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
Fever / chills are signs of infection and possibly early peritonitis
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.
Detailed abdominal assessments will indicate if inflammation or infection may be developing. For example, a rigid abdomen may indicate peritonitis.
Maintain optimal hydration for improved intestinal motility to prevent constipation
- 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
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nursing.com/cornell
