NSG6320 Practicum I: Adult Health,Adults & Gerontology Essay

NSG6320 Practicum I: Adult Health,Adults & Gerontology Essay

Case 1: A forty-nine-year-old healthy Caucasian female has her routine labs done, which reveal the following:

• ALT 381 ↑↑
• AST 184 ↑↑
• ALP 64
• GGT 14
• Alb, INR, platelets normal

She has had liver tests in the past and her ALT and AST fluctuate from normal to 300 s.

Autoimmune markers negative. She is on no meds.

What is your next best action to take and why? Further history?

Liver function tests help determine the health of the patient’s liver by measuring levels of bilirubin, liver enzymes, and proteins in the blood. AST and ALT tests are used to measure the enzymes which are released by the liver in response to a disease or damage (Martin & Friedman, 2018). From the provided history, the ALT and AST levels are elevated. As such, further evaluation of the patient’s condition is necessary as this indicates possibilities of liver disease or damage. It is necessary to evaluate the possibilities of chronic liver diseases like chronic hepatitis C and Cirrhosis as they are associated with mildly elevated ALT and AST levels. The elevated liver enzyme might as well result from non-hepatic medical conditions like acute muscle injury and polymyositis among others. As such, it will be necessary to conduct a thorough physical examination of the patient’s liver and evaluate whether the patient is susceptible to hepatitis B viral infection, and drug hepatotoxicity. Further patient history such as associated symptoms, medical history, family history for hepatic disorders, allergic response, social history, reproductive history, history of sexually transmitted infections, and drug use are needed for further assessment of the patient’s condition.

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Diagnostics? What are some of your differentials?

Elevated ALT and AST levels primarily indicate the presence of liver disease as a result of hepatocyte damage. Some of the conditions which the patient might be suffering from include acute cholecystitis and biliary colic,  pancreatitis, alcohol liver disease, and hepatitis among others (Cai et al., 2020). Further evaluation of the patient’s symptoms and diagnostic tests will however reveal the actual liver disease the patient is suffering from. For instance, Serologic tests for hep B by determining the surface antigen, in addition to hep B core antibody (anti-HBc) immunoglobulin M (IgM) are needed to determine whether the patient is suffering from an infection caused by acute hepatitis B virus (HBV). Positive results for HBsAg will indicate both acute and chronic HBV infection.

Case 2: Mrs. Keppy is a fifty-five-year-old married female who comes to your office because her husband was recently diagnosed with hepatitis C. She wants to know if she should be tested and what she can expect from her husband’s diagnosis. What will you say to her regarding her risk factors and her husband’s treatment and prognosis?

Hepatitis C is a rare viral infection characterized by inflammation of the liver and can result in significant damage to the liver. The mode of transmission of the infection is through blood contaminated with the virus (Ford et al., 2018). Most patients are normally asymptomatic, hence have no idea whether they have the disease, as symptoms take time to appear. In the case study above, it is highly recommended that Mrs. Keppy gets tested for Hep C virus, but the decision is entirely up to her. She is at high risk of being exposed to the virus if her blood gets into contact with that of her husband. Consequently, early diagnosis of the disease is associated with a better prognosis as a result of timely treatment. The treatment therapy involves the use of direct-acting antiviral (DAA) tablets, which are very effective in clearing the virus from the patient’s body, with a success rate of 90% within 8 to 12 weeks of medication. About 30% of people with the infection however clear the virus from their body without any treatment within 6 months.

References

Cai, Q., Huang, D., Yu, H., Zhu, Z., Xia, Z., Su, Y., … & Xu, L. (2020). COVID-19: Abnormal liver function tests. Journal of hepatology, 73(3), 566-574. https://doi.org/10.1016/j.jhep.2020.04.006

Ford, M. M., Jordan, A. E., Johnson, N., Rude, E., Laraque, F., Varma, J. K., & Hagan, H. (2018). Check Hep C: a community-based approach to hepatitis C diagnosis and linkage to care in high-risk populations. Journal of Public Health Management and Practice, 24(1), 41-48. https://doi.org/10.1097/PHH.0000000000000519

Martin, P., & Friedman, L. S. (2018). Assessment of liver function and diagnostic studies. In Handbook of liver disease (pp. 1-17). Elsevier. ISBN: 9780323478823

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For this assignment, you will review the latest evidence based guidelines as they pertain to the case below. Discussion of the case is based on the course objectives and weekly content, which emphasize the core learning objectives for an evidence-based primary care curriculum.
Tasks:
Case 1
A forty-nine-year-old healthy Caucasian female has her routine labs done, which reveals the following:
• ALT 381 ↑↑
• AST 184 ↑↑
• ALP 64
• GGT 14
• Alb, INR, platelets normal
She has had liver tests in the past and her ALT and AST fluctuate from normal to 300 s.
• Autoimmune markers negative. She is on no meds.
o What is your next best action to take and why? Further history?
o Diagnostics? What are some of your differentials?
Case 2
Mrs. Keppy is a fifty-five-year-old married female who comes to your office because her husband was recently diagnosed with hepatitis C. She wants to know if she should be tested and what she can expect from her husband’s diagnosis. What will you say to her regarding her risk factors and her husband’s treatment and prognosis?
As in all assignments, cite your sources in your work and provide references for the citations in APA format.

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SUO Discussion Rubric (20 Points) – Version 1.2

Course: NSG6320-Practicum I: Adult Health – Adults & Gerontology CP02

Response	No Submission 0 points	Emerging (F-D: 1-4) 4 points	Satisfactory (C: 5- 6) 6 points	Proficient (B: 7-8) 8 points	Exemplary (A: 9- 10) 10 points	Criterion Score
Quality of Initial Posting	No initial posting exists to evaluate.	The information provided is inaccurate, not	The information provided is accurate, giving a basic	The information provided is accurate, displaying a good	The information provided is accurate, providing an in-	/ 10
		focused on the	understanding of the	understanding of the	depth, well thought-
		assignment’s topic,	topic(s) covered. A	topic(s) covered. A	out understanding
		and/or does not	basic understanding	good understanding	of the topic(s)
		answer the	is when you are able	is when you are able	covered. An in-
		question(s) fully.	to describe the	to explain the terms	depth understanding
		Response	terms and concepts	and topics covered.	provides an analysis
		demonstrates	covered. Despite	Initial posting	of the information,
		incomplete	this basic	demonstrates	synthesizing what is
		understanding of the	understanding,	sincere reflection	learned from the
		topic and/or	initial posting may	and addresses most	course/assigned
		inadequate	not include	aspects of the	readings.
		preparation.	complete	assignment,
			development of all	although all
			aspects of the	concepts may not be
			assignment.	fully developed.

 

Participation

No Submission 0 points

Emerging (F-D: 1-2) 2 points

Satisfactory (C) 3 points

Proficient (B) 4 points

Exemplary (A:) 5 points

Criterion Score

 

Participation	No Submission 0 points	Emerging (F-D: 1-2) 2 points	Satisfactory (C) 3 points	Proficient (B) 4 points	Exemplary (A:) 5 points	Criterion Score
Participation in Discussion	No responses to other classmates were posted in this discussion forum.	May include one or more of the following: *Comments to only one other student’s post. *Comments are not substantive, such as just one line or saying, “Good job” or “I agree. *Comments are off topic.	Comments to two or more classmates’ initial posts but only on one day of the week. Comments are substantive, meaning they reflect and expand on what the other student wrote.	Comments to two or more classmates’ initial posts on more than one day. Comments are substantive, meaning they reflect and expand on what the other student wrote.	Comments to two or more classmates’ initial posts and to the instructor’s comment (if applicable) on two or more days. Responses demonstrate an analysis of peers’ comments, building on previous posts. Comments extend and deepen meaningful conversation and may include a follow-up question.	/ 5

 

 

Writing

No Submission 0 points

Emerging (F-D: 1-2) 2 points

Satisfaction (C) 3 points

Proficient (B) 4 points

Exemplary (A) 5 points

Criterion Score

 

Writing	No Submission 0 points	Emerging (F-D: 1-2) 2 points	Satisfaction (C) 3 points	Proficient (B) 4 points	Exemplary (A) 5 points	Criterion Score
Writing Mechanics (Spelling, Grammar, Citation Style) and Information Literacy	No postings for which to evaluate language and grammar exist.	Numerous issues in any of the following: grammar, mechanics, spelling, use of slang, and incomplete or missing citations and references. If required for the assignment, did not use course, text, and/or outside readings (where relevant) to support work.	Some spelling, grammatical, and/or structural errors are present. Some errors in formatting citations and references are present. If required for the assignment, utilizes sources to support work for initial post but not comments to other students. Sources include course/text readings but outside sources (when relevant) include non- academic/authoritati ve, such as Wikis and .com resources.	Minor errors in grammar, mechanics, or spelling in the initial posting are present.   Minor errors in formatting citations and references may exist. If required for the assignment, utilizes sources to support work for both the initial post and some of the comments to other students. Sources include course and text readings as well as outside sources (when relevant) that are academic and authoritative (e.g., journal articles, other text books, .gov Web sites, professional organization Web sites, cases, statutes, or administrative rules).	Minor to no errors exist in grammar, mechanics, or spelling in both the initial post and comments to others. Formatting of citations and references is correct. If required for the assignment, utilizes sources to support work for both the initial post and the comments to other students. Sources include course and text readings as well as outside sources (when relevant) that are academic and authoritative (e.g., journal articles, other text books, .gov Web sites, professional organization Web sites, cases, statutes, or administrative rules).	/ 5

Overall Score