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NSG550 Diagnostic Reasoning for Nurse Practitioners

Module 8 Discussion

A 42-year-old Hispanic woman presents to the primary care office complaining of 24 hours of steady epigastric and right upper abdominal pain with sudden onset and several episodes of nausea and vomiting. She has experienced similar painful episodes in the past, usually in the evening following heavy meals, but the episodes always resolved spontaneously within hours. This time the pain did not improve, so she sought medical attention. She has no medical history and takes no medications. She is married, has three children, and does not drink alcohol or smoke cigarettes.

On examination, she is febrile, tachycardic with a heart rate of 104 bpm, blood pressure 115/74 mm Hg, and shallow respirations of 22 breaths per minute. She is moving uncomfortably on the stretcher, her skin is warm and diaphoretic, and she is jaundiced. Her abdomen is soft, mildly distended with marked right upper quadrant and epigastric tenderness to palpation; muscle guarding and rebound tenderness; hypoactive bowel sounds; and no masses or organomegaly appreciated.

What is the probable diagnosis?

What are other possible diagnoses?

At this stage of the case study, what diagnostic studies and basic treatments are most appropriate to order and why?

Please be specific and precise with answers. A table format or bullet points would be beneficial in presenting your information with clarity or organization.

Reference for management of the case study:

Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459328/

Reference most current articles for each category.