Differential Diagnosis and Diagnostic Testing
Chief Complaint
Based on the data provided for the patient in the Case #2 scenario, the chief complaint is persistent abdominal pain for two weeks, which is accompanied by morning nausea and vomiting, loss of weight (8 pounds), lack of appetite, and diarrhea over the past few days.
Physical Exam
A thorough physical assessment is a vital procedure that should be done for any patient in the clinical setting. This procedure helps evaluate the patient during the first encounter and daily in the ward to identify any changes either in response to treatment or due to the disease prognosis. The findings of the physical assessment are compared to the normal ranges, and any deviation from the normal is noted, and intervention is initiated to help achieve the normal findings. The process should be done from head to toe following four techniques of examination, namely, inspection, auscultation, palpation, and percussion. However, depending on the severity and the workload, healthcare providers may concentrate on the subjective data from the client and do a thorough examination of the areas of interest pertaining to the patient’s complaint (Toney-Butler & Unison-Pace, 2023).
For this case, the focus will be more concentrated on the abdomen based on the patient’s complaint. To begin with, an inspection of the abdomen will be conducted to look for any observable abnormalities like abdominal distension, any visible scars, surgical sites, discoloration, hernias, and visible peristalsis. Second, the next exam is to auscultate the abdomen to listen to bowel sounds that may indicate gastroenteritis or any obstruction. The sounds may be hyperactive or hypoactive. Thirdly, palpation is done to note any tenderness, rebound tenderness, guarding, and masses. The findings from palpation may help localize the problem, for example, if tenderness is found. The last technique of physical examination is percussion, which involves percussing to pick the sound produced so as to determine the nature of the content underneath. For instance, a dull sound on percussion suggests a solid mass, and it may also suggest a solid mass from organ enlargement in the liver or spleen.
Diagnostic Tests and How the Findings May Be Used to Make a Diagnosis
In supplementation of the findings from the physical examination, a couple of diagnostic techniques need to be used, including a complete blood count to identify infection and other hematologic conditions. In this case, there might be elevated white blood cells that may signify infection. Secondly, the basic metabolic profile is crucial in this case for vomiting, diarrhea, and weight loss. This test is done to evaluate the electrolyte balance and hydration status, which are significant in this case due to the vomiting and diarrhea that may cause electrolyte imbalance. The third test is the C-reactive protein or Erythrocyte Sedimentation Rate, which measures the level of inflammation in the body. Lastly, stool studies are necessary in this scenario, as they are justifiable by the gastrointestinal symptoms. The stool culture will test for bacterial pathogens, ova, and parasites to determine any parasitic infection, clostridium difficile toxin, and fecal calprotectin to detect inflammation of the intestines. All the above tests are done to point out the pathological process responsible for the complaint reported by the patient (Mealie et al., 2024).
Differential Diagnosis
The subjective data reported by the patient and the findings from a physical examination may be suggestive of various diagnoses from which the actual diagnosis of the patient will be picked after confirmatory tests rule out all the other diagnoses. To begin with, infectious gastroenteritis, whose symptoms include diarrhea, abdominal pain, nausea, vomiting, and weight loss, is a result of prolonged situations of this condition. Secondly, inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis may result in the symptoms reported by the patient and some findings of the diagnostic tests. Thirdly, irritable bowel syndrome may be added to the list due to its presentation with abdominal pains and changes in bowel habits, but the weight loss in the patient makes it a less likely diagnosis. The fourth differential diagnosis is celiac disease, which may present with the symptoms reported by the patient. Lastly, per Patterson et al. (2023), parasitic infections can also be on the list since they may also present the same way the patient presented in this case.
References
Mealie, C. A., Ali, R., & Manthey, D. E. (2024, May 25). Abdominal examination. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK459220/
Patterson, J. W., Kashyap, S., & Dominique, E. (2023, July 10). Acute abdomen. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK459328/
Toney-Butler, T. J., & Unison-Pace, W. J. (2023, August 28). Nursing admission assessment and examination. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK493211/
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Question 
When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools to help in understanding a patient’s condition. In turn, beginning with a differential diagnosis supports the process of further applying information to narrow the possibilities of what the condition may be and working to arrive at the most accurate diagnosis for planning treatment.
Differential Diagnosis and Diagnostic Testing
For this Case Study Assignment, you will determine the physical exams and diagnostic tests that would be most appropriate for gaining information and a better understanding of your patient’s condition. Then, based on your analysis, you will formulate a differential diagnosis for the patient.
To prepare:
- By Day 1 of this week, your Instructor will assign a patient profile for this Assignment. Note: Please see the Course Announcements section of the classroom for your patient profile Assignment.
- Review this week’s Learning Resources.
- Review the details of the patient case study.
- Consider what physical exams and diagnostic tests would be most appropriate to gather more information about the patient’s condition.
- Reflect on how the results would be used to make a diagnosis.
- Identify three to five (3–5)possible conditions that may be considered in a differential diagnosis for the patient.
Assignment: Diagnostic Reasoning
Include the following:
- Identify the patient’s chief complaint.
- Identify what physical exams and diagnostic tests would be most appropriate to gather more information about the patient’s condition. Be specific and explain your reasoning.
- Explain how the results would be used to make a diagnosis.
- Identify three to five (3–5)possible conditions that may be considered in a differential diagnosis for the patient. Explain your thinking.