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Scenario: Mrs. Dolan is a 46-year-old female who presented to the emergency department with complaints of episodic abdominal pain, a low-grade fever, and diarrhea for almost two weeks. Mrs. Dolan was on vacation in another country when she developed pain in the left lower quadrant of her abdomen

Scenario: Mrs. Dolan is a 46-year-old female who presented to the emergency department with complaints of episodic abdominal pain, a low-grade fever, and diarrhea for almost two weeks. Mrs. Dolan was on vacation in another country when she developed pain in the left lower quadrant of her abdomen

Mrs. Dolan is a 46-year-old female who presented to the emergency department with complaints of episodic abdominal pain, a low-grade fever, and diarrhea for almost two weeks. Mrs. Dolan was on vacation in another country when she developed pain in the left lower quadrant of her abdomen. Mrs. Dolan delayed seeking health care because of fear of the country’s unfamiliar medical system and the assumption that bad water or food she had while on vacation must have given her a stomach “bug.” Mrs. Dolan also reports a recent onset of painful urination. Upon examination in the emergency room, Mrs. Dolan is found to be dehydrated with a fever of 102.58F (39.2 8C). Vital signs are blood pressure (BP) 106/58, pulse 88, and respiratory rate of 22. Her potassium (K1) level is 2.8 mEq/L, erythrocyte sedimentation rate (ESR) is 37 mm/hr, and white blood cell (WBC) count is 16,000 cells/ mm3. A urinalysis showed a positive urinary tract infection (UTI) and an abdominal/pelvic computed tomography (CT) scan revealed diverticulitis with a question of an ileus. Mrs. Dolan is admitted and started on intravenous (IV) fluid of D51/2 normal saline (NS) with 20 mEq of potassium chloride (KCl) at 50 mL per hour. Two IV antibiotics (cefoxitin sodium and metronidazole) are prescribed. Her admitting orders include nothing by mouth (NPO), bed rest, IV morphine sulfate for pain management, stools to be checked for occult blood, strict intake and output (I & O), and repeat blood work in the morning to monitor her K+. Her height and weight on admission are 5 feet 7 inches and 170 lbs (77.3 kg). She is prescribed diphenoxylate hydrochloride with atropine sulfate, propantheline bromide, and acetaminophen as “as needed” pro re nata (prn) medications.

1. Explain how Mrs. Dolan’s symptoms might be related to her urinary tract infection.

2. The emergency department health care provider considered several differential diagnoses for Mrs. Dolan and a diagnosis of diverticulitis was determined. What diagnostic test confirmed Mrs. Dolan’s diagnosis of acute diverticulitis?

3.  Mrs. Dolan’s abdominal/pelvic CT scan revealed diverticulitis with a question of an ileus. What is an ileus?


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