Case Study #1
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.
Identify a key factor in his family history that might have profound implications for his health and present state of mind.
3.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.What is diverticulitis? What are the consequences of untreated diverticulitis?
4.While the patient is experiencing the severe crampy pain of acute diverticulitis, what interventions would you perform to help him feel more comfortable?
5. What is the rationale for ordering bed rest?
T.H. is being sent home with prescriptions for metronidazole (Flagyl) 500mg PO q6h, ciprofloxacin (Cipro) 500mg PO q12h, and dicyclomine (Bentyl) 20mg 4 tomes per day for 5 days.
6.For each medication, state the drug class and the purpose for T.H.
7.Given his history, what questions must you ask T.H. before he takes the initial dose of metronidazole? State your rationale
8.What is a disulfiram reaction?
9. What are the signs and symptoms of an allergic reaction