Reference no: EM132470628
Scenario
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 registered nurse doing his initial workup. Your findings include a mildly obese man who demonstrates moderate guarding of his abdomen with both direct and rebound tenderness, especially in the left lower quadrant (LLQ). His vital signs are 168/98, 110, 24, 100.4 ° F (38 ° C), and he is slightly diaphoretic. T.H. reports that he has periodic constipation. He has had previous episodes of abdominal cramping, but this time the pain is getting worse.
Past medical history reveals that T.H. has a "sedentary job with lots of emotional moments," he has smoked a pack of cigarettes a day for 30 years, and he has had "2 or 3 mixed drinks in the evening" until 2 months ago. He states, "I haven't had anything to drink in two months." He denies having regular exercise:"just no time." His diet consists mostly of "white bread, meat, potatoes, and ice cream with fruit 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 died of colon cancer. He takes no medications and denies the use of any other drugs or herbal products.
1. Identify four general health risk problems that T.H. exhibits.
2. Identify a key factor in his family history that might have profound implications for his health and present state of mind.
3. Identify three key findings on his physical exam, and indicate their significance.
4 GastrointestinalCASE STUDY PROGRESS
The physician ordered a KUB (x-ray of the kidneys, ureters, and bladder), CBC, and complete metabolic profile. 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? For ordering bed rest?
CASE STUDY PROGRESS
T.H. is being sent home with prescriptions for metronidazole (Flagyl) 500 mg PO q6h, ciprofloxacin (Cipro) 500 mg PO q12h, and dicyclomine (Bentyl) 20 mg qid PO ×5 days.
7. For each medication, state the drug class and the purpose for T.H.
8. Given his history, what questions must you ask T.H. before he takes the initial dose of metronidazole? State your rationale.
9. What is a disulfiram reaction?
4 Gastrointestinal
10. When teaching T.H. about the metronidazole prescription, which instructions need to be included? (Select all that apply.)
a. Avoid all alcohol-containing products while on this medication.
b. If his urine turns reddish brown, notify his doctor immediately.
c. Take the medication exactly as scheduled, without skipping doses.
d. He might feel some tingling or numbness in his hands, which is an expected effect.
e. Take the medication with or after meals.
f. This medication might cause a metallic taste.
11. What specific information would you want to know before T.H. starts the antibiotics?
12. What are the signs and symptoms of an allergic reaction?
13. T.H. asks you if he can take a laxative for his occasional constipation. What is your answer?
14. T.H. asks you about his diet. "I'm confused. I was always told that I needed to be eating a high-fiber diet, which is difficult for me. But the doctor just told me that I need to be on a low-fiber diet for now, so now I'm confused. Which is it supposed to be?" How will you answer his question?
CASE STUDY PROGRESS
To help T.H. work through his dietary concerns, you obtain a referral to a registered dietitian.
15. What measures do you think the dietitian will discuss with T.H. to avoid recurrent diverticulitis once his acute symptoms are resolved?