Diverticula are outpouchings of the intestinal wall lining. When these pouches become inflamed or infected, they can lead to diverticulosis (inflammation) or diverticular disease (infection). These conditions can cause significant pain in your abdomen and other signs and symptoms like fever or nausea. Diverticular disease occurs when fecal matter leaks through weakened areas of your intestine, which causes inflammation.
The goal of this blog post is to provide nursing students with information on nursing diagnosis, the care plans, and interventions for diverticulitis which may help them better understand it and learn how they can best assist their patients in its management.
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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
Diverticulitis is an inflammation of the intestine that most often occurs in the colon. The inflammation is caused by a bacterial infection of any one or more of the pouches created as part of diverticulosis. The inflammation can come on suddenly, or you may have a history of gradual onset over 24 to 48 hours. This condition can affect any part of your colon, but it is most common in the sigmoid colon (the last 5 feet).
- Diverticulitis may be caused by poor diet intake (such as low dietary fiber or too much fat), obesity, and age. The weakening of the walls can be attributed to long bouts of constipation.
To help prevent diverticulitis from becoming a serious condition, you should increase your intake of foods rich in fiber and maintain an active lifestyle.
- Diverticular disease occurs when fecal matter leaks through weakened areas in the intestinal tract wall, and infection follows (strands in the diverticular disease called “diverticular abscesses”). This leakage of fecal material often occurs because the muscular layer around the intestinal wall is too weak to contain the strong contractions that push food, liquids, and wastes through the intestines (leaky gut syndrome).
- The passage of fecal matter causes inflammation, which occurs in one or more of the pouches created as part of diverticulosis. The most common pain sites are along your left side (left-sided diverticulitis).
Risk factors associated with diverticulitis include;
- Deficiency in dietary fiber (low fiber or lack of roughage in the diet)
- Eating a high-fat diet/refined sugars
- Consuming caffeinated beverages;
- Lack of movement (sedentary lifestyle)
- Lack of roughage can lead to constipation. As the stool is hard, it may impact the colon wall causing diverticulosis.
Signs and symptoms of diverticulitis include:
- Pain in your upper abdomen and left side that can radiate to your low back or pelvic area
- Fever of 100.4 Â°F (38 Â°C) or higher
- Nausea and vomiting with or without blood
- More than three bowel movements a day, especially when associated with nausea and/or vomiting
- Blood in your stools
- Recurring left lower quadrant abdominal pain that doesn’t respond to non-steroidal anti-inflammatory drugs (NSAIDs) or other standard treatments for intestinal inflammation, such as antibiotics.
The most important thing to do if you think you are having symptoms of diverticulitis is to see your doctor as soon as possible so they can begin treatment.
Your doctor will feel for tenderness, swelling, and possibly a mass or lump in your colon. The presence of either means that diverticulitis has developed.
Your doctor may also ask you about the pain you have experienced and whether it radiates from the lower left to the right side through the lower abdomen. This description suggests that gas has become trapped on the left side of your abdomen, and it is moving across the abdominal wall to the right side, where you experience pain from the pressure of this gas against your diaphragm.
Your doctor may order blood tests and a fecal occult blood test (gastrointestinal bleeding) as well as a CT scan to help identify diverticula and diverticular complications that might be present.
An abdominal CT scan uses a combination of X-rays and computer technology to make detailed images of the abdomen. An abdominal CT scan can detect fluid in the abdomen or signs of inflammation or infection.
Colonoscopy is a visual examination of the colon using a long flexible tube with a tiny camera on its tip, which allows the doctor to see the inside of the colon in detail. An anaesthetic is used to numb the patient’s bowel, and a local or general anaesthetic may keep them still during the procedure. Colonoscopy can detect colorectal polyps, inflammation of the colon’s inner lining (diverticulitis), tumors, and other problems that affect the colon.
Risk Factors for Diverticulitis
1) Diverticular Abscess (acute): Risk for impaired gas exchange secondary to respiratory infection or pulmonary edema.
2) Diverticular Abscess (acute): Risk for injury secondary to ileus and constipation.
3) Impaired Gas Exchange: Risk for Infection secondary to decreased respiratory function secondary to the presence of an abscess in the lungs with or without peritonitis.
4) Impaired Gas Exchange: Risk for Sepsis secondary to possible peritonitis secondary to abscess formation.
5) Impaired Gastric Mucous Membrane Barrier Integrity: Risk for Decreased Metabolic Transformation of Medications or Toxins: Antibiotics, anti-inflammatories; risk for complications secondary to antibiotic therapy caused by bowel perforation and sepsis.
6) Constipation: Risk for Constipation secondary to decreased mobility or inability to access food/fluids due to pain, NPO status.
7) Decreased Cardiac Output: Risk for Decreased Cardiac Output secondary to infection in the lungs, peritonitis, abscess formation.
8) Impaired Skin Integrity: Risk for Impaired Skin Integrity secondary to pain with movement or manipulation of the skin secondary to inflammation/infection.
The patient should have a high fiber diet to help prevent constipation. Give clear fluids only if tolerated.
Fluid restriction to <1500mL/day until LLQ pain resolves; no caffeine.
Teach the patient how to sit on a commode to avoid straining (renal damage).
Patient instructed in colostomy care if required. Patient to be isolated per the protocol and taught how to care for a stoma (renal damage).
Patients should be informed of the rationale for antibiotics, analgesics and colostomy & instructed in use. If a patient refuses medications, plan ways to make the patient comply with orders to prevent renal damage.
Monitor temperature and pulse, watch for respiratory status changes. Ask the patient about symptoms of pain, nausea, vomiting to determine the level of distress. Offer sips of water every 1-2 hours to prevent dehydration. Assess the amount, color and character (thick or thin), urine output. Assess output with drain, fecal matter to determine infection.
Assess abdominal distention every 2-4 hours if placed on NPO status; monitor bowel sounds and output to determine constipation. Administer laxatives as ordered if no bowel sounds/output; check NG tube placement to ensure it is not impacted (tubing will be clear).
Assess vital signs every 2 hours; monitor fluid intake and output by drain/NG tubes, amount bowel sounds; watch for fever, dyspnea if on a ventilator or intubated. Monitor NG tube to ensure patency.
Check bowel sounds and NG tube output every 2 hours; administer laxative as ordered if unable to have a BM by the end of the shift or Q6 hours.
Record BP every hour. Assess patient for fever, dyspnea, pulmonary edema and decreased output from drain/tube.
Assess pain every 2-4 hours with movement, assess for signs of infection. Reassess the wound site daily; if there is increasing pain, erythema or drainage from the opening in the abdomen, then change the dressing and/or wound care to prevent infection.
Intestinal obstruction, perforation and fecal impaction; Immobility is a risk factor for these issues.
- Drains be placed to assess for fluid collection and allow drainage of edema. Recommendations are given to prevent increased pain/inflammation in the abdominal area, “deep breathing may help decrease pain”.
- Recommend patient use abdominal binders at all times when in bed to prevent edema and abdominal distention.
- Patients should ambulate every 2-4 hours to decrease the risk of swelling, ulcerations or hernias.
- Recommend wound care to prevent the formation of another abscess.
Treatment of Diverticulosis
Treatment may include IV fluids, antibiotics, analgesics, change in diet and possibly surgery. Steroids may be used to decrease swelling of the colon if so prescribed by a physician(s). Patients will receive IV fluids and antibiotics as prescribed. The physician may order x-rays if an infection is present. Providing extra fluids, ice chips, and pain medication as needed helps to decrease the risk of constipation.
Patients should receive fluid restrictions as ordered by the physician; if unable to have a bowel movement for 2 days, then speak with the physician regarding laxative use or enemas/suppositories, or use suppositories if the patient has a history of rectal bleeding.