For each scenario, what is the most

For each scenario, what is the most likely diagnosis based on the HPI and PE. List possible differential diagnoses and rationale. What is the treatment plan? Patient education Pharmacological Nonpharmacological treatments Additional diagnostic testing as needed. Referrals (if needed) Follow-up plan Scenario 1 CC: Heartburn in a 46-Year-Old Male HPI: Patient complains of pain in his mid-chest for the past couple of months that has progressively worsened over the last couple of weeks. He states it is worse when he goes to bed at night or when he eats a large meal. He has been eating out a lot more over the past couple of months because he has been traveling a lot for work. He denies any nausea or vomiting. He has been taking OTC Tums for the past few weeks, but he has to take 10-12 a day and only gets minimal relief. He denies any unusual weight gain or loss. PE: Exam reveals an obese, Caucasian male with mild epigastric tenderness. No hepatosplenomegaly. Bowel sounds normoactive in all four quadrants. Scenario 2 CC: Abdominal Pain in a 27-Year-Old Female HPI: Patient complains of left-lower abdomen pain for the last 6 months associated with immediate and frequent urges to have a BM. She states she usually has three or four loose BMs a day. Her symptoms are usually worse when she eats fried foods or dairy. No blood in stool. No recent travel outside of the United States, and no camping. She reports she recently broke up with her boyfriend of 6 years and has been under a lot of stress at work. She denies any unusual weight gain or loss. No fever. She denies trying any medications to ameliorate the symptoms. PE: Exam reveals a thin, Caucasian female with mild diffuse tenderness in the lower abdomen, moderate in the left-lower quadrant. No hepatosplenomegaly. Bowel sounds are hyperactive in all four quadrants. DRE is WNL. Scenario 3 CC: Frequent Urination in a 65-Year-Old Male HPI: Patient complains of painless, frequent urination approximately every 45 minutes to an hour for the past 5 months. He states that he hates visiting doctors because they always try to find something wrong with him. His wife made him this appointment, but he thinks his problem is just because he is getting older. He denies any pain on urination or any blood in the urine. He also denies any difficult voiding. There is no foul odor in the urine or discharge from the penis. He has tried to reduce his liquid consumption, but it has not made much of a difference. He denies any pelvic or rectal pain. He has not had any labs done in the past 5 years. In addition, he has not had a physical done in 10 years. PE: Exam reveals an African American male in no apparent distress. Abdomen is soft, nontender, with no masses or distensions on palpation. No hepatosplenomegaly. DRE reveals an enlarged, firm, smooth, symmetrical prostate. SCIENCE HEALTH SCIENCE NURSING FNP 652

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