During an initial abdominal assessment, which finding suggests that the patient's condition is stable without immediate signs of an acute abdominal emergency?

B) Absence of rebound tenderness and guarding

A) Presence of mild tenderness in the lower quadrants

B) Absence of rebound tenderness and guarding

C) Normal bowel sounds in all quadrants

D) Dull ache rated 4 out of 10 on the pain scale

What is the primary goal of initiating a clear liquid diet for a patient with suspected diverticulitis?

B) To rest the bowel and reduce inflammation

A) To increase bowel movement frequency

B) To rest the bowel and reduce inflammation

C) To enhance nutrient absorption

D) To promote rapid weight loss

What is the primary reason for advancing the patient's diet from clear liquids to a low-fiber diet in this case?

A) To improve the patient's nutritional intake

C) To increase the patient's energy levels

D) To enhance the absorption of antibiotics

Which of the following lab results indicates that the patient's renal function is stable?

C) Blood urea nitrogen (BUN) level of 15 mg/dL

D) Potassium level of 4.0 mEq/L

Which laboratory value indicates that the patient's kidney function is stable?

C) Blood urea nitrogen (BUN) level of 15 mg/dL

B) Potassium level of 4.0 mEq/L

C) Blood urea nitrogen (BUN) level of 15 mg/dL

D) White blood cell count of 7,000/µL

Which of the following interventions is most appropriate for a patient experiencing mild anxiety about resuming a normal diet after hospitalization for gastrointestinal issues?

A) Provide reassurance and education on dietary progression

B) Increase the patient's fluid intake to flush out anxiety

C) Administer an anti-anxiety medication immediately

D) Advise the patient to avoid all fiber until the next follow-up appointment

Which of the following vital sign measurements indicates that the patient is stable for discharge?

B) Heart rate of 72 beats per minute

A) Blood pressure of 140/90 mmHg

B) Heart rate of 72 beats per minute

C) Respiratory rate of 22 breaths per minute

D) Oxygen saturation of 88% on room air

Geriatric abdominal pain - Nursing Case Study

Pathophysiology

• Primary mechanism: Decreased gastrointestinal motility - As people age, the digestive system slows down, leading to constipation or bowel obstruction, which can cause abdominal pain.

• Secondary mechanism: Altered pain perception - Older adults may have a diminished ability to perceive pain accurately, which can mask the severity of conditions like peptic ulcers or diverticulitis, leading to delayed diagnosis and treatment.

• Key complication: Risk of ischemic bowel disease - Age-related vascular changes, such as atherosclerosis, can reduce blood flow to the intestines, causing severe abdominal pain and potentially leading to bowel necrosis if not promptly addressed.

Patient Profile

Demographics:

78-year-old female, retired school teacher

History:

• Key past medical history: Hypertension, osteoarthritis

• Current medications: Lisinopril 10 mg daily, acetaminophen 500 mg as needed

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Mild abdominal discomfort

• Key symptoms: Intermittent, diffuse abdominal pain over the past week; no nausea, vomiting, or changes in bowel habits

• Vital signs: Blood pressure 128/76 mmHg, heart rate 72 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F, oxygen saturation 98% on room air

Section 1

Initial Assessment Findings:

Upon initial assessment, the nurse conducted a thorough abdominal examination. The patient's abdomen was soft and non-distended, with mild tenderness noted in the lower quadrants. Bowel sounds were present and normal across all quadrants, indicating some level of gastrointestinal activity. The patient reported the pain as a dull ache, rating it at a 4 out of 10 on the pain scale. She described it as intermittent, with no specific aggravating or alleviating factors identified. The patient's skin turgor was normal, and there were no signs of dehydration or malnutrition. Her oral mucosa was moist, and she expressed a good appetite despite the discomfort.

The nurse also performed a basic neurological assessment to evaluate any potential neurological causes of altered pain perception. Cranial nerves were intact, and the patient demonstrated no deficits in sensation or motor function. Cognition was clear, and the patient was oriented to person, place, and time. The absence of red flags such as fever, guarding, or rebound tenderness suggested that the condition was stable without immediate signs of acute abdominal emergencies like perforation or peritonitis.

These findings provided a foundation for further diagnostic testing to rule out underlying conditions such as ischemic bowel disease or early-stage diverticulitis. The initial assessment pointed towards a non-acute etiology, allowing the healthcare team to focus on managing symptoms and preventing potential complications. This assessment phase set the stage for ordering appropriate laboratory and imaging studies to clarify the diagnosis and guide future interventions.

Section 2

New Diagnostic Results:

Following the initial assessment, the healthcare team ordered a series of diagnostic tests to further evaluate the cause of the patient's abdominal pain. Blood work, including a complete blood count (CBC) and basic metabolic panel (BMP), was conducted. The results revealed a slightly elevated white blood cell count of 11,500/mm³, suggesting a mild inflammatory process. Electrolyte levels were within normal limits, and renal function was stable with a creatinine level of 0.9 mg/dL. Liver function tests were unremarkable, indicating no hepatic involvement.

An abdominal ultrasound was performed to visualize the internal structures of the abdomen. The ultrasound showed mild thickening of the sigmoid colon, raising the suspicion of early-stage diverticulitis. No abscesses or free fluid were noted, and the appendix appeared normal, ruling out appendicitis. These findings supported the initial assessment of a non-acute condition but indicated the need for monitoring and management of the inflammation to prevent complications such as infection or bowel obstruction.

Based on these results, the healthcare team initiated a conservative management plan. The patient was started on a clear liquid diet to rest the bowel, with gradual progression to a low-fiber diet as tolerated. Oral antibiotics, specifically a combination of ciprofloxacin and metronidazole, were prescribed to address the suspected diverticulitis. The patient was educated on the importance of fluid intake to maintain hydration and was advised to report any worsening of symptoms or new developments, such as fever or increased pain, to the nursing staff promptly. This approach aimed to alleviate the patient's symptoms, promote healing, and prevent further complications.

Section 3

Response to Interventions:

Over the next 48 hours, the patient demonstrated a positive response to the conservative management plan. Her abdominal pain decreased significantly, now rated at a 3 out of 10 on the pain scale, compared to the initial 6 out of 10. She reported no further episodes of nausea or vomiting. The nursing team noted that the patient was gradually tolerating the clear liquid diet, and her bowel sounds were normal, indicating that bowel function was stable. The patient's vital signs remained within normal limits, with a temperature of 98.2°F, heart rate of 78 beats per minute, blood pressure of 120/70 mmHg, and a respiratory rate of 16 breaths per minute. The absence of fever and normal vital signs suggested that inflammation was under control and the antibiotics were effective.

Throughout her stay, the patient was compliant with the prescribed fluid intake and dietary modifications. The nursing staff provided continuous education about the importance of completing the full course of antibiotics and recognizing signs of potential complications, such as severe abdominal pain or fever. The patient verbalized understanding and expressed relief at the improvement of her symptoms.

The healthcare team decided to advance the patient’s diet to a low-fiber diet, as tolerated, to promote bowel rest and prevent further irritation of the colon. The patient was encouraged to continue monitoring her symptoms and maintain follow-up care with her primary care provider to ensure continued recovery. This approach aimed to support the healing process, prevent recurrence, and prepare the patient for discharge with a comprehensive understanding of her condition and the necessary lifestyle adjustments.

Section 4

New Diagnostic Results:

As the patient continued to improve, the healthcare team conducted follow-up diagnostic tests to ensure that her recovery was on track. A repeat abdominal ultrasound was performed to assess the state of the gastrointestinal tract and confirm the resolution of any previously noted abnormalities. The ultrasound results were reassuring, showing no signs of obstruction, perforation, or significant inflammatory changes, which indicated that the conservative management approach was effective. Additionally, a complete blood count (CBC) was ordered to monitor for any indicators of infection or inflammation. The CBC results returned within normal limits, with a white blood cell count of 7,000/µL, which further confirmed that the inflammation was under control.

Laboratory tests also included an assessment of the patient's electrolytes and renal function, given her recent fluid management. The results revealed stable electrolyte levels, with sodium at 138 mEq/L, potassium at 4.0 mEq/L, and chloride at 102 mEq/L. Blood urea nitrogen (BUN) and creatinine levels were also normal, at 15 mg/dL and 0.8 mg/dL respectively, indicating good kidney function. These findings provided additional reassurance that the patient's condition was stable and that she was likely ready for further dietary advancements as she prepared for discharge.

With the positive diagnostic results, the healthcare team discussed the next steps with the patient, emphasizing the importance of gradual dietary progression and adherence to the prescribed medications. The patient expressed understanding and was eager to continue her recovery at home, armed with the knowledge and resources needed to maintain her health and prevent potential complications. The team remained vigilant, ready to address any changes in her condition, while also planning a follow-up appointment to ensure sustained improvement and support her transition back to her usual activities.

Section 5

As the patient prepared for discharge, the healthcare team performed a final comprehensive assessment to ensure she was truly ready to transition back home. Vital signs were stable, with a blood pressure of 120/80 mmHg, heart rate of 72 beats per minute, respiratory rate of 18 breaths per minute, and an oxygen saturation of 98% on room air. These stable vitals supported the clinical decision to progress her care plan. The patient reported minimal abdominal discomfort, rating her pain as 2 on a scale of 0 to 10, which was a significant improvement from her initial presentation. Her bowel sounds were active and normal in all quadrants, and she was passing flatus regularly, further indicating the resolution of her gastrointestinal issues.

During a discussion about her dietary progression, the patient expressed mild anxiety about resuming her normal diet. The healthcare team provided reassurance and education on introducing fiber gradually and monitoring for any signs of recurrence, such as bloating or abdominal pain. A dietitian was consulted to develop a personalized meal plan that included easily digestible foods to support her gastrointestinal health while promoting adequate nutrition. The patient was encouraged to maintain hydration and adhere to a schedule of small, frequent meals to prevent any undue stress on her digestive system.

As the patient prepared to leave the hospital, she was given clear instructions on recognizing early signs of complications, such as changes in bowel habits or increased abdominal pain. A follow-up appointment was scheduled for one week after discharge to reassess her condition and adjust her care plan as needed. By maintaining regular communication with her healthcare providers, the patient was set to enjoy a smooth recovery and a return to her normal activities with confidence. The team remained committed to monitoring her progress and ensuring that any new complications were addressed promptly.