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A 67 y.o. (year old) female presents to the ER with increasing L lower abdominal pain for 3 days. She has had a fever of 102F for the past 2 days, nausea and 3 episodes of bloody diarrhea since yesterday. Her past history is significant for diverticular disease and HTN (hypertension). She has been admitted 2 times previously for diverticulitis, the last one being approximately 1 ½ years ago. On examination the patient is in moderate distress and febrile at 102.5F and her BP is 140/90. Her abdomen is slightly distended and appreciably tender throughout the L lower abdomen. The decision is made to admit her with diagnosis of acute diverticulitis. Before beginning drug therapy, what 2 factors related to the history not present above must be known? _____________________ _ Name two bacteria (not just “gram-neg rods”) that you are familiar with that could possibly be causing this infection Before starting an antibiotic, name 4 factors that need to be taken into consideration with regard to the drug itself and the patient. ____________ Based on your answers to #3, what would be the BEST CHOICE for an antibiotic at this time? What type of “diet order” should be given for this patient?_ What “activity level” should be assigned for this patient at this time? (take into consideration the history above, patient age, elimination needs; Ex; bed rest, bed rest with bedside commode, etc.) ______________ On day 2 of admission during the night, the patients fever spikes to 104F. Her skin is ‘cool and moist’ and her BP drops to 90/60. On exam, her abdomen is now “rigid” and acutely tender in the LLQ (left lower quadrant). Given the above information, what has the patient developed secondary to her infection?_ What has most likely occurred related to her initial diagnosis and “disease location” that has produced the change in her status? _ The “rigid abdomen” is a likely indicator that she is developing or has developedsecondary to your answer in #8. Given the above changes, where should this patient be transferred to in the hospital at this time?_________________________________

A 67 y.o. (year old) female presents to the ER with increasing L lower abdominal pain for 3 days. She has had a fever of 102F for the past 2 days, nausea and 3 episodes of bloody diarrhea since yesterday. Her past history is significant for diverticular disease and HTN (hypertension). She has been admitted 2 times previously for diverticulitis, the last one being approximately 1 ½ years ago. On examination the patient is in moderate distress and febrile at 102.5F and her BP is 140/90. Her abdomen is slightly distended and appreciably tender throughout the L lower abdomen. The decision is made to admit her with diagnosis of acute diverticulitis. Before beginning drug therapy, what 2 factors related to the history not present above must be known? ___________________________________________ ___________________________________________ Name two bacteria (not just “gram-neg rods”) that you are familiar with that could possibly be causing this infection ________________________________________ ________________________________________ Before starting an antibiotic, name 4 factors that need to be taken into consideration with regard to the drug itself and the patient. ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Based on your answers to #3, what would be the BEST CHOICE for an antibiotic at this time? ________________________________________________ What type of “diet order” should be given for this patient?_______________________ What “activity level” should be assigned for this patient at this time? (take into consideration the history above, patient age, elimination needs; Ex; bed rest, bed rest with bedside commode, etc.) ______________________________________________________ On day 2 of admission during the night, the patients fever spikes to 104F. Her skin is ‘cool and moist’ and her BP drops to 90/60. On exam, her abdomen is now “rigid” and acutely tender in the LLQ (left lower quadrant). Given the above information, what has the patient developed secondary to her infection?___________________________________________________________ What has most likely occurred related to her initial diagnosis and “disease location” that has produced the change in her status? ___________________________________________________________ The “rigid abdomen” is a likely indicator that she is developing or has developed________________________________secondary to your answer in #8. Given the above changes, where should this patient be transferred to in the hospital at this time?_______________________________________________________________

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