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?
