Question

PN 200 Fundamentals of Nursing II Concept Map: Diverticulitis Tim Haute, a 57-year-old stockbroker, has come to the gastroenterologist for treatment of recurrent mild to severe cramping in his abdomen and blood streaked stool. You are the nurse doing his initial assessment. You findings include a mildly obese man (male pattern obesity) who demonstrates mild guarding of his abdomen with both direct and rebound tenderness, especially in the LLC. Vital signs are 168/98, P 110, R 24, T. 98.4 and he is slightly diaphoretic. Mr. Haute states that he has periodic constipation. He has had previous episodes of abdominal cramping, but this time the pain is getting worse. PMH: Mr. Haute has a sedentary job with many emotional moments"; he has smoked a pack of cigarettes a day for the past 30 years and has had 2-3 mixed drinks in the evening" until 2 months ago. He states, “I have not had anything to drink in 60 days." He denies regular exercise with the statement "Just no tie." His diet consists of white bread, meat, potatoes and ice cream with fruits and nuts over it. He denies a history of pulmonary or cardiac and no personal history of cancer, although his father and older brother died of colon cancer. He takes no "routine” medications and denies the use of any other drugs. The physician orders a KUB, CBC, and CMP. Based on the X-ray and lab findings, physical exam and history the physician diagnosis the patient with acute diverticulitis and discusses the outpatient treatment plan with him. The physician now orders bed rest and anticholenergies for Mr. Haute. The physician orders metronidazole for this patient. 1. Prepare a list of questions you would ask this patient prior to administering metronidazole and state your rationale. 2. Explain what a disulfiram reaction is. You continue to teach the patient about both disulfiram and metronidazole reactions and interactions. You decide that there are some other instructions you need to give to the patient regarding his metronidazole prescription. The physician has now ordered Ampicillin for the patient. 3. State additional information you would need to know before starting the patient on Ampicillin Revised 1/20

Answer 1

1. List of questions to be asked before administration of alcohol to a patient are :-

- check the identity of the patient ( Rationale - to confirm the correct patient , to avoid medication error )

- ask the patient did he had any allergic reaction with metronidazole in past . ( Rationale - to avoid allergic reactions and complications again )

- ask the patient did he or she had alcohol in the last 24hours.( Rationale - to avoid disulfiram reaction)

2. A person on metronidazole cannot fully digest alcohol, and drinking can cause the toxic acetaldehyde to build up in the bloodstream. Because of this, people who drink alcohol while taking Flagyl may experience a disulfiram-like reaction.

Disulfiram is a drug used to support the treatment of chronic alcoholism by producing an acute sensitivity to ethanol. Disulfiram works by inhibiting the enzyme acetaldehyde dehydrogenase, causing many of the effects of a hangover to be felt immediately following alcohol consumption , even it can be fatal .

3. Additional information required to be asked before starting ampicillin is to ask for any hypersensitivity reactions to ampicillin or penicillin medications before

- information regarding renal and hepatic functions

4. Nursing Interventions and Rationales

Monitor vital signs

Fever / chills are signs of infection and possibly early peritonitis

Provide Bowel Rest

Maintain NPO status during initial phase of antibiotic treatment to kill infection and help bowel rest

As symptoms decrease, advance diet to clear liquids and then increase fiber slowly.

Assess abdominal pain

Detailed abdominal assessments will indicate if inflammation or infection may be developing. For example, a rigid abdomen may indicate peritonitis.

Monitor hydration status

Maintain optimal hydration for improved intestinal motility to prevent constipation

Administer medications

Antibiotics – for infection

Analgesics – for pain

IV Fluids – for hydration and bowel motility

Psyllium – (bulk-forming laxative) absorbs water from the intestine and makes stool easier to pass

Provide nutrition education

Hydrate (2-3 L fluids daily, unless contraindicated for renal or cardiac disease) to avoid constipation

Probiotics – to help regulate the intestinal bacteria

Avoid foods that trigger flare up (low-fiber foods)