Diverticulitis Nursing Diagnosis & Care Plan

Last updated on February 21st, 2023 at 07:28 am

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
• Bloating
• Abdominal distention and tenderness
• Abdominal cramps
• Constipation
• 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:

1. Abscess formation. This is the most common complication which is due to the accumulation of pus in the diverticula.
2. Bowel obstruction because of scarring
3. 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.

1. 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.
2. 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. 
3. 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:
4. 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.
5. 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.
6. 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 Diagnosis for Diverticulitis

Diverticulitis Nursing Care Plan 1

Acute Pain

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.

Nursing Interventions for Diverticulitis

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.

Diverticulitis Nursing Care Plan 2

Imbalanced Nutrition: Less than Body Requirements

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.

Nursing Interventions for Diverticulitis

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.

Diverticulitis Nursing Care Plan 3

Risk for Infection

Nursing Diagnosis: Risk for Infection post bowel resection

Desired Outcome: The patient will be able to avoid the development of an infection after surgery.

Nursing Interventions for Diverticulitis

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. 

Diverticulitis Nursing Care Plan 4

Constipation

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.

Nursing Interventions for Diverticulitis

Commence a stool chart. Use a standardized stool assessment tool such as Bristol stool chart. To monitor the patient’s bowel pattern.

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.

Diverticulitis Nursing Care Plan 5

Knowledge Deficit

Nursing Diagnosis: Knowledge Deficit related to diet and medication regimen secondary to diverticulitis as manifested by insufficient accurate information and increased risk of preventable complications.

Desired Outcomes:

• The patient will verbalize understanding of the disease process, its prognosis and possible complication if left untreated.
• The patient will express understanding about the importance of their compliance and cooperation in the treatment management as manifested by following the prescribed medication regimen and dietary plan. .
• The patient will express understanding of the diet recommendation which is high fiber diet and the importance of having moderate exercise as tolerated and enough fluid intake to enhance optimal bowel movement at home.

Nursing Interventions for Diverticulitis

Evaluate the patient’s level of knowledge about the entire disease, including its causes, risk factors, signs and symptoms, required treatment, prognosis, and possible complications. It provides baseline details and starting point for producing a health teaching plan. Through assessment of the patient’s perception of the disease process the identification and planning of individual teaching.

Identify what information needs to be discussed with the patient and also their capacity to do and practice it into action. Evaluate the patient’s readiness of acquiring new information about the disease.

Unexpected changes in one’s health condition and sometimes hospitalization are a few factors that can affect their capacity to learn new things. Considering the time allotted in teaching them and adapting to their situation and also their way of thinking of that.  

Educate the patient on how to identify and avoid risk factors and/or risk factors Several risk factors such as age, gender, genetics, obesity, lifestyle, smoking, diet, and medications can contribute to developing diverticulitis.

Discuss to the patient the essence of changing lifestyle to reduce the chance of several risk factors For those who have already adapted to living a risky lifestyle, changing it can be difficult to attain. Guidance and enough support system to them can be their partner in achieving the success of living in a complete lifestyle change.

During the non-acute phase of diverticulitis promote a high fiber diet Wheat bread, whole grain bread, and cereals are high in cellulose. Eating foods that are high in fiber will add bulk to stool and ensure consistency.

If not contraindicated, advise the patient to increase fluid intake of at least 2500 to 3000 ml per day. Increasing oral fluid intake prevents bloating that may happen with a high fiber diet.

Inform the patient to avoid drinking alcohol. Alcohol causes irritation to the gastrointestinal tract.

During the acute phase, advised the patient to avoid fiber rich foods. Foods high in fiber can increase bowel motility and will only irritate the gastrointestinal mucosa. If the symptoms subside, the patient may gradually have fiber on the diet.

Give clear liquids if tolerated. Upon hospitalization, the patient may be put in nothing per orem/nil by mouth or NPO status or may require inserting a nasogastric tube to promote the rest of the stomach.  To maintain adequate fluid balance and the patient is already stable to recover at home, giving clear liquid will help.

Promote rest during the acute phase and instruct the patient to avoid strenuous activities like lifting heavy objects, exercises, and other activities. Also avoid activities that exert too much effort like straining, coughing, and bending. Such activities may increase pressure inside the abdomen which may result in diverticulum perforation.

Conduct a discussion about their medication, its indication, action, side effects, and things to watch out for. Enough knowledge about the medication will prevent them from having misconceptions or misbeliefs in drug information.

 Give highlights on the importance of complying with standard treatment management and continuous follow-up visits. Inconstant and not having enough cooperation is one of the causes why diverticulitis progresses and worsens. Thus, consistent and strict follow-up appointments and compliance with the medication help lower the possibility of worsening conditions and lifetime complications.

Diverticulitis Nursing Care Plan 6

Risk for Ineffective Tissue Perfusion

Nursing Diagnosis: Risk for Ineffective Tissue Perfusion related to fecal obstruction of diverticula secondary to diverticulitis

Desired Outcomes:

• The patient will show sufficient gastrointestinal tract tissue perfusion as manifested by nonappearance of accumulated diverticular disease.
• The patient will verbalize relief of pain and the constraint of the acute phase of diverticular disease.
• The patient will exhibit effectiveness of the necessary and appropriate treatment management.
• The patient will be tolerating the prescribed diet, free from abdominal pain and distention.

Nursing Interventions for Diverticulitis

Conduct an abdominal assessment. Include the location of pain, characteristics, and pain level.  In the acute phase of diverticular disease, abdominal pain is most of the time characterized by cramp-like discomfort. An unexpected increase in pain can be a sign of rupture. It is considered an emergency, Thus, immediate transfer medical intervention is highly needed.

Monitor and record vital signs frequently. Decrease in blood pressure and increased heart rate are the first sign of low blood volume. When the volume of blood supply decreases, Inadequate perfusion in the gastrointestinal tract happens. Vital organs such as the brain and heart perfuse first.

Check the mean arterial pressure (MAP) frequently. Mean Arterial Pressure is the average arterial pressure within the one complete cycle of a heartbeat. It requires at least more than 60 mmHg to adequately perfuse all the body’s vital organs.

Obtain blood samples for laboratory studies as requested by the physician. Certain blood tests are needed to identify the presence of inflammation. Checking the complete blood count is done to monitor the level of hemoglobin, hematocrit, and white blood cell count. This is to identify if there is any bleeding, anemia, or infection. A basic metabolic panel test is also obtained to evaluate the electrolytes level and renal function. It has been observed that some patients with diverticulitis experience nausea, vomiting, diarrhea, and electrolyte imbalance. A urine test is done to rule out infection within the urinary tract, and a stool exam to check for occult bleeding.   

Give prescribed pain medications as prescribed.  Always follow the instruction of the physician and closely monitor the patient if the condition is improving or worsening

Physicians prescribed medicine for pain and it is important to take the medicine as instructed. This is to prevent any adverse reaction and overdosage of medication.

Evaluate the patient’s vital signs and the quality of pain 30 minutes after giving the medicine.  This is to observe the effectiveness of treatment management for the relief of pain. Note the peak time of the medication given and check the patient’s vital signs depending on its maximum time.

For episodes of severe pain, place the patient in a comfortable position and let the patient have complete bed rest.  During pain attacks, it is important to reduce gastrointestinal activity. It is important to lessen the stimulant in the gastrointestinal area.

Non-pharmacological pain relief is also beneficial to provide comfort to the patient.

Educate the patient about non-pharmacological methods to relax.  Non-pharmacological methods such as deep breathing exercises, guided imagery, and watching TV or listening to the radio are some helpful relaxation techniques to reduce gastrointestinal activity.

Monitor the patient’s fluid balance. A decrease in urine output can be an indication of a reduction in tissue perfusion, leading to impaired perfusion in vital organs.

10. Discuss with the patient the necessary lifestyle changes. It includes following the prescribed dietary guidelines, exercising as tolerated, stopping drinking alcoholic beverages, and smoking cessation.

These measures help to prevent the worsening of blood flow. Tobacco and alcohol cause constriction and spasm of the blood vessels that may interfere in having adequate perfusion. Meanwhile,  exercising and diet changes help in improving circulation that may increase perfusion in the blood vessels.

Make the patient ready for surgery as per the doctor’s advice.  Severe Diverticulitis as a result of obstruction as evidenced by severe pain requires immediate intervention like surgery.

Diverticulitis Nursing Care Plan 7

Risk for Deficient Fluid Volume

Nursing Diagnosis: Risk for Deficient Fluid Volume related to increased body temperature and dehydration secondary to diverticulitis.

Desired Outcomes:

• The patient will have a stable body temperature within the normal range, at 37.3 degrees Celsius.
• The patient will exhibit improvement in blood volume as evidenced by normal skin turgor, stable blood pressure at 110mm/Hg for systolic, and 70mm/Hg for diastolic volume, heart rate of 77 beats per minute, and adequate urinary output more than 30ml/hour.
• The patient will demonstrate sufficient fluid balance evidenced by absence of fever, elastic skin turgor, and moist skin membranes.
• The patient will sustain adequate intake of fluids and identify the measure to keep them hydrated.

Nursing Interventions for Diverticulitis

Observe and record vital signs at least every 4 hours.  During fever, our body loses fluids through the skin surface to help the body to lower its temperature. Leading to too much sweating and massive fluid loss. Hypotension and tachycardia are some evidence of decreased blood volume. Changes in heart rate are a compensatory process to maintain normal cardiac output. In most cases, if electrolyte imbalance occurs the pulse is weak and irregular. Decreased blood pressure is present in hypovolemia.

If necessary, adjust the room temperature and remove excess clothes, blankets, and linens.  To normalize the environment’s temperature and make the patient comfortable.

Evaluate signs of dehydration such as skin turgor, oral mucous membranes, peripheral pulses, and capillary refill.  Signs of dehydration are identified through the skin, for elderly patients skin turgor should be assessed on the inner thighs and over the sternum since most of them already lose skin elasticity. The tongue should be checked for longitudinal furrows.

Give the prescribed medication (antipyretics) if the body temperature increases.  Fever can cause dehydration due to fluid loss when the temperature increases. Normalizing body temperature can prevent further dehydration. Provide a tepid sponge bath if necessary to cool down the temperature and provide comfort.

Evaluate the patient’s mental status. Check alteration of mentation and sensorium like confusion, agitation, confusion, irritability, restlessness, and slowed response.  Dehydration and abnormalities in electrolytes are some of the manifestations of altered mentation or sensorium. Any changes in the level of consciousness and orientation may be an indication of inadequate cerebral perfusion.

Monitor the amount and characteristics of the urine.  Normal urine output should be 30ml per hour or more. Less than 30ml can be an indication of insufficient fluid volume. Dark-colored urine is concentrated and can be a sign of fluid deficit.

Weigh the patient daily, using the same scale and at the same time of the day, preferably early morning.  The imbalance in fluid volume is also assessed through weighing. It is considered one of the best assessment tools for fluid imbalance.

Encourage the patient to drink fluid based on the prescribed amount.  Oral replacement treatment is indicated for mild fluid deficiency. Elderly patients need to be reminded since most of them have a decreased sense of thirst. Flavored gelatin, frozen juice bar, sports drinks, and oral hydrating solutions can also be given for fluid replacement. Put the beverage within the patient’s visual field and close reach to serve as a constant reminder to them to drink. Also, easy access promotes increased fluid intake.

Monitor and record patient’s input and output accurately at least every 4 hours. Urine output less than intake increases urine-specific gravity.  These data provide information regarding the fluid status and circulating volume of the patient. Some patients do not track the amount of fluid they consume every day, and some forget to drink enough water throughout the day. Therefore, monitoring and recording patients’ input and output is important.

Assist the patient if he or she cannot eat without assistance.  Patients may feel weak and unable to have the prescribed amount by themselves. Thus, assistance is highly appreciated.

Advise the patient to avoid beverages that contain caffeine.  Caffeine contains diuretic properties that may promote fluid loss and electrolyte imbalance.

Monitor lab test results including electrolyte levels, hematocrit, creatinine, specific gravity, BUN, and osmolality.   These allow the healthcare monitoring team to identify if the treatment is effective or needs to consider other treatment plans. During fever, a large amount of fluid is lost, and electrolyte levels are affected.  Sodium is one of many that are lost when sweating. Low levels of the electrolyte can lead to muscle spasms, dysrhythmias, brain swelling, and tiredness.

More Diverticulitis Nursing Diagnoses

• Alteration in Comfort
• Disturbed Sleep Pattern

Nursing References

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. (2022). 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. (2020). 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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