Question

PN 200 Fundamentals of Nursing II Concept Map: Diverticulitis Tim Haute, 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 nurse doing his initial assessment. You findings include a mildly obese man (male pattern obesity) who demonstrates mild guarding of his abdomen with both direct and rebound tenderness, especially in the LLC. Vital signs are 168/98, P 110, R 24, T. 98.4 and he is slightly diaphoretic. Mr. Haute states that he has periodic constipation. He has had previous episodes of abdominal cramping, but this time the pain is getting worse. PMH: Mr. Haute has a sedentary job with many emotional moments"; he has smoked a pack of cigarettes a day for the past 30 years and has had 2-3 mixed drinks in the evening" until 2 months ago. He states, "I have not had anything to drink in 60 days." He denies regular exercise with the statement "Just no tie." His diet consists of white bread, meat, potatoes and ice cream with fruits and nuts over it. He denies a history of pulmonary or cardiac and no personal history of cancer, although his father and older brother died of colon cancer. He takes no "routine medications and denies the use of any other drugs. The physician orders a KUB, CBC, and CMP. Based on the X-ray and lab findings physical exam and history the physician diagnosis the patient with acute diverticulitis and discusses the outpatient treatment plan with him. The physician now orders bed rest and anticholenergies for Mr. Haute. The physician orders metronidazole for this patient. 1. Prepare a list of questions you would ask this patient prior to administering metronidazole and state your rationale, 2. Explain what a disulfiram reaction is. You continue to teach the patient about both disulfiram and metronidazole reactions and interactions. You decide that there are some other instructions you need to give to the patient regarding his metronidazole prescription The physician has now ordered Ampicillin for the patient. 3. State additional information you would need to know before starting the patient on Ampicillin Revised 1/20

Answer 1

1.The questions which has to be asked are

• Use of any medication ,herbal supplements(metronidazole highly interacts with them)
• Any medical conditions (liver ,renal disease can affect the absorption and may aggregate the condition)
• Any complaints associated with gastrointestinal system has to be considered because this can bleeding and severe gastrointestinal discomfort
• Having any complaints like headache
• Any genetic disease (cockayne syndrome),anemia because the drug interacts
• Hypersensitivity
• Drug allergy

2.Disulphiram reactions in simple refers to developing symptoms similar to when taken alcohol .

3.The additional question to be asked are

• Allergy to cephalosporin drugs because patient allergic to this antibiotic can be given ampicillin

Diverticulitis

Nursing diagnosis Acute pain/Impqired bowel pattern related to gastrointestinal inflammatory process or polys as evidenced by verbalisation, abdominal cramps, blood streak stool	Nursing diagnosis Ineffective cardiac output related to disease condition as evidenced by elevated blood pressure, heartrate, diaphoresis.
Intervention Administer medication to relieve pain Collect stool sample for investigations Monitor for anemia because if blood in stool Provide a soft bland diet to ensure easy digestion	Intervention Monitor vital signs, baseline data and even mild changes can be ruked out earlier Administer antihypertensive to reduce blood pressure Assess for any complications due to high blood pressure Treat the underlying cause to reduce the blood pressure
Positive outcomes The patient will have no pain and normal blood parameters	Positive outcomes The patinetbshoukd be normotensive
Negative outcomes Risk for anemia due to bleeding	Negative outcomes Risk for stroke can occur
Evaluation Patient able to fo all activities Verbalises no pain	Evaluation The patient has a normal blood pressure Hemodynamically stable.