Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis

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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)

Writing a Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis

A Nursing Care Plan (NCP) for Diverticulosis / Diverticulitis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Hey guys, In this care plan, we will explore diverticulosis and diverticulitis. In this care plan on diverticulosis and diverticulitis, we will cover the desired outcome, the subjective and objective data along with the nursing interventions and rationales for each. 

 

So, our medical diagnosis is diverticulosis and diverticulitis. So diverticulosis, is a benign condition where pouches will form along the intestinal wall kind of like this. So, diverticulitis involves small abscesses or infections in one or more of the didactic diverticula or even a perforation in the bowels. So, diverticulosis is the thickening of the outer wall of the intestine that causes narrowing, making it really hard for stool to move through, which will end up creating those pockets called diverticula. So, diverticulitis occurs when those stools pass slowly through the intestine and deposit fecal matter into those pockets and over time, this causes bacterial growth and inflammation. The desired outcome is that the patient will be free from pain and infection and will be compliant with the appropriate diet and medication regimen. 

 

Okay, so let’s take a look at the care plan. A patient that has diverticulosis without the diverticulitis may not experience any pain at all. In fact, they may not even realize they have the disease. At first, the patient that starts to get that diverticulitis, where those diverticula, the intestines become inflamed and irritated and infected. They are going to probably have some severe abdominal pain and cramping in the left, lower quadrant, along with some abdominal tenderness. Now remember, when the walls of the intestines become inflamed and irritated and thicken, it’s harder for the stool to move through. This is going to cause some constipation, which is going to cause nausea and abdominal bloating in your patient. 

 

Now, let’s look at our objective data. Your patient might be experiencing fever and chills if they have an infection, or even leukocytosis, so if the patient is severely constipated, they might experience some vomiting. You might notice that your patient’s guarding their abdomen just because of that pain from the constipation and inflammation, and possibly infection. So, the diverticulum might bleed, showing up in the stool as like a bright red color or even maroon color.  You might even notice evidence of the diverticula in a colonoscopy. 

 

Let’s look at our nursing interventions along with the rationales for each. So, we’re going to monitor the vital signs and the pain levels in our patient. We want to look out for fevers as fevers and chills are both signs of infection and your patient may experience a rigid abdomen, which could indicate peritonitis, which is pretty serious. You want to try to provide bowel rest in your patient, keep them NPO to rest those bowels and then, just advance as tolerated and ordered by the doctor. 

 

Our next nursing intervention is to monitor the hydration status of our patient because hydration is needed to help improve the intestinal motility and keep things moving and healthy. You will administer medications per doctor orders. Antibiotics might be provided for infections. Analgesics may be ordered for pain. IV fluids to help keep that patient hydrated and bulk-forming laxatives to help form those stools and keep it as regular as we can. 

 

The last nursing intervention is to provide nutrition education to your patient. Let them know they should try to hydrate with at least two to three liters of fluid a day, preferably water to avoid constipation. Probiotics are really nice to help keep regulation of the intestinal bacteria. Tell them to avoid foods that trigger any flare ups and try to eat a low fiber food diet. This might be kind of a trial and error kind of thing, where they have to test things out. 

 

We love you guys. Now go out and be your best self today and as always, happy nursing!

 

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