Week 12 Discussion 1: Case Study Discussion – Gastrointestinal Disorders

Value: 100 points

Due: To facilitate scholarly discourse, create your initial post by Day 3, and reply to at least two of your classmates, on two separate days, by Day 7.

Gradebook Category: Discussions

Initial Post

It is understood that thoughtful responses to your topic question(s) will take some time and thought. Please organize your thoughts before creating your initial post.

Based on your assigned team, create an initial post by answering all questions in your team’s case study, making sure to address all components of all questions.

By Day 3, post your initial response to your assigned part of the case study as a reply to the appropriate discussion thread. Please be sure to number the questions addressed and include all components of each question in your response. Each initial response must have a reference, including at least two scholarly references other than your textbook or course materials. Your post should comprehensively address the questions posed.

Team A: Gastroenteritis

Week 12 Discussion Team A Worksheet (Word)

Baby K., age 14 months, has vomiting and diarrhea and is crying continuously because of what appears to be severe abdominal pain. As part of your history, you discover Baby K. had some milk custard that may not have been properly stored. The most likely diagnosis is gastroenteritis, secondary to Staphylococcus aureus from the milk custard.

  • Briefly describe how S. aureus in the custard could cause vomiting and diarrhea.
  • What fluid and electrolyte imbalances would you expect in Baby K.? Please describe how at least one fluid and one electrolyte imbalance could develop in this situation.
  • Describe the signs of dehydration that can be expected in a child of this age. What about in an older child?
  • Explain the process and factors involved by which a young child can quickly develop vascular collapse if vomiting and diarrhea are severe.
  • Explain why water alone would not be adequate treatment for Baby K.
  • What other gastrointestinal conditions could cause vomiting and diarrhea in a young child? How will you definitively determine what condition is causing her symptoms?

Team B: Peptic Ulcer and Peritonitis

Week 12 Discussion Team B Worksheet (Word)

Ms. X., age 76, has been admitted to the emergency department with severe generalized abdominal pain and vomiting. No significant findings were immediately evident to indicate a cause, so she was admitted. Six hours later, Ms. X.’s blood pressure began to drop, and her pulse was rapid but thready. Exploratory abdominal surgery revealed a perforated gastric ulcer and peritonitis.

  • Describe the process by which an ulcer develops. Are ulcers limited to the stomach or can they occur elsewhere in the GI system? If so, where?
  • Suggest several possible factors contributing to ulcer formation. What questions would you want to as Ms. X. to determine her risk for gastric ulcers?
  • Explain why peptic ulcer may not be diagnosed in an early stage of development. In other words, why were there not any initial significant findings?
  • During her admission, Ms. X. continued to decompensate, and developed bacterial peritonitis. Describe the process of perforation of an ulcer and how this can lead to complications, including bacterial peritonitis.
  • Explain why Ms. X. showed signs of shock. Which type of shock would you expect?
  • Ms. X. was given antibiotics, intravenous fluids, and intravenous alimentation (total parenteral nutrition). Explain how each of these treatments functions to return Ms. X. to a more homeostatic state.

Team C: Hepatitis B and Cirrhosis

Week 12 Discussion Team C Worksheet (Word)

You are caring for J.B., age 35, who has had chronic hepatitis B for nine years. The origin of his acute infection was never ascertained. He is not married, lives alone, and sometimes has trouble managing his disease.

  • Describe the pathophysiology of acute hepatitis B infection. How is this different from chronic hepatitis B infection?
  • If J.B. had known about his exposure at the time, could any treatment measures have been undertaken at the time?
  • Describe two signs of the preicteric stage and three signs of the icteric stage of acute hepatitis B infection. In which of the stages could J.B. transmit the virus? Be sure to include discussion of the mode of transmission.
  • What serum markers remain high when chronic hepatitis B is present?
  • Explain how cirrhosis develops from chronic hepatitis B. Why is the early stage of cirrhosis relatively asymptomatic?

J.B.’s cirrhosis is now well advanced. He has developed ascites, edema in the legs and feet, and esophageal varices. His appetite is poor, he is fatigued, and he has frequent respiratory and skin infections. Jaundice is noticeable. He has been admitted with hematemesis and shock resulting from ruptured esophageal varices.

  • Explain why each of the following events occur: (1) excessive bleeding from trauma, (2) increased serum ammonia levels, and (3) hand-flapping tremors and confusion.

Reply Posts

Review all your peers’ posts, as they will help you prepare for the quiz this week. Select posts from two peers that addressed a case study from a different team than you. For example, students from Team A reply to one post from Team B and one post from Team C. Each reply must use at least one scholarly reference other than your textbook.

Thinking about your population-specific NP track and anticipated practice area:

  • Identify and explain two “pearls of wisdom” or “key concepts/ideas” you learned from reading your peers’ responses.
  • Describe a patient you might encounter in your future practice where you could apply the information learned in your peer’s post.

Please refer to the Grading Rubric for details on how this activity will be graded.

Posting to the Discussion Forum

  1. Select the appropriate Thread.
  2. Select Reply.
  3. Create your post.
  4. Select Post to Forum.