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Outline
Pathophysiology
Diverticulosis: A benign condition where pouches form along the intestine wall. These pouches may form anywhere along the intestine, but are most commonly found at the end of the descending and sigmoid colons on the left side of the abdomen. They are also commonly found in the first section of the small intestine, but diverticula in this area rarely cause problems.
Diverticulitis: involves small abscesses or infection in one or more of the diverticula, or perforation of the bowel.
Etiology
Diverticulosis– The thickening of the outer wall of the intestine causes narrowing of the inner space. This narrowing causes stool to move more slowly. Hard stools, produced from a low fiber diet, and slower transit time through the intestine create pressure on the intestinal wall, thus forming pockets called diverticula. These pockets are most often asymptomatic.
Diverticulitis- Stool passing slowly through the intestine deposits fecal material in the diverticula. Over time, bacterial overgrowth causes an inflammatory response and may form an abscess or infection in the diverticula. Advanced diverticular disease can result in perforations of the intestine and peritonitis if infection is leaked through the perforations into the abdominal cavity.
Desired Outcome
Patient will be free from pain and infection and will be compliant with appropriate diet and medication regimen.
Diverticulosis / Diverticulitis Nursing Care Plan
Subjective Data:
- Severe abdominal pain / cramping in LLQ
- Abdominal bloating
- Nausea / vomiting
- Constipation
- Abdominal tenderness
Objective Data:
- Fever / chills
- Vomiting
- Leukocytosis
- Guarding of abdomen
- Evidence of diverticula on colonoscopy
- Possible bloody stools
Nursing Interventions and Rationales
- Monitor vital signs
Fever / chills are signs of infection and possibly early peritonitis
- Provide Bowel Rest
Maintain NPO status during initial phase of antibiotic treatment to kill infection and help bowel rest
As symptoms decrease, advance diet to clear liquids and then increase fiber slowly.
- Assess abdominal pain
Detailed abdominal assessments will indicate if inflammation or infection may be developing. For example, a rigid abdomen may indicate peritonitis.
- Monitor hydration status
Maintain optimal hydration for improved intestinal motility to prevent constipation
- Administer medications
- Antibiotics – for infection
- Analgesics – for pain
- IV Fluids – for hydration and bowel motility
- Psyllium – (bulk-forming laxative) absorbs water from the intestine and makes stool easier to pass
- Provide nutrition education
- Hydrate (2-3 L fluids daily, unless contraindicated for renal or cardiac disease) to avoid constipation
- Probiotics – to help regulate the intestinal bacteria
- Avoid foods that trigger flare up (low-fiber foods)
References
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