Question

Concept Map: Acute 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 LLQ. 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. 1. Identify the general health risk problems this patient exhibits. 2. Identify three (3) key findings on his physical exam and indicate their significance. 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. 3. Differentiate between diverticulitis and diverticulosis.

Answer 1

1. General health risk problems in patient are

• smoking
• obesity
• history of constipation and intake of unbalanced diet
• family history of colon cancer
• lack of exercise
• stress at workplace

2. 3 key finding in physical exam

1. obesity: This makes the person vulnerable for many lifestyle disorders like diabetes mellitus, hypertension etc
2. abdominal guarding, diaphoresis: this may be due to the pain patient is experiencing and corresponding body response to pain is present.
3. Presence of rebound tenderness: It refers to pain or tenderness that occurs upon sudden release of pressure on the abdomen. Rebound tenderness is a symptom of many diseases, including appendicitis.

3. Diverticulosis is the harmless condition of having small pouches protruding from the wall of the colon and If infection occurs, the condition is called diverticulitis.Diverticulitis is a serious problem.

4.

Nursing diagnosis	interventions	positive outcome	negative outcome	evaluation
Acute pain	monitor vitals provide bowel rest that is NPO Assess abdominal pain monitor hydration status Administer medications as ordered like antibiotics, analgesics etc	Patient reports relief in pain	there is no effect on pain in patient.	patient reports relief in pain as evidenced by his verbal response and improvement in vitals.
Imbalanced nutrition: less than body requirements	Assess patient’ s nutritional intake. administer IV fluids if patient on npo Provide nutrition education including intake of 2- 3 litres of fluid unless contraindicated, avoiding low fibre foods like white bread, junk foods etc	Patient identifiesnutritional requirements	patient does not identify his nutritionalmodifications	patient identifies nutritional modificationstobemadeasevidencebyverbalresponse