Gastro-oesophageal reflflux SCENARIO Jim is a three-month-old baby born at 35 weeks’ gestation. He has been in hospital since birth with a variety of problems. He is now feeding enterally via a bottle, but is not thriving and his weight is falling off the centile chart. He has been on feed thickeners and ranitidine for the last month for gastro-oesophageal reflflux, but symptoms still persist. QUESTIONS: Jim gets an ear infection and is started on metronidazole suspension. The current reflux regimen continues. 1. What is the problem of using metronidazole suspension when the gastric content is acid suppressed? 2. What is the other potential risk of using metronidazole alongside ranitidine suspension?
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- Bowel Elimination Mrs Emma Brown is a 78-year old widow of 9 months. She lives alone in a low-income housing complex for older adults. Her 2 children live with their families in a city approximately 150 miles away. She has always enjoyed cooking for her family; however, now that she is alone, she does not cook for herself. As a result, she has developed irregular eating patterns and tends to prepare soup and toast meals. She gets little exercise and has had bouts of insomnia since her husband’s death. For the past month, Mrs Brown has been having a problem with constipation. She states she has a bowel movement about every 3 to 4 days and her stools are hard and painful to excrete. Mrs Brown decides to attend the health fair sponsored by the housing complex and seeks assistance from the county public health nurse. What nursing intervention is most appropriate before making suggestions to correct or prevent the problem she is experiencing? What suggestions can you give her about…Bowel Elimination Mrs Emma Brown is a 78-year old widow of 9 months. She lives alone in a low-income housing complex for older adults. Her 2 children live with their families in a city approximately 150 miles away. She has always enjoyed cooking for her family; however, now that she is alone, she does not cook for herself. As a result, she has developed irregular eating patterns and tends to prepare soup and toast meals. She gets little exercise and has had bouts of insomnia since her husband’s death. For the past month, Mrs Brown has been having a problem with constipation. She states she has a bowel movement about every 3 to 4 days and her stools are hard and painful to excrete. Mrs Brown decides to attend the health fair sponsored by the housing complex and seeks assistance from the county public health nurse. a. What nursing intervention is most appropriate before making suggestions to correct or prevent the problem she is experiencing? b. What suggestions can you give her about…Gastro-oesophageal reflflux SCENARIO Jim is a three-month-old baby born at 35 weeks’ gestation. He has been in hospital since birth with a variety of problems. He is now feeding enterally via a bottle, but is not thriving and his weight is falling off the centile chart. He has been on feed thickeners and ranitidine for the last month for gastro-oesophageal reflflux, but symptoms still persist. QUESTIONS: 1 What is gastro-oesophageal reflux and what are the main symptoms? 2a What is the rationale behind the ranitidine treatment already started? 2b What alternative class of drug may work in the same way as ranitidine, but be more effective? 2c What are the practical problems of using this second class of medicine in an infant? 3a Name three prokinetic agents which could be added to the regimen at this stage. 3b What is the rationale of use of these products? 3c Briefly mention the potential issues surrounding the use of each product.
- A 22-year-old comes to the emergency department with light-headedness, diarrhea and fatigue during the past 6 months. She has a 2-year history of gluten-sensitive enteropathy. Her pulse is 100/min. Physical examination shows generalized pallor and glossitis. A peripheral blood smear shows macroovalocytes and hypersegmented neutrophils. Her hemoglobin concentration is decreased, serum homocysteine concentration is increased, and serum methylmalonic acid concentration is within the reference range. This patient most likely has a deficiency of which of the following vitamins? a) Folic acid b) Niacin c) Vitamin B1 (thiamine) d) Vitamin B6 (pyridoxine) e) Vitamin B12 (cobalamin)Mr. Blair, a 75-year-old man weighing 60 kg, was admitted to the Gastroenterology Unit of the Miracle Hospital with severe diarrhea due to food poisoning. After examining Mr. Blair, Dr. Clark ordered IV fluids of D5W 1000 mL q12h, for the next three days with added electrolytes, such as potassium, sodium, calcium, and magnesium, since Mr. Blair was severely dehydrated. In addition, suspecting Salmonella poisoning, Dr. Clark prescribed Septra, 500 mg IV q12h, to be mixed in the D5W electrolytes fluid admixture. What considerations must be taken into account prior to admixing this order? (NAPRA 6.1, 6.2, 8.3, 9.2) If the drug is determined to be incompatible with D5W and electrolytes, what IV delivery system and/or administration method would you use to administer the medication? (NAPRA 2.3, 6.1, 6.2, 8.3, 9.2) What would be the infusion rate of the drug admixture in millilitres per hour and drops per minute when a primary IV administration set was…Measurement of sweat chloride concentration is useful in the screening of children suspected of having which of the following pancreatic diseases? 1) Cystic fibrosis 2 Insulinoma 3) Zollinger-Ellison syndrome 4) Pancreatic insufficiency no references, just homework
- 158. A 3-year-old girl is brought to the physician because of a 4-day history of irritability, vomiting, decreased urinary frequency and volume, and diarrhea. She visited a local petting zoo with her family 1 week ago. Her temperature is 38°C (100.4°F), pulse is 100/min, respirations are 30/min, and blood pressure is 130/100 mm Hg. Physical examination shows pallor, petechiae over the chest, and mild abdominal tenderness. Laboratory studies show: A) Elastin B) Fibrin Hemoglobin Hematocrit C) Hemosiderin D) IgA E) IgE F) IgG Erythrocyte count Leukocyte count Reticulocyte count Platelet count Serum Urea nitrogen Creatinine Bilirubin, total Direct Indirect Lactate dehydrogenase 5.9 g/dL (N=11-15) 31% (N=28% -45%) 3.1 million/mm³ (N=3.9-5.31) 18,000/mm³ (N=6000-17,500) 4.5% (N=0.5% -1.5%) 52,000/mm³ (N=150,000-400,000) Direct antiglobulin (Coombs) test result is negative. A photomicrograph of a peripheral blood smear is shown. Acetaminophen, amlodipine, and fluid and nutritional support…Considering the nutritional needs and diet restrictions for liver failure, which of the following meals would be most appropriate? O 1 whole grain tortilla, 1/4 cup refried beans, 2 oz chicken breast, 1 tablespoon sour cream, 1/2 cup seasoned yellow rice O 4 oz salmon, 1 oz baked seasoned steak fries, 1/2 cup beets, 1 cup whole milk O 4 oz roasted pork loin, 1 dinner roll, 1 tablespoon jam, 1/2 cup canned peaches, 1 cup frozen peasA 38-year-old female presents to the clinic with complaints of alternating diarrhea and constipation. She reports some abdominal discomfort and bloating that are relieved with her bowel movement. She states that her episodes are worse in times of stress. She denies any blood in her diarrhea. She denies any weight loss or anorexia. Her physical exam is all within normal limits. She has been prescribed a cellulose-containing dietary supplement, which her doctor says will increase the bulk of her stools. 1. What is the most likely diagnosis? 2. What is the biochemical mechanism of the dietary supplement’s effect on the intestines?
- A 39 yearold woman comes to the clinic complaining of diarrhea and abdominal pain. “I feel so weak.” She reports having four to five loose, occasionally bloody stools per day for the past two weeks, with abdominal cramping beginning over the past 48 hours. She has been self-treating with occasional other-the-counter (OTC) antidiarrheals without success. She denies recent antibiotic use. She complains of severe fatigue. She gave birth to her third child 6 weeks ago. She is not breast feeding. A complete blood count, blood chemistry (including electrolytes, renal function tests and blood glucose) and serum iron is ordered along with stool cultures, colonoscopy and upper gastrointestinal (UGI) endoscopy with small bowel follow-through. Lab Data: Sodium 140 mmol/L Potassium 3.5 mmol/L Chloride 105 mmol/L Urea 3.57 mmol/L Serum creatinine 115 µmol/L Glucose 7.8 mmol/L Iron 4.3 µmol/L Hb 132 g/L Hct 0.39 L/L WBC 7.68 x 109 with normal differential She…A 36-year-old, alcoholic woman presents with a 1-week history of yellow skin and sclerae. She has suffered persistent headaches. Her vital signs are normal. Physical examination reveals jaundice. Laboratory studies disclose markedly elevated levels of AST and ALT (956 and 1,400 UIL. respectively). A few days later, she develops hepatic encephalopathy and renal failure. A liver biopsy shows prominent centrilobular necrosis. Which of the following is the most likely diagnosis? (A) Acetaminophen toxicity (B) Fatty liver of pregnancy (C) Metastatic carcinoma (D) Reye syndrome (£) Wilson diseaseA 52 yo woman who for the last couple of days has been vomiting small amounts, and has had abdominal pain. The pain has become more severe in the last 8 hours. She expresses surprise at her vomiting because she has eaten and drunk very little. She has not had a bowel movement in 2 days. Her medical history shows abdominal surgery for a hysterectomy twelve months ago, on a background of severe endometriosis. Vital signs: RR: 16 bpmSpO2: 99% BP: 110/60 mmHg (MAP 77 mmHg) HR: 118 bpmTemp: 37 oC Pain assessment: P = upon movement and at restQ = aching with occasional stabbing painR = peri umbilical (central abdomen)S = 8/10T = Constant for last 48 hours Abdominal assessment: Inspection – distension, midline scarAuscultation – absent bowel soundsPalpation – general tenderness and guardingPercussion – gas-induced tympany Fluid status assessment: Weak pulses Pale and cool to the touchCap refill > 3secsReduced skin turgor – tongue furrowedDry mucous…