Pathophysiology and Pharmacology I (NS71001) Tutorial - Hepatobiliary System PDF

**Pathophysiology and Pharmacology I (NS71001)** **[Tutorial]** **Part 2 - Hepatobiliary System (Gallbladder disorder) -- Case Study: Mrs Pang** **[Learning Objectives]** **At the end of the tutorial, the students will be able to:** 1. Identify and discuss the likely diagnosis for the patient,...

**Pathophysiology and Pharmacology I (NS71001)** **[Tutorial]** **Part 2 - Hepatobiliary System (Gallbladder disorder) -- Case Study: Mrs Pang** **[Learning Objectives]** **At the end of the tutorial, the students will be able to:** 1. Identify and discuss the likely diagnosis for the patient, supporting answers with evidence 2. List the diagnostic investigations (i.e. lab tests, clinical examinations) for the patient 3. Discuss and analyse potential complications that may arise 4. Discuss the pharmacological management used for the patient 5. Present a pharmacology care plan (PCP) including nursing implications and health teaching of the pharmacological agents used **[Case Scenario]** Mrs Pang, age 50 years old presents to A&E with persistent abdominal pain and weight loss. She complaint that her abdominal pain has been progressively worsening over the past several months and she describes the pain as a constant dull ache, occasionally sharp, and radiating to her back. She also reports significant unintentional weight loss of 4-5kg over the past three months and frequent episodes of diarrhoea. Mrs Pang has been experiencing nausea and early satiety, making it difficult for her to maintain a regular diet. +-----------------------+-----------------------+-----------------------+ | Her vital signs upon | | **Physical | | arrival are: | | examination:** | | | | | | Blood pressure -- | | - **General:** | | 130/85 mmHg | | Appears thin and | | | | in mild distress. | | Pulse -- 88 beats | | | | per minute | | - **Abdomen:** Mild | | | | epigastric | | Respiration -- 18 | | tenderness | | per minute | | without guarding | | | | or rebound. | | Temperature -- 37.2 | | | | °C | | - No palpable | | | | masses or | | Oxygen saturation | | organomegaly. | | -- 98% on room air | | | | | | - Bowel sounds | | Pain: 4/10 | | present but | | | | slightly | | | | hypoactive. | | | | | | | | - **Skin:** No | | | | jaundice, but dry | | | | and flaky skin | | | | noted. | | | | | | | | **Lab Test:** | | | | | | | | Full Blood Count | | | | (FBC) - Mild anemia. | | | | | | | | Serum Amylase and | | | | Lipase - Normal to | | | | mildly elevated. | | | | | | | | Liver Function Tests | | | | (LFTs) - Within | | | | normal range | | | | | | | | Blood Glucose - 160 | | | | mg/dL. | | | | | | | | Serum Albumin - Low | | | | | | | | Fecal Elastase Test - | | | | Low, | +-----------------------+-----------------------+-----------------------+ [Instructions for Trainees] Form a group of 4-5 trainees. As a group, you are tasked to complete the following pre-tutorial activities based on the case scenario above. Each group is expected to discuss the answers with the lecturer and other groups during the tutorial.\ \ **[Pre-Tutorial Activities]** **[Activity 1]** **Trainees are required to do pre-reading and activities of the following topics (via Articulate Rise 360) in BrightSpace:** 1. **Hepatobiliary system Part 2 -- Pancreatic disorder** 2. **Hepatobiliary system Part 6 -- Pathophysiology and Pharmacology** **References:** - Adams, M.H, Holland, L.N., & Urban, C. Q. (2020). Pharmacology for nurses: A Pathophysiologic Approach. (6^th^ ed.). N.J., Pearson.  - Banasik, J. L. (2022). *Pathophysiology* (7th ed.). Elsevier Health Sciences.  - Craft, J., & Gordon, C. (2016). *Understanding Pathophysiology* (3rd ed.). Elsevier Health Sciences.  - Cook, N., Shepherd, A., Dunleavy, S., & McCauley, C. (2022). *Essentials of pathophysiology for nursing practice* (2nd ed.). SAGE Publications Ltd.  - Peate, I. (Ed.). (2021). *Fundamentals of applied pathophysiology: An essential guide for nursing and healthcare students* (4th ed.). Wiley  **[Activity 2 ]** Trainees are required to explore and provide insights on the following questions: +-----------------------------------+-----------------------------------+ | **Question** | **Answers** | +===================================+===================================+ | - **Identify and discuss the | | | likely diagnosis for the | | | patient, supporting answers | | | with evidence from case | | | scenario.** | | +-----------------------------------+-----------------------------------+ | - **List the diagnostic | | | investigations (i.e. lab | | | tests, clinical examinations) | | | for the patient.** | | +-----------------------------------+-----------------------------------+ | - **Relating the clinical | | | manifestations presented, | | | discuss potential | | | complications that may arise | | | for the patient. Support | | | answers with rationale.** | | +-----------------------------------+-----------------------------------+ | - **Identify the drugs in | | | treatment for Mrs Pang's | | | condition.\ | | | (focus specifically on | | | pancrealipase only)** | | +-----------------------------------+-----------------------------------+ **[Activity 3 ]** **Trainees are required to design a pharmacology care plan for Mrs Pang using the template below:** +-------------+-------------+-------------+-------------+-------------+ | **Drug | **Pharmacol | **Assessmen | **Implement | **Evaluatio | | class\ | ogical | t\ | ation\ | n\ | | \ | Drug | \ | \ | ** | | e.g. Loop | (examples)\ | *-What are | *-What are | | | diuretic** | \ | the | the | **-*Patient | | | e.g. | necessary | necessary | 's | | | Furosemide* | assessment | precautions | response to | | | * | prior to | in taking | a | | | | taking this | the | medication? | | | | medication? | medication? | \ | | | | *** | *** | -Adverse | | | | | | effects of | | | | | ***-Nursing | medication? | | | | | implication | \ | | | | | s/ | -Health | | | | | Contraindic | teaching*** | | | | | ations*** | | +=============+=============+=============+=============+=============+ | | | | | | +-------------+-------------+-------------+-------------+-------------+ **[In-Tutorial Activity ]** **Groups are to share and present the care plan and its findings.\ Duration: \~ 10minutes each group.\ \ [End-Tutorial Discussion:] Groups are to upload their care plan as an assignment on Brightspace under 'Discussion Forum". Lecturer to facilitate.**