discussion

Peer Response

Collaborative Posts

Review the plans posted by your peers from your advanced practice nursing role perspective (nurse practitioner).  From this mindset, reflect upon a discussion you would like to have with your colleagues about their plan.

· If you are a nurse practitioner did your peer develop a plan that aligns with evidence-based practice and current clinical guidelines? Etc.

Please be sure to validate your opinions and ideas with citations and references in APA format. 

Deanna Freeman-Jones

Management of the Patient with Peptic Ulcer Disease

Diagnosis

The presentation is most consistent with iron deficiency anemia, likely secondary to chronic blood loss or nutritional deficiency. The hemoglobin of 8.5 g/dL and hematocrit of 25% indicate a moderate to severe anemia. The patient’s early satiety, gnawing epigastric pain, anorexia, weight loss, and fatigue raise concern for a possible underlying gastric ulcer or malignancy. Cognitive changes and pallor support symptomatic anemia.

Management/Treatment Rationale

Based on the patient’s condition, my treatment goals include correcting anemia, identifying and treating the bleeding source, and alleviating GI symptoms. Initial management includes oral ferrous sulfate 325 mg three times daily (providing ~195 mg elemental iron daily) for treatment of iron deficiency anemia (Arcangelo & Peterson, 2021). Additionally, proton pump inhibitor (PPI) therapy, such as omeprazole 20 mg orally once daily, will help heal a likely gastric ulcer and reduce gastric irritation from iron, while improving GI symptoms and iron absorption (Bereda, 2022).

Prescription

1. Ferrous sulfate 325 mg PO TID :  Oral; Three times daily; Take on an empty stomach to enhance absorption; avoid dairy, caffeine, or antacids within 2 hours.

2. Omeprazole 20 mg PO daily:  Oral; Once daily, 30 minutes before breakfast; Do not crush or chew.

  Patient Education

I would educate the patient that iron therapy may cause GI upset, dark stools, and constipation – encourage a high fiber diet and hydration. Emphasize the importance of adherence for at least 3 to 6 months until ferritin and hemoglobin normalize. Counsel to rise slowly, manage fatigue, and report any worsening abdominal pain, black stools, or vomiting (Bereda, 2022).

Follow up

I would schedule a follow-up in 4 weeks to repeat CBC, ferritin, and assess response and tolerance. If hemoglobin fails to improve or GI symptoms persist, I would consider referral to gastroenterology for endoscopic evaluation to rule out peptic ulcer disease, gastric malignancy, or other bleeding sources. I would also assess the patient's cognitive status on the return visit

  References

Arcangelo, V. P., & Peterson, A. M. (2021).  Pharmacotherapeutics for advanced practice: A practical approach (5th ed.). Wolters Kluwer. Bereda, G. (2022). Peptic Ulcer disease: definition, pathophysiology, and treatment.  Journal of Biomedical and Biological Sciences,  1(2), 1-10.

Mariam Lomashvili

Diagnosis

The most likely diagnosis for this 60-year-old woman is iron deficiency anemia secondary to chronic gastrointestinal blood loss, likely due to gastric ulcer disease or gastric malignancy. Her hemoglobin of 8.5 g/dL and hematocrit of 25% indicate moderate anemia. Associated symptoms including pallor, dry skin, early satiety, gnawing epigastric pain, and mild nausea support the presence of a chronic underlying condition, possibly affecting the upper gastrointestinal (GI) tract. The recent cognitive changes and fatigue are also common in anemia and chronic illness (Lanier et al., 2018). Given her age and constellation of symptoms, it is imperative to rule out gastric carcinoma, which can present similarly and often remains occult until advanced (Sitarz et al., 2018).

Treatment Plan and Rationale

Immediate goals include correcting the anemia, identifying and treating the underlying source of blood loss, and ensuring nutritional support. First, I would order iron studies (serum ferritin, iron, TIBC), vitamin B12, folate, and a fecal occult blood test (FOBT). To evaluate the source of bleeding, the patient requires an urgent esophagogastroduodenoscopy (EGD). A referral to gastroenterology for endoscopic evaluation is warranted to rule out ulceration or malignancy. In the meantime, oral iron supplementation should begin to replenish iron stores. I would start with Ferrous sulfate 325 mg PO once daily, as this provides about 65 mg of elemental iron per dose. Lower-frequency dosing is now preferred to improve gastrointestinal tolerability and absorption (Sendur & Malkan, 2025). Because of early satiety and reduced oral intake, a nutritional consultation is also indicated to assess for caloric and micronutrient deficiencies and to provide guidance on nutrient-dense food intake while further diagnostics are underway.

Prescription

· Ferrous Sulfate 325 mg orally once daily

· Instructions: Take with orange juice or a source of vitamin C to enhance absorption. Avoid taking with dairy, calcium supplements, or antacids.

· Duration: Continue for at least 3 months after normalization of hemoglobin.

Should the patient not tolerate oral iron or if absorption is impaired, IV iron such as iron sucrose may be considered after further evaluation.

Patient Education

The patient should be educated about the cause and consequences of iron deficiency anemia, emphasizing the importance of iron therapy adherence and dietary adjustments. Foods rich in iron  (red meat, leafy greens, legumes) and vitamin C (citrus fruits) should be encouraged. She should also be advised to report any new or worsening symptoms such as black stools, fatigue, chest pain, or shortness of breath. Education should include an explanation that her early satiety and stomach discomfort are concerning for possible upper GI disease, and that a scope test (endoscopy) will help identify the cause of bleeding. Support should also be offered regarding emotional and cognitive changes, as these may improve once anemia is treated.

Follow-Up and Referral

The patient should return for a follow-up in 1–2 weeks to assess her tolerance to iron therapy, repeat her CBC, and review the results of initial lab tests. An urgent gastroenterology referral is needed for endoscopic evaluation. If a gastric malignancy is identified, oncology consultation will be required. Should there be persistent neurocognitive symptoms despite anemia correction, referral to neurology or geriatric psychiatry may be indicated.

References

Lanier, J. B., Park, J. J., & Callahan, R. C. (2018). Anemia in older adults.  American Family Physician,  98(7), 437–442.  https://www.aafp.org/pubs/afp/issues/2018/1001/p437.htmlLinks to an external site.

Sendur, I. N., & Malkan, U. Y. (2025). Comparison of efficiency and side effects of daily and alternate-day oral iron.  The Egyptian Journal of Internal Medicine,  37(1), 72.  https://doi.org/10.1186/s43162-025-00463-4Links to an external site.

Sitarz, R., Skierucha, M., Mielko, J., Offerhaus, G. J. A., Maciejewski, R., & Polkowski, W. P. (2018). Gastric cancer: Epidemiology, prevention, classification, and treatment.  Cancer Management and Research,  10, 239–248.  https://doi.org/10.2147/CMAR.S149619