Collaborative clinicians

Collaborative clinicians

From Textbook to treatment: A GI Med Adventure

Case 1 - Mrs. L.

Mrs. L, age 73, has chronic GERD. She's on omeprazole and takes calcium carbonate for bone health. She recently fall and fractured her hip. She says she also takes baking soda after meals to help with heartburn.

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case 1 - mrs. l. - 73 yo f - chronic gerd

baking soda

calcium absorption

Patient Education

Omeprazole

How would you address her use of baking soda for heart burn?

What should you teach her about long-term PPI use?

What concerns might you have about calcium absorption and her fracture risk?

What med class is omeprazole? What's its mechanism?

What if?

The patient is also taking iron supplements. How would that affect absorption?

Would calcium carbonate or calcium citrate be a better choice for this patient? Why?

If she had chronic kidney disease, which antacid would you avoid?

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Case 2 - Mr. H.

Mr. H. is a 55-year-old patient with newly diagnosed H. pylori-associated peptic ulcer disease. he's prescribed amoxicillin, clarithromycin, and a PPI for 14 days. He says, "I'm feeling better after day 4 - can I stop?

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case 2 - Mr. H. - 55 yo m - h. pylori infection

case questions

why 14 days?

Why triple therapy?

Why must he finish the 14-day course?

What is the rationale behind triple therapy?

medication timing?

common side effects?

What would you teach him about medication timing?

What are common side effects to warn him about?

What if?

What complications can arise if the patient stops antibiotics early?

Why might a provider choose clarithromycin vs. metronidazole?

If the patient develops severe diarrhea during treatment, what condition should you consider?

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Case 3 - Ms. B.

Ms. B. has frequent nausea with chemotherapy. She's prescribed ondansetron and scopolamine. She also reports dizziness and asks if she can drive to her appointments.

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case 3 - Ms. b. - chemotherapy enduced nausea and vomiting

Multiple antiemetics work better together than alone (synergistic effect).

Teach about risk for dizziness and drowsiness. Avoid driving or operating heavy machinery.

Give antiemetics 30-60 minutes before chemotherapy.

What are the mechanisms of ondansetron and scopolamine?

Why are multiple antiemetics sometimes used together?

What teaching should you give about side effects and driving?

When should antiemetics be given in relation to chemo?

Ondansetron blocks serotonin receptors; scopolamine blocks muscarinic receptors.

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What if?

What's the benefit of using ondansetron instead of promethazine?

What are signs of serotonin syndrome, and which antiemetic increases that risk?

If the patient prefers natural remedies, what safe option might you recommend (with provider approval)?

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Case 4 - Mr. J.

Mr. J., 60, is taking diphenoxylate with atropine for diarrhea. He calls in saying, "I took more than prescribed, and now my vision is blurring and my heart is racing."

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case 4 - Mr. j. - diphenoxylate with atropine for diarrhea

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Question 2

Question 3

Question 4

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What if?

What is the most appropriate nursing action in response to the patient's symptoms?

What's the antidote for severe anticholinergic toxicity?

Would loperamide be a safer option for long-term use? Why or why not?

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Case 5 - Mrs. M.

You are caring for Mrs. M., a patient with megaloblastic anemia due to B12 deficiency. She is starting IM cyanocobalamin. She also has a history of hypokalemia.

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Game Piece:

Choose a game piece and roll the dice. Answer a question (1–4). If correct, move your piece forward the number of spaces rolled.

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What if?

Why is potassium depletion a concern when starting B12 therapy?

What lab values should be monitored regularly in this patient?

What symptom might indicate improvement in neurologic function?

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