Reply 1- Erika- When a patient has diarrhea there are several good questions that can give the caregiver an idea of the origin of the problem. Dunphy, VVinland-Brown, Porter, & Thomas, (2015) discussed how there is different types of diarrhea that include osmotic, secretory, morphological changes or altered intestinal motility. However, learning some background data can help. Assessing the abdominal cavity would be important to rule out any abnormal physical findings. A diet history, water drinking sources, medications, medical surgical history, sexual practices, social history and even family history are all pertinent information to obtain to help determine causes of diarrhea (Dunphy, Winland-Brown, Porter, & Thomas, 2015). A few questions that can be asked include:
When did this problem start? Is this new? Does it come and go intermittently? How long has this been going on for? Have you traveled out of country? How often do you normally go? Is there anything that makes it worse? What color is the stool? What is the consistency? Is there a distinct smell? How many times a day are you going? Are there any other symptoms involved fever, nausea, vomiting or pain? Or anything else? Have you noticed the diarrhea to worsen with certain foods? Which foods?
Diagnostic testing can include running stool testing such as stool cultures, stool leukocytes. ova and parasites, stool sodium hydroxide (Dunphy et al., 2015). Labs that include blood draw could be a complete blood count to check for infectious idiopathy. Other labs include starting with anti TTG IgA and total IgA and serum IgG anti-glidin antibodies (Bakerman, 2014). Furthermore, invasive testing would include colonoscopy or proctoscopy exam (Dunphy et al., 2015).
The choice of treatment or handling abnormal results will depend on what results findings. For diarrhea, treatment includes fluid replacement, electrolyte management, anti-motility drugs it the origin is non-viral or bacterial (Dunphy et al., 2015). In cases where there is infection uses of antibiotics would be treatment. For severe cases like c-difficile, iv antibiotics would be required (Dunphy et al.,2015). Dunphy et al. (2015) explained that in more severe cases with pathogenic infection origins can require biopsy of intestinal mucosa to determine which antibiotic will be best.
The list of differentials would include chronic vs acute diarrhea. gastroenteritis, traveler’s diarrhea, irritable bowel syndrome, cram’s, ulcerative colits, c-diff and celiac disease. With testing many of the diagnosis could be ruled out. In a study performed. almost a quarter of healthcare professionals prefer to wait at least a 24-hour period before deciding to move forward with treatment of diarrhea (Mcintosh, Swanson & Howell (2001). All the information collected would be important to determine the route of treatment.
Reference Bakerman, S. (2014). ABC’s of interpretive laboratory data (5th ed.). Scottsdale, AZ: Interpretive Laboratory Data Inc. Dunphy. L. M.. Winland-Brown, J. E., Porter, B. 0., Thomas, D. J. (2015). Primary Care: The Art and Science of Advanced Practice Nursing (4th ed.). Philadelphia. PA: F. A. Davis Company McIntosh IB. Swanson V. & Howell K. (2001). Health professionals’ attitudes toward acute diarrhea management. Journal of Travel Medicine, 8(2), 60-65.
Reply 2 -Alexandria – Diagnostic Reasoning and Rationale for acute illness
Pharyngitis
Pharyngitis. or sore throat. is discomfort. pain, or scratchiness in the throat. It often makes it painful to swallow.
What questions need to be asked and what body part needs to be examined? How long have you had the symptom? This question will give the Clinician a better idea of the contagion period if it is a bacterial or viral infection. Have you had the symptom before — if so. what was done about it? This question will help determine if this is a reoccurring disease process as well as what past treatment was initiated and what the results were. How bad is the symptom? This question will give the clinician a base for the patients pain level to manage the pain associated with this disease Are the symptoms constantly present or does it come and go? This question will help the clinician establish the pattern of the symptoms and pain. How do the symptoms affect how your feel?
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