1. Leo 47 y.o. was admitted to the hospital for an executive check-up.

He had previously been complaining of chest

pains, generalized abdominal pains, belching and vomiting with altered bowel elimination patterns. He was
prescribed a soft diet with no activity restrictions. Initial Vital signs were T: 37.1 degrees Centigrade, P- 87
beats/min, RR: 21cycles/mins, BP:140/90. He was advised to remain in the hospital for further management after
having the following diagnostic lab results:
Blood Chemistry CBC Cardiac Enzymes/Lipid Panel
FBS 95mg/dl WBC 15,000/ CPK 60 units/L
BUN 16 mg/dl mm3* CPK-MB 0
Creatinine 0.8 RBC 5x LDH 150 units/L
mg/dl 106/uL Troponin T 0.2 ng/ml
Hgb 15 g/dl
Hct 45 %
Sodium 138 WBC Differential Total Cholesterol 300
mEq/L Neutrophils mg/dl* HDL 40
Potassium 3.0 75%* Lymphocytes mg/dl*
mEq/L* 30% LDL 250 mg/dl*
Chloride 99 Monocytes 7% Triglycerides 180 mg/dl*
mEq/L Eosinophils 19%*
Calcium 10 mg/dl Basophils 1%
PlateletCount

200,000/mm3

Hepatic Function Tests Urinalysi Fecalysi

s s
Albumin 5 g/dl Appearance clear Color pale
Billirubin Indirect 0.6 Color dark orange Consistency soft- formed
mg/dl Odor aromatic Blood negative
Direct 1.0 pH 5.0 Pus negative
mg/dl* Protein negative Ova and Parasites
Total 2.0 Sp. Gravity 1.005
mg/dl* Glucose negative Positive for ascaris
AST/SGOT 45 Casts none lumbricoides
units/L* WBC 1-2
ALT/ SGPT 48 RBC 0-1
units/L*

Ultrasound of Abdomen Chest X-Ray EGD and Colonoscopy

Calcifications of RUQ Normal Lung findings Normal gastric mucosa except
suggestive of GB stones Heart midline with normal size for mild strictures at duodenal
area with inflammation.

Colon normal with slight

erythematous areas suggestive
of injuries

1. What will be your focused physical assessment priorities before you start your care for Leo. (10 points)

ANSWER:
 Assessment of vital signs, the BP is slightly elevated at 140/10mmHg
 Abdominal assessment, including auscultation to check for bowel sounds in all four quadrants. Because
the patient suffers abdominal aches, belching, vomiting, and irregular bowel movements.
 Cardiovascular system assessment: for signs of any irregularities in auscultation, as the patient reported
chest discomfort and high cholesterol levels, predisposing him to coronary artery disease.
 Rectal and anus examinations may reveal the presence of blood and pain, whereas colonoscopy may
reveal erythematous areas suggestive of injury.
 Palpation, light palpation followed by deep palpation will be used to assess the presence of masses,
tenderness, discomfort, and guarding in the abdomen, as calcifications suggestive of gall bladder stones
are present and may cause tenderness in the right hypochondriac region.
  The patient is asked to breathe in and hold their breath while palpating the right hypochondriac region to
elicit Murphy's sign. Murphy's sign is positive if pain occurs when the inflamed gallbladder comes into
contact with the examiner's hand when breathing in. A positive Murphy’s sign may be seen.

2. Interpret the diagnostic lab test results for case Correlate the significant diagnostic tests an PA findings with the
pathophysiology of the condition. (10 points)

ANSWER:
.
 Normal potassium level is 3.5-5.0mEq/L. The patient's potassium level has dropped slightly (3.0 Eq/L)
due to vomiting, which is one of the causes of hypokalemia.
 Normal values of neutrophils are 40-60%. Abnormally elevated neutrophils (patient values:75%), may be
due to the inflammatory response that the patient is seen to have inflammation in his duodenum upon
colonoscopy.
 The eosinophils (normal range: 1% -4%) result 19% is very high, because the Eosinophils have anti-
parasitic and bactericidal activity that participates in immediate allergic reactions, and modulating
inflammatory responses that the patient has a pale colored stool and dark orange colored urine which is
both an abnormal color of stool and urine and that the bile duct did not properly drained or not working
properly.
 Normal WBC level is 4, 500- 10, 00 mm 3. Patient’s WBC count is 15, 000/ mm 3 which indicates allergic
reaction due to inflammation in the duodenal area upon having colonoscopy.
 The patient also has abnormally high laboratory values on the cardiac enzymes/Lipid panel, which may
indicate that fats are one of the causes of gallstone formation and may result in altered bowel
evacuation habits, resulting in abdominal pain.
 Total cholesterol level normal values: 140-250 mg/dl. The patient’s total cholesterol level is 300mg/dl,
LDL patients’ level is 25- mg/dl, patient triglycerides value is 180 mg/dl, which indicates high level of fats
that will cause the formation of stones in the gallbladder of the patient.
 Bilirubin normal values: 0-0.02 mg/dl mg/dl. Elevated bilirubin levels (2.0 mg/dl) indicate the liver or
gallbladder is not performing properly in the abdominal ultrasound and that the patient has a gall stone.
A gall bladder stone can obstruct the bile duct, which connects the liver to the gallbladder, as well as the
duodenum, the small intestine's opening. It helps in the movement of bile from the liver and gallbladder
into the intestines, which contains bilirubin.
 The patient's urinalysis (dark orange) revealed that there is a problem in the bile duct, which causes
discoloration of the urine, which can turn dark orange or brown.
 The fecalysis revealed that the patient had Ascaris lumbricoides, a type of roundworm that raised his
eosinophil counts and caused generalized abdominal pain. The color of stools is pale. In addition, the
patient stated that he was experiencing chest pain as a result of vomiting.
 The patient’s ultrasound reveals that there’s calcification of the RUQ, suggestive of GB stones. A
gallstone occurs when cholesterol and other substances found in bile form stones. When the stone
passes from the gallbladder into the small intestine or becomes stuck in the biliary duct, it can cause
pain, specifically in the mid to upper right section of the abdomen.
 The EGD and colonoscopy of the patient revealed normal gastric mucosa except for mild structures in
the duodenal area with inflammation, and the colon was normal with slight erythematous areas
suggestive of injuries. So, when there is an increase in bilirubin, cholesterol, and a decrease in
potassium, it is due to inflammation in the duodenum.
 The stomach is acidic by nature, and the acid can induce a burning feeling in the chest (heartburn).
Additionally, the patient has been prescribed omeprazole for Gastroesophageal Reflux Disease (GERD),
which can also cause heartburn.
3. Assuming that Leo was given Omeprazole 40 mgs. 2 times a day for GERD, what is the role of this drug and
nursing responsibilities for its administration? What position and diet modifications will be advised for him to
help manage his symptoms? (10 points)

ANSWER:
 Omeprazole is used to prevent or suppress the acid reflux from stomach to esophagus. It is sold under
brand names Prilosec and Losec among others, is used in the treatment of peptic ulcer disease, and
Zollinger-Ellison syndrome.
o Gastric acid-pump inhibitor: suppresses gastric acid secretion by specific inhibition of the
hydrogen-potassium ATPase enzyme at the secretory surface of the gastric parietal cells; block
the final step of acid production.
 Nursing responsibilities:
o Administer before meals. Caution the patient to swallow capsules whole-not to open, chew, or
crush them.
o Be aware that patient may be at increased risk for hip, wrist, and spine fracture; weigh benefits
and risks before use.
o Caution the patient to avoid driving and other hazardous activities until he knows drug effects
concentration and alertness.
o Tell the patient to report if experiencing this side effects; dizziness, headache, nausea,
vomiting, diarrhea.
 Avoid lying down for at least two hours after a meal or after drinking acidic beverages, like soda, or
other caffeinated beverages. This can help to prevent stomach contents from flowing back into the
esophagus.
 Keep your head elevated while you sleep. Using an extra pillow or two can also help to prevent reflux.
 Eat smaller and more frequent meals each day instead of a few large meals. This promotes digestion
and can aid in preventing heartburn.
 Wear loose-fitting clothes to ease pressure on the stomach, which can worsen heartburn and reflux.
 Quit smoking. Smoking can increase the production of stomach acid and reduce the function of the
lower esophageal sphincter, the muscle that keeps acid and other stomach content from reentering the
esophagus. Smoking can also decrease the amount of saliva, which neutralizes acid produced by the
body.
 Reduce excess weight around the midsection. This can ease pressure on the stomach. Such pressure
can force some stomach contents back up the esophagus.