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DiverticulaDisease

Kerri-Ann Mchayle-Henry

Medica; Surgical Nursing 1 Gastrointestinal System03/03/10 1Diverticular Disease


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03/03/10 2Diverticular Disease


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Diverticulosis is the presence of many abnormal

pouchlike herniations in the wall of the intestine.

Diverticulitis is the term used to describe an

inflammation of one or more of the diverticula.Usually occurs in the sigmoid colon of the large

intestines

This is usually a symptom free disease unless bleeding

or inflammation occurs Muscle of the colon hypertrophies and becomes rigid mucosa and submucosa herniates through the colon

wall

at weak points in the intestinal walls, herniation occur Muscles weaken as part of general aging or lack of

fiber

w/o inflammation diverticula cause few problems03/03/10 3Diverticular Disease


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AssessmentAssessment contdcontdIf generalized peritonitis is present:-profound guarding occurs- rebound tenderness is more widespread- sepsis, hypotension, or hypovolemic shock can

occur

If the perforated diverticulum is close to the rectum,

a palpable mass may be felt during a rectal exam

Orthostatic changes may occur

If bleeding is massive, the patient may have

hypotension and dehydration that result in shock.



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When infection developes disease becomes

Diverticulitis, characterized by:

- elevated WBC

- decreased H&H (in the presence of Chronic orsevere bleeding)

- hematuria

- possible occult blood

Diagnostic Tests:

- X-ray with barium contrast (expt. acute drv-itis)

- Colonoscopy

- Flat film done to test for perforation

- CT Scan & Abdominal Ultrasonography to test

for abcess of bowel r/t drv-it is and to rule out

tumor in the large intestines03/03/10 Diverticular Disease 6


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Non-Surgical Management



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03/03/10 Diverticular Disease 9


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Surgical

Management



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Bowel prep. w. enemas and laxatives daily for 1 to 2 days b4 surgery in no-acute stages;

A low-fiber diet several days clear-liquid diet for the day or evening b4 surgery.

Due to risk of perforation aggressive bowel preparation is not required

bowel prep withheld for acute inflammation, persistent fever and abdominal pain

Operative:Minimally Invasive Surgery(MIS) by Laparoscopy ( recov. time) or Tradtnl (recov. time)

Post: The patient may have a drain in place at the abdominal incision site for several

days. If a colostomy, the stoma may be covered with a petroleum gauze dressing bc the

colostomy does not drain for about 2 days or a colostomy bag may be placed over the

stoma. monitor for pinkish to cherry red color w/o retraction or prolapse into theabdomen NPO w. NGT until peristalsis returns (about 2 to 3 days)Clear liquids are then

introduced slowly. Gradually, the diet is advanced to solidPatients who had laparoscopic

surgery do not usuallyhave an NGT. Most patients with a colostomy for diverticulitis

have a sigmoid colostomy because the sigmoid colon is the most common site of

diverticulitis. Drainage from a sigmoid colostomy at first consists of loose stool, but

eventually the stool becomes formed. A tight seal around the stoma is essential to avoidcontact of feces with the skin. Give the patient an opportunity to express feelings about

the ostomy. reinforcing that anger and depression are normal responses. encourage the

patient to look at the stoma and touch the pouching system. teach the patient how to

self-manage ostomy care.


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Chart 60-7NURSING FOCUS ON THE OLDER ADULT: Diverticulitis

Provide antibiotics, analgesics, and anticholinergics as prescribed.Observe older patients carefully for side effects of these drugs,

especially confusion (or increased confusion), urinary retention orfailure, and orthostatic hypotension. Do not give laxatives or enemas. Teach the patient and thefamily about the importance of avoiding these measures. Encourage the patient to rest and to avoid activities thatmay increase intra-abdominal pressure, such as straining and

bending. While diverticulitis is active, provide a low-fiber diet. Whenthe inflammation resolves, provide a high-fiber diet. Teach thepatient and family about these diets and when they areappropriate. Because older patients do not always experience the

typical pain or fever expected, observe carefully for other signs ofactive disease, such as a sudden change in mental status. Perform frequent abdominal assessments to determinedistention and tenderness on palpation. Check stools for occult or frank bleeding.

(Ignatavicius, Donna D.. Medical-Surgical Nursing: Patient-Centered Collaborative Care, SingleVolume, 6th Edition. W.B. Saunders Company, 022009. 64.3.4.1.1.2.2.1).



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Hospital stay for pt with divirticulitis is 2-4 days per complication

For pt with good response to meds, nutrition is next step

Assess pts resources to choose correct diet

Teach pt about incision care and temporary activity limitation

N t iti i t ll b ti t t t


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Nurse-nurtritionist colloboration to encourage pt to:

- eat diet high in hemi- and cellulose fiber

- Wheat Bran; whole grain breads; cereals.

- eat at least 25-35g of fiber per day

- high fiber fresh fruits and vegetables to add bulk to stool

If pt is intolerant:- drink lots of water to decrease bloating

- start diet gradually if high fiber was not common

- use bulk forming laxatives like metamucil to increase fecal size & consistency

- avoid alcohol b/c is cause bowel irritation

- avoid seeds and nuts b/c they could block diverticulum

- fat intake should not exceed 30% of daily caloric intake- when there are symptoms of diverticulitis avoid all fiber

- provide oral and written instructions on insicion care


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