WK#5
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 (100.20 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.
2. Identify the clinical findings from the case that supports a diagnosis of acute diverticulitis.
3. List 3 risk factors for acute diverticulitis.
4. Discuss why antibiotics and IV fluids are indicated in this case.
NR507 Week 5 Discussion Rubric
| NR507 Week 5 Discussion Rubric | |||||||
| Criteria | Ratings | Pts | |||||
| This criterion is linked to a Learning OutcomeApplication of Course Knowledge:
The student: 1. Compares and contrasts the pathophysiology between diverticular disease (diverticulosis) and diverticulitis. 2. Identifies the clinical findings from the case that supports a diagnosis of acute diverticulitis. 3. Lists 3 risk factors for acute diverticulitis. 4. Discusses why antibiotics and IV fluids are indicated in this case. (4 critical elements) |
|
30 pts | |||||
| This criterion is linked to a Learning OutcomeSupport from Evidence-Based Practice:
Initial discussion post is supported with appropriate, scholarly sources; AND Sources are published within the last 5 years (unless it is the most current CPG); AND Reference list is provided and in-text citations match; AND All answers are fully supported with an appropriate EBM argument. |
|
3 |
### Discussion: Acute Diverticulitis
**1. Compare and Contrast the Pathophysiology Between Diverticular Disease (Diverticulosis) and Diverticulitis**
**Diverticulosis**
– **Pathophysiology:** Diverticulosis is characterized by the presence of diverticula, which are small, bulging pouches that form in the walls of the colon, most commonly in the sigmoid colon. These pouches result from increased pressure within the colon, causing weak spots in the colon wall to bulge outward. This condition is often asymptomatic and is typically found incidentally during imaging studies or colonoscopy.
– **Risk Factors:** Age, low-fiber diet, sedentary lifestyle, and increased intraluminal pressure contribute to the development of diverticula.
**Diverticulitis**
– **Pathophysiology:** Diverticulitis occurs when one or more diverticula become inflamed or infected. This inflammation is often due to the obstruction of the diverticular opening by fecal matter, leading to increased pressure, impaired blood flow, and bacterial overgrowth. The inflammation can result in localized infection, formation of an abscess, or even perforation of the colon wall.
– **Symptoms:** Diverticulitis presents with symptoms such as abdominal pain (usually in the left lower quadrant), fever, nausea, vomiting, and changes in bowel habits. It can lead to more severe complications if not treated appropriately.
**Key Differences**
– **Diverticulosis** is a non-inflammatory condition characterized by the presence of diverticula, whereas **diverticulitis** involves inflammation and potential infection of these diverticula.
– **Diverticulosis** often does not present with symptoms, while **diverticulitis** presents with symptoms and requires intervention.
**2. Clinical Findings from the Case Supporting a Diagnosis of Acute Diverticulitis**
The clinical findings in this case that support a diagnosis of acute diverticulitis include:
– **Left Lower Quadrant Pain:** The patient exhibits pain localized to the LLQ, which is consistent with diverticulitis as the sigmoid colon is commonly affected.
– **Positive Stool for Occult Blood:** This suggests bleeding in the gastrointestinal tract, which can occur with inflammation or irritation in diverticulitis.
– **Fever:** The patient has a low-grade fever (100.2°F), which is indicative of infection or inflammation.
– **Abdominal Distension and Tenderness:** The distended abdomen with tenderness in the LLQ is a common physical finding in diverticulitis.
– **Imaging Findings:** The abdominal X-ray shows a bowel-gas pattern consistent with an ileus, and the CT scan reveals a distended small bowel with no mass or abscess, supporting the diagnosis of acute diverticulitis.
**3. Three Risk Factors for Acute Diverticulitis**
1. **Age:** The prevalence of diverticulitis increases with age, particularly in individuals over 50 years old.
2. **Low-Fiber Diet:** A diet low in fiber contributes to increased intraluminal pressure and the formation of diverticula, increasing the risk of diverticulitis.
3. **Obesity:** Being overweight or obese is associated with an increased risk of diverticulitis due to associated dietary and lifestyle factors that exacerbate diverticular disease.
**4. Discussion of Why Antibiotics and IV Fluids Are Indicated in This Case**
– **Antibiotics:** Antibiotics are crucial in treating diverticulitis to manage the bacterial infection associated with inflammation. They help to reduce the infection, prevent complications such as abscess formation, and promote healing of the inflamed diverticula. In this case, the patient was prescribed intravenous antibiotics to address the acute infection effectively.
– **IV Fluids:** Intravenous fluids are indicated to address dehydration, which is evidenced by the patient’s pale mucosa, poor skin turgor, mild hypotension, and tachycardia. Adequate hydration is essential for maintaining electrolyte balance, supporting organ function, and promoting recovery. Fluids also help to support blood pressure and improve overall patient stability.
**References**
Include scholarly sources and evidence-based guidelines relevant to diverticulitis, its pathophysiology, treatment protocols, and management. Ensure that the references are within the last 5 years and are formatted according to APA 7th edition guidelines.
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This response covers the key elements required for the discussion, including the pathophysiology, clinical findings, risk factors, and treatment rationale for acute diverticulitis. Ensure that your post is well-supported by current scholarly sources and meets the criteria outlined in the grading rubric.
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