Reference no: EM133280320

Case Study, Chapter 47, Management of Patients With Intestinal and Rectal Disorders

1. Paul Jones, a 35-year-old patient, presents at the clinic after a CT scan of the abdomen with contrast agent was positive for diverticulitis. The patient presents with nausea, vomiting, fever, and chills; left lower quadrant abdominal pain described as spasms; and a firm mass. Bowel sounds are present in all four quadrants. The patient reports bouts of constipation with a hard narrow stool that is difficult to pass and periods of diarrhea with abdominal cramping. The stool is negative for occult blood. The patient has no other medical conditions. The vital signs include: BP, 110/70; P, 100; R, 22; and T, 101°F. The white blood count and ESR are elevated. The physician prescribes a broad-spectrum antibiotic, amoxicillin clavulanate for 10 days, and propantheline bromide (Pro-Banthine) before meals and at bedtime, psyllium (Metamucil), and docusate sodium (Colace). Diet is as follows: clear liquids until inflammation subsides for 24 to 48 hours, and then advance diet, as tolerated, increasing the intake of fresh fruits and vegetables at least five servings per day, and bran cereal every day. The patient is also instructed to eat whole grain bread. (Learning Objective 3)

What questions should the nurse ask the patient while taking a history?

What patient education should the nurse provide to the patient being treated for diverticulitis on an outpatient basis?

2. Mr. Thompson sustained a gunshot wound to the abdomen and underwent an exploratory laparotomy and creation of an ileostomy due to damage to the small bowel. You are assigned to care for Mr. Thompson on the third postoperative day. He has a nasogastric tube to low intermittent suction, and he is emitting greenish aspirate. IV access is through a triple lumen right subclavian catheter, and he is receiving D5 0.9% NS with 20 mEq K (potassium)/liter. Mr. Thompson has a dressing to the left abdomen, and there is moderate amount of fluid draining out of his ileostomy. (Learning Objective 6)

What is the rationale for the nasogastric tube to low intermittent suction?

Mr. Thompson is at risk for which kinds of electrolyte imbalances?

Upon assessment of the stoma, what findings substantiate a healing stoma?

Mr. Thompson asks when his bowel output will become more solid and if he will be able to have a continent ostomy. How should the nurse respond?

What is the rationale for a low residue diet in the patient with an ileostomy?