Lower GI Disorder
Case;
Tommy, a 56-year-old school counsellor, has come into the gastroenterologist’s office for recurrent mild to severe cramping in his abdomen and blood-streaked stool. Here are the findings of the initial nursing assessment upon his arrival at the clinic:
• Mildly obese man.
• Guarding of his abdomen with both direct and rebound tenderness, especially in the LLQ.
• BP: 168/98, HR: 110, RR: 24, Temp: 38 degrees.
• Slightly diaphoretic.
• He reports that he has periodic constipation.
• He reports previous episodes of abdominal pain, but this time, “the pain is getting worst.”
Tommy’s past medical history:
• A sedentary job with “lots of emotionally draining moments.”
• Smoked a pack of cigarettes a day for the past 20 years.
• Drinks 2-3 large cans of beer every evening until three months ago.
• The diet consists of white bread, meat, ice cream and nuts.
• He denies a history of cardiac or pulmonary problems.
• No personal history of cancer.
• Father and older brother died of colon cancer.
• Not on any medications.
1. Identify 3 risk factors for Tommy based on the nursing assessment and past medical history.
2. Identify 3 key findings from the initial nursing assessment and explain their significance.
The gastroenterologist ordered a CBC and a CT scan of the abdomen with contrast. Based on the radiology and lab results, physical examination findings and his history, Tommy is diagnosed with acute diverticulitis.
3. What are 3 results we can anticipate someone with diverticulitis to demonstrate? What are the normal ranges for each of these results?
4. Explain the pathophysiology of diverticulitis.
5. What are the potential causes of diverticulitis?
6. What are the complications of untreated diverticulitis?
Tommy is being sent home with a prescription of antibiotics, and you, the nurse, need to discuss an outpatient treatment plan with him.
7. What are 5 measures that Tommy can do to avoid recurrent diverticulitis once his acute symptoms have resolved?
8. Why is it important for Tommy to avoid increasing intraabdominal pressure?
9. Now it’s your turn! Search for a scholarly article on diverticulitis. Review the article and the findings. How can you implement the findings of this article in your future practice?
3. Results we can anticipate someone with diverticulitis to demonstrate are increased white blood cell count, elevated C-reactive protein levels and positive cultures for bacterial infections such as E coli or Klebsiella pneumoniae. Normal ranges for these results would be a white blood cell count between 4,300-10,800 cells/mcL; C reactive protein level less than 0.5 mg/dL; and no presence of bacteria in culture results.
4. The pathophysiology of diverticulitis involves the formation of small sacs called diverticula which form in weakened areas along the walls of the large intestine usually near bends which leads to inflammation which causes symptoms like cramping, bloating and diarrhea that may become severe enough to require hospitalization if not treated properly at home first .
5. Potential causes of diverticulitis include diets low in fiber causing constipation leading to increased pressure within bowels making them more prone to forming diverticula; prolonged use medications like glucocorticoids or opiates; physical trauma resulting from surgery or accidents; inflammatory bowel diseases like Crohn’s disease; genetic predisposition ; autoimmune disorders ;and weak immune system response .
6. Complications untreated diverticulitis include abscesses , fistulas , peritonitis , obstruction , sepsis , intestinal rupture and even death .
7. Measures Tommy can do to avoid recurrent episodes once his acute symptoms have resolved includes eating high fiber foods such as whole grain cereals fruits vegetables beans legumes nuts seeds ; drinking plenty fluids especially water help soften stools reduceconstipation limit exacerbation symptoms through hydration ; reducing stress increasing physicalactivity help divert focusfrom food intake while calming bodynerves simultaneously encouraging healthyeating practices reducingriskof recurrent flares upsfrom occurring too oftenduring every day life ;avoiding cigarette smokingalcohol consumption smoking cigarettes alcoholic beverages increase riskdiverticular flare upsdue toxins producing carcinogens releasing intobody potentiallycausing damage internal organslungs digestive tract ;preparing own meals using fresh ingredients instead processed high fat foodswill lower chances experiencing recurrencein future allowingindividual controloverwhat typefoodsperson puts into theirbody ultimately determining how healthymakes individual overall being able maintain goodhealth habits throughout entire lifespan.
8 Why important avoidincreasing intraabdominalpressureAs resultdiverticular disease patientsexperience periods whereintraabdominalpressure increasesas person eats largermeals consumesmore carbonated drinksduring period indigestion alternating between constipationdiarrheaif uncontrolledcause excessivestrainbowel wallslower regionsthese also prone punctureformation diverticular pockets thissituation knownacutediverticular colitisextremely painful leadstoinfectionsinflammationsmaking harderpatient releasetheir fecal matter thus increasingpainful symptomsoverall eventuallyleadingchronic conditions requiringlongterm pharmacological treatments
9 Implementing FindingsScholarly ArticleIn termpracticing clinical setting learned implementation keyfindings scholarly articleon Diverticultis will helpsafe guard patientspossiblecomplications whendiagnosedwith thisconditionallows registered nurseseducatepatientsabout risksassociatedwiththeir diagnosisproper hygienemore effectivetreatment strategies availableprovidebetterquality careforthe patientovertime Additionally workingcollaborativelywith doctorsteachersdieticiansother relevant healthcare professionalswill create multidisciplinaryteam able provideholistic approach treatment patientssufferingfromDiverticultismaking sure thatall necessarymeasuresaretaken tomaintain best possiblewellbeingforthemselvesfamily members theycarefor