Sample Answer for NURS 6501 WEEK 5 Gastrointestinal Disorders Included After Question
In this exercise, you will complete a 5-essay type question Knowledge Check to gauge your understanding of this module’s content.
Possible topics covered in this Knowledge Check include:
- Ulcers
- Hepatitis markers
- After HP shots
- Gastroesophageal Reflux Disease
- Pancreatitis
- Liver failure—acute and chronic
- Gall bladder disease
- Inflammatory bowel disease
- Diverticulitis
- Jaundice
- Bilirubin
- Gastrointestinal bleed – upper and lower
- Hepatic encephalopathy
- Intra-abdominal infections (e.g., appendicitis)
- Renal blood flow
- Glomerular filtration rate
- Kidney stones
- Infections – urinary tract infections, pyelonephritis
- Acute kidney injury
- Renal failure – acute and chronic
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
BY DAY 7 OF WEEK 5
Complete the Knowledge Check By Day 7 of Week 5.
A Sample Answer For the Assignment: NURS 6501 WEEK 5 Gastrointestinal Disorders
Title: NURS 6501 WEEK 5 Gastrointestinal Disorders
Concept Map Template
Primary Diagnosis: Acute diverticulitis
- Describe the pathophysiology of the primary diagnosis in your own words. What are the patient’s risk factors for this diagnosis?
| Pathophysiology of Primary Diagnosis | |
| Diverticulitis occurs due to perforations in the wall of the diverticula, which can be either microscopic or macroscopic. Earlier, practitioners believed that the blockage of the colonic diverticulum by fecaliths resulted in elevated pressure within the diverticulum, leading to perforation (Piccioni et al., 2021). It is currently theorized that high luminal pressure is caused by food particles, which subsequently result in erosion of the diverticular wall. This results in localized inflammation and tissue death, leading to perforation. The mesenteric fat can potentially have micro-perforations. These complications may include the formation of local abscesses, the development of fistulas in nearby organs, or intestinal obstruction. Untreated frank bowel wall perforations can result in peritonitis and mortality if not promptly diagnosed and treated. | |
| Causes | Risk Factors (genetic/ethnic/physical) |
| Diverticular disease arises from the inflammation of the diverticula, which are small bulges that form in the large intestine. Infection of diverticula results in symptoms of diverticulitis. The etiology of diverticula formation remains uncertain; however, a notable association has been observed between insufficient dietary fiber intake and their development (Turner et al., 2021). | Turner et al. (2021) suggest a hereditary nature of diverticulitis, with a potential gene association, particularly prevalent among families. Insufficient presence of beneficial bacteria in the colon can lead to the development of this condition. Obesity is a significant risk factor for the development of diverticulitis. Cigarette smokers have a higher likelihood of developing diverticulitis compared to individuals who do not smoke—physical inactivity. |
- 2. What are the patient’s signs and symptoms for this diagnosis? How does the diagnosis impact other body systems, and what are the possible complications?
| Signs and Symptoms – Common presentation | How does the diagnosis impact each body system? Complications? |
| The clinical presentation of acute diverticulitis exhibits variability by the disease’s severity. Due to the tendency of diverticulitis to occur on the left side of the body in Western countries, patients with simple cases usually have lower quadrant stomach discomfort. Patients of Asian descent commonly exhibit right-sided abdominal pain. The pain may indicate either a continuous or sporadic pattern. Sugi et al. (2020) found that abdominal pain can be associated with changes in bowel habits, such as diarrhea (35%) or constipation (50%). Patients may experience vomiting and nausea, potentially due to bowel obstruction. Fever frequently occurs in patients who have abscesses and perforation. When the inflammatory part of the intestine comes into direct touch with the bladder wall, patients may have dysuria, frequency, and urgency. This condition is known as sympathetic cystitis. | Approximately 25% of individuals experiencing acute diverticulitis may encounter complications such as abscess formation, bowel obstruction due to scarring, the development of abnormal connections (fistulas) between different sections of the bowel or between the bowel and other organs, and peritonitis resulting from the rupture of an infected or inflamed pouch, leading to the release of intestinal contents into the gut (Sugi et al., 2020). |
- What is another potential diagnosis that presents similarly to this diagnosis (differentials)?
According to Qaseem et al. (2022), other conditions might be considered in the differential diagnosis of acute diverticulitis, such as Crohn’s disease, acute appendicitis, colitis, and colon cancer.
- What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?
Clinical diagnosis of acute diverticulitis may be established only by evaluating the patient’s medical history and physical examination. Leukocytosis and increased levels of acute phase reactants, such as ESR and CRP, may be detected using laboratory testing (Sugi et al., 2020). The preferred radiographic examination for diagnosing acute diverticulitis is a computed tomography (CT) scan of the abdomen and pelvis. It is recommended to use water-soluble oral or rectal contrast, along with intravenous contrast, unless there are any reasons to avoid it. It is advisable to schedule a colonoscopy around six to eight weeks after the symptoms have subsided to exclude the possibility of cancer, inflammatory bowel disease, or colitis, especially if the patient has not had a colonoscopy recently (Rottier et al., 2019).
- What treatment options would you consider? Include possible referrals and medications.
The conventional approach of treating diverticulitis in an outpatient setting involves abstaining from food intake, increasing fluid consumption, and administering oral antibiotics that target gram-negative rods and anaerobic bacteria. In the United States, the most often prescribed treatment involves the use of quinolones or sulfa medications together with metronidazole or amoxicillin-clavulanate as a single agent. This treatment regimen typically lasts for a duration of 7 to 10 days (Sagar, 2019). Nurses must aid in instructing the patient on adherence to dietary limitations. An infectious disease specialist and a gastroenterologist must ascertain the optimal period of antibiotic treatment, while a general surgeon must establish a care regimen for any pelvic abscess.
References
Piccioni, A., Franza, L., Brigida, M., Zanza, C., Torelli, E., Petrucci, M., Nicolò, R., Covino, M., Candelli, M., Saviano, A., Ojetti, V., & Franceschi, F. (2021). Gut microbiota and acute diverticulitis: Role of probiotics in managing this delicate pathophysiological balance. Journal of Personalized Medicine, 11(4), 298. https://doi.org/10.3390/jpm11040298
Qaseem, A., Etxeandia-Ikobaltzeta, I., Lin, J. S., Fitterman, N., Shamliyan, T. A., & Wilt, T. J. (2022). Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis: A clinical guideline from the American College of Physicians. Annals of Internal Medicine, 175(3), 399–415. https://doi.org/10.7326/m21-2710
Rottier, S. J., Van Dijk, S. T., Van Geloven, A. a. W., Schreurs, W. H., Draaisma, W. A., Van Enst, W. A., Puylaert, J. B. C. M., De Boer, M., Klarenbeek, B., Otte, J. A., Felt, R. J. F., & Boermeester, M. A. (2019). Meta-analysis of the role of colonoscopy after an episode of left-sided acute diverticulitis. British Journal of Surgery, 106(8), 988–997. https://doi.org/10.1002/bjs.11191
Sagar, A. (2019). Management of acute diverticulitis. British Journal of Hospital Medicine, 80(3), 146–150. https://doi.org/10.12968/hmed.2019.80.3.146
Sugi, M., Sun, D., Menias, C. O., Prabhu, V., & Choi, H. H. (2020). Acute diverticulitis: Key features for guiding clinical management. European Journal of Radiology, 128, 109026. https://doi.org/10.1016/j.ejrad.2020.109026
Turner, G. A., O’Grady, M. J., Purcell, R., & Frizelle, F. (2021). Acute diverticulitis in Young Patients: A review of the changing Epidemiology and etiology. Digestive Diseases and Sciences, 67(4), 1156–1162. https://doi.org/10.1007/s10620-021-06956-w
A Sample Answer For the Assignment: NURS 6501 WEEK 5 Gastrointestinal Disorders
Title: NURS 6501 WEEK 5 Gastrointestinal Disorders
Scenario 1: Peptic Ulcer
A 65-year-old female comes to the clinic with a complaint of abdominal pain in the epigastric area. The pain has been persistent for two weeks. The pain described as burning, non-radiating and worse after meals. Denies N&V, weight loss or obvious bleeding. She admits to frequent belching with bloating.
PMH: seasonal allergies with Chronic Sinusitis, positive for osteoarthritis,
Meds: Claritin 10 mg po daily, ibuprofen 400-600 mg po prn pain
Family Hx-non contributary
Social history: Separated recently pending divorce; stressful situation with trying to manage two homes. Works as a Legal Assistant at a local law firm. She has 35 PPY of smoking, drinks 1-2 glasses of wine a day, and 6-7 cups of coffee per day. She denies illicit drug use, vaping or unprotected sexual encounters.
Breath test in the office revealed + urease.
The healthcare provider suspects the client has peptic ulcer disease.
Question:
- What is the pathophysiology of PUD/ formation of peptic ulcers?
Your Answer:
Peptic ulcers occur when there is a break in the mucous lining of the GI tract, and it comes into contact with hydrochloric acid and pepsin. The epithelial cells of the stomach and duodenum secrete mucus in response to irritation of the epithelial lining due to cholinergic stimulation. Ulcers or breaks in the mucosa of the GI tract occur with H. pylori infection, use of NSAIDs, trauma, infection, and physical or psychological stress (Alsinnari et al., 2022). H. pylori is spread by oral to oral, fecal-oral routes. It damages gastric epithelial cells reducing the effectiveness of gastric mucus. NSAIDs interrupt prostaglandin synthesis, which maintains the mucous barrier of the gastric mucosa. PUD can be chronic, with spontaneous remissions and exacerbations associated with trauma, infection, and physical or psychological stress.
References
Alsinnari, Y. M., Alqarni, M. S., Attar, M., Bukhari, Z. M., Almutairi, M., Baabbad, F. M., & Hasosah, M. (2022). Risk factors for recurrence of peptic ulcer disease: A retrospective study in tertiary care referral center. Cureus, 14(2), e22001. https://doi.org/10.7759/cureus.22001