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Social history

  • April 14, 2021
  • Manyara2021
  • 383

High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis. Mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea.
Cardiovascular: No edema. No palpitations.
Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored
ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal
Assessment:
Primary Diagnosis: Recurrent H. Pylori infection gastritis
Secondary Diagnoses: Dyspepsia
Differential Diagnosis: Peptic Ulcer Disease
Previous medication plan: two months ago and failed.
Clarithromycin      500 mg po BID for 2 weeks
Omeprazole      40 mg po BID for 2 weeks and then po daily.
Cipro      500 mg po BID for 2 weeks
Plan: Tests
Pt had EGD done 2 weeks ago that showed H. Pylori positive gastritis in biopsy results.
Urea breath test 8 weeks after treatment with H. Pylori medications. Pt needs to stop PPI’s 2 weeks prior to Urea Breath test.
Labs: No new labs are needed.
Referrals: may refer based on effect of medication therapy given for 2 weeks.
Follow up: return to office in 8 weeks to reevaluate symptoms.
 
As a future nurse practitioner, it is important that you determine the medications used for recurrent H. Pylori infection.
Please discuss new therapy guidelines for H. Pylori treatment, and provide patient education.
Below is the website for the American Academy of Gastroenterology Clinical Guidelines (ACG) for the updated H. Pylori therapy. Feel free to consult other peer-reviewed articles within 5 years of publication.
Total of 2 post needed. 1 initial and 1 reply.
http://gi.org/wp-content/uploads/2017/02/ACGManagementofHpyloriGuideline2017.pdf
List three approaches to message authentication.
3.2 What is a message authentication code?
3.4 What properties must a hash function have to be useful for message authentication?
3.5 In the context of a hash function, what is a compression function?
3.6 What are the principal ingredients of a public-key cryptosystem?
3.7 List and briefly define three uses of a public-key cryptosystem.
3.8 What is the difference between a private key and a secret key?
3.9 What is a digital signature?
 
 

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