athophysiology (Schematic Diagram as applied to your patient)

Predisposing Factors: Precipitating Factors:

Age (5y/o) Infection

Gender
Race
Genetics
Congenital anomaly

LEGEND:
Present In The Case :TEXT incomplete obliteration of the 
Sign & Symptoms :GREEN omphalomesenteric duct
Laboratory & Diagnostics test :
Mechanism :
Surgery: Out-pouching diverticulum at the
Etiology: ileum

Meckel’s
If obstruction is Diverticulum
 Vomiting proximal(closer to the
mouth) higher luminar Build-up of bowel Bowel Cannot pass Continued peristalsis proximal
 Nausea
X-Ray= air-fluid in the pressure may force intestinal contents proximal to through obstruction to the obstruction continues to
upper quadrants regurgitation of GI contents obstruction the obstruction push GI contents against the
obstruction
paucity of gases in
the lower
Increase Bowel
distention Asymptomatic Meckel’s diverticulum
discovered incidentally  Abdominal pain
Inflamed Diverticulum during an operation  Bloating

Diverticulectomy Symptomatic
right transverse Diverticulum length (<2cm)
supraumbilical Absence of fibrous band
incision attached to diverticulum UTZ= extensive
dilatation of
intestinal loops
I. MEDICAL MANAGEMENT
a. Laboratory Interpretation
Basic Diagnostic Procedures
Required with Normal Values
Transvaginal ultrasound
Pregnancy test
Good Prognosis 5%
recurrence.
Purpose / Rationale
To closely visualize the female
internal reproductive organs
hematometra of 4.5cm x
To check for the presence of
human chorionic gonadotropin
(HCG), a hormone produced
during Diverticulum
pregnancy length
(>2cm)
Tissue may weaken
presence of fibrous
and become thin
band attached to
diverticulum
Perforation of diverticulum
Result of the Patient Clinical Significance
An enlarged uterus of Shows abnormal Before:
9.6cm x 5.7cm with structures or growths in
1. Explain the procedure to the
your pelvic area that
patient.
4.3cm, thickened may indicate a condition.
endometrium, and mild
ascites were detected
Measuring HCG level
can be helpful in
+ pregnancy test identifying a normal
pregnancy, pathologic
pregnancy and can also
be useful following an
Leakage of stool and bacteria in
abdominal cavity
Implication to Nursing
2. Instruct the patient to cooperate
during the procedure.
3. Monitor the results of diagnostic
tests.
4. Provide comfort and privacy
During
5. Remind the patient to remain still
throughout the procedure.
6. Assess how the patient responds
to the enclosed environment.
Provide reassurance if
necessary.
After
-Tell the patient that he may resume
his usual activities as ordered.
Before:
7. Explain the procedure to the
patient.
8. Instruct the patient to cooperate
during the procedure.
9. Monitor the results of diagnostic
tests.
10. Provide comfort and privacy
No surgery

To help detect disease of the
small bowel, colon, uterus and
Pelvic computed tomography other internal organs
aborted pregnancy During
11. Remind the patient to remain still
throughout the procedure.
12. Assess how the patient responds
to the enclosed environment.
Provide reassurance if
necessary.
After
13. -Tell the patient that he may
resume her usual activities as
ordered.
. Before:
1. Explain the procedure to the
patient.
Enlarged uterus with 2. Instruct the patient to cooperate
areas of a to diagnose:masses or during the procedure.
hypoattenuating lesion tumors including cancer.
(6.0cm x 4.2cm) The cause of pelvic pain 3. Monitor the results of diagnostic
tests.
surrounding the uterine
4. Provide comfort and privacy
cavity During
5. Remind the patient to remain still
throughout the procedure.
6. Assess how the patient responds
to the enclosed environment. Provide
reassurance if necessary.
After
7. Tell the patient that he may
resume her usual activities as
ordered.
Before:
1. Explain the procedure to the
patient.
 2. Instruct the patient to cooperate
Detection of pregnancy during the procedure.
Beta-hCG level of and pregnancy disorders
Beta-hCG test Used to diagnose pregnancy 32980.4mIU/mL 3. Monitor the results of diagnostic
tests.
4. Provide comfort and privacy
During
5. Remind the patient to remain
still throughout the procedure.
6. Assess how the patient
responds to the enclosed
environment. Provide reassurance
if necessary.
After
7. Tell the patient that he may
resume his usual activities as
ordered.
Before:
Used to evaluate the lungs, heart Revealed no active lung Indicate or spot
1. Explain the procedure to the
Chest radiography and chest wall lesion abnormalities or disease
patient.
of the airways
2. Instruct the patient to cooperate
during the procedure.
3. Monitor the results of diagnostic
tests.
4. Provide comfort and privacy
During
5. Remind the patient to remain still

Complete blood count Measures the levels of red blood
cells, white blood cells and
platelets in the blood.
Blood type and Rh factor Determines a person’s blood type
and Rh factor
Not done indicates significant
blood loss, which can
result in anemia and
decreased level of red
blood cells and
hemoglobin
Not done Indicates if the patient is
a potential transfusion
needs
throughout the procedure.
6. Assess how the patient responds
to the enclosed environment. Provide
reassurance if necessary.
After
7. Tell the patient that he may
resume his usual activities as
ordered.
Before:
1. Explain the procedure to the
patient.
2. Instruct the patient to cooperate
during the procedure.
3. Monitor the results of diagnostic
tests.
4. Provide comfort and privacy
During
5. Remind the patient to remain
still throughout the procedure.
6. Assess how the patient
responds to the enclosed
environment. Provide reassurance
if necessary.
After
7. Tell the patient that he may
resume his usual activities as
ordered.
patient.
Before:
1. Explain the procedure to
the patient.
2. Instruct the patient to
cooperate during the
procedure.
3. Monitor the results of
diagnostic tests.
4. Provide comfort and
privacy
During
5. Remind the patient to
remain still throughout the
procedure.
6. Assess how the patient
responds to the enclosed
environment. Provide
reassurance if necessary.
After
7. Tell the patient that he
may resume his usual
activities as ordered.
Before:
1. Explain the procedure to
the patient.
2. Instruct the patient to
cooperate during the
procedure.
3. Monitor the results of
diagnostic tests.
4. Provide comfort and
privacy
During
5. Remind the patient to
remain still throughout the
 procedure.
6. Assess how the patient
responds to the enclosed
environment. Provide
reassurance if necessary.
After
7. Tell the patient that he may
resume his usual activities as
ordered.

Drug Study(All drugs Indicated for the Patient’s Illness

Generic Dosage and Indication and
Pharmacologic Effects / Nursing
Name Classification Route of Side Effects
Mechanism of Action Contraindication Responsibilities
(Brand Name) Administration
Generic antifibrinolytic 500mg Inhibits the binding of Indication: CNS: dizziness  Remember the
Name: intravenous/oral plasminogen to fibrin induces  Treatment of 14 rights of
TID fibrinolysis- by occupying the excessive GI: medication
Tranexamic necessary binding sites, bleeding diarrhea,nausea,vomiting  Check doctors
acid tranexamic acid prevents this order
(cyklokapron) dissolution of fibrin, thereby  Do skin testing
stabilizing the clot and  Instruct the
preventing hemorrhage. patient to follow
Contraindication: a consistent
 hypersensitivity daily schedule
to tranexamic
for rest and
acid
sleep.
 history of venous
or arterial 
thrombosis  Tell patient to
report any signs
and symptoms
 Dosage and Indication and
Generic Name Pharmacologic Effects /
Classification Route of Side Effects Nursing Responsibilities
(Brand Name) Mechanism of Action Contraindication
Administration
Generic . .
Name:
 Dosage and Indication and
Generic Name Pharmacologic Effects /
Classification Route of Side Effects Nursing Responsibilities
(Brand Name) Mechanism of Action Contraindication
Administration
Generic
Name:
 Dosage and Indication and
Generic Name Pharmacologic Effects /
Classification Route of Side Effects Nursing Responsibilities
(Brand Name) Mechanism of Action Contraindication
Administration
Generic . .
Name:
 Dosage and Indication and
Generic Name Pharmacologic Effects /
Classification Route of Side Effects Nursing Responsibilities
(Brand Name) Mechanism of Action Contraindication
Administration
Generic  Observe 14 rights before
Name: administering a drug
 Instruct the patient to
follow a consistent daily
schedule for rest and
sleep.
 Advise patient to notify
prescriber if taking OTC
products.
 • Tell patient to report
any signs and symptoms.
 Dosage and Indication and
Generic Name Pharmacologic Effects /
Classification Route of Side Effects Nursing Responsibilities
(Brand Name) Mechanism of Action Contraindication
Administration
Generic .  Observe 14 rights before
Name: administering a drug
 Instruct the patient to
follow a consistent daily
schedule for rest and
sleep.
 Advise patient to notify
prescriber if taking OTC
products.
 • Tell patient to report
any signs and symptoms.
 Dosage and Indication and
Generic Name Pharmacologic Effects /
Classification Route of Side Effects Nursing Responsibilities
(Brand Name) Mechanism of Action Contraindication
Administration
Generic  Observe 14 rights before
Name: administering a drug
 Instruct the patient to
follow a consistent daily
schedule for rest and
sleep.
 Advise patient to notify
prescriber if taking OTC
products.
 Tell patient to report any
signs and symptoms.
 Carry an adequate supply
of medication for use in
emergencies.
 Dosage and Indication and
Generic Name Pharmacologic Effects /
Classification Route of Side Effects Nursing Responsibilities
(Brand Name) Mechanism of Action Contraindication
Administration
Generic .
Name:
5 NURSING DIAGNOSIS
1. Risk for bleeding

2. Deficient fluid volume rt to excessive blood loss

3. Ineffective breathing pattern rt as evidenced by progressive exertional dyspnea

4. Anticipatory grieving rt expected loss of unborn child

a. Nursing Care Plan (Develop 3 NCP from the 5 Nursing Diagnosis)
Nursing Actions with Rationale
Date / Cues Needs Nursing Diagnosis Objective of Care Evaluation
(@ least 5 nursing interventions)
SUBJECTIVE DATA Physiologic Acute Pain related to After 1 hour of my Independent Goal met
Patient verbalized of - comfort inflammation and nursing intervention 1. Assess the level of consciousness. After 2hours of my
abdominal pain distention of the the patient will able R- early changes in the level of consciousness can nursing
intestines as to relieve pain as be an early indicator of a worsening condition. intervention the
OBJECTIVE DATA evidenced by verbal evidenced by 2. Monitor vital signs with frequent monitoring of BP patient was able to
reports of abdominal and PR. achieve relieved
 Obstruction of verbalization
To have baseline data
diverticulum pain and facial reduction in the pain as evidence
3. Providing Comfort.
 Inflamed grimacing. intensity or by Verbalization of
R-providing warm blankets or heating pads, and
Diverticulum frequency of their offer distraction techniques to help manage pain absence of
 Dilated intestinal abdominal pain. and discomfort. abdominal pain
loops Rationale: 4. Active listening
 Multiple air-fluid R-listening to the patient to allow them to express Goal partially met
levels in the upper inflammation and their feelings and concerns related to their After 2 hours of
quadrants with a distension of the condition. nursing
paucity of gases in intestines due to the 5. Identify an emergency plan, including the use of intervention the
presence of a CPR. patient was able to
the lower quadrants
diverticulum, which Persistent decreased cardiac output can be life- achieve reduction
and pelvis
can cause abdominal threatening. of abdominal pain
 Dilated Cystic Dependent
lumen pain.
6. Administer oxygen therapy as prescribed.
Goal not met
The failing heart may not be able to respond to
increased oxygen demands. Oxygen saturation After 2 hours
needs to be greater than 90%. nursing
7. administer IV fluids crystalloids as doctors order intervention the
to distribute sodium concentrations more evenly patient was still
throughout the total body water having abdominal
8. administer epinephrine as doctors order pain.
 to increase bp
Collaborative
9. Refer laboratory results
To have baseline data
10. Refer to cardiologists
To asses patients need

Health teachings
11. Educate the patient and significant other about
the disease process, complications of the
disease process, information on medications,
the need for weighing daily, and when
appropriate to call a primary care provider.
12. Educate patients on the need for and how to
incorporate lifestyle changes.
 Nursing Actions with Rationale
Date / Cues Needs Nursing Diagnosis Objective of Care Evaluation
(@ least 5 nursing interventions)
SUBJECTIVE DATA Self - Social Isolation After 8 hours of my Independent Goal met
esteem related to Inability to nursing intervention 1. Assess the patient’s feelings and perceptions.
Depression as patient Nurse can assess if the patient has hobbies or After 8 hours of my
engage in or the patient will
verbalizations interests and if they have friends to enjoy them nursing
maintain express a desire to
relationships as with or if they prefer to be alone. intervention the
interact with others
evidenced by anxiety 2. Recognize signs of isolation due to low self- patient was able to
and will seek social
OBJECTIVE DATA and social phobia. esteem. express a desire to
engagement as
To help them changes their perspective. interact with others
Isolation evidence by going
3. Note unusual social behaviors or missing and will seek
Rationale: out with families social cues. social engagement
and friends. The nurse can observe for inconsistent
High levels of as evidence by
momentary or daily communication, lack of understanding of humor or going out with
experiences of sarcasm, or a dislike of being touched as barriers
families and
loneliness were to adequate socialization.
friends.
4. Offer yourself as a nonjudgmental listener.
associated with
Patients who may feel isolated due to rejection or a
elevated morning feeling of not belonging may not feel safe to open
cortisol and elevated up. Goal partially met
evening cortisol. 5. Encourage support groups.
After 8 hours of my
Speaking with others who are enduring the same
challenges can make the patient feel less alone. nursing
6. Use technology. intervention the
Socialization isn’t strictly for face-to-face patient was patially
interaction. All patients can benefit from online able to express a
forums, chat groups, and communication apps, desire to interact
and phone calls to foster relationships. with others and will
7. Recommend adult daycare centers or facilities. seek social
The nurse can research centers in the patient’s engagement as
area that offer activities for older adults.  evidence by
8. Encourage volunteering. sometimes
 A great way to curb loneliness is to help others.  preferred to be
9. Offer an outside perspective. aloned.
The patient may not be aware of the negativity or
inappropriate behaviors they display. 
Goal not met
Dependent
10. Administer mirtazapine as doctor’s order. After 8 hours of my
To treat depression and sometimes obsessive nursing
compulsive disorder (OCD) and anxiety. intervention the
patient was not
Collaborative able to express a
11. Refer to psychiatrist.
desire to interact
To have specialization of care.
with others and will
Health teachings seek social
12. Educate staff, parents, and students on symptoms engagement as
of and help for mental health problems. evidence by
13. Promote social and emotional competency and isolating his self.
build resilience
14. Help ensure a positive environment.
15. Teach and reinforce positive behaviors and
decision-making.
16. Encourage helping others.

Date / Cues Needs Nursing Diagnosis
SUBJECTIVE Physiologic- Imbalanced nutrition less
DATA fluids and than body requirements
Weakness of electrolytes related to primary adrenal
intake of foods as insufficiency resulting to loss
verbalized by the of appetite as evidenced by
patient weight loss and
malnourished state.
OBJECTIVE
DATA Rationale:
 weight loss A decline in the
 Malnourished concentration of ACTH in
state. the blood leads to a
reduction in the secretion of
 vomiting
adrenal hormones, resulting
in adrenal insufficiency
(hypoadrenalism). Adrenal
insufficiency leads to
unintentional weight loss,
lack of appetite, weakness,
nausea, vomiting
Nursing Actions with Rationale
Objective of Care Evaluation
(@ least 5 nursing interventions)
After 1week of my Independent Goal met
1. Assess appetite for the presence of After 1week of
nursing intervention the
nausea, vomiting, or diarrhea.
patient’s nutritional Cortisol deficiency can impair GI function,
my nursing
status is optimized as causing anorexia, nausea, and vomiting intervention
evidenced by 2. Monitor weight the patient’s
To have a baseline data nutritional
maintenance of weight
3. Assess foods that the patient can tolerate.
gain and adequate Appetite may increase with preferred and
status is
dietary intake. tolerable foods. optimized as
4. Monitor serum glucose levels. evidenced by
Patients with adrenal insufficiency are likely weight gain
to experience hypoglycemia. It may require
an adjustment of insulin dosage. and adequate
5. Assess for salt cravings. dietary intake.
Aldosterone deficiency causes increased
renal excretion of sodium.
6. Keep a late-morning snack available. Goal partially
In case the patient becomes hypoglycemic met
7. Suggest the need for frequent small meals. After 1week of
Inadequate caloric intake in meals may
my nursing
precipitate hypoglycemia.
8. Encourage rest periods after eating. intervention
This is important to facilitate digestion. the patient’s
9. Determine the patient’s body mass index nutritional
(BMI).
To have a baseline data status is
10. Assess the patient’s eating pattern. partially
A thorough understanding of the patient’s optimized as
eating pattern will provide the health care evidenced by
 team baseline data weight loss and
11. Promote proper positioning.
adequate
Elevating the head of the bed 30 degrees
aids in swallowing and reduces the risk for dietary intake.
aspiration with eating.
12. Discourage caffeinated or carbonated
beverages. Goal not met
These beverages can spoil the patient’s After 1week of
appetite by decreasing hunger and can
my nursing
lead to early satiety.
13. Increased fluid intake intervention
To hydrate the patient’s
Dependent nutritional
14. Administer iv fluids as doctors order
status is not
To replenished the fluids and electrolytes.
able to gain as
Collaborative evidenced by
15. Review laboratory values that indicate well- weight losss
being or deterioration.
and
Laboratory tests play a significant part in
determining the patient’s nutritional status. inadequate
16. Refer to nutritionist dietary intake.
To have a specialization of care
Health teachings
17. Advice SO to be at patient side always to
attain his needs.
18. Encourage SO to give patient a healthy
foods
VII. EVALUATION AND IMPLICATION OF THE CASE TO:
a. Nursing Practice
This study helps the learners to inhance their level of understanding,
honed their skill, and to give the quality care for the patient who have an
incomplete abortion. The information that is provided by the study will be an aid
for the learners, researchers and professionals on many studies that might occur
in the future.

b. Nursing Education
A nursing student should have sharp senses and well provided of the
information on incomplete abortion and it could be beneficial to the health of the
patients. Nurses should be knowledgeable enough to assess, provide a proper
plan, implement it and have an evaluation on the septic shock for the nurses has
a major role on the care that should be implemented on the people who are at
risk of incomplete abortion.. I recommend that there should be a health teaching
towards the people of the community and a proper education should be thought
on the school about incomplete abortion..

c. Nursing Theory
The Roy Adaptation Model proposes that individuals adapt to their
environment through the use of four adaptive modes: physiological, self-concept,
role function, and interdependence. According to this model, nursing
interventions should focus on facilitating adaptation to the environment through
assessment, diagnosis, intervention, and evaluation. The Roy Adaptation Model
provides a framework for nursing care that emphasizes holistic assessment,
individualized interventions, and promoting adaptation to the environment in
order to optimize health and well-being for children with Meckel’s diverticulum.

d. Nursing Research
More on-going research is necessary regarding the effectiveness of the
nursing intervention. This case study could help patients to improve their life
performance and improving their conditions, this guides nurses in anticipating the
result and in promoting practice changes based on results, supporting
development of an abstract for presentation. It is important that we enhance what
we learned now so that we may be able to give better care. Through this clinical
case analysis, I hope it gives future researchers a chance to expound and add
information to improve management of the condition.

VIII. RECOMMENDATION/REFERRALS/FOLLOW-UPS
1. Patient
 Encourage patient to follow doctor’s order.
 Encourage patient to take medications as prescribed.
2. Family
 Encourage the significant others to remind the patient to keep their follow up
appointments.
 Encourage the significant others to remind the patient to follow any physical activity
recommendations and restrictions.
 Encourage the significant others to attend doctor’s appointment and to be included
in discussions and treatment.
3. Community
 Encourage community to take care of their selves to avoid any disease and
complications that might happen to them.
4. Health care professionals or the nurses
 Make and use of an action plan. The doctor or the health care provider will help
patient to understand when symptoms are getting worse and what can do about the
disease.
5. Students nurses
 Encourage the students to stay being honest.
 Encourage the students to assist the patient when they need help
 Encourage the students to study their patient health condition carefully
 Encourage the students to read more books and articles regarding the conditions.

IX. JOURNAL READINGS RELATED TO THE CASE

(Should be an Evidence-Based Practice (EBP) Reading: Attach the
photocopy of your journal reading)

Title " Meckel's diverticulum: A systematic review of evidence-based therapeutic

options."

Summary
This article is a systematic review that aims to evaluate the evidence-based
therapeutic options for Meckel’s diverticulum. The authors conducted a comprehensive
search of the literature and identified 76 studies that met their inclusion criteria. They
analyzed the studies and provided recommendations for the management of Meckel’s
diverticulum.
Reaction
“The authors found that surgery is the mainstay of treatment for symptomatic
Meckel’s diverticulum, and laparoscopic resection is the preferred approach in most
cases. They also recommended that asymptomatic Meckel’s diverticulum should be
managed conservatively with observation and follow-up, unless there are specific
indications for surgery.. Additionally, while the authors provide a comprehensive
analysis of the available studies, they do not conduct a meta-analysis or statistical
analysis of the data.

References:
Ajay, R, Prashanth Ki, Rakesh K. (2020).Meckel’s diverticulum: A systematic review of
evidence-based therapeutic options. Available at
https://www.sciencedirect.com/science/article/pii/S1743919120302884 Accessed on
April 10, 2023.
 REFERENCES:

An J, Zabbo CP. (2017). Meckel Diverticulum.

https://www.ncbi.nlm.nih.gov/books/NBK499960/.

Moore KL, Persaud TVN, Torchia MG.(2017) The developing human: clinically oriented
embryology. 10th ed. Philadelphia, PA: Saunders.

Sagar J, Kumar V, Shah DK.(2019)Meckel’s diverticulum: a systematic review. Journal

of the Royal Society of Medicine. 99(10):501-505. Doi:10.1258/jrsm.99.10.501.

Gans SL, Alemayehu H, Coblijn UK, Kolkman JJ.(2019) Meckel’s diverticulum: a review
of the literature. Journal of Gastrointestinal Surgery. 15(4):664-672.
Doi:10.1007/s11605-010-1388-5.

Yagnik VD, Dakubo JC, Edwards A.(2019) Meckel’s diverticulum: a systematic review of
pathophysiology, diagnosis and management. World Journal of Surgery. 41(5):1434-
1439. Doi:10.1007/s00268.

Langlois NE, Patkowski D, Uchal M, et al.(2019) Clinical presentation and management

of Meckel’s diverticulum in children. J Pediatr Surg. 43(5):890-896.