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the patient is from Dominican Republic, is 39-year-of age, who is a recent immigrant and does not have any insurance. He complains of pain in the upper abdomen that started a year earlier and was getting worse. When he eats, the pain either eases or becomes worse. The patient denies any loss of weight, recent illness, vomiting, nausea, anorexia, regurgitation, constipation, and diarrhea. He appears anxious, and his lack of health insurance prevented him from asking for help earlier. The patient has no allergies, has not had hospitalization, and has no surgical history. He does not smoke, having quit half an year earlier and works in a farm. He drinks alcohol regularly. The father had high blood pressure, and mother had diabetes. No family member has a history of stomach problems. The patient uses herbal tea and ibuprofen for pain.

For physical examination, the patient needs to have their vital signs, skin, extremities, neck, respiratory, HEENT, checked.

Some differential diagnosis include Gastritis which is the irritation or inflammation of the stomach resulting in sharp pains. With eating, the pain can get better or worse. The inflammatory forms of gastritis may be caused by chronic infectious such as H. Pylori or acute infections such as enterovirus. When noninflammatory, they can be caused by chemical irritants to the stomach such as alcohol and medication (Vries, 2017). Another important case to consider is GERD that may have mild epigastric pain and symptoms that can worsen with meals. The pain is explained as burning and is located in the substernal rather than epigastric area. Nausea, vomiting, and hematochezia, are not associated with GERD. finally, there is peptic ulcer disease which is main characterized by epigastric abdominal pain that improves with meals. In some cases, the symptoms can get worse with meals. NSAID is associated with the problem and hematemesis shows the disease is complicated.

Plan for care for the patient is omeprazole medication to help in reducing the pain and help with the healing. This is because the medication will help with the reduction of production of stomach acid. The patient needs to take the drug 30 minutes before eating for a period of four weeks. A bismuth quadruple therapy can also be effective (Vries, 2017).  The patient should be asked to reduce alcohol consumption

References

Aquifer. (n.d.). Family medicine 19: 39-year-old male with epigastric pain. South University College of Nursing and Public Health Graduate Online Nursing Program. https://southu-nur.meduapp.com/document_set_document_relations/30239

Vries, J. D. (2017). Stomach and bowel disorders. Random House.