Nursing Care Plans for Diverticulitis, Interventions and Nursing Diagnosis with Examples

Introduction

Diverticulitis is the infection or inflammation of pouches that can form in your intestines. Diverticula are the name for these pouches. Diverticulitis is the infection or inflammation of pouches that can form in your intestines. These pouches are called diverticula.

The pouches generally aren’t harmful. They can show up anywhere in your intestines. If you have them, it’s called diverticulosis. If they become infected or inflamed, you have diverticulitis.

Sometimes, diverticulitis is minor. But it can also be severe, with a massive infection or perforation of the bowel.

The pouches are ordinarily harmless. They might appear in your intestines at any time. Diverticulosis is the medical term for having them. Diverticulitis occurs when they get infected or inflamed.

Diverticulitis might be modest at times. However, it can be severe, resulting in a considerable infection or intestinal perforation.

This blog post discusses diverticulitis care plans, Interventions, nursing Diagnosis, causes, symptoms and preventions. As you follow along, remember that our qualified writers are always ready to help in any of your nursing assignments. All you need to do is place an order with us!

Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Diverticulitis

Diverticulitis is an inflammatory bowel disease that most commonly affects the colon. A bacterial infection of one or more of the pouches produced due to diverticulosis causes inflammation. The inflammation may appear quickly or develop gradually for 24 to 48 hours. This illness can affect any region of your colon, although the sigmoid colon is the most commonly affected (the last 5 feet).

Diverticula are one or more pockets or bulges that form in the wall of your colon. They are tiny, bulging pouches in the digestive tract walls, often seen in the colon or the lower part of the intestine.

Diverticula are like expanded areas or bubbles that form when you fill the inner tube of a bike tire with too much air. The increase in pressure from too much air being pumped into the inner tube causes the bubble to form where the rubber is the weakest. Similarly, increased pressure inside the colon causes pockets or bulges (diverticula) to form in weakened areas of your colon’s walls.

Diverticula can range from pea-size to much more extensive. Although they can form anywhere in the inner lining of your colon, they are most commonly found in your lower left side, in the S-shaped segment of your colon called the sigmoid colon.

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What’s the difference between diverticulosis and diverticulitis?

The presence of these microscopic bulges or pockets (diverticula) in your colon is known as diverticulosis. They rarely cause symptoms or necessitate treatment. Diverticulosis, on the other hand, can result in diverticulitis.

Diverticulitis is an infection and inflammation of one or more diverticula. You might have discomfort, nausea, a fever, and other symptoms. This is a much more severe and even life-threatening illness.

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Pathophysiology

This clinical manifestation can occur in any portion of the intestine, although it is most common in the Sigmoid colon, the lower part of the colon.

These herniations happen when blood vessels break through the muscle layer of the intestinal wall. When pressure builds up in the intestinal lumen, only the mucosal layers, not the muscular wall, generate an outpouching.

Diverticulitis develops when feces obstructs the diverticula, causing ischemia and inflammation. In addition, gut microorganisms may trigger an inflammatory response.

Risk Factors

1. Age. The risk for developing diverticulitis increase with age, with higher incidence noted among older people.
2. Gender. It is commonly seen in males under the age of 50.
3. Genetics. There are disorders like Marfan syndrome, Ehlers-Danlos syndrome and Williams-Beuren syndrome that can trigger the formation of diverticula.
4. Obesity. Excessive weight gain increases visceral fat, which is related to diverticulitis.
5. Smoking. Nicotine can decrease muscle tone and activity of the sigmoid colon.
6. Sedentary lifestyle. Lack of exercise and physical activity decreases intestinal motility, which increases the risk of acquiring the disease.
7. Diet. The consumption of high fat, low fibre diet is also associated with the development of diverticula.
8. Medications. There are certain drugs such as steroids, NSAIDs, and opioids due to their risk of diverticular bleeding.

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
• A palpable, tender rectal mass may be present

Complications of Diverticulitis

If you don’t treat it, diverticulitis can lead to serious complications that require surgery:

Abscesses, collections of pus from the infection, may form around the infected diverticula. If these go through the intestinal wall, you could get peritonitis. This infection can be fatal. You’ll need treatment right away.

Perforation or tear in the intestinal wall can lead to abscesses and infection because of waste leaking into the abdominal cavity.

Scarring can lead to a stricture or blockage of the intestine.

Fistulas can develop if an infected diverticulum reaches a nearby organ and connects. This most often happens between the large intestine and the bladder. It can lead to a kidney infection. Fistulas can also form between the large intestine and the skin or the vagina.

Stricture, which happens when the colon narrows in the affected area.

Nursing Diagnosis for Diverticulitis

If you have symptoms of diverticulitis, it’s important to be seen by your healthcare provider to get the correct diagnosis.

First, your healthcare provider will ask you about your medical history, including your current symptoms, the types of foods you normally eat, how often you have bowel movements and other questions about your bowel movements and review any medications you are currently taking. Your healthcare provider will check your abdomen for pain and tenderness.

Other tests that may be performed or ordered to help diagnose your condition include:

Blood test: Your blood is checked for signs of infection, such as a high white blood cell count.

Stool sample: Your stool sample is checked for the presence of abnormal bacteria or parasites as possible causes of your infection, abdominal pain, blood in stool, diarrhea or your other symptoms.

Digital rectal exam: In this physical exam, your healthcare provider gently inserts a gloved, lubricated finger into your rectum to feel for any problems in your anus or rectum.

CT scan: A CT scan can show infected or inflamed diverticula and reveal the severity of diverticulitis.

Barium enema (also called lower gastrointestinal tract radiography): A liquid containing barium is injected into your anus in this test. The liquid coats the inside of your colon, which helps make any problems in your colon more visible on X-rays.

Sigmoidoscopy: In this exam, a thin, flexible tube with a light on the end is inserted into your rectum and moved into your sigmoid colon. The tube is connected to a video camera. The camera allows a visual inspection of your sigmoid colon (where most diverticula form) and rectum.

Colonoscopy: In this exam, the full length of your colon can be examined. A thin, flexible, lighted tube with a camera, called a colonoscope, is inserted through your rectum and into your colon. During a colonoscopy, your colon is checked for abnormal growths, sores, ulcers, bleeding or other problems that could cause changes in bowel habits or abdominal pain. Tissue samples can be taken, and polyps can be removed.

Angiography: If you have rapid, heavy rectal bleeding, this procedure helps find where the bleeding is coming from. During this test, the arteries that supply the colon are injected with a harmless dye that allows the source of the bleeding to be seen.

Laboratory studies:

WBC

Hematocrit and Hemoglobin

Occult stool sample

C-reactive protein (CRP)

Urinalysis

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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 the presence of mild symptoms, home treatment may be advised. The patient will be advised to maintain a liquid diet until the bowel heals and progress with a 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 the 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 a 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 full recovery from a diverticulitis attack.

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When is surgery for diverticulitis considered?

Surgery for diverticulitis is considered if you have:

1. Abscesses: An abscess is a contained or “walled-off” infection in the abdomen. If the fluid in an abscess (a collection of bacteria and white blood cells) is not successfully drained with a needle or catheter, surgery is needed. In surgery, the abscess is cleaned up, and the affected part of the colon is removed.
2. Perforation/peritonitis: A tear (perforation) in your colon allows pus or stool to leak into your abdominal cavity, resulting in peritonitis. This is a life-threatening infection that requires emergency surgery to clean the cavity and remove the damaged part of the colon.
3. Blockages or strictures: Previous infections in your colon can cause scars to form, which can result in a partial or complete blockage or strictures (narrowing of sections of the colon). A complete blockage requires surgery (partial blockage does not).
4. Fistulas: A fistula is an abnormal passageway or tunnel that forms and connects with another organ. An abscess that erodes into the surrounding tissue creates these passageways. A fistula in the colon can connect to the skin, bladder, vagina, uterus or another part of the colon. Most fistulas don’t close on their own, so surgery is needed.
5. Continued rectal bleeding (also called diverticular bleeding): Diverticular bleeding occurs when a small blood vessel near the diverticula bursts. Mild bleeding usually stops on its own, but about 20% of cases require treatment. Surgery may be needed if other attempts to stop the bleeding fail, such as clipping, drug infusion or cauterizing the bleeding artery. If bleeding is heavy and rapid, emergency surgery is needed.
6. Severe diverticulitis that has not responded to other treatment methods.
7. Multiple attacks despite following a high-fibre diet. You and your surgeon may decide surgery to remove the diseased part of the colon is the best method to prevent future attacks.

Nursing Care Plans for Diverticulitis

Nursing Care Plan 1: Acute Pain

It is related to the presence and inflammation of the diverticula as evidenced by a 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 an absence of restlessness.

Interventions	Rationale
Administer prescribed pain medications.	To alleviate the symptoms of acute abdominal pain. Pain medication 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 the 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: Risk for Imbalanced Nutrition

Desired Outcome

 The patient will be able to achieve weight within their normal BMI range, demonstrating healthy eating patterns and choices.

Interventions	Rationale
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 their 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 fibre diet.	A low-fat high fibre diet is ideal for patients with diverticulitis.
Refer the patient to the dietitian.	To provide more specialized care for the patient in terms of nutrition and diet in relation to post-surgical status.

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Nursing Care Plan 3: Risk for Infection post bowel resection

Desired Outcome

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

Interventions	Rationale
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 dressing.

Nursing Care Plan 4: Constipation related to the inflammatory process of diverticulitis

It is evidenced by type 1-2 stools on Bristol stool chart, inability to open bowels in the last three days, irritability.

Desired Outcome

The patient will be able to re-establish normal bowel elimination.

Interventions	Rationale
Commence a stool chart. Use a standardized stool assessment tool such as the 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 fibre 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 fibre

References

• ncbi.gov
• scholar.google.com

Related FAQs

1. What is the best diet for patients with diverticulitis?

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 Diagnosis: Risk for Infection post bowel resection

2. How is uncomplicated diverticulitis treated?

Uncomplicated diverticulitis. If your symptoms are mild, you may be treated at home. Your doctor is likely to recommend: Antibiotics to treat infection, although new guidelines state that in very mild cases, they may not be needed.

3. How is diverticulitis diagnosed?

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 CT scan – the confirmatory test for diverticulitis, it also determines its severity and treatment options

4. When should I go to the hospital for diverticulitis?

More-severe cases typically require hospitalization. Nutrition therapy for diverticulitis is a temporary measure to give your digestive system a chance to rest. Eat small amounts until bleeding and diarrhea subside.

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