Question

In: Nursing

A 47-year-old male patient, who is a house painter and whom you haven't seen in several...

A 47-year-old male patient, who is a house painter and whom you haven't seen in several years, presents

with chronic fatigue and mild chest pain frequently relieved by taking a break from painting. He's

married to a 47-year-old woman with multiple sclerosis and has two married children and one

grandchild living nearby. He also complains of frequent eructation, flatulence, and indigestion after

eating. He was told (when he weighed 30 lbs. less than he does now) that he could control his

hyperlipidemia by diet.

CC: "I'm always tired, and I have this annoying chest pain when I climb a ladder."

Past medical history: Anxiety, cholecystectomy, vasectomy

Vital signs: Blood pressure (BP): 146/88; height, 6 ft; weight, 242 lbs.

Lab results: TC 230; LDL 180; HDL 32

What additional subjective data do you think the patient will share?
What additional objective data will you be assessing for?
What National Guidelines are appropriate to consider?
What tests will you order?
Will you be looking for a consult?
What are the top 3 differential diagnoses and why? What is your final diagnosis? Give rationale.
Are there any legal/ethical considerations in treating this patient
What is your plan of care?
Are there any Healthy People 2020 objectives that you should consider?

Expert Solution

*Ask the patient that do you have persistent pain in the upper right abdomen, nausea and vomitting, as these are the additional informations to be collected for further evaluation for the correct diagnosis.

*patient's psychological status also be assessed.

*Clinical practice guidelines are intended to indicate the best available approach to medical conditions as established by systematic review of available data and expert opinion. Recommendations are not intended to be exclusive given the complexity of the health care environment. These guidelines are intended to be flexible and should be applied with consideration of the unique needs of individual patients and the evolving medical literature. These guidelines are applicable to all physicians who are appropriately credentialed and address the clinical situation in question, regardless of specialty.

*Following are the additional diagnostic evaluations to be performed.

Ultrasound of the abdominal cavity.
General and biochemical blood.
Intravenous cholangiography.
Esophagogastroduodenoscopy for examination of the stomach, duodenum and the area major duodenal papilla.
Retrograde cholangiopancreatography.
Analysis of biliary sludge obtained through endoscopic retrograde cholangiopancreatography (ERCP)
SeHCAT or other test for bile acid diarrhea

*Cardiology consultation needed.

* sphincter of Oddi dysfunction,post-surgical adhesions,biliary microlithiasis andare thepossible diagnosis.

final diagnosis is post cholesystectomy syndrome.Because patient experience symptoms of Dumping syndrome and also all other symptoms usually occurs after many years of cholisystectomy.

*No legal considerations

*

Telephone consultations identified factors that increase the risk of complications after surgery.
Telephone consultations enabled recognition of potential patients for delayed surgical recovery.
Telephone consultations helped perioperative nurses provide accurate interventions to prevent or mitigate delayed recovery
Telephone consultations identified factors that increase the risk of complications after surgery.
Telephone consultations enabled recognition of potential patients for delayed surgical recovery.
Telephone consultations helped perioperative nurses provide accurate interventions to prevent or mitigate delayed recovery.
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