Diverticulitis NCLEX Review Care Plans
Nursing Study Guide on Diverticulitis
Diverticulitis is the inflammation or infection of the diverticula found in the intestines.
The diverticula are little, bulging pouches in the walls of the digestive tract, often seen in the colon or the lower part of the intestine.
The condition becomes more common with age, but it usually seen in men above the age of 40.
The majority of the people diagnosed with this condition do not have any symptoms, while some people experience abdominal pain, bloating, or a significant change in bowel habits.
Mild cases are treated with medication and diet modification, while surgery may be required for severe cases.
Signs and Symptoms of Diverticulitis
Although most of the cases are painless, the following signs and symptoms of diverticulitis may develop, these include:
- Abdominal pain. It is usually localized in the left lower quadrant of the abdomen, while those of Asian descent experience pain on the right side. Pain is described as steady and may last for several days. It may also worsen with straining, lifting or coughing
- Nausea and vomiting
- Abdominal distention and tenderness
- Abdominal cramps
- Elevated temperature
- Palpable, tender rectal mass may be present
In severe cases of diverticulitis, the following symptoms may occur:
- Blood in stool (Hematochezia)
- Bowel obstruction
- Bowel perforation
Causes and Risk Factors of Diverticulitis
Diverticula develop when the weak areas of the intestinal wall begin to bulge.
This will cause the protrusion of small marble sized pouches through the intestinal wall.
It can form in any areas of the intestine but it commonly affects the colon.
Diverticulosis may cause fecal obstruction in the opening of the diverticula and diverticular tear, resulting in inflammation and infection known as diverticulitis.
There are several risk factors that contribute in the development of diverticulitis:
- Age. The risk for developing diverticulitis increase with age, with higher incidence noted among older people.
- Gender. It is commonly seen in males under the age of 50.
- Genetics. There are disorders like Marfan syndrome, Ehlers-Danlos syndrome and Williams-Beuren syndrome that can trigger the formation of diverticula.
- Obesity. Excessive weight gain increases visceral fat which is related in the occurrence of diverticulitis.
- Smoking. Nicotine can decrease muscle tone and activity of the sigmoid colon.
- Sedentary lifestyle. Lack of exercise and physical activity decreases intestinal motility which increases the risk for acquiring the disease
- Diet. The consumption of high fat, low fiber diet is also associated in the development of diverticula.
- Medications. There are certain drugs such as steroids, NSAIDs, and opioids due to their risk of diverticular bleeding.
Complications of Diverticulitis
Diverticulitis may cause serious complications if left untreated. Most of the complications are brought about by the perforation of intestinal wall, resulting in the leakage of waste material into the abdominal cavity.
As a result, around 25% of the people diagnosed with diverticulitis may develop the following conditions:
- Abscess formation. This is the most common complication which is due to the accumulation of pus in the diverticula.
- Bowel obstruction because of scarring
- Peritonitis. This condition is the inflammation of the tissue lining of the abdominal cavity known as the peritoneum. It is a serious condition requiring immediate treatment, caused by the spilling of waste material resulting from the perforation in the intestinal wall.
Diagnosis of Diverticulitis
The diagnosis for diverticulitis is done during an acute attack, which also includes tests to rule out other diseases:
- Physical assessment specifically abdominal examination and pelvic examination for women
- Pregnancy test to rule out pregnancy for women of childbearing age
- Liver enzyme test
- Stool examination
- CT scan – the confirmatory test for diverticulitis, it also determines its severity and treatment options
Treatment of Diverticulitis
The treatment of diverticulitis will depend upon the severity of signs and symptoms.
- At-home treatment. In uncomplicated diverticulitis where there is presence of mild symptoms, home treatment may be advised. The patient will be advised to maintain on liquid diet until the bowel heals and may progress with soft diet once the symptoms improve.
- Antibiotics. In some cases, oral antibiotics may be prescribed to treat any infection. However, hospitalization is required for complicated diverticulitis with severe symptoms. The treatment would include intravenous antibiotics and tube insertion to drain abdominal abscess.
- Surgery. Surgical treatment may be required for people with complications such as obstruction, perforation, and abscess in the intestinal wall, as well as for those who are immunocompromised, or people with recurrent episodes of diverticulitis. There are two types of surgical intervention to treat diverticulitis:
- Primary bowel resection. This can be performed as an open surgery or via laparoscopic approach. It involves the removal of the affected intestinal segments and anastomosis of the healthy segments which allows bowel movements to return to normal.
- Bowel resection with colostomy. The surgeon creates an opening or a stoma to enable the passage of stool. This is recommended for severe inflammation and can be reversed once the inflammation has subsided.
- Colonoscopy. The doctor may advise colonoscopy after six weeks of recovery. This diagnostic procedure is done once there is fully recovery from a diverticulitis attack.
Nursing Care Plans for Diverticulitis
Nursing Care Plan 1
Nursing Diagnosis: Acute Pain related to presence and inflammation of diverticula as evidenced by pain score of 10 out of 10, verbalization of right upper quadrant abdominal pain and cramping, guarding sign on the abdomen, abdominal rigidity, and restlessness
Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.
|Administer prescribed pain medications.||To alleviate the symptoms of acute abdominal pain.|
Pain medications may include narcotics, anticholinergics, or smooth muscle relaxants.
|Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.||To monitor effectiveness of medical treatment for the relief of abdominal pain. The time of monitoring of vital signs may depend on the peak time of the drug administered.|
|Elevate the head of the bed and position the patient in semi Fowler’s.||To increase the oxygen level by allowing optimal lung expansion.|
|Place the patient in complete bed rest during severe episodes of pain||To reduce gastrointestinal stimulations thereby decreasing GI activity.|
|Perform non-pharmacological pain relief methods: relaxation techniques such as deep breathing exercises, guided imagery, and provision of distractions such as TV or radio.||To provide optimal comfort to the patient.|
|Prepare the patient for surgery as ordered.||Severe acute pain due to obstruction from severe diverticulitis may require immediate surgical intervention.|
Nursing Care Plan 2
Nursing Diagnosis: Risk for Imbalanced Nutrition: Less than Body Requirements
Desired Outcome: The patient will be able to achieve a weight within his/her normal BMI range, demonstrating healthy eating patterns and choices.
|Ask the patient’s preferences regarding food and drinks. Discuss with the patient the short term and long-term nutritional goals.||To help the patient gain a sense of control in his/her nutritional intake and meal planning.|
|Create a daily weight chart and a food and fluid chart. Calculate caloric intake.||To effectively monitor the patient’s daily nutritional intake and progress in nutritional goals.|
|Help the patient to select appropriate dietary choices to follow a low-fat high fiber diet.||Low-fat high fiber diet is ideal for patients with diverticulitis.|
|Refer the patient to the dietitian.||To provide a more specialized care for the patient in terms of nutrition and diet in relation to post-surgical status.|
Nursing Care Plan 3
Nursing Diagnosis: Risk for Infection post bowel resection
Desired Outcome: The patient will be able to avoid the development of an infection after surgery.
|Assess vital signs and observe for any signs of infection.||Infection may be evidenced by fever and can be accompanied by respiratory distress.|
|Obtain daily blood samples as ordered.||To monitor neutrophil and white blood cell counts.|
|Teach the patient and caregiver how to perform proper hand hygiene.||To maintain patient safety and reduce the risk of infection.|
|Orient the patient and caregiver on how to perform proper wound care.||To ensure that the principles of asepsis are carefully followed when changing wound dressings.|
Nursing Care Plan 4
Nursing Diagnosis: Constipation related to inflammatory process of diverticulitis as evidenced by type 1-2 stools on Bristol stool chart, inability to open bowels in the last 3 days, irritability
Desired Outcome: The patient will be able to re-establish normal bowel elimination.
|1. Commence a stool chart. Use a standardized stool assessment tool such as Bristol stool chart.||To monitor the patient’s bowel pattern.|
|2. Administer laxatives as prescribed.||To help evacuate stools, the following laxatives can be used as prescribed:|
•Stimulant laxatives •Stool softeners, especially for the elderly patients •Bulk laxatives
|Encourage to increase oral fluid intake as tolerated, ideally at least 2L per day. Check if the patient is in any fluid restriction before doing so.||To help soften the stool and make it easier to pass.|
|Encourage physical mobility and exercise as tolerated.||To increase bowel peristaltic movement.|
|Encourage fiber intake of at least 25 grams per day for women and 38 grams per day for men, as recommended by the dietitian.||To help the food move through the intestines. Examples of good dietary fiber include artichokes, carrots, and spinach.|
Other Nursing Diagnoses:
- Deficient Knowledge
- Alteration in Comfort
- Disturbed Sleep Pattern
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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