Transformative Clinical Practices - Part A

Introduction

The case study report discusses about 76 years old women from Italy, namely Mrs. Maria Rosie, who suffered from an abdominal pain three days back, due to which she was admitted to the hospital. Moreover, it was suspected that she was suffering from diverticular illness, which has become more aggressive. In the due course of this report, the aetiology of her illness would be presented with due consideration given to the discussion about the urine tract infection. In the second part of this report, important consideration would be given towards determining a well-formulated nursing examining techniques that will be used for accessing Mrs. Maria, who was admitted due to pain in her abdominal. Moreover, appropriate nursing management plans would be determined that would be significance in the context of that particular patient. Furthermore, in the case of this case study report, consideration would be given in terms of determining the interdisciplinary management process, that is the roles and responsibilities of the different team members that would be included in the process.

Aetiology of the Disease Process

A Diverticular disease builds up in a patient when there is a formation of pouches in the way of their digestive tract, more specifically on the big intestine of the patient, that is their colon. Moreover, these pouches are itself known as diverticula (Dirks et al., 2019), which has the potential to develop feeble spots in the external part of the wall balloon present in the intestine of the patient.

The Diverticular disease occurs only when the pouches in the digestive tract of the patient gets swollen and, in few cases, it also holds the chance of getting contaminated. Mostly, it takes place when the mouth of the digestive tract of a patient is obstructed by foods that can’t be digested in a complete way. Furthermore, there is no particular reason for the formation of the concerned disease (Hu et al., 2016), however, it has been determined by the experts that there are several hereditary conditions as well as environment-oriented conditions that adds up to the growth of the diverticular disease. In this context, Mrs. Rosie suffered from abdominal pain due to which she was admitted in the hospital and also it was determined that she was active volunteers who regularly engaged herself in the street food activities, which might have led to this aggressive formation of the diverticular disease.

Furthermore, it has also been determined that the formation of the diverticular disease is found majorly in people who are above the age of 40 and Mrs. Rosie was even 76 years old. Additionally, this disease has no prior symptom (Collins et al., 2015), while the symptoms are only visible when the diverticula of the patient gets swollen and the patient shows its symptoms in the form of a severe pain in the abdomen.

Pathology- Urine Tract Infection

UTI ( Urine Tract Infection) occurs in case of a person, when the renal structure of that particular person gets inflamed and he or she starts showing systems of trouble while passing urine and even feels an urge of passing urine very frequently (Maguire et al., 2018). The UTI occurs in a person when the microorganisms enter the urethra or even the bladder of that particular person, mostly in the form of bacteria. Moreover, the UTI has the potential to cause a severe or even a minor illness in a person. Furthermore, in this context, it has been determined that Mrs. Rosie was suffering from Type 2 diabetes, due to which the urine tract infection can be a common occurrence for her. In this context, Mrs. Rosie also doesn’t drink sufficient amount of water, which also increases the possibilities of infection in the urinary tract of the patient.

Here are certain risk factors that increases the chance of Diverticulitis disease:

The cases of the diverticulitis diseases rise with the increasing age of a person. In this context, Mrs. Maria Rosie was even 76 years of age, hence she also had a high chance of being prone to the diverticulitis disease.
The chances of the diverticulitis diseases are higher in those individuals who is critically obese. Being an active participant in the street food events, Mrs. Rossie consumed a lot of street food which might have also increased her chance of being obese.
The smokers have a higher chance of getting prone to the diverticulitis disease. However, there is no evidence in the given case study that Mrs. Rossie was a smoker.
Absence of exercise also increases the possibility of the occurrence diverticulitis disease. However, Mrs. Rossie engaged in an average level of exercise and had a highly energetic social life.
High fat diet as well as low in fiber diet in integration also increases the possibility of the diverticulitis disease. In this context, even Mrs. Rossie has a combination of low-fiber food that is pasta and high fat food that is salami in her diet once in a week when her family visits her.
Furthermore, there are certain types of medicines which also increases the chance in a person of getting prone to the diverticulitis disease. However, Mrs. Rossie consumed Metformin 500 mg and Perindopril 4 mg, wherein Metformin 500 mg is anti-inflammatory drug and Perindopril 4 mg is also a Nonsteroidal anti-inflammatory drugs ( NSAIDs), which increases the prospect of the diverticulitis disease (Kołodziejczak et al., 2017).

Additionally, there are certain physiological factors, which also creates an impact on the diverticulitis disease, due to which the patients experience pain in the left size of their lower abdominal, they experience fever as well as tenderness. In this context, Mrs. Rossie was experiencing pain in her abdominal, due to which she has been admitted to the hospital three days back.

Transformative Clinical Practices - Part B

Nursing Assessment

Here are few the nursing assessment methods that can be used to assess Mrs. Maria Rossie:

Abdominal and Pelvic Scan- CT scan is known to be the most effective technique for diagnosing the diverticulitis disease (Balasubramanian et al., 2017). This is a kind of an assessment which can be used to find out the seriousness of the disease in a particular patient and also assist in the process of treating that particular patient. Hence, in the case of Mrs. Maria Rossie, it is significant to conduct this particular assessment and then only the suspected abruption of the diverticulitis disease in her can be confirmed.
Colonoscopy- This is another nursing assessment method that can be used to examine Mrs. Maria Rossie. In this assessment method, a mini camera examines the inner side of the colon to determine the extent of inflammation caused to it (Aggarwal et al., 2018). This will determine the reason for a sudden abdominal pain for Mrs. Maria Rossie.
CT Scan- In the case of Mrs. Maria Rossie, the CT scan of the brain of the patient would be highly recommended. The concerned patient was having a feeling of confusion at the decision of her being discharged and going back to her home. In this situation the brain CT scan would be a vital requirement for the patient, because she is already suffering from hypertension or high blood pressure (O’Leary et al., 2015), which increases the chance of blood clot or strokes, which is a key cause of confusion in a patient.

This is known to be an assessment method, wherein the patient is placed inside a machine that is in the shape of tunnel, which moves around and click the images of the brain of a patient from various different positions.

Nursing Management Strategies

A nursing care plan concentrates on the process of minimizing the symptoms of a particular disease which in this case would be the diverticulitis disease, working towards the health enhancement of the patient and motivating the patient to active physically.

No food should be directed through the mouth of the patient. Moreover, even in the context of the given case study, Mrs. Rossie is also on intravenous antibiotics since the time she had been admitted in the hospital, which is another vital requirement for ensuring a good treatment to the patient suffering from diverticulitis disease. Moreover, nasogastric suctions should be instituted in the concerned patient. Furthermore, the patient should be kept on complete rest, which would be very significant for a patient like Mrs. Rossie, because of her old age, her confusion and most importantly her diverticulitis disease. The nursing management staff should take adequate steps to initiate the restoration of the regular bowel removal pattern of the patient by making use of the stool softeners that is mostly used in the case of old age patients, as they are soft and they have a lesser possibility of being dependent on the laxatives (Rezapour et al., 2018). Since, Mrs. Rossie is an elderly patient, thus, the administration of the stool softener would be an appropriate element of her treatment strategy. As a part of the nursing management strategy for the diverticulitis diseases, it is significant to avoid any scope of constipation in that particular patient. In this context, the patient should be motivated to perform exercise on a daily basis that rises the bowel vermiculation. Considering from the prospect of Mrs. Rossie, she was an active person who also engages in average exercising practice so this would be an adequate option for her. Proper initiative should be taken to include medicines like antibiotics, ant-spasm and opioids analgesics medications for the concerned patient (Rezapour et al., 2018). Gradually, get back to the regular bowel removal practice as and when the indications of the diverticulitis disease minimize. Additionally, the water intake of the patient should be risen slowly till the time when the patient is consuming 6-8 glasses of water in a . Last, but not the least, low fiber food should be given to the patient and the quantity should be increased till the moment when the patient is on high-fiber food(Rezapour et al., 2018). Furthermore, in the case of Mrs. Rossie medicines should be provided with great level of care because of the old age of the patient, in cases when the high fiber food is avoiding the scope of constipation in the patient.

Education

Educating the patient about the appropriate nursing management strategies plays an equally important role in the treatment of the patient suffering from diverticulitis disease (Rezapour et al., 2018).The patients should be aware that the main goal of the nursing intervention of such a patient would allow the easy of passing of bowel via the colon of the patient without causing any major complication to that particular patient.

Transformative Clinical Practices - Part C

Interdisciplinary Management

In the case of providing an effective treatment to Mrs. Maria Rossie, an interdisciplinary management team would be required. The team would consist of the fundamental care doctors, who is always in connection with the patients and who accesses the patient regularly. Moreover, in the case of the given case study, also a Gastroenterologist as well as a General Surgeon would be included in the team in case the intensity of the disease gets severe in the patient, which was the case with Mrs. Maria Rossie. Furthermore, a contagious team should also be included with an attempt to find out the right kind of antibiotic that will enable the patient to gradually overcome the diverticulitis disease (Tursi, 2015). This is concerned to be more important if the associated diverticulitis disease is not responsive to the systematic treatment plan that was established for that particular patient. The registered nurse would also be included in the interdisciplinary team, who in turn will regulate the bowel pattern of the patient, according to which various medications would be adjusted.

Conclusion

Through this report it can be concluded that the occurrence of the diverticulitis disease is most common in the old age people, like Mrs. Maria Rossie, in the context of the given case study, who is 76 years of age. The most common indication of the diverticulitis disease that was determined in this report was the pain in lower abdomen, and Mrs. Rossie also experienced abdominal pain due to which she was admitted in the hospital.

Furthermore, in order to ensure the effective treatment of the patient, the determined role of the registered nurse is monitor the bowel elimination pattern of the patient and take proper initiatives to control the same, regulate the fibre intake of the patient and ensure that the patient is on bed rest, among many other intervention measures that has been discussed in the case study.

References for Transformative Clinical Practices

Aggarwal, R., Indiran, V., & Maduraimuthu, P. (2018). Different etiologies of an unusual disease: Colouterine fistula–Report of two cases. The Indian Journal of Radiology & Imaging, 28(1), 37. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894316/

Balasubramanian, I., Fleming, C., Mohan, H. M., Schmidt, K., Haglind, E., & Winter, D. C. (2017). Out-patient management of mild or uncomplicated diverticulitis: a systematic review. Digestive surgery, 34(2), 151-160. Retrieved from https://www.karger.com/Article/Abstract/450865

Collins, D., & Winter, D. C. (2015). Modern concepts in diverticular disease. Journal of clinical gastroenterology, 49(5), 358-369. Retrieved from https://www.ingentaconnect.com/content/wk/jcga/2015/00000049/00000005/art00004

Dirks, K., Calabrese, E., Dietrich, C. F., Gilja, O. H., Hausken, T., Higginson, A., ... & Nylund, K. (2019). EFSUMB position paper: recommendations for gastrointestinal ultrasound (GIUS) in acute appendicitis and diverticulitis. Ultraschall in der Medizin-European Journal of Ultrasound, 40(02), 163-175. Retrieved from http://medi-guide.meditool.cn/ymtpdf/F667E2AD-2B0B-303C-0D48-856385AD50F5.pdf

Hu, F. B., Satija, A., Rimm, E. B., Spiegelman, D., Sampson, L., Rosner, B., ... & Willett, W. C. (2016). Diet assessment methods in the Nurses' Health Studies and contribution to evidence-based nutritional policies and guidelines. American journal of public health, 106(9), 1567-1572. Retrieved from https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2016.303348

Kołodziejczak, M., Santoro, G. A., Sobocki, J., Szopiński, T., Wiączek, A., & Sudoł-Szopińska, I. (2017). Anorectal malformation as a cause of recurring perineal abscesses–value of anorectal endosonography and magnetic resonance imaging: a case report. Medical Ultrasonography, 19(2), 228-231. Retrieved from https://www.medultrason.ro/medultrason/index.php/medultrason/article/view/928

Maguire, L. H., Handelman, S. K., Du, X., Chen, Y., Pers, T. H., & Speliotes, E. K. (2018). Genome-wide association analyses identify 39 new susceptibility loci for diverticular disease. Nature genetics, 50(10), 1359-1365. Retrieved from https://www.nature.com/articles/s41588-018-0203-z/

O’Leary, D. P., Lynch, N., Clancy, C., Winter, D. C., & Myers, E. (2015). International, expert-based, consensus statement regarding the management of acute diverticulitis. JAMA surgery, 150(9), 899-904. Retrieved from https://jamanetwork.com/journals/jamasurgery/article-abstract/2389261

Rezapour, M., Ali, S., & Stollman, N. (2018). Diverticular disease: an update on pathogenesis and management. Gut and liver, 12(2), 125. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5832336/

Tursi, A. (2015). New medical strategies for the management of acute diverticulitis. Expert review of gastroenterology & hepatology, 9(10), 1293-1304. Retrieved from https://www.tandfonline.com/doi/abs/10.1586/17474124.2015.1075881

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