Gastroenterology Disorder in Elderly Male Patient

Analysis of the Disorder

The abnormal physiological processes linked to dissimilar digestive system disorders are intricate. As evident in the case of the sixty-year-old Italian man, queasy stomach, heartburn, and nausea are the most common indications in such disorders. A comprehensive knowledge of the pathophysiology of the digestive system disorders, as for numerous other gastrointestinal disorders, integrates biological and psychosocial aspects such as playing a critical function in the conception, in addition to propagation of symptoms. Heritable, autonomic, mental, hormonal, and environmental aspects could have resulted in the disorder and for many of such aspects evidence is extremely strong. On the contrary, it is improbable that a single aspect could clarify the pathophysiology of the disorder in the patient as it is deemed an intricate interaction of different aspects (Tack et al., 2012).

The symptoms of the disorder the Italian man in the case is suffering from encompass heartburn, acute abdominal pain, gout, queasy stomach, and nausea. There was no vomiting or blood in the stool. Nonetheless, the symptoms could be misconstrued and their impact and implication misapprehended by both healthcare professionals and the patient. This explains why the Italian man is being treated for different illnesses such as hypertension, gout, and hypercholesterolemia. The Italian man is noncompliant with the prescribed medication since he is worried about the side effects, and he appears to be taking an overdose of Indocin as a way of his addressing the gout problem. Digestive system disorders are common though poorly comprehended and (as evident in the case) normally prove discouraging to health care professionals and patients (Walker, Sherman, Bruehl, Garber, & Smith, 2012). Some of the challenges emanating from limited medical trials for such disorders encompass the patient being subjected to costly checks on the lookout for elusive organic diseases.

In a bid to realize the diagnosis of the disorder, the caregiver carried out a comprehensive and accurate social, family, and medical history while taking note of the symptoms experienced by the patient and any other relevant details (Tack et al., 2012). Physical examination was done on the patient to assist in the evaluation of the problem more entirely. Moreover, the Italian man was required to undertake a more thorough diagnostic assessment, which comprised of laboratory tests, radiological studies, and electrocardiogram tests. As treatment options for the disorder, the Italian man purchases over-the-counter (OTC) drugs (antacids) in the remedy of heartburn. Moreover, the Italian man is using non-steroidal anti-inflammatory drugs in the management of gout problems. The prescribed medications encompass Indocin 50 mg, after every six hours when necessary to manage gout symptoms, Zocor 20 mg, two times in a day, and Propranolol 50mg, three times in a day.

Difference of the Disorder from Normal Development

The disorder has resulted in the patient having a range of symptoms such as abdominal pain, gout, and depression to mention a few. The difference of the disorder from normal development lies in the fact that unlike in a normal case, the disorder results in pain, which could at times be so intense that it turns out to be the major concentration of the patient’s life thus resulting in other effects such as depression. The disorder does not just affect the quality of life but has created a vital economic effect too. Studies affirm that a disorder has the potential of making an individual lose at least 12 working days in a year because of ill health (Hartono, Mahadeva, & Goh, 2012).

Physical and Psychological Demands

Some of the potential physical and psychological demands that the disorder places on the patient and his family members encompass the ones listed below:

  1. Stress, worry, and anxiety
  2. Depression
  3. Fear of death
  4. Panic
  5. Poor mobility
  6. Low self-worth
  7. Frustration
  8. Fretfulness and impatience

It is evident from the case that both the patient and his wife are exceedingly worried about his health. The patient is even speculating having cardiac arrest since his father passed away at a similar age. The patient feels that he has led an excellent life and would not need it fade away early. Although he becomes anxious fast, he tries hard not to express it. The affected physical and psychological aspects are gradually leading the patient to a sedentary way of life with the progressive loss of physical activity. This could ultimately result in social segregation and incapacity to engage in different activities in life. Attributable to the responsibility of caring for the patient, the family members could experience similar psychological and physical demands as the ones the patient experiences (Hartono et al., 2012).

Major Concepts to Be Shared With the Patient and Family

Fears of the patient could be managed through excellent communication engaging the patient and family members in the sharing of concepts. This could make the patient feel more knowledgeable and in control. The patient ought to share his worries and anxiety with his family and this could have the benefit of making the members of family cater for his needs, help him determine the aspects that appear to have impacts on his symptoms, and deliberate with him to develop a lasting plan to manage the disorder. In addition, the patient could share concerns such as the desire of being served by a different caregiver for suitable referral arrangements to be made if necessary. The members of the family ought to support the patient in building up ideas before presenting their thoughts and further information that they could require. The significant thing is giving the patient the chance to approve or reject opinions and make the ultimate resolutions on what objective to attempt (Sperber et al., 2014).

Major Interdisciplinary Team Workforce Required and the Way the Team Will Offer Care

Competent interdisciplinary team personnel assist in the successful communication with the patients, which will assist in the provision of care to realize the most favorable disorder management and results (Sperber et al., 2014). Nevertheless, some incompetent personnel do not have the comprehension of the manner in which to communicate with the patients to offer care for the disorder. Major and competent interdisciplinary personnel are the ones that give attention, listen to, and assist the patient in the identification of the aspects that contribute to the disorder. For the provision of optimal care, the interdisciplinary team personnel should make the patient gain the understanding that the disorder is serious but manageable. If the patient does not understand the seriousness of the problem, he might never make modifications to better his health. Moreover, the interdisciplinary team personnel should inform the patient of the different options in the management of the disorder. For instance, the disorder could be managed through the application of diet, exercise, and medication. In this regard, the patient could prepare with respect to the costs and benefits of every option to avoid being caught off guard.

Facilitators and Obstacles to the Most Favorable Disorder Management and Results

Compliance with care and adherence to the prescribed medications are the greatest facilitators in the optimal management of care (Sperber et al., 2014). On the contrary, noncompliance is amid the challenges that caregivers have to manage for quality care. In addition, gastrointestinal disorders are wide ranging. The disorders are related to several symptoms such as nausea, abdominal problems, and pain, in addition to disordered bowel behaviors to mention a few. The strength of the disorders could vary from infrequent signs to regular ones. Currently, for the majority of gastrointestinal disorders, there is no identified cause thus the capacity to diagnose them suitably is at times difficult. This could result in caregivers trying to handle the wrong disorder, which could lead to delayed management of the actual disorder. Moreover, some of the current health care methods are not planned with the consideration of the patient and do not empower patients with respect to engaging in the management of their conditions. Such approaches obstruct the quality of care and could lead to unsuccessful caregiver-patient affiliations.

Strategies to Triumph over the Recognized Barriers

Some of the approaches that could assist in the overcoming of barriers in the management of disorder encompass allowing the patient to embark on an active role in the management of care (Sperber et al., 2014). The patient could also take medication that prevents or handles the onset of some symptoms. This could be achieved through close collaboration with the caregiver to know the right medications for the management of the disorder. Moreover, the patient could join hands with the caregiver in the designing and application of a care plan to address the disorder and enhance the quality of life. When the patient is supported in the engagement of disorder management, he realizes the quality of care and the finest results. Finally, since it is hard for the patients to perform what they do not understand, the first stride in encouraging patients to engage in care management is through educating them.

Care Plan

Patient Initials: ______ Age: ______60_________ Sex: _____Male______

Subjective Data

Client Complaints:

  • Acute umbilical pain, which began after eating

HPI (History of Present Illness):

  1. Acute abdominal pain
  2. Bothering hunger pains in the umbilical region
  3. Nausea
  4. Fever
  5. Heartburn, which would at times be relieved after taking over-the-counter antacids
  6. Contemplating heart attack

PMH (Past Medical History):

  1. Under the treatment of hypertension, gout, and hypercholesterolemia
  2. Has had stomach problems when he was young
  3. An Upper Gastrointestinal back was done
  4. Had appendectomy 2 decades ago
  5. Has been taking non-steroidal anti-inflammatory drugs to manage gout symptoms
  6. Persistent queasy stomach
  7. Heartburn, which he is managing with OTC medications
  8. Nausea
  9. No identified drug allergies

Significant Family History:

  1. He has two brothers, and both have high cholesterol and blood pressure
  2. The medical problems of the two brothers began in their early fifties
  3. Considerable record of gout in the family

Social/Personal History:

  1. A retired teacher
  2. Conducts some teaching with no official endorsement
  3. Gets teachers’ pension
  4. Has a health insurance cover
  5. Desires being active but has developed gout problems
  6. He does not see the need to modify his lifestyle to become healthier
  7. Walks a day or two in a week
  8. He does not smoke, denies the use of drugs, but takes wine each night, at times to excess
  9. Despite his wife making healthy foods in the house, he finds himself taking junk food regularly

Description of Client’s Support System:

  1. His wife and former colleagues create his support systems
  2. His wife runs a grocery business
  3. Together, they generate around 50,000 US dollars per annum

Behavioral or Nonverbal Messages:

  1. He feels he has an excellent life and would not like it to end early
  2. Does not have unnecessary stress and his expectation is that something will be done for his treatment

Client Awareness of Abilities, Disease Process, and Health Care Needs:

  1. He is not socially isolated and desires to engage in community activities as a way of managing depression
  2. Becomes anxious very simply
  3. He desires to undertake more activities, but his pain is detrimental
  4. Likes going to meet his caregiver though he views it as a social experience

Objective Data

Vital Signs including BMI:

  • Blood Pressure right arm sitting 175/70; Temperature: 99 po; Pulse: 64 regular; Breathing: 18 and not labored

Physical Assessment Findings:

  1. Head, Eye, Ear, Nose and Throat examination: within the normal range
  2. Abdomen: Positive Bowel Sounds in all quadrants. Similar to percussion all through. Prickly pain with tactual exploration in the epigastric area, continuing to the back. No Holo-Systolic Murmur. No peritoneal symptoms.
  3. Rectum: Light brown stool and Hemoccult negative
  4. Carotid bruit: No bruits
  5. Extremities, Encompassing Pulses: 2+ pulses all through, not edema
  6. Heart: Regular Rate and Rhythm without murmur
  7. Lungs: Clear to auscultation
  8. Lymph Nodes: Not palpated

Lab Tests and Results:

  1. Complete Blood Count: within the normal range
  2. Liver Function Tests: within the normal range
  3. Helicobacter pylori: Positive
  4. Amylase and Lipase: within the normal range

Radiological Studies:

  • Ultrasound of the abdomen: The liver and gall bladder are normal

Electrocardiogram Interpretation:

  • Electrocardiography: Normal sinus rhythm

Client’s Support System:

  1. The wife has osteoarthritis, which hinders her capacity to be active
  2. His wife is worried about his health just as he is

Client’s Locus of Control and Readiness to Learn

Though elderly, the patient has remained physically and psychologically active thus characteristically reporting considerable degrees of well-being. For believing that he could control the events affecting him (such as heartburn problems) the Italian man is purchasing OTC medications. The client is noncompliant with the stipulated medication since he is worried about the side effects of the drugs. Moreover, he has taken up alternative therapy as he contemplates depression. His readiness to learn is evident when he becomes concerned about his symptoms. The patient does not suffer social segregation and desires to engage in community endeavors as he believes it would be beneficial in curing his depression. Despite his pain being detrimental, he desires and tries doing more activities such as walking a day or two in a week.

ICD-9 Diagnoses/Client Problems

From the tests and examination done on the patient, it is evident that he is suffering from gastrointestinal disorders, also referred to as digestive disorders. A number of disorders simultaneously influence different sections of the gastrointestinal system while others influence just a single section or organ. With respect to the results of the physical examination, medical history, and laboratory tests (such as H. pylori positive and no blood in stool), it is evident that the patient is suffering from non-ulcer dyspepsia (Bassotti et al., 2014). The conducted tests are vital with respect to assisting the caregiver in the location, diagnosis, and treatment of the disorder.

Advanced Practice Nursing Intervention Plan

Patient Details Caregiver Details
Medicaid Number: Medicaid Number:
Name: Name:
Date of Birth: Care Plan Date: 25-2-15
Collaborations Engaged Follow-up Plans
Nurse Regular phone calls in the course of the first month of seeking treatment, after that, when necessary, but no less than once in three months
Family Request his wife, children, or any other relative to assist him complete report form regularly for the first month after treatment, and then as required.
Medications Dose Frequency Indication
Indocin 50 mg After every 6 hours, when necessary Gout
Zocor 20 mg Two times in a day
Propranolol 50 mg Three times in a day
Symptom:Intermittent heartburn for some weeks, nausea, no vomiting, no blood in the stool, depression.
Long Term Goal:Some symptoms such as depression, gout, and abdominal pains will be considerably decreased and will not hinder the patient’s operations. Depression will be assessed through a t score of 60 or less on Depressed scale.
Expected completion date: 21-10-15
Short Term Goals: Date Established Date
Completed
Date Achieved
  1. The caregiver, patient, and family members will develop a plan of care
25-2-15 25-2-15 25-2-15
  1. The patient will report no heartburn for three consecutive weeks
25-2-15 18-3-15
  1. The patient will report no queasy stomach for three consecutive weeks
25-2-15 15-4-15
  1. The patient will report that pain is reduced to a comfort level (3 or 4)
25-2-15 21-10-15
Action/Intervention Responsible Individual(s) Scientific Rationale
  1. Evaluate location and strength of pain in addition to alterations in its characteristics each hour
  1. The patient
  2. His wife
The evaluation of the position and degree of pain and character change prepares the caregiver to potential problems, for instance, the progression of gout or abdominal pains (Bassotti et al., 2014).
  1. Instruct the patient on the appropriate application of Patient-Controlled Analgesia, in addition to successful pain management approaches
  1. The caregiver
Even with the uptake of medication, pain may not disappear at once but could proceed gradually. Nevertheless, there could still be some affected areas giving an actual sensation of pain (Schurman, Kessler, & Friesen, 2014). Making the patient aware that such occurrences are normal cannot alleviate the pain but will decrease anxiety after medication. The knowledge of when drugs could be taken with respect toPatient-Controlled Analgesia is critical to pain management. Addressing pain early enough prevents it from proceeding past the tolerance level of the patient.
  1. Take PRN (as needed) medications as stipulated for the alleviation of pain, using opioid, in addition to non-opioid medications.
  1. The patient
  2. His wife
Taking of other pain-relieving medications, opioid and non-opioid, will enhance the success of pain administration. Some medications such as non-steroidal anti-inflammatory drugs will assist in reducing swelling and decreasing pain (Bassotti et al., 2014).
Evaluation Date: Progress:
Evaluation Date: Progress:
Involvement of family: The patient’s wife and children will take part in family therapy and follow through his health condition. His wife will officially and unofficially examine her husband’s symptoms, difficulties, progress, and taking of medications. His children will assist him in the execution of new activities and getting more active as will be instructed.
Services Required past scope of the program: Medication management by his personal doctor
Expected Completion date for intensity of care:
21-10-15
Patient Signature:
Caregiver Signature:
Caregiver Name/Title:

References

Bassotti, G., Antonelli, E., Villanacci, V., Salemme, M., Coppola, M., & Annese, V. (2014). Gastrointestinal motility disorders in inflammatory bowel diseases. World journal of gastroenterology: WJG, 20(1), 37-44.

Hartono, J. L., Mahadeva, S., & Goh, K. L. (2012). Anxiety and depression in various functional gastrointestinal disorders: Do differences exist? Journal of digestive diseases, 13(5), 252-257.

Schurman, J. V., Kessler, E. D., & Friesen, C. A. (2014). Understanding and treatment of chronic abdominal pain in pediatric primary care. Clinical pediatrics, 53(11), 1032-1040.

Sperber, A. D., Gwee, K. A., Hungin, A. P., Corazziari, E., Fukudo, S., Gerson, C., & Whitehead, W. E. (2014). Conducting multinational, cross‐cultural research in the functional gastrointestinal disorders: Issues and recommendations. A Rome Foundation working team report. Alimentary pharmacology & therapeutics, 40(9), 1094-1102.

Tack, J., Camilleri, M., Chang, L., Chey, W. D., Galligan, J. J., Lacy, B. E., & Stanghellini, V. (2012). Systematic review: Cardiovascular safety profile of 5‐HT4 agonists developed for gastrointestinal disorders. Alimentary pharmacology & therapeutics, 35(7), 745-767.

Walker, L. S., Sherman, A. L., Bruehl, S., Garber, J., & Smith, C. A. (2012). Functional abdominal pain patient subtypes in childhood predict functional gastrointestinal disorders with chronic pain and psychiatric comorbidities in adolescence and adulthood. PAIN®, 153(9), 1798-1806.

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