NURSING > CASE STUDY > NURSING PNP401 Case Study # 2 - Lower GI disorder: Tommy, a 56-year-old school counselor. (All)

NURSING PNP401 Case Study # 2 - Lower GI disorder: Tommy, a 56-year-old school counselor.

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NURSING PNP401 Case Study # 2 - Lower GI disorder: Tommy, a 56-year-old school counselor.-Tommy, a 56-year-old school counselor, has come into the gastroenterologist office for recurrent mild to severe cramping in his abdomen and blood-streaked stool. Here are the findings of the initial nursing assessment upon his arrival to the clinic: • Mildly obese man • Guarding of his abdomen with both direct and rebound tenderness, especially in the left lower quadrant (LLQ) • BP: 168/98, HR: 110, RR: 24, Temp: 38 degrees • Slightly diaphoretic • He reports that he has periodic constipation. • He reports previous episodes of abdominal pain but this time “the pain is getting worst” Tommy’s past medical history: • A sedentary job with “lots of emotional draining moments”. • Smoked a pack of cigarettes a day for the past 20 years. • Drinks 2-3 large cans of beer every evening until 3 months ago. • Diet consists of white bread, meat, ice cream and nuts. • He denies history of cardiac or pulmonary problems • No personal history of cancer • Father and older brother died of colon cancer • Not on any medications 1. Identify 3 risk factors of Tommy based on the nursing assessment and past medical history. (0.5/ea point, 1.5 marks total) Family history: Tommy’s father and brother both died due to colon cancer and this family related medical history can be a risk factor for him. Smoking and substance use: Smoking and alcohol both are toxic substances for the stomach and these can irritate the stomach lining and exacerbate the symptoms. Diet high fat and low in fiber: His diet includes only carbohydrates and fats which and since he is not consuming any fibers, it can lead to constipation and eventually stomach diseases. 2. Identify 3 key findings from the initial nursing assessment and explain their significance (0.5/ea point, 3 marks total) Rebound tenderness in left lower quadrant (LLQ): Left lower abdominal tenderness is associated with serious disease related to abdominal abscess, inflammatory bowel disease and bowel obstruction. Fever: Patient is experiencing low-grade fever. Constipation: patient is experiencing periodic constipation that means he is experiencing changes in bowel movement. Three three symptoms are commonly associated with inflammatory bowel disease - diverticulitis. (The gastroenterologist ordered a complete blood count (CBC), and a CT scan of the abdomen with contrast. Based on the radiology and lab results, physical examination findings and his history, Tommy is diagnosed with acute diverticulitis.) 3. What are 3 results we can anticipate someone with diverticulitis to demonstrate? What are the normal ranges for each of these results? (0.5/ ea point, 3 marks total) CT scan: This imaging test can identify inflamed or infected pouches in the stomach and confirm a diagnosis of diverticulitis. CT scan can also indicate the severity of diverticulitis and guide treatment. Blood test: Blood tests need to be done to check for signs of infection, such as a high white blood cell count.

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