Diverticulitis

our report in MSN 132

1. Diverticulitis
Presented By:
Burila, John Louise
Capili, Jan Bernice
Engalla, Wilmar

2. DiverticulitisDiverticulitis
►Definition:Definition:
►Diverticulitis is out pouching of the mucosal Diverticulitis is out pouching of the mucosal
lining of the GIT, commonly in the colonlining of the GIT, commonly in the colon
►Diverticula/ diverticulosis are multiple out Diverticula/ diverticulosis are multiple out
pouchingspouchings
►Diverticulitis is acute inflammation and Diverticulitis is acute inflammation and
infection caused by trapped fecal material infection caused by trapped fecal material
and bacteriaand bacteria

3. Complication:Complication:
►PeritonitisPeritonitis
►Bowel obstructionBowel obstruction
►Fistula formationFistula formation
►HemorrhageHemorrhage
►Abscess formationAbscess formation
Etiology:Etiology:
Precipitating factors:Precipitating factors:
►Low-fiber dietLow-fiber diet
► Use of corticosteroidsUse of corticosteroids
►Use of NSAIDSUse of NSAIDS
Predisposing factor:Predisposing factor:
► Age-Age- most common in older adults (60 up) most common in older adults (60 up)

4. Symptomatology


 due to the stimulation of the
diverticula during contraction of the
abdominal muscle

 due to inflammation/infection
 due to the diet (low fiber)

 due to stimulation of the
cerebral cortex to increase reflux
mechanism
 due to constipation
 due to the perforation of the
diverticula
 due to the development of
abscess or perforation
 crampy lower left quadrant
abdominal pain, worsens with
movement, coughing or straining
 Low grade fever
 chronic constipation with
episode of diarrhea
 nausea and vomiting
 abdominal distention
 occult bleeding
 signs and symptoms of
peritonitis


RationaleSymptoms

5. PathophysiologyPathophysiology

6. Laboratory test:
►WBC count
►Urinalysis
►Guiaic testing of the stool

Diagnostic studies:
►Barium EnemaBarium Enema
►Abd X-rayAbd X-ray
►CT scanCT scan
►UTZ AbdUTZ Abd
►Flexible sigmoidoscopy or colonoscopyFlexible sigmoidoscopy or colonoscopy
►Intravenous PyelogramIntravenous Pyelogram
Surgical procedure:
► Two-stage Hartmann procedure

7. Collaborative Management
►high fiber diet
►liberal fluid intake of 2500 - 3000 mL/day
►avoid nuts and seeds which can become trapped in
the diverticula
►bulk - forming laxatives
►curing an acute episode:
► bed rest
► NPO, then clear liquid to rest the bowel
► avoid high fiver foods to prevent irritation of
the mucosa
► IVF's, antibiotics, analgesics, anticholinergics
(Pro - Banthine)
► NGT insertion to relieve distention
►weight loss to reduce intraabdominal pressure

8. Patients with mild symptoms abdominal pain due to muscular spasm
in the area of the diverticula may benefit from anti-spasmodic drugs
such as:
► chlordiazepoxide (Librax)
► dicyclomine (Bentyl),
► atropine, scopolamine, phenobarbital (Donnatal), and
hyoscyamine (Levsin).
Oral antibiotics are sufficient when symptoms are mild. Some
examples of commonly prescribed antibiotics include:
► ciprofloxacin (Cipro)
►metronidazole (Flagyl)
►cephalexine (Keflex)
► Doxycycline (Vibramycin).

9. Nursing ManagementNursing Management
Impaired tissue integrity r/t gastrointestinal (colon) obstruction as evidenced by diverticulaImpaired tissue integrity r/t gastrointestinal (colon) obstruction as evidenced by diverticula
►Nursing InterventionsNursing Interventions
 Monitor BP, PR, & RR at least every 4 hours. (Increase in PR and RR may Monitor BP, PR, & RR at least every 4 hours. (Increase in PR and RR may
be an early indication of fluid volume deficit due to bleeding/infection)be an early indication of fluid volume deficit due to bleeding/infection)
Take temperature every 4 hours. (Elevation greater than 38.3 C may Take temperature every 4 hours. (Elevation greater than 38.3 C may
indicate an increase in the severity of the disease.indicate an increase in the severity of the disease.
Perform an abdominal assessment every 4 to 8 hours or more often as Perform an abdominal assessment every 4 to 8 hours or more often as
indicated, including measuring abdominal girth, ausculting bowel sounds indicated, including measuring abdominal girth, ausculting bowel sounds
and palpating the abdomen for tenderness.and palpating the abdomen for tenderness.
Assess for evidence of lower intestinal bleeding by visual examination and Assess for evidence of lower intestinal bleeding by visual examination and
guiaic testing of stools for occult blood.guiaic testing of stools for occult blood.
Maintain IVF, TPN, and accurate intake and output records.Maintain IVF, TPN, and accurate intake and output records.
Give antibiotic as indicated.Give antibiotic as indicated.

10. Nursing ManagementNursing Management
Altered Comfort: Acute Pain r/t out pouching colon and stimulation of the diverticula during abdominal Altered Comfort: Acute Pain r/t out pouching colon and stimulation of the diverticula during abdominal
contractioncontraction
Nursing InterventionsNursing Interventions
► Describe the characteristics of pain, frequency, intensity, location, and duration.Describe the characteristics of pain, frequency, intensity, location, and duration.
► Provide emotional support and comfortable measures to the client.Provide emotional support and comfortable measures to the client.
► Provide pain management.Provide pain management.
► Give analgesics as indicated.Give analgesics as indicated.
Anxiety r/t possible surgery of the diverticulaAnxiety r/t possible surgery of the diverticula
Nursing InterventionsNursing Interventions
► Monitor emotional reaction and anxiety level of the patient.Monitor emotional reaction and anxiety level of the patient.
► Explain the treatment regimen and plan of care to the patient/SO.Explain the treatment regimen and plan of care to the patient/SO.
► Discuss to the patient and SO the need for surgery of the patient’s condition and its possible Discuss to the patient and SO the need for surgery of the patient’s condition and its possible
complications.complications.
► Provide collaborative management of the patient’s medical management.Provide collaborative management of the patient’s medical management.
► Provide comfort to the patient Provide comfort to the patient

11. Nursing ManagementNursing Management
Risk for Nutritional Imbalance: less than body requirement r/t Risk for Nutritional Imbalance: less than body requirement r/t
impaired nutritional absorption secondary to disease impaired nutritional absorption secondary to disease
processprocess
► Nursing InterventionsNursing Interventions
►Provide adequate nutrition to the patient such foods high Provide adequate nutrition to the patient such foods high
in fiber.in fiber.
►Include the use of TPN in nutritional management of the Include the use of TPN in nutritional management of the
patient.patient.
►Weight the patient to determine the deviation of the Weight the patient to determine the deviation of the
patient nutritional status.patient nutritional status.
►Refer to dietician for appropriate plan of nutritional Refer to dietician for appropriate plan of nutritional
treatment to the patient.treatment to the patient.