<p> Gastrointestinal Disorder Case Study #3</p><p>MP a 56-year-old general contractor who is admitted to your telemetry unit directly from his internist’s office with a diagnosis of chest pain. On report, you are informed that he has an intermittent 2-month h/o of chest tightness with substernal burning that radiates through to the mid-back intermittently, in a stabbing fashion. Symptoms occur after a large meal; with heavy lifting at the construction site; and in the middle of the night when he awakens from sleep with coughing, SOB, and a foul, bitter taste in his mouth. Recently he has developed N, without emesis, worse in the morning or after skipping meals. He c/o “heartburn” 3 or 4 times a day. He takes a couple Rolaids or Tums. He keeps a bottle at home, at the office, and in his truck. VS at his physician’s office were 130/80 lying, 120/72 standing, 100, 20, 98.6˚F. Pulse Ox is 92% on room air. A 12-lead EKG showed normal sinus rhythm with a rare premature ventricular contraction (PVC).</p><p>1. What are some common causes of chest pain?</p><p>MP indicates that usually the chest pain is relieved with his antacids, but this time they had no effect. A “GI cocktail” consisting of Mylanta and viscous lidocaine given at the physician’s office briefly helped decrease symptoms. </p><p>2. What was the purpose and giving MP the Mylanta and lidocaine? How do these drugs work?</p><p>MP has smoked 1 ppd for the past 35 years, drinks 2 or 3 beers on most nights, and has noticed a 20 pound weight gain over the past 10 years. He feels “so tired and old now.” MP has dark circles under his eyes and c/o daytime fatigue. His wife is even sleeping in another bedroom because he is snoring so loudly. He also reinjured his lower back a month ago at work lifting a pile of boards, so his physician prescribed Ibuprofen 800 mg bid or tid for 4 weeks.</p><p>Gastrointestinal Disorders – Case Study #3 3. Change the pounds that he gained into kg.</p><p>4. Which factors in MP’s life are likely contributing to his chest pain and nausea? Explain how.</p><p>5. What is a hiatal hernia, and what is its role in GERD?</p><p>MP’s 12-lead EKG was normal, and the first set of cardiac enzymes were normal. CBC showed an elevated WBC (6,000), Hgb 15, Hct 47%, platelets 220,000. Chem profile revealed Na+ 140, K+ 3.8, BUN 20, Creatinine 1.0. The CXR showed no abnormalities. MP begins to c/o N; as you hand him a bath basin, he promptly vomits coffee-ground emesis with specks of bright red blood. VS remain stable.</p><p>6. What did MP vomit and why?</p><p>You inform your charge nurse. The gastroenterologist gives several orders and states he will be there in 45 minutes. The orders are as follows:</p><p>NPO status for emergent EGD STAT CBC</p><p>O2 by NC Type and Cross (T&C) for 2 units of PRBC’s and hold Start a Protonix drip at 8 mg/hr Insert an NGT and start a gastric lavage with water or saline Insert 2 large bore IV’s and start NS (normal saline) @ 100 ml/hr</p><p>7. Explain the rationale for each of the preceding orders .</p><p>8. Making two columns list drugs that will decrease HCL acid production/output (what is their classification) and drugs that will neutralize HCl acid/raise the gastric pH (what is their classification)? </p><p>Gastrointestinal Disorders – Case Study #3</p>