A patient with a suspected pericolic abscess due to diverticulitis presents with worsening abdominal pain, fever, and elevated white blood cell count. Which of the following nursing interventions is most appropriate to prioritize at this time to prevent further complications?

B) Prepare the patient for potential percutaneous drainage of the abscess.

A) Encourage the patient to increase oral fluid intake to prevent dehydration.

B) Prepare the patient for potential percutaneous drainage of the abscess.

C) Administer analgesics to manage the patient's pain as prescribed.

D) Monitor the patient's vital signs every 4 hours to detect changes.

A patient with a suspected pericolic abscess due to diverticulitis presents with worsening abdominal pain, fever, and tachycardia. Which nursing intervention is the highest priority in managing this patient’s current condition?

B) Preparing the patient for a possible percutaneous abscess drainage

A) Administering prescribed antibiotics to address the infection

B) Preparing the patient for a possible percutaneous abscess drainage

C) Monitoring vital signs and fluid balance closely

D) Educating the patient about dietary modifications to prevent future episodes

A patient with a pericolic abscess has undergone percutaneous drainage and is receiving intravenous metronidazole and ciprofloxacin due to a penicillin allergy. The healthcare team observes a slight decrease in fever and stabilization of heart rate, but the patient continues to report abdominal bloating and discomfort. Which nursing intervention is most appropriate to address the patient's current symptoms and promote recovery?

A) Encourage the patient to ambulate frequently to promote bowel motility.

B) Administer a laxative to relieve abdominal bloating and discomfort.

C) Increase the rate of intravenous fluids to ensure adequate hydration.

D) Provide a high-residue diet to enhance gastrointestinal function.

A patient with a history of penicillin allergy is receiving intravenous metronidazole and ciprofloxacin for a pericolic abscess. Despite some improvement, she reports ongoing abdominal bloating and discomfort. Which nursing intervention should be prioritized to address her symptoms and support recovery?

B) Encourage ambulation to promote gastrointestinal motility

A) Administer a prescribed laxative to relieve bloating

B) Encourage ambulation to promote gastrointestinal motility

C) Increase fluid intake to ensure adequate hydration

D) Apply a warm compress to the abdomen to reduce discomfort

A patient with a new onset of increased abdominal pain, nausea, and changes in vital signs after initial improvement from a previous intervention is noted to have a new pericolic abscess on CT scan. What is the most appropriate initial nursing intervention to address her hypotension and prevent further complications?

A) Administer prescribed antibiotics to target the infection

C) Prepare the patient for immediate surgical intervention

D) Apply a heating pad to the abdomen to relieve pain

A patient with a history of diverticulitis is experiencing increased abdominal pain, nausea, and hypoactive bowel sounds. The CT scan reveals a new pericolic abscess. The healthcare team has initiated fluid resuscitation. What is the most appropriate nursing intervention to address the patient's current symptoms and prevent further complications?

C) Prepare the patient for surgical intervention by ensuring NPO status and providing preoperative education.

A) Administer antiemetic medication to manage nausea and reduce the risk of dehydration.

B) Encourage the patient to increase oral intake to prevent further dehydration and electrolyte imbalance.

C) Prepare the patient for surgical intervention by ensuring NPO status and providing preoperative education.

D) Monitor the patient's pain levels and administer prescribed analgesics to improve comfort and prevent ileus.

A patient with a pericolic abscess post-drainage is experiencing elevated heart rate and low blood pressure, indicating hemodynamic instability. Despite fluid resuscitation, the patient reports significant abdominal pain. Which of the following is the most appropriate next step in nursing management?

C) Request a repeat abdominal ultrasound to assess the effectiveness of the drainage procedure.

A) Increase the rate of isotonic saline infusion to further stabilize blood pressure.

B) Administer prescribed analgesics to manage reported abdominal pain.

C) Request a repeat abdominal ultrasound to assess the effectiveness of the drainage procedure.

D) Monitor the patient closely and document changes in vital signs without additional interventions.

A patient with a pericolic abscess has undergone percutaneous drainage and is now experiencing significant abdominal discomfort described as deep, throbbing pain. Her vital signs indicate persistent hemodynamic instability with an elevated heart rate and low blood pressure. What is the nurse's priority intervention in this situation?

C) Notify the healthcare provider about the patient's abdominal pain and vital signs

A) Administer additional isotonic saline boluses to address hemodynamic instability

B) Reassess the patient's pain level and administer prescribed analgesics

C) Notify the healthcare provider about the patient's abdominal pain and vital signs

D) Encourage the patient to ambulate to improve bowel function

A patient with a small bowel obstruction secondary to edema and inflammation is being managed with nasogastric decompression and fluid therapy. Which nursing action is most critical in evaluating the effectiveness of the current treatment plan?

A) Monitoring for a decrease in abdominal distention and pain

B) Measuring the patient's input and output every shift

C) Assessing the patient's breath sounds for signs of pulmonary edema

D) Checking the patient's skin turgor and mucous membranes for hydration

A patient with a small bowel obstruction and mild hyponatremia is receiving nasogastric decompression and low-dose diuretics. Which nursing intervention is the most appropriate to monitor the effectiveness of the management plan?

D) Evaluate the patient's urine output and specific gravity.

A) Measure the patient's abdominal circumference daily.

B) Monitor the patient's heart rate and rhythm.

C) Assess the patient's lung sounds for crackles.

D) Evaluate the patient's urine output and specific gravity.

Diverticulitis - Nursing Case Study

Pathophysiology

• Primary mechanism: Diverticulitis begins with the formation of diverticula, which are small pouches protruding from the colon wall due to increased intraluminal pressure, often associated with a low-fiber diet. These pouches can become inflamed when trapped fecal matter or bacteria lead to infection.

• Secondary mechanism: Inflammation of the diverticula causes localized tissue inflammation, resulting in microperforations. This process exacerbates the local immune response, leading to further swelling, obstruction, and potential rupture of the diverticula.

• Key complication: If untreated, diverticulitis can lead to abscess formation, perforation, or peritonitis, increasing the risk of systemic infection and requiring surgical intervention to prevent widespread complications.

Patient Profile

Demographics:

45-year-old female, accountant

History:

• Key past medical history: Previous episodes of mild diverticulitis, history of hypertension, and irritable bowel syndrome

• Current medications: Lisinopril 10 mg daily, Omeprazole 20 mg daily, and occasional use of over-the-counter ibuprofen

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Severe abdominal pain in the lower left quadrant

• Key symptoms: Nausea, fever, bloating, and changes in bowel habits (alternating constipation and diarrhea)

• Vital signs: Temperature 101.4°F, heart rate 102 bpm, blood pressure 150/95 mmHg, respiratory rate 20 breaths per minute

Section 1

As the healthcare team proceeds with the initial assessment, they note that the patient's lower left quadrant abdominal pain has intensified, with tenderness and guarding upon palpation. The patient reports that her nausea has worsened, and she feels increasingly bloated despite minimal oral intake over the past 24 hours. Her bowel habits remain erratic, with episodes of constipation followed by loose stools. Upon further evaluation, the patient exhibits rebound tenderness, suggesting possible progression towards peritoneal irritation. Vital signs reveal a persistent fever of 101.8°F and tachycardia with a heart rate now at 108 bpm, while blood pressure remains elevated at 152/98 mmHg. Her respiratory rate has increased to 22 breaths per minute, indicating potential distress or pain.

Laboratory results return showing a marked leukocytosis with a white blood cell count of 16,000/mm³, suggesting an ongoing infectious or inflammatory process. C-reactive protein levels are elevated, further corroborating an acute inflammatory state. An abdominal CT scan is ordered, revealing thickening of the sigmoid colon with evidence of multiple diverticula. Notably, a localized fluid collection adjacent to the colon suggests an evolving pericolic abscess. This complication necessitates prompt intervention to prevent further deterioration, such as perforation or peritonitis.

Given these findings, the healthcare team must reconsider the current management plan. The presence of an abscess may require drainage, either percutaneously or surgically, to prevent rupture and systemic infection. Antibiotic therapy is reviewed and adjusted to cover anaerobic and gram-negative bacteria, considering her allergy to penicillin. The team discusses the potential need for surgical consultation and emphasizes the importance of monitoring the patient's fluid status, pain management, and overall stability. The unfolding scenario highlights the critical need for timely intervention and vigilant monitoring to mitigate the risk of severe complications.

Section 2

As the healthcare team implements the revised management plan, they closely monitor the patient’s response to the interventions. Within the first 12 hours, the patient undergoes percutaneous drainage of the pericolic abscess under ultrasound guidance. The procedure is successful, and approximately 50 mL of purulent fluid is aspirated and sent for culture and sensitivity analysis. The patient is started on intravenous metronidazole and ciprofloxacin, given her penicillin allergy, to cover potential anaerobic and gram-negative organisms.

Following the intervention, the patient's clinical status is observed for any signs of improvement. Her fever shows a slight decrease to 100.5°F, and her heart rate begins to stabilize, now at 98 bpm. Despite these encouraging signs, her abdominal examination reveals persistent tenderness, though with less guarding than before. Her respiratory rate decreases to 20 breaths per minute, indicating some relief in discomfort. However, the patient reports ongoing bloating and discomfort, which prompts the team to reassess her bowel function and fluid status.

Laboratory follow-ups reveal a gradual decline in white blood cell count to 14,500/mm³, suggesting a positive response to the antibiotics. However, the culture results from the aspirated fluid indicate the presence of Escherichia coli, confirming the need for continued targeted antibiotic treatment. The healthcare team remains vigilant, recognizing the potential for further complications such as recurrent abscess formation or perforation. They emphasize the importance of ongoing pain management, regular monitoring of vital signs, and nutritional support to prevent dehydration and promote recovery. As the patient progresses, the team prepares for a possible surgical consultation to address any underlying structural issues that may predispose her to recurrent episodes.

Section 3

As the healthcare team continues to monitor the patient, they note that her initial positive response to the intervention has plateaued. Despite the reduction in fever and stabilization of heart rate, she now reports an increase in abdominal pain, rated at 7 out of 10, and a new onset of nausea. These symptoms raise concern for the development of new complications. A repeat abdominal examination reveals localized rebound tenderness in the left lower quadrant, and the presence of mild distension. Her bowel sounds are hypoactive, indicating potential ileus or ongoing inflammation that may be impeding normal bowel function.

Alarmingly, the patient’s vital signs begin to reflect a subtle yet concerning trend: her heart rate has increased again to 110 bpm, and her blood pressure has dropped slightly to 100/60 mmHg, suggesting possible dehydration or a systemic inflammatory response. The team orders an abdominal CT scan with contrast to evaluate for any new abscess formation or signs of perforation. Concurrently, they initiate fluid resuscitation with isotonic saline to address her hypotension and ensure adequate hydration, and they continue to monitor her urine output closely to assess renal function.

The CT scan results reveal a small, new pericolic abscess adjacent to the initial site, measuring approximately 3 cm, and some thickening of the sigmoid colon wall. These findings confirm the need for additional interventions to prevent further complications. The healthcare team discusses the possibility of repeating percutaneous drainage and consults with the surgical team to evaluate the necessity of more definitive surgical management to prevent further episodes. The patient is informed of the situation and involved in decision-making, emphasizing the importance of her understanding and engagement in the treatment plan as her journey continues.

Section 4

As the healthcare team addresses the newly identified pericolic abscess, they decide to proceed with percutaneous drainage under ultrasound guidance. The procedure is performed with minimal complications, and an indwelling catheter is placed to facilitate continuous drainage. Post-procedure, the patient is closely monitored in the recovery area, where her vital signs are reassessed. Her heart rate remains elevated at 108 bpm, and her blood pressure is now 95/58 mmHg, indicating persistent hemodynamic instability. The nursing team administers additional isotonic saline boluses to improve her circulatory status. Her respiratory rate is slightly elevated at 22 breaths per minute, but her oxygen saturation remains stable at 98% on room air.

Lab results drawn after the procedure reveal a white blood cell count of 15,000/µL, suggesting ongoing infection or inflammation. Her hemoglobin level has dropped to 10.5 g/dL, warranting further monitoring for potential bleeding or anemia. The patient's electrolytes show a mild hyponatremia with a sodium level of 132 mmol/L, likely secondary to fluid shifts and dilutional effects from aggressive fluid resuscitation. The clinical team decides to continue broad-spectrum antibiotics to address potential bacterial involvement and adjust her fluid management plan to correct the electrolyte imbalance.

Despite these interventions, the patient continues to report significant abdominal discomfort, now described as a deep, throbbing pain, which raises concerns regarding the adequacy of the drainage procedure or the possibility of additional complications such as bowel obstruction or worsening ileus. The surgical team revisits the imaging findings and collaborates with the medical team to weigh the risks and benefits of potential surgical intervention. They emphasize the importance of involving the patient in these discussions, ensuring she is fully informed of her condition and the rationale behind each step of the treatment process. This collaborative approach aims to empower the patient, enhance compliance, and ultimately improve her outcomes as they navigate the complexities of her diverticulitis management.

Section 5

As the patient's journey continues, the clinical team closely monitors her response to the interventions. Initially, there appears to be a slight improvement in her hemodynamic status following the administration of isotonic saline boluses, with her blood pressure rising to 100/60 mmHg. However, her heart rate remains elevated at 104 bpm, indicating that she is still experiencing some degree of stress or discomfort. The patient's temperature also begins to rise, now at 38.2°C (100.8°F), suggesting a possible infectious process that is not yet fully controlled.

To further investigate the underlying cause of her persistent symptoms, the medical team orders a repeat CT scan of the abdomen and pelvis. The imaging reveals that while the pericolic abscess has decreased in size due to the drainage, there is now evidence of a new small bowel obstruction, likely secondary to edema and inflammation around the affected area. This finding correlates with the patient's report of deep, throbbing abdominal pain and her slightly distended abdomen upon palpation.

In light of these developments, the clinical team adjusts the management plan. They initiate nasogastric decompression to relieve the obstruction and reduce the risk of further complications. The patient's fluid and electrolyte management is reassessed, and the team decides to introduce a low-dose diuretic to manage her mild hyponatremia while continuing antibiotic therapy to address the ongoing infection. The collaborative effort remains focused on ensuring the patient's understanding and involvement in her care, emphasizing the importance of timely intervention and monitoring for signs of improvement or further complications. This approach aims to stabilize the patient's condition and prevent escalation to more invasive surgical interventions unless absolutely necessary.