CARE OFCLIENTS WITH PROBLEM IN NUTRITION, AND GASTRO-INTERNAL, METABOLISM
AND ENDOCRINE, PERCEPTION AND COORDINATION, (ACUTE AND CHRONIC) STUDENT’S ACTIVITY SHEET
BS NURSING / THIRD YEAR
Session # 6 (2 hours and 30 minutes)
LESSON TITLE: APPENDICITIS AND DIVERTICULAR Materials:
DISEASE
Book, pen and notebook, projector
References:
LEARNING OUTCOMES:
Upon completion of this lesson, the nursing student can: Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K.
1. Recognize the clinical manifestations of the disorders. (2008). Brunner &Suddarth’s Textbook of
Medical-Surgical Nursing 11th Edition.
2. Identify the risk factors/causes.
Lippincott Williams &Wilkins
3. Determine the diagnostic tests/findings.
4. Identify medical and nursing management of the disorders.
CHECK FOR UNDERSTANDING (15 minutes)
The instructor will prepare 10-15 questions that can enhance critical thinking skills. Students will work by themselves to
answer these questions and write the rationale for each question.
Multiple Choice
RATIONALIZATION ACTIVITY (DURING THE FACE TO FACE INTERACTION WITH THE STUDENTS)
The instructor will now rationalize the answers to the students and will encourage them to ask questions and to discuss
among their classmates for 20 minutes.
1. During assessment, the nurse is looking for positive indicators of appendicitis, which include all of the following except:
A. vomiting
B. low-grade fever
C. Thrombocytopenia
D. Abdominal tenderness upon palpation
ANSWER: C. Thrombocytopenia
RATIO: Positive indicators of appendicitis vomiting, low-grade fever and abdominal tenderness upon palpation.
2. On physical examination, the nurse should be looking for tenderness on palpation at Mcburney’s point, which is located
in the:
A. Right lower quadrant
B. Right upper quadrant
C. Left lower quadrant
D. Left upper quadrant
ANSWER: A. Right lower quadrant
RATIO: McBurney's point refers to the point on the lower right quadrant of the abdomen at which tenderness is
maximal in cases of acute appendicitis.
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3. Which of the following complications is thought to be the most common cause of appendicitis?
A. A fecalith
B. Bowel kinking
C. Internal bowel occlusion
D. Abdominal bowel swelling
ANSWER: A. A fecalith
RATIO: A fecalith is a hard piece of stool which is stone like that commonly obstructs the lumen. Due to
obstruction, inflammation and bacterial invasion can occur. Tumors or foreign bodies may also cause obstruction."
4. An enema is prescribed for a client with suspected appendicitis. Which of the following actions should the nurse take?
A. Prepare 750 ml of irrigating solution warmed to 100*F.
B. Question the physician about the order.
C. Provide privacy and explain the procedure to the client.
D. Assist the client to left lateral Sim’s position.
ANSWER: B. Question the physician about the order.
RATIO: Enemas are contraindicated in an acute abdominal condition of unknown origin as well as after recent
colon or rectal surgery or myocardial infarction. The other answers are correct only when enema administration is
appropriate.
5. A client with acute appendicitis develops fever, tachycardia, and hypotension. Based on these assessment findings, the
nurse suspects which of the following complications?
A. Peritonitis
B. Bowel ischemia
C. Intestinal obstruction
D. Deficient fluid volume
ANSWER: A. Peritonitis
RATIO: "Complications of acute appendicitis are perforation, peritonitis, and abscess development. Signs of the
development of peritonitis include abdominal pain and distention, tachycardia, tachypnea, nausea, vomiting,
and fever.
6. Eleanor, a 62 y.o. woman with diverticulosis is your patient. Which interventions would you expect to include in her
care?
A. Low-fiber diet and fluid restrictions.
B. Total parenteral nutrition and bed rest.
C. High-fiber diet and administration of psyllium.
D. Administration of analgesics and antacids.
ANSWER: C. High-fiber diet and administration of psyllium.
RATIO: She needs a high-fiber diet and a psyllium (bulk laxative) to promote normal soft stools.
7. Which of the following types of diets is implicated in the development of diverticulosis?
A. Low-fiber diet
B. High-fiber diet
C. High-protein diet
D. Low-carbohydrate diet
ANSWER: A. Low-fiber diet
RATIO: Diverticular disease is associated with a fiber-poor diet a diet low in fruits, vegetables, whole grains, and
legumes but high in animal products and/or refined foods.
8. Donald is a 61 y.o. man with diverticulitis. Diverticulitis is characterized by:
A. Periodic rectal hemorrhage.
B. Hypertension and tachycardia.
C. Vomiting and elevated temperature.
D. Crampy and lower left quadrant pain and low-grade fever.
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ANSWER: D. Crampy and lower left quadrant pain and low-grade fever.
RATIO: One sign of acute diverticulitis is crampy lower left quadrant pain. A low-grade fever is another common
sign.
9. Medical management of the client with diverticulitis should include which of the following treatments?
A. Reduced fluid intake
B. Increased fiber in diet
C. Administration of antibiotics
D. Exercises to increase intra-abdominal pressure
ANSWER: C. Administration of antibiotics
RATIO: Administration of antibiotics; Antibiotics are used to reduce the inflammation.
10. Which of the following mechanisms can facilitate the development of diverticulosis into diverticulitis?
A. Treating constipation with chronic laxative use, leading to dependence on laxatives
B. Chronic constipation causing an obstruction, reducing forward flow of intestinal contents
C. Herniation of the intestinal mucosa, rupturing the wall of the intestine
D. Undigested food blocking the diverticulum, predisposing the area to bacterial invasion.
ANSWER: D. Undigested food blocking the diverticulum, predisposing the area to bacterial invasion.
RATIO: Undigested food blocking the diverticulum, predisposing the area to bacterial invasion; Undigested food
can block the diverticulum, decreasing blood supply to the area and predisposing the area to invasion of bacteria.
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