Diverticulitis – Pathophysiology, Podcast, and Nursing care plan

Diverticulitis

Diverticulitis

In order to understand diverticulitis, we need to know what diverticulum are. Diverticulum (more than one is called diverticula), is the development in some patients as a protrusion or out-pouching of the inner lining of the intestine. They are usually characterized by a small pouch with a thin neck.  When diverticula are present, the patient is said to have developed diverticulosis.

 

DiverticulaSome patients may be born with diverticulum. However, the majority of diverticula will develop or appear at at older age. They will usually appear in the large intestine. Diverticula develop in areas of the colon that are weakened from pressure (hard stools etc). The out-pouching protrude through the large intestinal wall.

Diverticula can be common in older patients and usually do not cause any issues.

When we see inflammation of the diverticula or that the diverticula become infected usually from the diverticula tearing, the diagnosis of diverticulitis can be made.

The patients that are at the highest risk for developing diverticulitis are:

  • Older patients
  • Smoking
  • Sedentary lifestyle (lack of exercise).
  • Obesity
  • Diet that is low in fiber and high in animal fat
  • Some medications (steroids, opiates, and non-steroidal anti-inflammatory drugs).

Diverticulitis

Signs and Symptoms

Patients with a history of diverticulosis usually have no signs or symptoms of illness. It is not uncommon for these patients to have bloating or cramping to the lower abdomen. When symptoms do appear, they are severe and have a fairly sudden onset.

  • Abdominal tenderness
  • Gas
  • Bloating
  • Fever
  • Nausea and or vomiting
  • Decreased appetite

Diagnosis

The presence of abdominal pain can be caused by several different types of diseases or infections that healthcare professional will need to do rule out other possibilities.

  • Blood tests
  • Pregnancy test
  • Liver function test
  • Stool cultures
  • CT scan
  • Abdominal ultrasound

Treatment

Treatment of diverticulitis is dependent upon the severity of symptoms

  • Antibiotics
  • Pain medications
  • Bed rest
  • Bowel rest ( liquid diet for 1-2 days)
  • Increase more fiber to diet

Complications

  • Fistula formation – this is a an abnormal connection between another part of the body and the colon.
  • Perforation – this is a tear in the colon
  • Stricture formation – this is a narrowed area in the colon
  • Abscess formation – Area that is filled with  pus or infection

Our Podcast for Diverticulitis:

 

 Nursing Care Plan

Nursing Diagnosis

1. Acute Pain related to inflamed bowel as evidenced by patient rates pain at 8/10 on pain scale and states abdominal cramping and tenderness in abdomen.

Desired outcomes:

Patient will report a decrease in pain from 8 to 0 on the pain scale by discharge.

InterventionsRationals
InterventionsRationals
Assess level of pain using appropriate pain scale. Assess pain 30 minutes before and after pain medication is given.Using an appropriate age pain rating scale will help the healthcare providers monitor the level of pain and adjust pain medications as needed.
Administer pain medications as prescribed and indicated.Analgesics are helpful in relieving pain and helping in the recovery process.
Check for number of bowel movements at least once per shift.Immobility caused by pain may decrease the parasympathetic stimulation to the bowel.
Incorporate nonpharmacologic measures to assist with control of pain.Ideally, the use of comfort measures will distract the patient from pain and may increase the effectiveness of pharmacological measures.

2. Risk for infection 

Desired outcomes:

By discharge, the patient will remain free signs and symptoms of infection.

InterventionsRationals
InterventionsRationals
Assess vital signs including temperature every 4 hours and as needed. Report any abnormal findings to the healthcare provider.Fever is often one of the first signs of infection.
Assess mental status and level of consciousnesses every 4-6 hours.Mental status changes, confusion, or any deterioration from baseline can signify infection.
Report and note any abnormal laboratory values (i.e. elevated WBC count) to the healthcare provider.Certain abnormal laboratory results could be an indicator of infection.

Disclaimer:

Please follow your facilities guidelines and policies and procedures. The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

 

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Anna C. RN-BC, BSN, PHN, CMSRN Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process. She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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