I.

INTRODUCTION

Colonic Diverticulosis
Diverticulosis, otherwise known as "diverticular disease", is the condition of
having diverticula in the colon which are outpocketings of the colonic mucosa and
submucosa through weaknesses of muscle layers in the colon wall. Colonic
diverticulosis is one of the most widespread diseases of developed Western countries.
An increase in its prevalence has been reported, and a low-fiber diet has been shown to
be the major cause among other predisposing factors. It also affects a considerably
significant proportion of younger adults.

Sign and Symptoms of Diverticular Disease

Diverticulosis usually produces no symptoms, but may cause recurrent left lower
quadrant pain, which is commonly accompanied by alternating constipation and
diarrhea and is relieved by defecation or the passage of flatus. Symptoms resemble
irritable bowel syndrome (IBS) and suggest that both disorders may coexist.
Mild diverticulitis produces moderate left lower abdominal pain, mild nausea,
gas, irregular bowel habits, low-grade fever, and leukocytosis. In severe diverticulitis,
the diverticula can rupture and produce abscesses or peritonitis, which occurs in up to
20% of such patients. Symptoms of rupture include abdominal rigidity and left lower
quadrant pain. Peritonitis follows release of fecal material from the rupture site and
causes signs of sepsis and shock (high fever, chills, and hypotension). Rupture of the
diverticulum near a vessel may cause microscopic or massive hemorrhage, depending
on the vessel’s size.
Chronic diverticulitis may cause fibrosis and adhesions that narrow the bowel’s
lumen and lead to bowel obstruction. Symptoms of incomplete obstruction are
constipation, ribbonlike stools, intermittent diarrhea, and abdominal distention.
Increasing obstruction causes abdominal rigidity and pain, diminishing or absent bowel
sounds, nausea, and vomiting.

Causes Diverticular Disease

No one knows for certain why diverticulosis develops; however, a few theories
have been suggested. Some experts believe that abnormal contraction and spasm
(resulting in intermittent high pressure in the colon) may cause diverticula to form in a
weak spot of the intestinal wall. Low fiber diets may play a role in the development of
diverticulosis. In rural Africa where the diet is high in roughage, diverticulosis is rare.
There also appears to be a genetic predisposition to diverticulosis, that is, if your
parent or grandparent had diverticulosis you may develop it as well.
II. PATIENT’S PROFILE

Name: J.P.O

Age: 63

Gender: Male

Birthday: September 9,1948

Birthplace: Pangasinan

Address: Olivarez , Binan Laguna

Nationality: Filipino

Religion: Catholic

Status: Married

Occupation: none

Admission Date: Nov. 21,2011(10:30pm)

Attending Physician: Dra. E. B.

Initial Diagnosis: HPN 2 DMII LGIB VS UGIB: Etiology to be determined

Final Diagnosis: Colonic Diverticulosis

History of present illness:

At around 7:30pm patient experienced bloody stool 2 episodes, persistence of
the above condition prompted consult at the ER, another episode of flush blood stool
approximately 200cc, persistence of the above condition prompted the patient to be
admitted.

History of past illness: + Hypertension

+DM

+Hx of TIH 2008 ,admitted at OPH

Area Assessed Technique Normal Findings Actual Findings Evaluation
Skin
Light brown, tanned Suggests
Color Inspection skin (vary according to Pale looking skin. decreased in
race) blood supply.
Suggest a
Moist and light colored
Lips Dry lips. sign of
Inspection lips.
dehydration.
Inspection/
Moisture Skin normally dry Skin normally dry Normal
Palpation
Sign of
Temperature Palpation Warm to touch Cold to touch
hypothermia.
Smooth, soft and
Smooth, soft and
flexible palms and soles
flexible palms and soles
Texture Palpation (thicker) Normal
(thicker)
Skin snaps back
Skin snaps back
Turgor Palpation immediately 1-2 Normal
immediately
seconds

Nails
Transparent, smooth and Transparent, smooth and Good
Nails Inspection
convex cut and clean convex cut and clean grooming
Signs of poor
Nail beds Inspection Pinkish Pale
circulation.
Nail base Inspection Firm Firm Normal
White color of nail bed
Sign of poor
Inspection/ under pressure should
Capillary refill slow circulation.
Palpation return to pink within 2-3
seconds

Hair
Distribution Inspection Evenly distributed Evenly distributed Normal
Color Inspection Black Black Normal
Inspection/
Texture Smooth Smooth Normal
Palpation

Eyes
Eyes Inspection Parallel to each other Parallel to each other Normal
Pupils equally round Pupils equally round
Inspection
Visual Acuity react to light and react to light and Normal
(penlight)
accommodation accommodation
Symmetrical in size, Symmetrical in size,
Eyebrows Inspection extension, hair texture extension, hair texture Normal
and movement and movement
Eyelashes Inspection Distributed evenly and Distributed evenly and Normal
 curved outward long curved outward
Eyelids Inspection Same color as the skin Same color as the skin Normal
Transparent with light Pale Suggests a sign
Conjunctiva Inspection
pink color of anemia
Sclera Inspection Color is white Color is white Normal
Cornea Inspection Transparent, shiny Transparent, shiny Normal
Pupils Inspection Black, constrict briskly Black, constrict Normal
briskly
Iris Inspection Clearly visible Clearly visible Normal

Nose
Shape, size and Inspection Smooth, symmetric with Smooth, symmetric with
skin color same color as the face same color as the face Normal
Nares Inspection Oval, symmetric and Oval, symmetric and
without discharge without discharge Normal

Mouth and Pharynx

Lips Inspection Pink, moist symmetric Pale and dry Suggests a
sign of
dehydration.
Buccal mucosa Inspection Glistening pink soft Pale and dry Suggests a
moist sign of
dehydration.
Gums Inspection Slightly pink color, Slightly pink color, moist
moist and tightly fit and tightly fit against Normal
against each tooth each tooth
Neck moves freely, Neck moves freely,
Neck Rom Inspection Normal
without discomfort without discomfort
Rises freely with Rises freely with
Thyroid gland Palpation Normal
swallowing swallowing
Trachea Inspection Midline Midline Normal

Skin same color with Skin same color with the

Normal
Inspection the rest of the body rest of the body
Abdomen
Inspection
Asymmetrical Asymmetrical Normal
Palpation
Neurology System
Fully conscious, respond
Fully conscious, respond Normal
Level of quickly to stimulus
Inspection to questions quickly,
consciousness
perceptive of events

Behavior and Inspection Makes eye contact with Makes eye contact with
 examiner, hyperactive examiner, hyperactive
Normal
appearance expresses feelings with expresses feelings with
response to the situation response to the situation
VITAL SIGNS

date time BP PR RR TEMP

11-22-11 8:00am 120\90 61 19 36.4
12:00nn 120\90 58 19 36
4:00pm 120\80 63 19 36.9
8:00pm 130\80 65 20 36.8
11-23-11 7:30am 120\90 65 22 35.4
7:40am 120\80 65 22 35.4
8:00am 120\80 65 22 35
8:15am 120\90 65 22 35.3
8:30am 120\90 65 22 35.4
8:45am 120\90 65 22 35.6
4:00pm 130\80 65 19 36.2
8:00pm 140\100 57 18 36
11-24-11 8:00am 130\80 67 18 36.7
12:00nn 120\80 68 18 36.7

80

70

60

50

40
PR
RR
30
TEMP
20

10

0
n n
a m 0n pm pm a m a m a m a m a m a m pm pm a m 0n
:00 2:0 :00 :00 :30 :40 :00 :15 :30 :45 :00 :00 :00 2:0
8 1 4 8 7 7 8 8 8 8 4 8 8 1
IV. ANATOMY AND PHYSIOLOGY

The Digestive System

The digestive system is made up of the digestive tract—a series of hollow organs
joined in a long, twisting tube from the mouth to the anus and other organs that help the
body break down and absorb food.

Functions of Digestive System

1. Take in food. Food and water are taken into the body through the mouth.
2. Break down the food. The food that is taken into the body is broken down during
the process of digestion from complex molecules to smaller molecules that can
be absorbed.
3. Absorb digested molecules. The small molecules that result from digestion are
absorbed through the walls of intestine for use in the body.
 4. Provide nutrients. The process of digestion and absorption provides the body
with water, electrolytes, and other nutrients such as vitamins and minerals.
5. Eliminate wastes. Undigested material, such as fiber from food, plus waste
products excreted into the digestive tract are eliminated in the feces.
Parts
 Mouth - The mouth is the first portion of the alimentary canal that receives food
and saliva. The oral mucosa is the mucous membrane epithelium lining the
inside of the mouth.

 Pharynx - is the part of the throat situated immediately posterior to (under)

the mouth and nasal cavity, and anterior to the esophagus and larynx. The
human pharynx is conventionally divided into three sections:
the nasopharynx (epipharynx), theoropharynx (mesopharynx), and
the laryngopharynx (hypopharynx). The pharynx is part of the digestive
system and also the respiratory system; it is also important in vocalization.

 Esophagus - is an organ in vertebrates which consists of a muscular tube

through which food passes from thepharynx to the stomach. During swallowing,
food passes from the mouth through the pharynx into the esophagus and travels
via peristalsisto the stomach. The word esophagus is derived from
the Latin œsophagus, which derives from the Greek word oisophagos , lit.
"entrance for eating." In humans the esophagus is continuous with
the laryngeal part of the pharynx at the level of the C6 vertebra. The esophagus
passes through posterior mediastinum in thorax and enters abdomen through a
hole in the diaphragm at the level of the tenth thoracic vertebrae (T10). It is
usually about 25–30 cm long depending on individual height. It is divided into
cervical, thoracic and abdominal parts. Due to the inferior pharyngeal constrictor
muscle, the entry to the esophagus opens only when swallowing or vomiting.

 Stomach - is a muscular, hollow, dilated part of the alimentary canal which

functions as an important organ of the digestive tract in some animals,
including vertebrates, echinoderms, insects (mid-gut), and molluscs. It is involved
in the second phase of digestion, following mastication (chewing).
The stomach is located between the esophagus and the small intestine. It
secretes protein-digesting enzymes and strong acids to aid in food digestion,
(sent to it via oesophageal peristalsis) through smooth muscular contortions
(called segmentation) before sending partially digested food (chyme) to the small
intestines.
 Pancreas - is a gland organ in the digestive and endocrine system of vertebrates.
It is both an endocrine gland producing several important hormones,
including insulin, glucagon, and somatostatin, as well as a digestive organ,
secreting pancreatic juicecontaining digestive enzymes that assist the absorption
of nutrients and the digestion in the small intestine. These enzymes help to
further break down the carbohydrates, proteins, and lipids in the chyme.

 Liver- is a vital organ present in vertebrates and some other animals. It has a
wide range of functions, including detoxification, protein synthesis, and
production of biochemicals necessary for digestion. The liver is necessary for
survival; there is currently no way to compensate for the absence of liver function
long term, although liver dialysis can be used short term.
This organ plays a major role in metabolism and has a number of
functions in the body, including glycogen storage, decomposition of red blood
cells, plasma protein synthesis, hormone production, and detoxification. It lies
below the diaphragm in the abdominal-pelvic region of the abdomen. It
produces bile, an alkaline compound which aids in digestion via
the emulsification of lipids. The liver's highly specializedtissues regulate a wide
variety of high-volume biochemical reactions, including the synthesis and
breakdown of small and complex molecules, many of which are necessary for
normal vital functions.

 Gallbladder - is a small organ that aids mainly in fat digestion and

concentrates bile produced by the liver. In humans the loss of the gallbladder is
usually easily tolerated.

 Small intestine- is the part of the Gastrointestinal tract following the stomach and
followed by the large intestine, and is where much of the digestion and
absorption of food takes place. In invertebrates such as worms, the terms
"gastrointestinal tract" and "large intestine" are often used to describe the
entire intestine. This article is primarily about the human gut, though the
information about its processes is directly applicable to most placental mammals.
The primary function of the small intestine is the absorption of nutrients and
minerals found in food.

Parts of small intestine:

 Duodenum- first section of the small intestine, about 25cm long

 Jejunum- is the middle section of the small intestine, about 2.5m long
  Ileum - is the final section of the small intestine in most higher vertebrates,
including mammals, reptiles, and birds. In fish, the divisions of the small
intestine are not as clear and the terms posterior intestine or distal
intestine may be used instead of ileum.

 Appendix- is narrow, dead-end tube about three-to-four inches long that

hangs off of the cecum.

 Large intestine- is the third-to-last part of the digestive

system in vertebrate animals. Its function is to absorb water from the remaining
indigestible food matter, and then to pass useless waste material from the body.
[1]
This article is primarily about the human gut, though the information about its
processes are directly applicable to most mammals.

The large intestine consists of the cecum and colon. It starts in the right iliac
region of the pelvis, just at or below the right waist, where it is joined to the bottom
end of the small intestine. From here it continues up the abdomen, then across the
width of the abdominal cavity, and then it turns down, continuing to its endpoint at
the anus.

Parts of Large intestine:

 Cecum- is a pouch, connecting the ileum with the ascending colon of
the large intestine. It is separated from the ileum by the ileocecal
valve (ICV) or Bauhin's valve, and is considered to be the beginning of the
large intestine. It is also separated from the colon by the cecocolic
junction. The appendix is connected to the cecum. The cecum is
usually peritoneal, while the ascending colon is retroperitoneal.

 Ascending colon- is smaller in caliber than the cecum.

It passes upward, from its commencement at the cecum, opposite
the colic valve, to the under surface of the right lobe of the
liver, on the right of the gall-bladder, where it is lodged in a
shallow depression, the colic impression; here it bends
abruptly forward and to the left, forming the right colic
flexure (hepatic).

 Transverse colon- the longest and most movable part of the colon,
passes with a downward convexity from the right hypochondrium
 region across the abdomen, opposite the confines of the epigastric and
umbilical zones, into the left hypochondrium region, where it curves
sharply on itself beneath the lower end of the spleen, forming the splenic
or left colic flexure. The right colic flexure is adjacent to the liver.

 Descending colon- of humans passes downward through the

left hypochondrium and lumbar regions, along the lateral border of the
left kidney.
At the lower end of the kidney it turns medial ward toward the
lateral border of the psoas muscle, and then descends, in the angle
between psoas and quadratus lumborum, to the crest of the ilium, where it
ends in the sigmoid colon.

 Sigmoid colon- is the part of the large intestine that is closest to the
rectum and anus. It forms a loop that averages about 40 cm. in length,
and normally lies within the pelvis, but on account of its freedom of
movement it is liable to be displaced into the abdominal cavity.

 Rectum- is the final straight portion of the large intestine in

somemammals, and the gut in others, terminating in the anus. The human
rectum is about 12 cm long. Its caliber is similar to that of the sigmoid
colon at its commencement, but it is dilated near its termination, forming
the rectal ampulla.

 Anus- is an opening at the opposite end of an animal's digestive tract from

the mouth. Its function is to control the expulsion of feces, unwanted semi-
solid matter produced during digestion, which, depending on the type of
animal, may be one or more of: matter which the animal cannot digest,
such as bones;[1] food material after all the nutrients have been extracted,
for example cellulose or lignin; ingested matter which would be toxic if it
remained in the digestive tract; and dead or excess gut bacteria and
other endosymbionts.
Functions of Digestive secretions
Fluid or Enzyme Source Function
Mouth
Saliva Salivary gland Moistens and lubricates food
Salivary amylase Salivary gland Digests starch
Lipase Salivary gland Begins lipid digestion
Lysozyme Salivary gland Weak antibacterial action
Stomach
Hydrochloric acid Gastric glands Kills bacteria, activates pepsin
Pepsinogen Gastric glands Active form, pepsin, digests protein
Mucus Mucous cells Protects lining
intrinsic factor Gastric glands Binds to vitamin b12, aiding in its absorption
Gastrin Gastric glands Increase stomach secretions
Small intestine
and Associated
glands
Bite salts Liver Emulsify fats
Bicarbonate ions Pancreas Neutralize stomach acid
Trypsim, Pancreas Digests protein
chymotrypsin
Carboxypeptidase Pancreas Digests protein
Pancreatic Pancreas Digests starch
amylase
Pancreatic lipase Pancreas Digests lipid
Nucleases Pancreas Digest nucleic acid
Mucus Duodenal glands Protects duodenum from stomach acid and
and goblet cells digestive enzymes
Secretin Duodenum Inhibits gastric secretions
Stimulates sodium bicarbonate secretion from
the pancreas and bile secretion (enzyme)
Cholecystokinin Duodenum Inhibits gastric motility and secretion,
stimulates gallbladder contraction
Peptidases Small intestine Digest polypeptide
Amylase Small intestine Digests starch
Lipase Small intestine Digests lipid
Sucrase Small intestine Digests sucrose
Lactase Small intestine Digests lactose
Maltase Small intestine Digests maltose

Deglutition
Deglutition, or swallowing, can be divided into three separate phases; the
voluntary phase, the pharyngeal phase phase, and the esophageal phase. During the
voluntary phase, a bolus, or mass of food, is formed in the mouth. The bolus in pushed
by the tongue against the hard palate, forcing the bolus toward the posterior part of the
mouth and into the oropharynx.
The pharyngeal phase of swallowing is a reflex that is initiated when a bolus of
food stimulates receptors in the oropharynx. This phase of swallowing begins with the
elevation of the soft palate, which closes the passage between the nasopharynx and
oropharynx. The pharynx elevates to receive the bolus of food from the mouth. The
three pharyngeal constrictor muscles then contract in succession, forcing the food
through relaxes, and food is pushed into the esophagus. As food passes through the
pharynx, the epiglottis is tipped posteriorly so that the opening into the larynx is
covered, preventing food from passing into the larynx.
The esophageal phase of swallowing is responsible for moving food from the
pharynx to the stomach. Muscular contractions of the esophagus occur in peristaltic
waves. A wave of relaxation of the circular esophageal muscles precedes the bolus of
food down the esophagus, and a wave of strong contraction of the circular muscles
follows and propels the bolus the bolus through the esophagus. The peristaltic
contractions associated with swallowing cause relaxation of the lower esophageal
sphincter in the esophagus as the peristaltic waves approach the stomach.

Movement in the small intestine

Mixing and propulsion of chime are the primary mechanical events that occur in
the small intestine. Peristaltic contractions proceed along the length of the intestine for
variable distances and cause the chime to move along the small intestine. Segmental
contractions are propagated for only distances and function to mix intestinal contents.
The ileocecal sphincter at the juncture of the ileum and the large intestine
remains mildly contracted most of the time, but peristaltic contractions reaching
ileocecal sphincter from the small intestine cause the sphincter to relax and allow
movement to chime from the small intestine into the cecum. The ileocecal valve allows
chime to move from the ileum into the large intestine, but tends to prevent movement
from the large intestine back into the ileum.

Functions of liver
Function Explanation
Ingestion Bile neutralizes stomach acid and emulsifies fats, which facilitates
fat digestion.
Excretion Bile contains excretory products such as cholesterol, fats, and bile
 pigments, such as bilirubin, that result from hemoglobin breakdown
Nutrient storage Liver cells remove sugar from the blood and store it in the form of
glycogen; also store fat, vitamins, copper, and iron
Nutrient Liver cells convert some nutrients into others; for example, amino
conversion acids can be converted to lipids or glucose; fats can be converted
to phospholipids; vitamin D is converted to its active form
Detoxification of Liver cells remove ammonia from the circulation and convert it to
Non- Modifiable Factors: Modifiable Factors:
harmful chemicals urea, which is eliminated in the urine; other substances
1. Eating habitsare
1. Age: 63 y/0
Colonic Diverticulosis
detoxified and secreted in the bile or excreted in the urine
2. Race
Synthesis of new Synthesizes blood proteins such as albumin, fibrogen, globuluns,
molecule and clotting factors

Digestion, absorption, and transport

Thickening
Digestion of the muscular
is the breakdown of foodwall
to (taeniae
moleculescoli)
thatofare
the small
colon enough to be
Constipation
absorbed into the circulation. Mechanical digestion breaks large food particles down into
smaller ones. Chemical digestion involves the breaking of covalent chemical bonds in
organic molecules by digestive enzymes. Carbohydrates are broken down into
monosaccharide’s, proteins are broken down into amino acids, and fats are broken
down into fatty acids and glycerol.

Absorption begins
Increased in the required
pressure stomach,bywhere sometosmall,
the colon lipid-soluble
eliminate feces molecules,
such as alcohol and aspirin, can diffuse through the stomach epithelium into the
circulation. Most absorption occurs in the duodenum and jejunum, although some
occurs in the ileum. Some molecules can diffuse through the intestinal wall. Others must
be transported across the intestinal wall. Transport requires carrier molecules and
includes facilitated diffusion, cotransport, and active transport. Cotransport and active
transport require energy to move transported molecules across the intestinal wall.
Vigorous contractions in the colon
Diarrhea

Inner intestinal lining pushed outward

V. PATHOPHYSIOLOGY
Herniates where vasa recta penetrates between the taeniae coli

Forms pouches called diverticula

Fecal material or undigested food particles collect in a diverticulum
Inflammation Fever
(Diverticulitis)

Overgrowth of normal colonic bacteria

Mucus secretion

Distension of diverticulum
Mucus in stool

Diverticulum bursts Bleeding

Obstruction of the colon Hematochezia

Was not seen in patient

VI. MEDICAL MANAGEMENT

A. Diet

 NPO diet
NPO diet is advised if you have a gastrointestinal illness or a
disease that prevents you from having normal GI function. When you have
nausea, vomiting and diarrhea that cannot be controlled you may have to
be NPO to allow your gastrointestinal tract and bowels to rest. Patients
 with bowel obstructions are often NPO for the same reason. This makes
sense because food cannot continue to go in if it cannot come back out.

 Clear liquid diet

A clear liquid diet is often used before tests, procedures or
surgeries that require no food in your stomach or intestines, such as
before colonoscopy. It may also be recommended as a short-term diet if
you have certain digestive problems, such nausea, vomiting or diarrhea,
or after certain types of surgery.

B. Intravenous Fluid

D5W 500cc This medication is a solution given by

vein (through an IV). It is used to supply
water and calories to the body. It is also
used as a mixing solution (diluent) for
other IV medications. Dextrose is a
natural sugar found in the body and
serves as a major energy source.
When used as an energy source,
dextrose allows the body to preserve its
muscle mass.
PNSS 1L Plain Normal Saline Solution or PNSS
is used after blood transfusion because
it is the only compatible diluent or
'cleaner' after transfusion.

C. Laboratory Test

CBC and Platelet It is used as a broad screening test to

check for such disorders as anemia,
infection, and many other diseases.
Urinalysis It is used as a screening and/or
diagnostic tool because it can help
detect substances or cellular material
in the urine associated with different
metabolic and kidney disorders. It is
ordered widely and routinely to detect
any abnormalities that require follow
up.
Sodium test A sodium test checks how much
sodium (an electrolyte and a mineral)
is in the blood. Sodium is both an
electrolyte and mineral. It helps keep
the water (the amount of fluid inside
and outside the body's cells) and
 electrolyte balance of the body.
Potassium testing is frequently
ordered, along with other electrolytes,
as part of a routine physical. It is used
Potassium test
to detect concentrations that are too
high (hyperkalemia) or too low
(hypokalemia).

In order for blood to clot, the enzyme

thrombin must be generated from the
plasma precursor prothrombin.
Thrombin then converts soluble
fibrinogen into insoluble fibrin.
Generation of thrombin involves the
sequential activation of a number of
other plasma clotting factor, this
process is also being assisted by Ca++
and by factors released by platelets
Clotting time Test and damaged tissues . The time taken
for blood to clot mainly reflects the
time required for the generation of
thrombin in this manner. If the plasma
concentration of prothrombin or of
some of the other factors is low (or if
the factor is absent, or functionally
inactive), clotting time will be
prolonged. The expected range for
clotting time is 4-10 mins.

This test measures the time taken for

blood vessel constriction and platelet
plug formation to occur. No clot is
Bleeding time Test
allowed to form, so that the arrest of
bleeding depends exclusively on blood
vessel constriction and platelet action.
This test determines the concentration
Hemoglobin Test
of hemoglobin in whole blood.
Nursing Considerations for Complete Blood Count

Pretest:
∙ Positively identify the patient using at least two unique identifiers before providing
care, treatment, or services.

Patient Teaching:
 ∙ Inform the patient this test can assist in evaluating the amount of hemoglobin in
the blood to assist in diagnosis and monitor therapy.
∙ Obtain a history of the patient's complaints, including a list of known allergens,
especially allergies or sensitivities to latex.
∙ Obtain a history of the patient's cardiovascular, gastrointestinal, hematopoietic,
hepatobiliary, immune, and respiratory systems; symptoms; and results of
previously performed laboratory tests and diagnostic and surgical procedures.
∙ Note any recent procedures that can interfere with test results.
∙ Obtain a list of the patient's current medications, including herbs, nutritional
supplements, and nutraceuticals
∙ Review the procedure with the patient. Inform the patient that specimen
collection takes approximately 5 to 10 min. Address concerns about pain and
explain that there may be some discomfort during the venipuncture.
∙ Sensitivity to social and cultural issues, as well as concern for modesty, is
important in providing psychological support before, during, and after the
procedure.
∙ There are no food, fluid, or medication restrictions unless by medical direction.

Intratest:
∙ If the patient has a history of allergic reaction to latex, avoid the use of equipment
containing latex.
∙ Instruct the patient to cooperate fully and to follow directions. Direct the patient to
breathe normally and to avoid unnecessary movement.
∙ Observe standard precautions, and follow the general guidelines. Positively
identify the patient, and label the appropriate tubes with the corresponding
patient demographics, date, and time of collection. Perform a venipuncture;
collect the specimen in a 5-mL lavender-top (EDTA) tube. An EDTA Microtainer
sample may be obtained from infants, children, and adults for whom
venipuncture may not be feasible. The specimen should be mixed gently by
inverting the tube 10 times. The specimen should be analyzed within 24 hr when
stored at room temperature or within 48 hr if stored at refrigerated temperature. If
it is anticipated the specimen will not be analyzed within 24 hr, two blood smears
should be made immediately after the venipuncture and submitted with the blood
sample. Smears made from specimens older than 24 hr may contain an
unacceptable number of misleading artifactual abnormalities of the RBCs, such
as echinocytes and spherocytes, as well as necrobiotic white blood cells.
∙ Remove the needle and apply direct pressure with dry gauze to stop bleeding.
Observe/assess venipuncture site for bleeding or hematoma formation and
secure gauze with adhesive bandage.
∙ Promptly transport the specimen to the laboratory for processing and analysis.

Post-test:
∙ A report of the results will be sent to the requesting HCP, who will discuss the
results with the patient.
 ∙ Depending on the results of this procedure, additional testing may be performed
to evaluate or monitor progression of the disease process and determine the
need for a change in therapy. Evaluate test results in relation to the patient's
symptoms and other tests performed.

Nursing Considerations for Urinalysis

1. Instruct the patient to void directly into a clean, dry container. Sterile, disposable
containers are recommended. Women should always have a clean-catch
specimen if a microscopic examination is ordered. Feces, discharges, vaginal
secretions and menstrual blood will contaminate the urine specimen.
2. Collect specimens form infants and young children into a disposable collection
apparatus consisting of a plastic bag with an adhesive backing around the
opening that can be fastened to the perineal area or around the penis to permit
voiding directly to the bag. Depending on hospital policy, the collected urine can
be transferred to an appropriate specimen container.
3. Cover all specimens tightly, label properly and send immediately to the
laboratory.
4. If a urine sample is obtained from an indwelling catheter, it may be necessary to
clamp the catheter for about 15-30 minutes before obtaining the sample. Clean
the specimen port with antiseptic before aspirating the urine sample with a
needle and a syringe.
5. Observe standard precautions when handling urine specimens.
6. If the specimen cannot be delivered to the laboratory or tested within an hour, it
should be refrigerated or have an appropriate preservative added.

D. Diagnostic Test

Diagnostic x rays are useful in

detecting abnormalities within the
body. They are a painless, non-
Chest X-ray invasive way to help diagnose
problems such as broken bones,
tumors, dental decay, and the
presence of foreign bodies.
COLONOSCOPY A colonoscopy is an exam used to
detect changes or abnormalities in the
large intestine (colon) and
rectum.During a colonoscopy, a long,
flexible tube (colonoscope) is inserted
into the rectum. A tiny video camera at
the tip of the tube allows the doctor to
view the inside of the entire colon.If
necessary, polyps or other types of
abnormal tissue can be removed
 through the scope during a
colonoscopy. Tissue samples
(biopsies) can be taken during a
colonoscopy as well.
Removal of a polyp by surgery. In the
case of polyps in the colon,
polypectomy may be done by open
abdominal surgery or, more commonly
today, by colonoscopy. During
colonoscopy, a small polyp may be
snipped off with a biopsy forceps and
POLYPECTOMY larger polyps may be removed by
putting a snare around the polyp base
and burning through the tissue with
electric cautery. Rarely is a polyp too
large to remove by colonoscopy. The
most common complications of
polypectomy include bleeding and
perforation (creating a hole in the
colon).

Nursing considerations for x-ray

1. Nurses may need to reduce anxiety in some patients, particularly in those who
are very young or confused. Some may be anxious about the exposure to
radiation, and need to be given as much information as possible about the test,
and to be reassured that the benefits of having the test far out way the very small
risk involved.
2. Some physical preparation is sometimes required, especially for more extensive
investigations involving contrast media.
3. Simple, loose clothing is important to gain access to that part of the body under
examination. This may mean a loose fitting gown for hospital patients. The
patient may need a dressing gown and footwear for privacy and warmth while
away from bed.
4. If the investigation involves contrast medium, check to see if the patient has any
allergies, particularly to iodine or seafood (which may indicate an iodine allergy).
Report any allergies the patient has to the radiography staff.
5. Some specialized X-ray investigations may require nothing by mouth for a few
hours before the test, or a particular bowel preparation. Often, the radiography
department will issue specific instructions when the appointment is made. Nurses
should ensure these instructions are carried out for all hospital patients.
6. Check that the patient has emptied the bladder before the test commences.
7. After the test, the patient should be returned to their normal activities if these
have been disturbed, i.e. eating and drinking, as quickly as possible.
 8. Whilst most contrast medium allergies are instantaneous, nurses should be
aware of possible longer-term reactions over the next few hours or days, and
observe patients accordingly.

Nursing considerations for Colonoscopic Polypectomy

1. Check the patient’s medical history for allergies, medications, and information
pertinent to the current complaint.
2. Tell the patient to maintain a clear liquid diet for 24 to 48 hours before the test and
to take nothing by mouth after midnight the night before.
3. Instruct the patient regarding the appropriate bowel preparation.
4. Inform the patient that he’ll receive an I.V. line and I.V. sedation before
the procedure.
5. Tell the patient that the colonoscope is well lubricated to ease insertion and initially
feels cool.
6. Explain that he may feel an urge to defecate when it’s inserted and advanced.
7. Inform him that air may be introduced through the colonoscope to distend the
intestinal wall and to facilitate viewing the lining and advancing the instrument.

E. Medication

Date Ordered Drugs Action

Tranexamic acid is a man-
made form of an amino acid
(protein) called lysine.
11/21/11 Tranexamic Acid
Tranexamic acid prevents
enzymes in the body from
breaking down blood clots.
Sucralfate is used to treat an
active duodenal ulcer.
Sucralfate can heal an active
ulcer, but it will not prevent
future ulcers from occurring. It
is not greatly absorbed into the
11/21/11 Sucralfate
body through the digestive
tract. It works mainly in the
lining of the stomach by
adhering to ulcer sites and
protecting them from acids,
enzymes, and bile salts.
 Nifedipine is in a class of drugs
called calcium channel
blockers. Nifedipine relaxes
(widens) your blood vessels
(veins and arteries), which
makes it easier for the heart to
pump and reduces its
11/21/11 Nifedifine workload.

Nifedipine is used to lower

hypertension (high blood
pressure) and to treat angina
(chest pain).

Telmisartan is in a group of
drugs called angiotensin II
receptor antagonists.
Telmisartan keeps blood
vessels from narrowing, which
lowers blood pressure and
improves blood flow.

Telmisartan is used to treat

high blood pressure
(hypertension). It is sometimes
11/21/11 Telmisartan given together with other blood
pressure medications.

Telmisartan is also used to

reduce the risk of stroke, heart
attack, or death from heart
problems in people who are at
least 55 years old with risk
factors for serious heart
disorders.
 Metformin is an oral diabetes
medicine that helps control
blood sugar levels.

Metformin is for people with

type 2 (non-insulin-dependent)
diabetes. Metformin is
11/21/11 Metformin
sometimes used in
combination with insulin or
other medications, but it is not
for treating type 1 diabetes.

Atorvastatin is a cholesterol-
lowering medication that blocks
the production of cholesterol (a
type of fat) in the body.

Atorvastatin reduces low-

density lipoprotein (LDL)
cholesterol and total
11/21/11 Atorvastatin cholesterol in the blood.
Lowering your cholesterol can
help prevent heart disease and
hardening of the arteries,
conditions that can lead to
heart attack, stroke, and
vascular disease.

Phospho soda works by

drawing liquid from the body
into the colon, therefore it can
cause severe dehydration,
especially if not used
11/22/11 Phosposoda
properly.Phospho soda works
by drawing liquid from the body
into the colon, therefore it can
cause severe dehydration,
especially if not used properly.
 Clonidine lowers blood
pressure by decreasing the
levels of certain chemicals in
11/23/11 Clonidine your blood. This allows your
blood vessels to relax and your
heart to beat more slowly and
easily.
Vitamin K is a necessary
participant in synthesis of
11/23/11 Vitamin K several proteins that mediate
both coagulation and
anticoagulation.
Phospho soda works by
drawing liquid from the body
into the colon, therefore it can
cause severe dehydration,
especially if not used
properly.Phospho soda works
by drawing liquid from the body
into the colon, therefore it can
cause severe dehydration,
especially if not used properly.
Pantoprazole is in a group of
drugs called proton pump
inhibitors. It decreases the
amount of acid produced in the
stomach.

Pantoprazole is used to treat

11/23/11 Pantoparazole erosive esophagitis (damage to
the esophagus from stomach
acid), and other conditions
involving excess stomach acid
such as Zollinger-Ellison
syndrome.

VII. LABORATORY AND DIAGNOSTICS

 A. COMPLETE BLOOD COUNT (CBC)
The complete blood count or CBC test is used as a broad screening test to check
for such disorders as anemia, infection, and many other diseases.

NAME: J.O. AGE: 63 yrs old

SEX: MALE
DATE REQUESTED: 11/21/11
SPECIMEN: BLOOD

RESULT NORMAL INTERPRETATION SIGNIFICANCE

VALUE
Hemoglobin 126 120-150g/L M Normal
110-140 g/L F
Hematocrit 0.41 0.40-0.54 M Normal
0.37-0.47 F
RBC count 4.5 4-5.5 x 1012/ L Normal
WBC count 9.35 5.0-10.0 x 109/ L Normal
Differential count
Neutrophils 0.64 0.50-0.70 % Normal
Lymphocytes 0.25 0.20-.40 % Normal
Monocytes 0.03 0-0.05 % Normal
Eosinophile 0-0.04 %
Basophiles 0-0.01 %
STABS 89.9 0-0.04% Increased
MCV 28.0 80-98 fl Decreased Due to
gastrointestinal
blood loss
MCH 311 26-32pg Increased
MCHC 320-360 g/L
Platelet count 287 x 10 / L 150-400 x 109/ L
9
Normal

B. ABO AND RH BLOOD TYPING

 Blood typing is a method to tell what specific type of blood you have. What type
you have depends on whether or not there are certain proteins, called antigens, on your
red blood cells.

NAME: J.O. AGE: 63 yrs old

SEX: MALE
DATE REQUESTED: 11/21/11

TEST NAME RESULT

ABO TYPING AND RH TYPING “A” Rh (D) POSITIVE

C. CLOTTING TIME AND BLEEDING TIME TEST

 Clotting test is used to check if you don't have any clotting disorders (such as
haemophilia or liver disease), to monitor anticoagulant therapy (such as warfarin or
heparin) or to check whether you may need transfusions of blood products after
having a large haemorrhage. Bleeding time is a blood test that looks at how fast
small blood vessels in the skin close to stop you from bleeding.

NAME: J.O. AGE: 63 yrs old

SEX: MALE
DATE REQUESTED: 11/21/11

Test name Result Normal value Interpretation

Bleeding time 3 mins 1-5 mins. Normal
Clotting time 4 mins and 30 sec. 2-6 mins. Normal

D. URINALYSIS
 The urinalysis is used as a screening and/or diagnostic tool because it can help
detect substances or cellular material in the urine associated with different metabolic
and kidney disorders. It is ordered widely and routinely to detect any abnormalities that
require follow up.

NAME: J.O. AGE: 63 yrs old

SEX: MALE
DATE REQUESTED: 11/22/11
SPECIMEN: URINE

RESULT NORMAL INTERPRETATION SIGNIFICANCE

VALUE
Color: Light yellow Straw to dark Normal
yellow
Transparency: Slightly Hazy Clear-Hazy Normal

Specific 1.010 1.003-1.029 Normal

gravity:
Reaction (pH): 5.0 5-8.5 Normal

Albumin: Negative Negative Normal

Glucose: Negative Negative Normal

PUS cells: 0-1/HFP 2-3/hpf Normal

WBC: 0-4/ HPF
RBC: 0-1/ HPF Male: 0-3/hpf Normal
Female: 0-5/hpf
Epithelial Rare/
Cells: occasional
Mucus thread: Occasional Rare/ Normal
occasional
 E. SODIUM AND POTASSIUM TEST
Potassium testing is frequently ordered, along with other electrolytes, as part of a
routine physical. It is used to detect concentrations that are too high (hyperkalemia) or
too low (hypokalemia). Soduim testing is used to detect abnormal concentrations of
sodium, termed hyponatremia (low sodium) and hypernatremia (high sodium). A doctor
may order this test, along with other electrolytes, to identify an electrolyte imbalance.

NAME: J.O. AGE: 63 yrs old

SEX: MALE
DATE REQUESTED: 11/23/11
SPECIMEN: SERUM

Test name Result Reference conventiona Reference INTERPRETATION

values l values
Sodium 141.69 136-145 3.90mmol/L 3.5-5.1 Normal
mmol/L
Potassium 3.68 mmol/L 3.5-5.1 3.90 mmol/L 3.5-5.1 Normal

Comments:

Result Normal value Interpretation

PT control: 11.6 seconds 10-12 seconds Normal
Test: 11.9 secs 10.5-13.4 secs Normal
% ACT: 94.3% 78-138% Normal
INR 1.03 1-2 Normal
PTT test 28.6 secs 25.4-38.4 secs Normal
 F. HEMATOCRIT AND HEMOGLOBIN TEST
Hematocrit and hemoglobin measurements are blood tests. Hematocrit measures the
amount of red blood cells that are in blood. Hemoglobin is a protein-iron compound in the blood
that carries oxygen from the lungs to all cells. Hematocrit and hemoglobin tests help diagnose
anemia and polycythemia.

NAME: J.O. AGE: 63 yrs old

SEX: MALE
Normal value Interpretation Normal Interpretation
Date/Time Test Test value

Hemoglobin Hematocrit
120-150g/L M 0.40-0.54
11/22/11- 114 110-140 g/L F Decreased 0.35 M Decreased
6:00 am 0.37-0.47
Due to F Due to
excessive excessive
bleeding bleeding
120-150g/L M 0.40-0.54
11/22/11- 107 110-140 g/L F Decreased 0.33 M Decreased
10:00 am 0.37-0.47
Due to F Due to
excessive excessive
bleeding bleeding
120-150g/L M 0.40-0.54
11/22/11- 116 110-140 g/L F Decreased 0.37 M Decreased
2:00 pm 0.37-0.47
Due to F Due to
excessive excessive
bleeding bleeding
120-150g/L M 0.40-0.54
11/23/11- 112 110-140 g/L F Decreased 0.35 M Decreased
3:00 am Due to 0.37-0.47
excessive F Due to
bleeding excessive
bleeding
120-150g/L M 0.40-0.54
11/23/11- 100 110-140 g/L F Decreased 0.32 M Decreased
6:00 am 0.37-0.47
Due to F Due to
excessive excessive
bleeding bleeding
120-150g/L M 0.40-0.54
11/23/11- 105 110-140 g/L F Decreased 0.33 M Decreased
12:00 pm 0.37-0.47
Due to F Due to
excessive excessive
bleeding bleeding
 120-150g/L M 0.40-0.54
11/23/11- 115 110-140 g/L F Decreased 0.35 M Decreased
6:30 pm 0.37-0.47
Due to F Due to
excessive excessive
bleeding bleeding

G. CHEST X-RAY (CHEST RADIOGRAPHY)

The chest x-ray is the most commonly performed diagnostic x-ray examination. A
chest x-ray makes images of the heart, lungs, airways, blood vessels and the bones of
the spine and chest.

NAME: J.O. AGE: 63 yrs old

SEX: MALE
DATE REQUESTED: 11/22/11

INTERPRETATION:

CHEST PA (14 X 17)

Suspicious infiltrates noted on the left intraclavicular

SPOT FILM OF THE LEFT UPPER LOBE IS SUGGESTED

 H. COLONOSCOPY REPORT
A colonoscopy is an internal examination of the colon (large intestine) and
rectum, using an instrument called a colonoscope.

NAME: J.O. AGE: 63 yrs old

SEX: MALE
DATE REQUESTED: 11/23/11
INDICATION: HEMATOCHEGIA

CLINICAL DIAGOSIS: LGB T/C DIVERTICULAR BLEEDING

Colonoscope inserted to cecum. There are multiple diverticular opening

distributed from ascending coon to descending colon. Abundant amount of retained
blood along colon to ascending sigmoid. Yellow stools seen at cecum. No active
bleeding is noted. 2 small polyps are seen at hepatic and rectum polypectomy with
spare done.

Diagnosis:

- Colonic diverticulosis

- Colonic polyps s/p spare polypectomy