NSG 3012 Week 4 Discussion – Male & Female Reproductive System
The underlying cause of these symptoms could be a host of various conditions. However, I believe this patient may have some sort of gallbladder disease, possibly cholecystitis. A distinctive feature of the pain is its sharp and tearing character, the localization in the right upper quadrant radiating to the right shoulder blade. There are cases where the pain is felt in the right jaw and the right eye. The patient usually excited shouts or groans and is always looking for a more convenient location. There is an increased pallor and sweating. It is almost always accompanied by a painful attack of nausea and vomiting. This type of pain is typically found in women.
The first would be a physical examination, such as Murphy’s Sign. Murphy’s Sign is a test for gallbladder disease in which the patient is asked to inhale while the examiner’s fingers are hooked under the liver border at the bottom of the rib cage. The inspiration causes the gallbladder to descend onto the fingers, producing pain if the gallbladder is inflamed. Deep inspiration can be very limited (Thomas, 2013). Having a physical Murphy’s sign examination performed will help the examiner determine if, in fact, the patient has acute cholecystitis. However, a confirmation of the diagnosis depends on a combination of physical findings and laboratory and imaging studies.
NSG 3012 Week 4 Discussion – Male & Female Reproductive System
The workup for cholecystitis may include laboratory tests (although these are not always dependable), radiography, ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), hepatobiliary scintigraphy (HBS), and endoscopy. Despite the fact that lab criteria are not dependable in recognizing all patients with cholecystitis, the accompanying discoveries might be helpful in arriving at the right diagnosis. Some lab tests to perform to confirm possible differential diagnoses consist of the following:
Leukocytosis with a left shift may be observed in cholecystitis
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels are utilized to assess for the presence of hepatitis and might be hoisted in cholecystitis or with regular bile duct
Bilirubin and alkaline phosphatase measures are utilized to assess for basic bile duct obstruction
Amylase/lipase measures are utilized to assess for the presence of pancreatitis. Amylase may likewise be raised gently in
Urinalysis is utilized to discount pyelonephritis and renal
All females of childbearing age ought to experience pregnancy testing
Complete blood count (CBC) (Dennis, Wile, & May, 2015)
The objectives of pharmacotherapy are to lessen morbidity and avoid complexities. Agents utilized as a part of patients with cholecystitis incorporate antiemetics, analgesics, and anti-microbial. Since this patient has stated that she feels nauseated, prescribing her an antiemetics, such as Prochlorperazine (Compazine), could help to alleviate her nausea. Since the patient is experiencing severe pain, prescribing her pain medication, such as Vicodin, will help with the pain. The one medication that would be imperative for this patient to be prescribed would be an antibiotic, possibly prophylactic antibiotic coverage with levofloxacin (Levaquin, 500 mg PO qd) and metronidazole (500 mg PO bid), which should provide coverage against the most common organisms (Bloom, 2016). Antibiotics will help to reduce further infection.
References:
Bloom, A. A. (2016). Cholecystitis Medication: Antiemetics, Analgesics, Antibiotics. Retrieved from http://emedicine.medscape.com/article/171886-medication#4
Dennis, B. M., Wile, G. E., & May, A. K. (2015). The Diagnosis of Acute Cholecystitis. Acute Cholecystitis, 27-40. doi:10.1007/978-3-319-14824-3_3
Thomas, S. (2013). Differentiating abdominal pain using Murphy’s Sign. Practice Nursing,24(3), 141-141. doi:10.12968/pnur.2013.24.3.141
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Question 
NSG 3012 Week 4 Discussion – Male & Female Reproductive System
A 44-year-old obese female is admitted to the emergency room with a fever and severe abdominal pain on the upper right side that radiates to the scapula. She states that she feels nauseated. She states that the pain began at a friend’s house during a party and is becoming more severe. You can see that she is quite uncomfortable.
What could be the underlying cause of these symptoms? What examinations would you perform? Why?
What laboratory tests would be needed to confirm possible differential diagnoses?
What pharmaceutical drugs are approved for treating the diagnosis that you concluded for this case