week 8

 Support with 1 journals no earlier than 5 years.   H. Pylori infection      Questions: As an NP student, needs to actuate the medications for alternate H. Pylori infection.  According to the ACC/AHA Guidelines, what medication should this accommodating be prescribed? Write her complete prescriptions application the decree autograph format.     ACC/AHA Guidelines  Chief complaint: “ I accept alternate H. Pylori infection”.   HPI: M.C. a 46-year-old hispanic changeable presents to the GI dispensary for complaint of alternate H. Pylori infection. She was advised about 2 ½ months ago with H. Pylori amateur analysis and bootless treatment. She has pmhx of dyspepsia, GERD.   She additionally indicates that she has noticed that her affection of dyspepsia are deepening for accomplished 2 months. She has associated her affection with nausea, agitated abdomen with all foods.   Denies associated affection of hematochezia, melena, hemoptysis, belly pain, fever, chills, affliction or any alternative symptoms.   PMH:   H. Pylori infection gastritis  Diabetes Mellitus, blazon 2  Surgeries: None  Allergies: NKDA  Vaccination History:  She receives an anniversary flu shot. Last flu attempt was this year        Social history:  High academy graduate, affiliated and no children. He frequently eats out in restaurants. He drinks one 4-ounce bottle of red wine daily. He is a above smoker that chock-full 3 years ago.  Family history:  Both parents are alive. Father has history of DM blazon 2, Tinea Pedis.   mother animate 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 belly pain.  Skin: No lesions. No rash. No itching.   Psychiatric: No anxiety. No depression.   Physical examination:  Vital Signs  Height: 5 anxiety 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored  HEENT: Normocephalic/Atraumatic, PERRL, EOMI; No teeth accident seen. Gums no redness.   NECK: Neck supple, no apparent masses, no lymphadenopathy, no thyroid enlargement.  LUNGS: Lungs bright bilaterally. Equal animation sounds. Symmetrical respiration. No respiratory distress.   HEART: Accustomed S1 with S2 during expiration. Pulses are 2+ in high extremities. No edema.  ABDOMEN: No belly distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Accustomed contour; No apparent masses.  GENITOURINARY: No CVA amore bilaterally. GU assay deferred.   MUSCULOSKELETAL: Slow amble but steady. No Kyphosis.  SKIN: Dry. Intact.    PSYCH: Accustomed affect. Cooperative.   Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine accustomed 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 accustomed  A:  Primary Diagnosis: Alternate H. Pylori infection gastritis  Secondary Diagnoses:  Dyspepsia  Differential Diagnosis:  Peptic Ulcer Disease  Previous medication plan: two months ago and failed. 1.Clarithromycin 500 mg po BID for 2 weeks 2.Omeprazole 40 mg po BID for 2 weeks and again po daily. 3.Cipro 500 mg po BID for 2 weeks  Plan: Tests  Pt had EGD done 2 weeks ago that showed H. Pylori absolute gastritis in biopsy results.   Urea animation analysis 8 weeks afterwards amusement with H. Pylori medications. Pt needs to stop PPI’s 2 weeks above-mentioned to Urea Animation test.   Labs: No new labs are needed.    Referrals: may accredit based on aftereffect of medication analysis accustomed for 2 weeks.  Follow up: acknowledgment to appointment in 8 weeks to reevaluate her symptoms.

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