I need support with this Nursing question so I can learn better.
Mr. J.R. would need to answer some follow-up questions such as... Can you tell me what you ate at the restaurant? Are you lactose intolerant? Have you traveled recently and if yes, where to? Do you take any OTC or prescribed medications such as antibiotics, laxatives, fiber, or motility agents? Do you have a dry mouth or throat? Any abdominal pain, bloating, distention, and gas? Any bloody stools? Color of his vomit? Is it projectile vomiting? Have you been around anyone with the same symptoms? Have you eaten or drank anything since it started? Any relieving or aggravating factors?
The three differential diagnoses for this patient are food poisoning, stomach flu (acute gastroenteritis), and Inflammatory Bowel Disease. The following were chosen as differential diagnoses because of the symptoms and labs associated. According to Zyoud, Shalabi, Imran, Ayaseh, Radwany, Salameh, Sa’dalden, Sharif, Sweileh, Awang, and Al-Jabi (2019), symptoms of toxigenic food poisoning mostly appear within 24 hours after ingesting contaminated food. Foodborne infections may not appear until 2–3 days later. Symptoms can include nausea, vomiting, diarrhea, abdominal pain, headache, and fever. Acute gastroenteritis is common and can be contracted by an infected individual, contaminated water or food. According to Chow, Leung, and Hon (2010), gastroenteritis is defined as the inflammation of the mucus membranes of the gastrointestinal tract and is characterized by diarrhea or vomiting. Inflammatory Bowel Disease is known to be the name of a group of diseases that affects the digestive tract. According to Karavasili, Saridi, Skamnelos, Tsiara, Katsanos, Kosmidou, and Christodoulou (2019), the etiology of IBD is still unknown, however, researchers acknowledged that multiple factors are engaged leading to different intestinal and extra-intestinal manifestations.
The physical examination will consist of vitals especially checking blood pressure, temperature and pulse for signs of dehydration. According to Epocrates (2020), it is important to evaluate fluid balance such as checking pulse, skin turgor, mucous membranes for dryness, capillary refill, and any orthostatic changes. The patient’s abdomen will also be palpated, percussed and bowel sounds will be assessed. Epocrates (2020) states hyperactive, normal or absent bowel sounds may be heard on the exam. The patient may display rebound tenderness or generalized abdominal tenderness. Stool culture will be ordered along with a stool for C Diff. On exam, the patient may have a rectal exam. According to Epocartes (2020), it can help in characterizing stool and content. The patient’s physical exam and interview would be enough at this time because his symptoms are all acute. According to Epocrates (2020), diagnostic evaluations are indicated in patients with severe illness. CBC and CMP would reorder paying special attention to creatinine and BUN levels.
Evidence-based plan of care will include the following. 1. Relieve any discomfort the patient may be feeling. 2. Maintaining skin integrity since he is using the bathroom frequently. 3. Give plenty of fluids. According to The Centers for Disease Control and Prevention (CDC, 2020), the patient must understand why he must replace lost fluids and electrolytes. IV fluids will be given immediately 30 mL/kg in 30 minutes and then taper. 4. The patient will be monitored for 6 hours to ensure the dizziness goes away and labs would be reordered to monitor labs and electrolytes. If all is well, the patient will be released. If dizziness continues, he will be admitted. 5. Avoid all foods that have been identified as the trigger. 6. Avoid drinks with sorbitol or fructose. 7. Explain the importance of medication compliance. The patient will be prescribed Zithromax (1 gram PO q 24hrs for 1 day then 500 mg PO q 24hrs for 2-6 days). The patient will also be prescribed Loperamide (start 4mg PO once and then 2mg PO after each loose stool). Max 16 mg/day (Eporcates, 2020). 7. If symptoms start up again at home or worsen please call immediately. 8. Please practice good hand hygiene and keep spaces clean.
Acute diarrhea eval. (2020). In Epocrates Essential for Apple iOS (Version 20.2) [Mobile Application Software]. Retrieved from http://www.epocrates.com/mobile/iphone/essentials
Chow, C. M., Leung, A. K., & Hon, K. L. (2010). Acute gastroenteritis: From guidelines to real life. Clinical and experimental gastroenterology, 3, 97–112. https://doi.org/10.2147/ceg.s6554
Karavasili, N. T., Saridi, M., Skamnelos, A., Tsiara, S., Katsanos, K. H., Kosmidou, M., & Christodoulou, D. K. (2019). Inflammatory bowel disease and infectious factors. International Journal of Caring Sciences, 12(1), 553–558.Zyoud, S., Shalabi, J., Imran, K., Ayaseh, L., Radwany, N., Salameh, R., Sa’dalden, Z., Sharif, L., Sweileh, W., Awang, R., & Al-Jabi, S. (2019). Knowledge, attitude and practices among parents regarding food poisoning: A cross-sectional study from Palestine. BMC Public Health, 19(1), 1–10. https://doi-org.libauth.purdueglobal.edu/10.1186/s12889-019-6955-2