Patient Case Study (Acute Care Nurse Practitioner Program)

Patient is a 68-year-old female with PMH of HTN, hypothyroidism, and DM II who presents to the ED with a 2-day history of “achy” left lower quadrant abdominal pain, 9/10 on pain scale, low-grade fever, and nausea that started about 12 hours ago. Her last colonoscopy was 2 years ago, findings were normal. 

Physical examination: T 101.6°F. Bowel sounds are hypoactive. There is generalized tenderness with guarding in the left lower quadrant. Her stool is negative for occult blood. KUB shows distended loops of bowel + gas patterns, and a moderate rectal fecal mass, but no evidence of free air. She is started on intravenous fluids and a BM protocol with minimal improvement in her symptoms. 

1. Discuss the following: Give 3-5 Differential Diagnoses for this patient.

2. What further testing would you perform to obtain your “working” diagnosis? 

3. What is your final “working” diagnosis with a complete Management plan?

4. What alternative or complementary techniques may benefit this patient both in acute care and for future prevention?