Lesson Objective for Nursing Care Plan: Diverticulosis/Diverticulitis

Imagine your large intestine as a busy highway. Normally, traffic (digestive waste) flows smoothly through it. Diverticulosis is like having small pockets or pouches (diverticula) forming along the sides of the highway. These pockets are like small rest areas off the road – they’re there, but they don’t usually affect the traffic flow.

However, if one of these pockets becomes inflamed or infected, it’s like a rest area on the highway developing problems, such as a blockage or a burst pipe. This is diverticulitis. It can cause symptoms like pain, fever, and changes in bowel habits, similar to how a problem at a rest area can cause traffic delays and disruptions. Treatment for diverticulitis often involves medical intervention, similar to roadwork or repairs, to resolve the issue and get the traffic (digestive process) moving smoothly again.

Upon completion of this nursing care plan for Diverticulosis/Diverticulitis, nursing students will be able to:

• Understand the Pathophysiology:
  • Develop a comprehensive understanding of the pathophysiology of diverticulosis and diverticulitis, including the formation of diverticula, risk factors, and the inflammatory processes involved in diverticulitis.
• Differentiate Between Diverticulosis and Diverticulitis:
  • Acquire the ability to differentiate between diverticulosis (presence of diverticula without inflammation) and diverticulitis (inflammation of diverticula). Identify key clinical manifestations and diagnostic criteria for each condition.
• Implement Dietary Modifications:
  • Demonstrate knowledge of dietary modifications essential for managing diverticular diseases. Understand the role of fiber, fluid intake, and avoidance of specific foods to prevent exacerbations and promote bowel health.
• Administer Medications Appropriately:
  • Gain proficiency in administering medications commonly prescribed for diverticulitis, such as antibiotics and analgesics. Understand the rationale behind each medication and monitor for potential side effects.
• Educate Patients on Self-Management:
  • Provide effective patient education on self-management strategies, lifestyle modifications, and signs of complications. Empower patients to actively participate in their care, recognize symptom triggers, and seek timely medical attention when needed.

Pathophysiology of Diverticulosis/Diverticulitis:

• Diverticulosis Formation:
  • Diverticulosis involves the development of small pouches (diverticula) along the walls of the colon, particularly in areas of weakened muscular layers. These pouches may protrude through the mucosal lining.
• Risk Factors:
  • Factors contributing to diverticulosis include aging, a low-fiber diet, and increased pressure within the colon during bowel movements. Weakened areas of the colon are more prone to diverticula formation.
• Diverticulitis Inflammation:
  • Diverticulitis occurs when diverticula become inflamed or infected. Inflammation may result from fecal matter becoming trapped in the diverticula, leading to bacterial overgrowth and subsequent inflammation.
• Complications and Abscess Formation:
  • In severe cases of diverticulitis, inflammation may progress, leading to the formation of abscesses or perforations in the diverticular wall. This can result in localized or generalized peritonitis.
• Symptoms and Clinical Manifestations:
  • Symptoms of diverticulosis may include abdominal pain, bloating, and altered bowel habits. In diverticulitis, symptoms intensify and may include localized abdominal tenderness, fever, nausea, vomiting, and changes in bowel patterns.

Etiology of Diverticulosis/Diverticulitis:

• Aging:
  • Advanced age is a significant risk factor for the development of diverticulosis. The structural changes in the colon associated with aging, such as decreased elasticity and muscle tone, contribute to the formation of diverticula.
• Low-Fiber Diet:
  • A diet low in fiber is a key contributor to diverticulosis. Inadequate fiber intake results in constipation, increased intra-colonic pressure during bowel movements, and a higher likelihood of diverticula formation.
• Connective Tissue Weakness:
  • Weakness in the connective tissue of the colonic walls is another predisposing factor. Genetic factors may play a role in determining the strength of the colonic tissues, making some individuals more susceptible to diverticula formation.
• Obesity:
  • Obesity is associated with an increased risk of diverticulosis and diverticulitis. Excess body weight, particularly abdominal adiposity, can contribute to elevated intra-abdominal pressure, promoting the development and progression of diverticular disease.
• Lack of Physical Activity:
  • Sedentary lifestyles and lack of regular physical activity are linked to an increased risk of diverticular diseases. Physical inactivity may contribute to constipation and impaired colonic motility, fostering the conditions for diverticula formation.

Desired Outcomes for Diverticulosis/Diverticulitis Nursing Care:

• Resolution of Acute Symptoms:
  • Achieve the resolution of acute symptoms associated with diverticulitis, including abdominal pain, tenderness, fever, and gastrointestinal disturbances. Monitor for a reduction in inflammatory markers.
• Prevention of Complications:
  • Prevent the progression of diverticulitis and the development of complications such as abscess formation, perforation, or peritonitis. Timely intervention and management contribute to a decrease in the risk of severe complications.
• Normalization of Bowel Function:
  • Promote the normalization of bowel function by addressing constipation, diarrhea, or alterations in bowel habits. Dietary modifications and lifestyle changes aim to improve overall colonic health and prevent exacerbations.
• Patient Education and Lifestyle Modification:
  • Empower the patient with knowledge and skills for long-term self-management. Provide education on dietary fiber, fluid intake, and lifestyle modifications to reduce the risk of diverticulosis recurrence and alleviate symptoms.
• Improved Quality of Life:
  • Enhance the patient’s overall quality of life by effectively managing symptoms, preventing complications, and promoting a proactive approach to self-care. Encourage the adoption of a balanced and health-promoting lifestyle.

Diverticulosis/Diverticulitis Nursing Care Plan

Nursing Assessment for Diverticulosis/Diverticulitis:

• Health History:
  • Gather a comprehensive health history, including information on gastrointestinal symptoms, dietary habits, bowel patterns, and any previous episodes of diverticulitis. Inquire about risk factors such as age, family history, and lifestyle.
• Presenting Symptoms:
  • Assess the patient’s current symptoms, including abdominal pain, tenderness, bloating, changes in bowel habits, fever, nausea, and vomiting. Note the duration and intensity of symptoms and any factors that exacerbate or alleviate them.
• Abdominal Examination:
  • Perform a thorough abdominal examination to assess for tenderness, distension, and palpable masses. Pay specific attention to the lower left quadrant, where diverticula are most commonly found.
• Vital Signs:
  • Monitor vital signs, including temperature, heart rate, blood pressure, and respiratory rate. Elevated temperature and an increased heart rate may indicate inflammation or infection.
• Laboratory Tests:
  • Order and interpret relevant laboratory tests, including a complete blood count (CBC) to check for leukocytosis, inflammatory markers (such as C-reactive protein), and a comprehensive metabolic panel to assess electrolyte balance.
• Diagnostic Imaging:
  • Collaborate in obtaining diagnostic imaging studies, such as abdominal computed tomography (CT) scans, to visualize the presence and extent of diverticula, as well as signs of inflammation or complications.
• Bowel Function Assessment:
  • Assess bowel function, including the frequency and consistency of bowel movements. Document any signs of constipation, diarrhea, or changes in stool appearance.
• Patient Education and Lifestyle Habits:
  • Engage in patient education to gather information on dietary habits, fiber intake, fluid consumption, and physical activity. Assess the patient’s readiness to make lifestyle modifications to prevent diverticular disease recurrence.

Nursing Interventions and Rationales

• Monitor vital signs to determine if condition is worsening or improving.
  Fever / chills are signs of infection and possibly early peritonitis

• Provide Bowel Rest

• Assess abdominal pain

• Maintain fluid balance

• Administer medications

• Provide nutrition education

Evaluation of Diverticulosis/Diverticulitis Nursing Care:

• Symptom Resolution:
  • Evaluate the resolution of acute symptoms, including abdominal pain, tenderness, and gastrointestinal disturbances. Monitor for a decrease in inflammation markers and assess the patient’s overall comfort.
• Prevention of Complications:
  • Assess whether interventions and management strategies effectively prevented the progression of diverticulitis and complications such as abscess formation, perforation, or peritonitis.
• Bowel Function Normalization:
  • Evaluate the normalization of bowel function, including improvements in bowel habits, consistency of stool, and the absence of symptoms such as constipation or diarrhea. Monitor for signs of improved colonic health.
• Patient Adherence to Lifestyle Modifications:
  • Assess the patient’s adherence to prescribed dietary modifications, increased fiber intake, fluid consumption, and other lifestyle changes aimed at preventing diverticulosis recurrence. Explore any challenges or barriers to adherence.
• Patient Education and Empowerment:
  • Evaluate the patient’s understanding of diverticulosis and diverticulitis, as well as their ability to manage symptoms and prevent future episodes. Measure the effectiveness of education in promoting patient empowerment and proactive self-care.

References

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3174080/
• https://www.webmd.com/digestive-disorders/understanding-diverticulitis-basics
• https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758