Episode of Diverticulitis Managed Nonoperative Essay Paper

Episode of Diverticulitis Managed Nonoperative Essay Paper

History of the Presenting Complaint

J.R is a 47 years old white male who presented with generalized abdominal pain for three days. The pain was of acute onset and was intense at the left lower quadrant. The pain was constant,  not radiating, it was aggravated by exertion and relieved by rest. During the first day, the pain was very severe at 9 out of 10 and has been gradually reducing up to 5 out of 10. The pain was very severe such that the patient could not eat. The patient also complained of diarrhea with food content, non-mucoid, and not bloodstained. The episodes of diarrhea were alternating with episodes of constipation. It was associated with nausea and a few episodes of vomiting. However, there was no reported history of reflux, weight loss, night sweats, and general body weakness. Episode of Diverticulitis Managed Nonoperative Essay Paper

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Past Medical and Surgical History

The patient is known to have diabetes mellitus and hypertension. He reports having been diagnosed with GI bleeding four years ago. He is no lisinopril 10mg, Amlodipine 5 mg, Metformin 1000mg, and Lantus 10 Units qhs. There is no known history of food and drug allergy. The patient was previously admitted for two weeks in the general ward and transfused two pints of blood because of the GI bleeding. However, he has not undergone any minor or major surgical procedure.

Personal, Social-Economic, And Family History

J.R is a 47 years old white male who is married to one wife with two children. He is a staunch Christian and an active member of his church. He denies smoking tobacco but takes alcohol occasionally. His parents and siblings are alive. His father suffers from type two diabetes mellitus and hypertension while his mother suffers from hypertension, GERD, and hyperlipidemia. There is no history of colon cancer in the family.

Review of Systems

The system affected is the gastrointestinal system. It presents with abdominal pain, diarrhea, nausea, vomiting, and constipation. The cardiovascular, respiratory, musculoskeletal, and genital-urinary systems are not affected. The patient denies easy fatigability, headache, weight loss, and night sweats. Episode of Diverticulitis Managed Nonoperative Essay Paper

Objective Data

General Examination

The patient is short, obese, and clinically afebrile. He has no pallor, jaundice, dehydration, lymphadenopathy, cyanosis, and finger clubbing. The skin is intact with no lesions and no urticarial. His vitals are blood pressure at 160/86mmHg, pulse rate of 92beats per minute, the temperature of 99.8 degrees Celcius, oxygen at 98% room air, and BMI of 30kgsm2. The patient is alert, oriented to time, place, and person.

Systemic Examination

Gastrointestinal system: the abdomen has a normal contour, it is normal, and is moving with respiration. There are no therapeutic marks or scars noted. On auscultation, abdominal bruits are present with hyperactive bowel sounds. On palpation, the skin has a normal temperature, are there is tenderness noted at the left lower quadrant. There are no palpable abdominal masses. On percussion, there was a tympanic note and there was no shifting dullness.

Cardiovascular system: The patient has a normal-active precordium at the 5th intercostal space mid-clavicular line. The heart sounds are present with a regular rhythm and normal rate. There are no murmurs and other added heart sounds heard on percussion. Parasternal heaves and thrills are not palpable.

Respiratory system: the chest wall is symmetrical, moving with respiration and no obvious masses and skin lesions. There is a resonant note on percussion and normal vesicular breath sounds on auscultation. The musculoskeletal and genital urinary systems are normal.

Diagnostic Tests

A complete blood count is done to rule out diverticulitis with increased white blood cells and leukocytosis. The C-reactive proteins and erythrocyte sedimentation rate are elevated thus determining the inflammation markers as in diverticulitis. Radiological markers are the abdominal CT scan, ultrasound, and X-ray. An abdominal CT scan has a comparative sensitivity and specificity making it accurate to make a diagnosis of acute diverticulitis (Lin, et al, 2019). Abdominal ultrasound and X-ray have limited data in making a diagnosis because it shows non-specific bowel abnormalities. Hence, the CT scan is more preferred comparing to the ultrasound and X-ray. Episode of Diverticulitis Managed Nonoperative Essay Paper

Assessment

Differential diagnoses are Diverticulitis, Gastroenteritis, and inflammatory bowel syndrome. Diverticulitis presents with abdominal pain on the left lower quadrant associated with diarrhea and nausea. Upon examination, the patient is dehydrated, has tachycardia, and leathery. The patient has hyperactive bowel movement and tenderness at the left lower quadrant. Diverticulitis is accurately diagnosed by an abdominal CT scan (Almalki, et al, 2020). Gastroenteritis presents with generalized abdominal pain associated with diarrhea, nausea, vomiting, and fever. On examination, the patient is clinically febrile with fever, dehydration, tachycardia, tachypnea, and tachycardia. The accurate diagnostic test is a stool study for any pathogens and microorganisms causing diarrhea (Sunkara, et al, 2019). Inflammatory bowel syndrome presents with abdominal pain on the right lower quadrant and radiates to the left lower quadrant. It is associated with episodes of diarrhea that alternates with constipation (Friedrich, et al, 2019). The patient also presents with nausea, vomiting, and abdominal bloating. On examination, the patient is clinically afebrile. The diagnostic test in this patient is an endoscopy. The primary diagnosis for this patient is diverticulitis.

A woman went to the emergency room for severe abdominal cramping. She was diagnosed with diverticulitis; however, as a precaution, the doctor ordered a CT scan. The CT scan revealed a growth on the pancreas, which turned out to be pancreatic cancer—the real cause of the cramping.

 

Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen.

 

In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

 

To Prepare

Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study. Episode of Diverticulitis Managed Nonoperative Essay Paper

 

With regard to the Episodic note case study provided:

Review this week’s Learning Resources, and consider the insights they provide about the case study.

Consider what history would be necessary to collect from the patient in the case study.

Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

The Assignment

Analyze the subjective portion of the note. List additional information that should be included in the documentation.

Analyze the objective portion of the note. List additional information that should be included in the documentation.

Is the assessment supported by the subjective and objective information? Why or why not?

What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?

Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

See case study below

In this Assessment 1 Assignment, you will analyze an Episodic Note case study that describes abnormal findings in patients seen in a clinical setting. This is in a scholarly paper format and not SOAP format this week. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions. Follow the rubric…..Be sure to use APA format…..and upload by Day 7. Episode of Diverticulitis Managed Nonoperative Essay Paper

 

Subjective:•CC: “My stomach hurts, I have diarrhea and nothing seems to help.”•HPI: JR, 47 yo WM, complains of having generalized abdominal pain that started 3 days ago. He has not taken any medications because he did not know what to take. He states the pain is a 5/10 today but has been as much as 9/10 when it first started. He has been able to eat, with some nausea afterwards.•PMH: HTN, Diabetes, hx of GI bleed 4 years ago •Medications: Lisinopril 10mg, Amlodipine 5 mg, Metformin 1000mg, Lantus 10 units qhs•Allergies: NKDA•FH: No hx of colon cancer, Father hx DMT2, HTN, Mother hx HTN, Hyperlipidemia, GERD •Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

 

Objective:•VS: Temp 99.8; BP 160/86; RR 16; P 92; HT 5’10”; WT 248lbs•Heart: RRR, no murmurs•Lungs: CTA, chest wall symmetrical•Skin: Intact without lesions, no urticaria •Abd: soft, hyperactive bowel sounds, pos pain in the LLQ•Diagnostics: None

 

Assessment:•Left lower quadrant pain •Gastroenteritis

 

PLAN: This section is not required for the assignment.

 

  1. This week is the Midterm exam….due to be completed by Day 7. Please be mindful that when you sit down to take the exam….you will have exactly 2 hours and then the exam will shut down and submit.

 

  1. You should continue to be practicing all of your assessment skills with your patient at home, and work in

 

Week 6: Assessment of the Abdomen and Gastrointestinal System

On your way home from dinner, you start experiencing sharp pains in your abdomen. You ate seafood—could you have food poisoning? What else might be causing your pain? Appendicitis? Should you head to the emergency room, or should you wait and see how you feel in the morning?

 

Numerous ailments can affect the GI system and the abdomen. Because the organs are so close, it can be difficult to conduct an accurate assessment. Also, pain in another area of the body can affect the GI system. For example, patients with chronic migraines often report nausea.

This week, you will explore how to assess the abdomen and gastrointestinal system.

Learning Objectives

Students will:

Evaluate abnormal abdomen and gastrointestinal findings

Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the abdomen and gastrointestinal system

Identify  concepts, theories, and principles related to advanced health assessment

Learning Resources

Required Readings (click to expand/reduce)

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 6, “Vital Signs and Pain Assessment”

This chapter describes the experience of pain and its causes. The authors also describe the process of pain assessment.

Chapter 18, “Abdomen”

In this chapter, the authors summarize the anatomy and physiology of the abdomen. The authors also explain how to conduct an assessment of the abdomen.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 3, “Abdominal Pain”

This chapter outlines how to collect a focused history on abdominal pain. This is followed by what to look for in a physical examination in order to make an accurate diagnosis.

Chapter 10, “Constipation”

The focus of this chapter is on identifying the causes of constipation through taking a focused history, conducting physical examinations, and performing laboratory tests.

Chapter 12, “Diarrhea”

In this chapter, the authors focus on diagnosing the cause of diarrhea. The chapter includes questions to ask patients about the condition, things to look for in a physical exam, and suggested laboratory or diagnostic studies to perform.

Chapter 29, “Rectal Pain, Itching, and Bleeding”

This chapter focuses on how to diagnose rectal bleeding and pain. It includes a table containing possible diagnoses, the accompanying physical signs, and suggested diagnostic studies.

Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.

Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.

These sections below explain the procedural knowledge needed to perform gastrointestinal procedures.

Chapter 107, “X-Ray Interpretation: Chest (pp. 480–487)

Chapter 115, “X-Ray Interpretation of Abdomen” (pp. 514–520)

Note: Download this Student Checklist and Abdomen Key Points to use during your practice abdominal examination.

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Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Abdomen: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Abdomen: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Document: Midterm Exam Review (Word document)

Optional Resource

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527)

This chapter explores the health assessment processes for the abdomen, perineum, anus, and rectosigmoid. This chapter also examines the symptoms of many conditions in these areas.

Chapter 10, “The Urinary System” (pp. 528–540)

In this chapter, the authors provide an overview of the physiology of the urinary system. The chapter also lists symptoms and conditions of the urinary system.

Required Media (click to expand/reduce)

Assessment of the Abdomen and Gastrointestinal System – Week 6 (14m)

Accessible player

Online media for Seidel’s Guide to Physical Examination

 

It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapter 17 that relate to the assessment of the abdomen and gastrointestinal system. Refer to Week 4 for access instructions on https://evolve.elsevier.com/

In this Assessment 1 Assignment, you will analyze an Episodic Note case study that describes abnormal findings in patients seen in a clinical setting. This is in a scholarly paper format and not SOAP format this week. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions. Follow the rubric…..Be sure to use APA format…..and upload by Day 7. Subjective:•CC: “My stomach hurts, I have diarrhea and nothing seems to help.”•HPI: JR, 47 yo WM, complains of having generalized abdominal pain that started 3 days ago. He has not taken any medications because he did not know what to take. He states the pain is a 5/10 today but has been as much as 9/10 when it first started. He has been able to eat, with some nausea afterwards.•PMH: HTN, Diabetes, hx of GI bleed 4 years ago •Medications: Lisinopril 10mg, Amlodipine 5 mg, Metformin 1000mg, Lantus 10 units qhs•Allergies: NKDA•FH: No hx of colon cancer, Father hx DMT2, HTN, Mother hx HTN, Hyperlipidemia, GERD •Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys) Objective:•VS: Temp 99.8; BP 160/86; RR 16; P 92; HT 5’10”; WT 248lbs•Heart: RRR, no murmurs•Lungs: CTA, chest wall symmetrical•Skin: Intact without lesions, no urticaria •Abd: soft, hyperactive bowel sounds, pos pain in the LLQ•Diagnostics: None Assessment:•Left lower quadrant pain •Gastroenteritis PLAN: This section is not required for the assignment. 2. This week is the Midterm exam….due to be completed by Day 7. Please be mindful that when you sit down to take the exam….you will have exactly 2 hours and then the exam will shut down and submit. 3. You should continue to be practicing all of your assessment skills with your patient at home, and work in Episode of Diverticulitis Managed Nonoperative Essay Paper

References

Almalki, T., Garfinkle, R., Kmiotek, E., Pelsser, V., Bonaffini, P., Reinhold, C., & Boutros, M. (2020). Family History Is Associated With Recurrent Diverticulitis After an Episode of Diverticulitis Managed NonoperativelyDiseases of the Colon & Rectum63(7), 944-954.

Friedrich, M., Pohin, M., & Powrie, F. (2019). Cytokine networks in the pathophysiology of inflammatory bowel disease. Immunity50(4), 992-1006.

Lin, L., Liu, K., Liu, H., Wu, J., & Zhang, Y. (2019). Capsule endoscopy is a diagnostic test for Meckel’s diverticulum. Scandinavian journal of gastroenterology54(1), 122-127.

Sunkara, T., Rawla, P., Yarlagadda, K. S., & Gaduputi, V. (2019). Eosinophilic gastroenteritis: diagnosis and clinical perspectives. Clinical and experimental gastroenterology12, 239. Episode of Diverticulitis Managed Nonoperative Essay Paper

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