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Chamberlain NR 507 Week 5 Case Study DB- Diverticulitis

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  • July 6, 2023
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Week 5 DB – Diverticulitis


Requirements:
Read the case study below.
In your initial discussion post, answer the questions related to the case scenario and
support your response with at least one evidence-based reference by Wed., 11:59 pm
MT.
Provides a minimum of two responses weekly on separate days; e.g., replies to a post
from a peer; AND faculty member’s question; OR two peers if no faculty question using
appropriate resources, before Sun., 11:59 pm MT.
Case Scenario:
An 84- year-old -female who has a history of diverticular disease presents to the clinic
with left lower quadrant (LLQ) pain of the abdomen that is accompanied by with
constipation, nausea, vomiting and a low-grade fever (100.2 F) for 1 day.
On physical exam the patient appears unwell. She has signs of dehydration (pale mucosa,
poor skin turgor with mild hypotension [90/60 mm Hg] and tachycardia [101 bpm]). The
remainder of her exam is normal except for her abdomen where the NP notes a
distended, round contour. Bowel sounds a faint and very hypoactive. She is tender to
light palpation of the LLQ but without rebound tenderness. There is hyper-resonance of
her abdomen to percussion.

 The following diagnostics reveal:
 Stool for occult blood is positive.
 Flat plate abdominal x-ray demonstrates a bowel-gas pattern consistent with an
ileus.
 Abdominal CT scan with contrast shows no evidence of a mass or abscess. Small
bowel in distended.
Based on the clinical presentation, physical exam and diagnostic findings, the patient is
diagnosed with acute diverticulitis and she is admitted to the hospital. She is prescribed
intravenous antibiotics and fluids (IVF). Her symptoms improved and she could tolerate a
regular diet before she was discharged to home.
Discussion Questions:

1. Compare and contrast the pathophysiology between diverticular disease
(diverticulosis) and diverticulitis.
Diverticula are small bulging pouches that occur in areas of weakness within the large
intestine. Development of these pouches are called diverticular disease or
diverticulosis. When these pouches become inflamed or infected due to colon
contents becoming trapped in the pouches it is then referred to as diverticulitis.
Factors that can contribute to diverticular disease include wall structure of the colon,
motility, individual genetics, fiber intake, vitamin D, obesity, and physical activity
levels (Rezapour et al., 2018).

The pathophysiology for diverticulosis can often be asymptomatic and sometimes
found after patients have undergone imaging for other reasons. Symptomatic

, Week 5 DB – Diverticulitis


diverticulosis is often a complication that leads to diverticulitis (Rezapour et al.,
2018).

Diverticulitis occurs when the diverticula become inflamed and is the most common
complication of diverticulosis which can also be further categorized as complicated or
uncomplicated. Complicated diverticulitis includes formation of an abscess, fistula,
obstruction or perforation of the colon (Rezapour et al., 2018).


2. Identify the clinical findings from the case that supports a diagnosis of acute
diverticulitis.
- History of diverticular disease
- Left lower quadrant (LLQ) pain
- Constipation
- Nausea
- Vomiting
- Low-grade fever
- Distended, round abdomen
- Hypoactive bowel sounds with hyperresonance
- Occult blood
- X-ray shows ileus
-CT shows distended small bowel


3. List 3 risk factors for acute diverticulitis.
- Low dietary fiber, high fat
- Obesity
- Aging


4. Discuss why antibiotics and IV fluids are indicated in this case.
IV fluids are needed due to patient’s signs of dehydration (pale mucosa, poor skin
turgor with mild hypotension 90/60 mm Hg and tachycardia 101 bpm) and will help
with her constipation to increase motility.
Antibiotics are indicated as this patient is higher risk for complications at age 84 and
has a current fever with constipation, nausea, vomiting and a positive occult blood
test (Hall et al., 2020).


References:
Hall, J. F., Hardiman, K. M., Lee, S. Y., Lightner, A. L., Stocchi, L., Paquette, I. M., Steele, S.
R., Feingold, D. L., & Surgeons, R. (2020). The American Society of Colon and Rectal
Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic
Diverticulitis. Diseases of the Colon & Rectum, 63(6), 728–
747. https://doi.org/10.1097/dcr.0000000000001679

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