T.H., 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
registered nurse doing his initial workup. Your findings include a mildly obese man who
demonstrates moderate guarding of his abdomen with both direct and rebound tenderness,
especially in the left lower quadrant (LLQ). His vital signs are 168/98, 110, 24, 100.4° F (38° C);
he is slightly diaphoretic. T.H. reports that he has periodic constipation. He has had previous
episodes of abdominal cramping, but this time the pain is getting worse. Past medical history
reveals that T.H. has a "sedentary job with lots of emotional moments," he has smoked a pack of
cigarettes a day for 30 years, and he had "two or three mixed drinks in the evening" until
2 months ago. He states, "I haven't had anything to drink in 2 months." He denies having regular
exercise: "just no time." His diet consists mostly of "white bread, meat, potatoes, and ice cream
with fruit and nuts over it." He denies having a history of cardiac or pulmonary problems and has
no personal history of cancer, although his father and older brother died of colon cancer. He
takes no medications and denies the use of any other drugs or herbal products.
1. Identify four general health risk problems that T.H. exhibits.
Obese, Smokes, No exercise and drinks
2. Identify a key factor in his family history that might have profound implications for his health
and present state of mind.
His dad and older brother died of colon cancer
3. Identify three key findings on his physical examination, and indicate their significance.
Tenderness in LLQ, Vital signs are not close to normal, Severe cramping
Case Study Progress:
The physician ordered a KUB (x-ray study of the kidneys, ureters, and bladder), complete
blood count (CBC), and complete metabolic profile. Based on x-ray and laboratory findings,
physical examination findings, and history, the physician diagnoses T.H. as having acute
diverticulitis and discusses an outpatient treatment plan with him.
4. What is diverticulitis? What are the consequences of untreated diverticulitis?
Pouches that are formed in the GI trac that get inflamed. Untreated can lead to serious
complications. Serious complications may require surgery and without it, it could be fatal.
5. While the patient is experiencing the severe crampy pain of acute diverticulitis, what
interventions would you perform to help him feel more comfortable?
Give them antibiotics, and stool softner. Change to a liquid diet for a few days. NSAIDs
6. What is the rationale for ordering bed rest?
It will help you colon rest combined with a liquid diet.
Case Study Progress:
T.H. is being sent home with prescriptions for metronidazole (Flagyl) 500mg PO q6h,
ciprofloxacin (Cipro) 500mg PO q12h, and dicyclomine (Bentyl) 20mg qid PO×5days.
7. For each medication, state the drug class and the purpose for T.H.
Metronidazole – antibiotic it treats infection
Ciprofloxacin – antibiotic treats bacterial infection
Dicyclomine – anticholinergics treats IBS
8. Given his history, what questions must you ask T.H. before he takes the initial dose of
metronidazole? State your rationale.
This study source was downloaded by 100000817935606 from CourseHero.com on 02-01-2022 07:32:58 GMT -06:00
https://www.coursehero.com/file/82693486/GI-Case-Studydocx/
recurrent mild to severe cramping in his abdomen and blood-streaked stool. You are the
registered nurse doing his initial workup. Your findings include a mildly obese man who
demonstrates moderate guarding of his abdomen with both direct and rebound tenderness,
especially in the left lower quadrant (LLQ). His vital signs are 168/98, 110, 24, 100.4° F (38° C);
he is slightly diaphoretic. T.H. reports that he has periodic constipation. He has had previous
episodes of abdominal cramping, but this time the pain is getting worse. Past medical history
reveals that T.H. has a "sedentary job with lots of emotional moments," he has smoked a pack of
cigarettes a day for 30 years, and he had "two or three mixed drinks in the evening" until
2 months ago. He states, "I haven't had anything to drink in 2 months." He denies having regular
exercise: "just no time." His diet consists mostly of "white bread, meat, potatoes, and ice cream
with fruit and nuts over it." He denies having a history of cardiac or pulmonary problems and has
no personal history of cancer, although his father and older brother died of colon cancer. He
takes no medications and denies the use of any other drugs or herbal products.
1. Identify four general health risk problems that T.H. exhibits.
Obese, Smokes, No exercise and drinks
2. Identify a key factor in his family history that might have profound implications for his health
and present state of mind.
His dad and older brother died of colon cancer
3. Identify three key findings on his physical examination, and indicate their significance.
Tenderness in LLQ, Vital signs are not close to normal, Severe cramping
Case Study Progress:
The physician ordered a KUB (x-ray study of the kidneys, ureters, and bladder), complete
blood count (CBC), and complete metabolic profile. Based on x-ray and laboratory findings,
physical examination findings, and history, the physician diagnoses T.H. as having acute
diverticulitis and discusses an outpatient treatment plan with him.
4. What is diverticulitis? What are the consequences of untreated diverticulitis?
Pouches that are formed in the GI trac that get inflamed. Untreated can lead to serious
complications. Serious complications may require surgery and without it, it could be fatal.
5. While the patient is experiencing the severe crampy pain of acute diverticulitis, what
interventions would you perform to help him feel more comfortable?
Give them antibiotics, and stool softner. Change to a liquid diet for a few days. NSAIDs
6. What is the rationale for ordering bed rest?
It will help you colon rest combined with a liquid diet.
Case Study Progress:
T.H. is being sent home with prescriptions for metronidazole (Flagyl) 500mg PO q6h,
ciprofloxacin (Cipro) 500mg PO q12h, and dicyclomine (Bentyl) 20mg qid PO×5days.
7. For each medication, state the drug class and the purpose for T.H.
Metronidazole – antibiotic it treats infection
Ciprofloxacin – antibiotic treats bacterial infection
Dicyclomine – anticholinergics treats IBS
8. Given his history, what questions must you ask T.H. before he takes the initial dose of
metronidazole? State your rationale.
This study source was downloaded by 100000817935606 from CourseHero.com on 02-01-2022 07:32:58 GMT -06:00
https://www.coursehero.com/file/82693486/GI-Case-Studydocx/
