope, ophthalmoscope, penlight, and a weighing scale.
Diagnosis
The definitive diagnosis for Mr. Rodriguez is peptic ulcer disease. The most etiological causes of PUD are H. pylori infection and the use of NSAIDs. The development of ulcers results from an imbalance between the gastric mucosal protective barrier and destructive factors. During infection with H. pylori, penetration of the bacteria is aided by factors like neutral PH in the stomach and bicarbonate-mediated chemotactic motility (Malik et al., 2020). During the colonization of the stomach mucosal lining, epithelial cells degenerate resulting in increased exfoliation of surface epithelial cells. As a result, immature cells form the surface of the stomach lining leading to impaired bicarbonate production (Malik et al., 2020). At the same time, the complement system is activated leading to the release of inflammatory mediators like cytokines and neutrophils. Inflammation and the release of enzymes like alcohol dehydrogenase by the bacteria damage the gastric mucosa leading to the formation of ulcers.
Apart from this mechanism, PUD can result from prolonged use of NSAIDs. The mechanism of ulcer formation can be explained using three mechanisms. These drugs inhibit the production of cyclooxygenase 1 enzyme that causes decreased blood flow to the stomach causing injury (Malik et al., 2020). On another mechanism, drugs that inhibit cyclooxygenase 2 enzyme lead to inhibition of leukocyte adhesion that predisposes the stomach to injury. Another basic mechanism is that NSAIDS cause topical irritation that causes epithelial damage that causes mucosal injury.
Differential Diagnosis
Gastroesophageal reflux disease is a condition that can present with epigastric pain. Normally, the lower esophageal sphincter (LES) acts as an antireflux barrier protecting the esophagus from the acidic gastric content. Dysfunction of LES results from distention of the stomach after meals and is observed when pressure is within 1-4 mmHg (Chen & Brady, 2019). GERD can also result from transient lower esophageal sphincter relaxation that is triggered by gastric distention after meals. Factors like delayed stomach emptying may also influence the development of GERD leading to observed symptoms.
References
Chen, J., & Brady, P. (2019). Gastroesophageal Reflux Disease: Pathophysiology, Diagnosis, and Treatment. Gastroenterology Nursing : The Official Journal of the Society of Gastroenterology Nurses and Associates, 42(1), 20–28.
https://doi.org/10.1097/SGA.0000000000000359
Malik, T. F., Gnanapandithan, K., & Singh, K. (2020). Peptic Ulcer Disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK534792/
National Health Institute. (2020). National Institute of Diabetes and Digestive and Kidney Diseases: Symptoms and causes of GER & GERD.
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