Question

T.H>, 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 LVN doing his initial work-up. You findings include a mildly obese male who demonstrates moderate guarding of his abdomen with both direct and rebound tenderness, especially in the left lower quadrant. His vital signs are 100.4F-110-24168/98, he is slightly diaphorectic. T.H. reports that he has periodic constipation. He has had previous episodes of abdominal cramping but this time the pain is getting worse. He has no known drug allergies.

Past medical history reveals that T.H. has a “sedentary job with lots of emotional moments” he has smocked a pack of cigarettes a day for 30 years and has had “2 or 3 mixed drinks in the evening” until 2 months ago, he states, “I haven’t had anything to drink in 60 days.” He denies having regular exercise: “just no time” His diet consists mostly of “white bread, meat, potatoes, and ice cream with fruits and nuts over it.” He denies having a history of cardiac or pulmonary problems and no personal history of cancer, although his father and older brother dies of colon cancer. He takes no “regular” medication and denies the use of any other drugs.

1. Identify four general health risk problems T.H. exhibits.
2. Identify a key factor in his family history that may have profound implications for his health and present state of mind.
3. Identify three key findings on his physical exam, and indicate their significance.

CASE STUDY PROGRESS

The physician ordered a KUB (xray of the kidney, ureters, bladder), CBC, and complete metabolic profile (CMP). Based on x-ray and lab findings, physical examination, and history, the physician diagnoses. T.H. as having acute diverticulitis and discusses an outpatient treatment plan with him.

4.What is diverticulitis? What are the consequences of untreated diverticulitis?

5. While the patient is experiencing the severe crampy pain of acute diverticulitis, what interventions would you perform to help him feel more comfortable?
6. What is the rationale for ordering bed rest and anticholinergics?
7. What classes of medications would be prescribed for someone hospitalized for acute diverticulitis?

Answer 1

1- He is having Cardiac and pulmonary problem,

Family history of cancer

He is febrile,having chronic abdominal pain

Malena and constipation

Medication compliance

2-He had a family history of cancer ,but he is not willing to accept it .Also he is not taking his regular medications correctly.He thinks that he is normal and has no problems,thats why he is taking foof in his own way.

3- On his assessment it can be understand that he had severe abdominal pain ,had rebound tenderness in the left qudrant,and also blood contained stool suggestive symptoms of diverticulitis.

DIVERTICULITIS

4 -It is the inflammation or infection in one or more small pouches in the digestive tract.It occurs when small bulging pouches develop in the digestive tract.It is more common after the age of 40.Treatment consist of mainly diet modification and antibiotics.Treatment can include rest,a liquid or low fibre diet and antibiotics.Severe cases need hospital care and surgery.High fibre diet are advised by the doctor after the recovery of one episode to prevent future episodes.If left untreated the diverticulitis may lead to a collection of pus outside the colon wall or a generalized infection in the abdominal lining and may lead to peritonitis.If we are not treating this in correct time it willl leads to complications like Perforation of diverticulitis,Bowel obstruction,Bleeding,Fistula,Pylephelebitis.Complications of diverticulitis can be lifethreatening.

Pain management

To reduce abdominal pain caused by mild diverticulitis apply a heating pad to the abdomen to releive mild cramps and pain.also can try relaxation techniques such as slow deep breathing,staying in a quiet room ,meditation.Pain killers such as aspirin or ibuprofen sholud be avoided in case of pain because they increase the risk of internal bleeding,and may also upset the stomach.Acetaminophen is recommended for pain releif from diverticulitis .

We are advised to take bedrest for the patient with diverticulitis this is because fiber will not heal existing diverticula,but it may prevent more from forming.Doctors mainly prescribe liquid diet and bedrest for easy recovery.On the other hand we are giving Anticholenergics or antispasmodics ,these medicines treat abdominal spasm or cramps by slowing down the activity of stomach and intestine.Spasm are caused by muscles that tighten and squeeze and may cause pain.

Treatment consist of drugs antibiotics and anti cholenergics.

Commonly using are Ciprofloxacin and metronidazole

Trimethoprim sulfamethoxazole and metronidazole

Amoxicillin clavulanate

Moxifloxacin

and supportive management by IV fluids.