Case Study

50-year-old female complaining of pain in the left lower quadrant is admitted to the
facility. Height 5’4″, Wt.: 130, BP: 112/64, P: 100, R: 16, T: 100.2, Pulse Ox: 98%, Pain:
8/10. Pupils: PERRLA, Lung: Clear, Heart: Normal, Orientation X4, ABD: tender left
lower Quadrant, Bowel Sounds normal. Client state that she doesn’t eat fruits or vegetable very often, she doesn’t care for them. Her diet consists of mainly meat, foul, and fish. She has had discomfort on her left side for around a week and has been constipated a few times and has also had some diarrhea as well, but it got worse the last 2 days.

What is important to know in the history stated above?
What do you anticipate the physician is going to order?
What prep would need to be done for the anticipated doctor’s orders if any?
What subjective assessment/ data collection will you be collecting from the client?
What objective assessment/ data collection will you collect?

Labs are back: RBC: 4.8 million/mm3
, Hgb: 13 g/dL, Hct: 40%, ESR: 19 mm/hr,
WBC 9,500/mm3
, Plt: 350,000/mm3
, Occult Blood: Neg, Urinalysis: Normal
CT scan report indicates Diverticulosis
The physician has diagnosed the client with diverticular disease.

What would you anticipate the medical management to be for this client?
What interventions would you perform for this client?

The client has been improving over the last 24 hours, but is complaining that the pain has moved over to her right side starting about 2 hours ago she noticed it and she has become a
little nauseated, she has her knees flexed at this time and says it helps with the pain and she
doesn’t feel like eating her lunch.

What assessments and actions will you need to do for this client at this time?

Vital: BP: 148/84, P: 100, R: 24, T: 100.6, Pain: 710, Pulse Ox: 98%
Daily lab reports are back, and WBC is 13,500/mm3 and the ESR is 30 mm/hr

What do you suspect is going on with your client and what do you anticipate the physician will order?
What interventions will you perform for this client at this time?

Ultrasound confirmed appendicitis and the surgeon was called in to evaluate the client for
surgery.

What preoperative interventions would be done for this client?

The surgeon has determined they will have to wait for 3 more hours based on when the
client has eaten and drank last. You have continued to monitor the client. The client uses
the call light to call you. When you come into the room the client appears to be crying and
holding her abdomen and says she can’t handle the pain that has just started a while ago and has gotten really bad she fills that she is going to vomit because the nausea is really bad at this time.

What do you suspect has happened?
What assessment will you do at this time and what do you think you will find?
You report to the RN who has notified the surgeon. What do anticipate the surgeon to
order or do?
What interventions will you need to perform for this client?
What interventions will you do in the post-operative phase?

ANSWER

Case Study: Management of Diverticular Disease and Appendicitis

Introduction

This case study follows a 50-year-old female with complaints of pain in the left lower quadrant who is diagnosed with diverticular disease and later develops appendicitis. The nursing care provided during the client’s hospital stay is crucial for accurate assessment, timely interventions, and effective management of both conditions.

History Assessment
In the initial history, it is essential to note the client’s diet, which lacks fruits and vegetables. This information is relevant as it may contribute to gastrointestinal issues such as constipation and diarrhea. Additionally, the duration and nature of pain and any associated symptoms should be recorded.

Anticipated Physician Orders
Considering the symptoms and physical assessment findings, the physician may order further imaging tests such as a CT scan to confirm the diagnosis of diverticular disease. Diverticulosis, as indicated in the CT scan report, may require a combination of medical and dietary interventions.

Prep for Anticipated Doctor’s Orders
For the CT scan, the client may need to fast for a specified duration before the procedure to ensure accurate imaging results.

Subjective Data Collection
Collect subjective data related to the client’s pain, discomfort, bowel movements, and dietary habits. Obtain details about the recent onset of pain on the right side and associated symptoms like nausea.

Objective Data Collection
Objective data collection includes vital signs, physical examination findings, and laboratory reports (CBC, ESR) to monitor the client’s condition and identify any changes.

Medical Management for Diverticular Disease
The medical management for diverticular disease may include a combination of antibiotics, analgesics, and dietary modifications. High-fiber diet recommendations may be given to prevent further complications.

Interventions for Diverticular Disease
Nursing interventions may include pain management, monitoring for any signs of infection, and education on dietary modifications and potential complications.

Assessment and Actions for Changing Symptoms
The new symptoms of pain on the right side and nausea raise concerns for appendicitis. The nurse should perform a focused assessment, including a thorough abdominal examination, to assess for rebound tenderness and guarding.

Suspected Appendicitis
Based on the client’s symptoms and assessment findings, appendicitis is suspected, and the physician may order an ultrasound or other imaging tests to confirm the diagnosis.

Postoperative Interventions
Following the diagnosis of appendicitis and the decision for surgery, preoperative interventions may include administering prescribed medications, ensuring the client is NPO (nil per os) before surgery, and preparing the client physically and emotionally for the procedure.

Acute Pain Management
When the client reports increased pain and nausea, the nurse should reassess the client’s vital signs, perform a focused abdominal assessment, and administer prescribed analgesics. Nausea medication may also be given to alleviate discomfort.

Surgeon’s Orders
The surgeon may order immediate intervention, such as a change in medication, additional imaging, or an emergency appendectomy.

Post-Operative Interventions
Post-operative interventions include monitoring vital signs, assessing the surgical site for any signs of infection, pain management, early ambulation, and wound care.

Conclusion

This case study highlights the importance of accurate assessment and timely interventions in the management of diverticular disease and appendicitis. By closely monitoring the client’s condition and collaborating with the healthcare team, nurses can ensure optimal patient outcomes and support the recovery process.