NSG6005Week 4 assignment 1

NSG6005Week 4 assignment 1 Because TJ has unremarkable lab work and vital signs that are within normal limits, differential diagnoses can be narrowed significantly. Because of his history of bleedin g ulcer and multiple risk factors (over age 50, NSAID use, tobacco and alcohol use), and the lack of relief using Zantac, differential diagnoses are peptic ulcer disease (PUD), h. pylori infection, erosive esophagitis, or gastro esophageal reflux disease (GERD). The American College of Gastroenterology (ACG) recommend that patients with active or past history of PUD or on longterm NSAID therapy be tested and treated for h. pylori infection (Chey, Leontiadis, Howden, & Moss, 2017). Endoscopy may be ordered and is the preferred diagnostic test for PUD and erosive esophagitis according to the ACG. As previously mentioned, TJ has multiple risk factors that are possibly contributing to his symptoms. He is over age 50, uses NSAIDS daily to treat his osteoarthritis, he smokes tobacco, and drinks alcohol. TJ should be instructed to discontinue the OTC Zantac and NSAIDS. Selective NSAID treatment for TJ’s osteoarthritis will reduce potential for future recurrence of ulcers (Chou, McDonough, Nakamoto, & Griffin, 2016), and ACG recommendations for treatment of PUD and h. pylori are followed, which are 10-14 days of bismuth quadruple therapy (bismuth, proton pump inhibitor [PPI], tetracycline, and a nitro imidazole) (Chey, Leontiadis, Howden, & Moss, 2017). Pylera (metronidazole/tetracycline/bismuth subsalicylate) 125mg/125mg/140mg by mouth every six hours for 10 days (Chey, Leontiadis, Howden, & Moss, 2017). Prilosec (omeprazole) 20mg by mouth every 12 hours for 10 days (take with 10 oz. water) (Chey, Leontiadis, Howden, & Moss, 2017). Celebrex (celecoxib) 200mg by mouth every day (Chou, McDonagh, Nakamoto, & Griffin, 2016). Recommend smoking cessation and offer Nicodermpatch on 21/14/7 mg regimen and provide community support group information. Follow up visit 4 weeks after completion of Pylera and Prilosec to test for successful eradication of h. pylori and possible follow up endoscopy to verify healing of ulcerations (Chey, Leontiadis, Howden, & Moss, 2017). TJ should also receive patient education to stress the importance of compliance with medication regimen and follow up to minimize potential for recurrence and evaluate effectiveness of treatment. References Chey, W. D., Leontiadis, G. I., Howden, C. W., & Moss, S. F. (2017). ACG Clinical Guideline: Treatment of Helicobacter Pylori Infection. The American Journal of Gastroenterology,112(2), 212-239. doi:10.1038/ajg.2016.563 Chou, R., McDonagh, M. S., Nakamoto, E., & Griffin, J. (2016). Analgesics for Osteoarthritis: An Update of the 2006 Comparative Effectiveness Review [Internet]. Retrieved from