Harding: Lewis’s Medical-Surgical Nursing, 11th Edition
NGN Case Study
Title: Colon resection: Diverticulitis Pre-op and Post-op Care
Scenario: An otherwise healthy 60-year-old male, with diverticulosis that
was diagnosed during a colonoscopy 5 years ago, was admitted into the
hospital today with complaints of extreme left lower abdominal pain, bloat-
ing, nausea, and vomiting. A CT scan done in the emergency department
confirmed his diagnosis to be diverticulitis. The nurse documents the fol-
lowing assessment findings:
• • Reports abdominal pain of 9/10 on a 0-10 pain intensity scale
• • Blood pressure 142/70
• • Heart rate 115 bpm
• • Temperature 101.3
• • Absent bowel sounds in left lower quadrant
• • Reports he has had no food in the past 12 hours
• • Reports a history of excess flatulence
• • Drowsy but arouses easily with verbal stimuli
1. NGN Item Type: Enhanced Hot Spot
Highlight the assessment findings that require follow-up by the
nurse.
,Answers:
An otherwise healthy 60-year-old male, with diverticulosis that was diag-
nosed during a colonoscopy 5 years ago, was admitted into the hospital
today with complaints of extreme left lower abdominal pain, bloating, nau-
sea, and vomiting. A CT scan done in the emergency department con-
firmed his diagnosis to be diverticulitis. The nurse documents the following
assessment findings:
• • Reports abdominal pain of 9/10 on a 0-10 pain intensity scale
• • Blood pressure 142/70
• • Heart rate 115 bpm
• • Temperature 101.3
• • Absent bowel sounds in left lower quadrant
• • Reports he has had no food in the past 12 hours
• • Reports a history of excess flatulence
• • Drowsy but arouses easily with verbal stimuli
Rationale:
Although abdominal pain is a common symptom of diverticulitis, patients’
pain should be managed appropriately with analgesics. The blood pressure
is within normal limits and does not require follow-up. The heart rate is ele-
vated and may be a manifestation of the patient’s elevated pain. Once the
pain is managed, the heart rate should be reassessed. The elevated tem-
perature may be a sign of abscess development, which would require sur-
gical intervention. No food intake for the past 12 hours is most likely due
, to the patient’s complaint of nausea and vomiting. Hospitalized patients
with diverticulitis are kept NPO to prevent further inflammation to the
colon and prepare for a possible surgical intervention. Absent bowel
sounds in any abdominal quadrant may indicate a complication related to
diverticulitis. Excess flatulence is a common symptom of diverticulosis and
does not need further follow-up. Drowsiness does not need further follow-
up as long as the patient awakens easily with verbal stimuli.
Cognitive Skill: Recognize Cues
Reference: Harding et al., 11th ed., 2020, Ch. 42, pp. 957–958.
2. NGN Item Type: Cloze
Choose the most likely options for the information missing from
the statement, below, by selecting from the list of options pro-
vided.
The nurse recognizes that, based on the assessment data and patient’s
history, the patient is currently at risk for complications, including ______,
______, and ______.
Options
• • Abscess
• • Skin breakdown
• • Peritonitis
• • Constipation
NGN Case Study
Title: Colon resection: Diverticulitis Pre-op and Post-op Care
Scenario: An otherwise healthy 60-year-old male, with diverticulosis that
was diagnosed during a colonoscopy 5 years ago, was admitted into the
hospital today with complaints of extreme left lower abdominal pain, bloat-
ing, nausea, and vomiting. A CT scan done in the emergency department
confirmed his diagnosis to be diverticulitis. The nurse documents the fol-
lowing assessment findings:
• • Reports abdominal pain of 9/10 on a 0-10 pain intensity scale
• • Blood pressure 142/70
• • Heart rate 115 bpm
• • Temperature 101.3
• • Absent bowel sounds in left lower quadrant
• • Reports he has had no food in the past 12 hours
• • Reports a history of excess flatulence
• • Drowsy but arouses easily with verbal stimuli
1. NGN Item Type: Enhanced Hot Spot
Highlight the assessment findings that require follow-up by the
nurse.
,Answers:
An otherwise healthy 60-year-old male, with diverticulosis that was diag-
nosed during a colonoscopy 5 years ago, was admitted into the hospital
today with complaints of extreme left lower abdominal pain, bloating, nau-
sea, and vomiting. A CT scan done in the emergency department con-
firmed his diagnosis to be diverticulitis. The nurse documents the following
assessment findings:
• • Reports abdominal pain of 9/10 on a 0-10 pain intensity scale
• • Blood pressure 142/70
• • Heart rate 115 bpm
• • Temperature 101.3
• • Absent bowel sounds in left lower quadrant
• • Reports he has had no food in the past 12 hours
• • Reports a history of excess flatulence
• • Drowsy but arouses easily with verbal stimuli
Rationale:
Although abdominal pain is a common symptom of diverticulitis, patients’
pain should be managed appropriately with analgesics. The blood pressure
is within normal limits and does not require follow-up. The heart rate is ele-
vated and may be a manifestation of the patient’s elevated pain. Once the
pain is managed, the heart rate should be reassessed. The elevated tem-
perature may be a sign of abscess development, which would require sur-
gical intervention. No food intake for the past 12 hours is most likely due
, to the patient’s complaint of nausea and vomiting. Hospitalized patients
with diverticulitis are kept NPO to prevent further inflammation to the
colon and prepare for a possible surgical intervention. Absent bowel
sounds in any abdominal quadrant may indicate a complication related to
diverticulitis. Excess flatulence is a common symptom of diverticulosis and
does not need further follow-up. Drowsiness does not need further follow-
up as long as the patient awakens easily with verbal stimuli.
Cognitive Skill: Recognize Cues
Reference: Harding et al., 11th ed., 2020, Ch. 42, pp. 957–958.
2. NGN Item Type: Cloze
Choose the most likely options for the information missing from
the statement, below, by selecting from the list of options pro-
vided.
The nurse recognizes that, based on the assessment data and patient’s
history, the patient is currently at risk for complications, including ______,
______, and ______.
Options
• • Abscess
• • Skin breakdown
• • Peritonitis
• • Constipation
