DIVERTICULITIS TIFFANY NARANJO

VANESSA PITTMAN

MELISSA GONZALEZ

NICOLE CARVER

CLAUDIUS ALEXANDER

PATHOPHYSIOLOGY • Diverticula are saccular dilations or outpouchings of the mucosa that develop in the colon. Multiple

noninflamed diverticula are present in diverticulosis. Diverticulitis is inflammation of the diverticula, resulting in perforation into the peritoneum. Clinically, diverticular disease covers a spectrum from asymptomatic, uncomplicated diverticulosis to diverticulitis with complications such as perforation, abscess, fistula, and bleeding.

• Diverticula are common, especially in older adults, but most people never develop diverticulitis.45 Diverticula may occur anywhere in the GI tract but are most commonly found in the left (descending, sigmoid) colon. The etiology of diverticulosis of the sigmoid colon is thought to be associated with high luminal pressures from a deficiency in dietary fiber intake. The disease is more prevalent in Western, industrialized populations that consume diets low in fiber and high in refined carbohydrates. Diverticula are uncommon in vegetarians. Inadequate dietary fiber slows transit time, and more water is absorbed

CLINICAL MANIFESTATION

• Left lower quadrant abdominal tenderness

• Low-grade fever

• Palpable mass

• Distressed appearance

• Muscle spasms

• Abdominal tympany

RISK FACTORS

• Smoking

• Low-fiber diet

• Obesity

• Sedentary lifestyle

• Advancing age (more common in over age 40)

• Constipation

• Previous Diverticula

PICTURES

LAB AND DIAGNOSTICS• • History and physical examination

• • Testing of stool for occult blood

• • Barium enema

• • Sigmoidoscopy

• • Colonoscopy

• • CBC

• • Urinalysis

• • Blood culture

• • CT scan with oral contrast

• • Abdominal x-ray

• • Chest x-ray

NUTRITION

• High-fiber diet• Dietary fiber supplements• Stool softeners• Clear liquid diet• Mineral oil

MEDICATIONS

• Stool softeners• Anticholinergics• Clear liquid diet• Oral antibiotics• Mineral oil• Bulk laxatives

Acute Care: Diverticulitis• Antibiotic therapy• NPO status• IV fluids• Bed rest• NG suction• Surgery

NURSING INTERVENTIONS

• -Antibiotic therapy-NPO status-IV fluids-Bed rest-NG suction-Surgery *Possible resection of involved colon for obstruction of hemorrhage *Possible temporary colostomy

PATIENT EDUCATION• -Disorder, diagnostic testing, and treatment, including the use of antibiotics and the need for a high-fiber

diet-bowel and dietary habits (in uncomplicated diverticulosis), including foods allowed and those to be avoided-use of bowel rest with acute episodes-prescribed medications, including the use of stool softeners and bulk-forming agents to promote bowel elimination; duration of antibiotic therapy, if prescribed-possible need for surgery if diverticulitis occurs, and appropriate preoperative teaching-incisional or ostomy care as necessary -The need to remain active overall but restrict activity when diverticulitis occurs-Importance of continued follow-up and adherence to treatment regimen to prevent complications.

REFERENCES• Lewis, S. (2014). Lower Gastrointestinal Problems. In Medical-Surgical Nursing: Assessment and

Management of Clinical Problems (9th ed., pp. 995-996). St. Louis, Missouri: Mosby.

• Lippincott DocuCare (2016) Diverticular disease. Retrieved from: http://lnareference.wkhpe.com/ref/view.do?key=de009ce09223e7f7e4913af9593d0452d58a421c&nmn=openMonographFromGlobalId&monographId=CC.978-1-58255-511-9.chapter123&cssUrl=http://download.lww.com/docucare/assets/lns_branding/docucare-lns.css

• Lippincott Docucare (2016) Diverticulitis. Retrieved at: http://lnareference.wkhpe.com/ref/view.do?key=1b0042dcc6a797e0bf2375944f9dddb1ba26d992&nmn=openMonographFromGlobalId&monographId=CC.978-1-58255-511-9.chapter123&cssUrl=http://download.lww.com/docucare/assets/lns_branding/docucare-lns.css

• Lewis, S. (2014). Lower Gastrointestinal Problems. In Medical-Surgical Nursing: Assessment and Management of Clinical Problems (9th ed., pp. 994-996). St. Louis, Missouri: Mosby.

• Lewis, Sharon, Shannon Dirksen, Margaret Heitkemper, Linda Bucher. Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 9th Edition. Mosby, 2014.