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 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 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. Revised 9/9

Answer 1

ANSWER- 1) The general health risk problems this patient exhibits are;-

• local abscess formation
• Perforation
• Bleeding
• Peritonitis

ANSWER - 2) Diagnostic Evaluation :

• CBC - In this condition increase WBC indicate infection
• Colonoscopy - direct evidence of disease
• Stool Guiac test - test hidden blood in stool

Treatment Plan ;

• Advice for bed rest in acute phase
• Keep the patient NPO or clear fluids
• When inflammation resolve introduce fibre diet gradually
• DRUGS; 1) Antibiotics 2) Analgesic 3) Anti - cholenergics
• Advice the patient to avoid heavy lifting , strain , cough , or bend to prevent increase of intraabdominal pressure
• Monitor the patient for peritonitis
• Advice the patient avoid tight fitting clothes
• Advice the patient to avoid gas forming food items or indigestable foods like seeds , nuts, popcorn because it can trap in diverticula and can cause diverticulitis
• Give laxatives as prescribed

ANSWER 3) DIFFERENCE BETWEEN DIVERTICULITIS AND DIVERTICULOSIS

  DIVERTICULITIS DIVERTICULOSIS

1) Inflammation caused by 1)Multiple out pouching / herniation

food or feces trapped in diverticulum of the intestinal mucosa

2) Symptoms of diverticulitis painful cramps in the 2) not any major symptoms some people

abdomen, tenderness in abdomen , fever, may feel cramps and tenderness over

affected area.