Additional Subjective Data
It will be useful to inquire about the occurrence of heartburn, problems with digesting products containing lactose, abdominal pain, and the frequency of belching. Reports of increased thirst and hunger are also expected. Finally, stress and depression can be reported by the patient.
Additional Objective Data
To account for possible causes of belching and flatulence, the presence of hydrogen in the breath needs to be measured. If the patient keeps a “flatus diary,” the data from it can be useful.
Due to the high level of cholesterol, National Guidelines on preventing heart disease and stroke are appropriate to consider, especially about the possibility of artery blockage suggested by hyperlipidemia. Also, hyperlipidemia and digestion problems suggest the appropriateness of consulting National Guidelines on type 2 diabetes.
Tests and Rationale
Belching and flatulence suggest the possibility of bacterial overgrowth. Thus, a hydrogen breath test needs to be administered. Next, celiac disease tests may be necessary to determine the wheat, barley, and rye absorption as a possible cause of eructation and flatulence (Rubio-Tapia, Hill, Kelly, Calderwood, & Murray, 2013). In extreme cases, pancreatic insufficiency may be the reason for the symptoms, in which case exocrine pancreatic insufficiency test may be necessary. Finally, the triglyceride test may be required to confirm the hyperlipidemia, since both HDL and total cholesterol levels are consistent with the possibility.
The patient’s case does not present any issues that may require the assistance of consult. However, the familial nature of some conditions (e.g. hyperlipidemia) may create additional difficulties, in which case seeking the aid of the consult is advisable.
Medical and Nursing Diagnoses
The patient’s symptoms are consistent with medical conditions of hyperlipidemia and indigestion, belching, and chest pressure possibly caused by angina or other heart diseases, and high blood pressure (Sabatine & Cannon, 2015). The nursing diagnoses are belching, flatulence, inappropriate nutrition, lack of proper knowledge of causes for intestinal gas buildup, lack of understanding of required dietary habits, excessive weight, anxiety, fatigue and stress associated with it, increased thirst and/or hunger resulting from hyperlipidemia, instances of depression, and lack of knowledge for over-the-counter supplements that may relieve gas buildup.
Legal and Ethical Considerations
The main issue with the patient is that some of his conditions may be familial and, by extension, suffer from the same lack of understanding of dietary habits. However, while some outcomes may be prevented by healthy eating, other treatment options may result in complications. These issues should be carefully considered.
Plan of Care
Medical care includes medications such as Nexium or Lipitor, depending on test results. If clotting or artery blockages are identified, artery-relaxing or blood-thinning medications may be added. Digestive enzymes are recommended to assist digestion as a supplement. Nursing care includes nutritional regiment maintenance, fluid intake monitoring, anxiety reduction, and educating the patient on helpful techniques.
Healthy People 2020 Objectives
Several objectives are consistent with the case, such as reduction of the proportion of adults with high TC levels, increase awareness of symptoms of and response to stroke, and an increase of the proportion of physicians offering consultations on nutrition and weight.
Circle of Caring
Depending on their health condition, the patient’s family members can be a part of the circle of caring, especially considering the proximity of the children. Next, a counselor is recommended to help to overcome stress and depression. Finally, integrative therapists must be included, although test results are needed to confirm this option.
Additional Patient Teaching
The patient would benefit from the knowledge of relaxation techniques and exercises for preventing gas buildup, ways of self-diagnosis and cause detection, monitoring techniques (e.g. flatus diary), identification of undesirable foods and beverages, and self-reflection to identify causes of anxiety as connected to a health condition.
Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., & Murray, J. A. (2013). ACG clinical guidelines: diagnosis and management of celiac disease. The American Journal of Gastroenterology, 108(5), 656-676.
Sabatine, M. S., & Cannon, C. P. (2015). Approach to the patient with chest pain. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. Philadelphia, PA: Elsevier Saunders.