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Malnutrition and

Perforated
Diverticula
Taelin Lanier
Concord Hospital
ICU
Concord Hospital
This large scale non-profit hospital is part of a regional health
care system providing advanced clinical care to the
community. 1

295 6 5 608 8 18

Licensed Floors Outpatient Full Time


Full Time Staf Dietetic Interns
Beds Facilities RDNs
Role of an
RDN
Depends
EN & TPN
CDE
Other

Malnutrition 2
RDs have the opportunity to not
only increase awareness of
hospital malnutrition but also
improve patient outcomes by
working collaboratively with
physicians and nurses on an
interdisciplinary health care
team to administer the best
nutrition interventions
03/06- 3/07
Day 0-1

Meet Mrs. EJ
Pleasant 85-yr female complaints of severe abdominal pain. Her son, a
physician, confirms pt. reports of increasing abdominal distention (4wks) and
worsening constipation (3wks).

Treated for constipation with laxatives


diarrhea /48-hours.
no improvement in symptoms
decreases appetite
Calls 911

http://www.jerseycheapwholesalechina.com/
Per H&P notes via Horizon Abdominal_Distention.aspx
Patient Information
Social Hx
Surgical Hx
Portland, Maine
Retired advertisement- Home w/ Bilateralsalpingo-oophorectomy,
husband hysterectomy
No history of ETOH, drugs Carcinoma removal
Medical Hx Home Rx
Cancer: breast, basal nose Herbal supplements
Pernicious anemia, osteopenia Vitamin/min supplements
Hypothyroidism Synthroid
Alzheimer's disease
Aricept
Diverticulosis? Per H&P, Surgical Cx via Horizon
03/07- Day 1
CT scan
Gross free air & fluid
Thickening of sigmoid colon
Medical Dx Vitals

Colectomy.aspx
Conditions/Sigmoid-
sinai.edu/Patients/Health-
https://www.cedars-
Hypotensive (60/51)
Perforated HR: 128
RR: 29
Diverticula
Temp: 96.9

Sepsis3 Labs
Lytes are low
WBC: 22,000, platelets : 27
pH 7.15

Per H&P, Surgical Cx via Horizon


Perforated Diverticula 4-10
Tear in the wall of the intestines that originated from inflamed and infected
abnormal pouches within the intestinal wall.
Hinchey : diverticulitis with generalized pus or fecal matter within the
S&S: Severe stomach pain, chills,peritonitis
fever, N/V, abnormal lytes, high WB, anemia
Dx: Abdominal CT, MRI, water soluble contrast enema, exploratory laparoscopy
Tx: Temp ostomy & anastomosis, Hartmanns, resection, open abdomen serial
washout
Rx: IV Abx (ciprofloxacin OR ceftriaxone, ceftolozane, meropenem +
metronidazole, OR many more)
MNT:
NPO- 24-48hrs
Nutrition Support- depending on GI fx.
Low fiber- first 6-8 weeks of PO + meds
Medlineplus.gov, Emedicine.medscape.com
Obstructions can
also lead to
perforated bowels 11

https://www.youtube.com/watch?v=sBm12CkNtAo
Sepsis 12-13

Severe infection reaching the blood stream causing


inflammation and often times a drop in blood pressure (septic
shock).
Dx: 2+ of an elevated HR, RR, WBC, Temp, platelet ct.,
imaging
Tx: Fluid resuscitation, pressor support, IV antibiotics
Rx: IV Antibiotix (vancomycin)
MNT:
Stage 1- stress phase- NPO (24hrs)
Stage 2- Low kcal, high pro- 2-10 day https://www.drugtargetreview.c
om/news/21842/orexin-septic-
Stage 3- High kcal, high pro- HD stable shock/
Pathophysiology of
bowel perforation &
sepsis
03/07- Day 1

Medical Tx for EJ
Fluid Operation: Surgery: total
resuscitation: Laparoscopy, colectomy w/ end
0.9% NS
abdominal washout ileostomy 16

Principles & Practices of Surgery: Colon,


Rectum, Anus.