Michael Emory
MTCC PNE / 2014 / PM
1-27-2014
Diverticulitis
Diverticulitis is an inflammation of a diverticulum or of diverticula (multiple) in theintestinal tract, especially the colon, and most often in the sigmoid colon. It can result when food and bacteria retained in a diverticulum produces infection and inflammation that can impede drainage and can lead to perforation or abscess formation.( Lippincott Williams & Wilkins, 2013. Print. ). A diverticulum is a small sac-like out-pouching of mucosal and sub-mucosal layers of the colonic wall. In most cases there are more than one diverticulum and although these diverticula can form anywhere, including in your esophagus, stomach and small intestine, most occur in your large intestine. The presence of multiple diverticulum (diverticula) in the colon with no symptoms or inflammation issues is referred to as diverticulosis, however only a small percentage of persons with diverticulosis develop diverticulitis. Because these pouches seldom cause any problems, you may never know you have them. However when they do become inflamed, it often spreads to the surrounding bowel wall. In an acute circumstance, an abscess may develop leading to peritonitis, erosion of blood vessels that may produce bleeding, and finally gangrene, accompanied by a perforation could possibly develop. If the condition becomes chronic, constipations worsens, with mucus in the stool, severe abdominal pain, and like intestinal obstruction.( F.A. Davis, 1993 Print).
Diverticulitis is found in approximately 10% of the U.S. population, but is more common inpeople that are over 60 years old, rising to an occurrence of 60% in those over 80 years old. A congenital predisposition is likely when the disorder is present in those under 40 years old.( Lippincott Williams & Wilkins, 2013. Print. ). The exact cause of the formation of these sac-like out-pouches is unknown; however, a diet with a low intake of dietary fiber is considered a major cause of the disease.( Delmar, 2011. Print). Diverticular disease is common in developed or industrialized countries, particularly the United States, England, and Australia where low-fiber diets are common. The disease is rare in countries of Asia and Africa, where people eat high-fiber vegetable diets. Fiber is the part of fruits, vegetables, and grains that the body cannot digest. Both the soluble and insoluble forms of fiber help make stools soft and easy to pass. Fiber also prevents constipation. Constipation makes the muscles strain to move stool that is too hard. It is the main cause of increased pressure in the colon. The excess pressure causes the weak spots in the colon to bulge out and become diverticula. (Web. 28 Jan. 2014).
Treatment for diverticulitis focuses on clearing up the infection and inflammation, resting the colon, and preventing or minimizing complications. An attack of diverticulitis without complications may respond to antibiotics within a few days if treated early. To help the colon rest; bed rest and a liquid diet, along with a pain reliever is the common remedy. An acute attack with severe pain or severe infection may require a hospital stay. Most acute cases of diverticulitis are treated with antibiotics and a liquid diet. The antibiotics are given by injection into a vein. In some cases, however, surgery may be necessary and the affected portion of the bowel is removed. A colon resection is performed and a colostomy may be required, temporarily or possibly long term. ( Lippincott Williams & Wilkins, 2013. Print. ). For most people with diverticulosis, the condition leading up to diverticulitis, eating a high-fiber diet is the only treatment required. Fiber keeps stool soft and lowers pressure inside the colon so that bowel contents can move through easily.
Nursing care for patients with diverticulitis covers a wide range of observations, planning, interventions, and evaluation. The focus evolves around the planning and implementation of the maintenance of normal bowel elimination, pain relief, and preventing complications. Patients need to be educated about the disease and its symptoms.
During an acute episode, the nurse should adhere to the prescribed treatment with fluid and electrolyte replacement; and antibiotics, antispasmodics, analgesics, and stool softeners; and nasogastric suction, as prescribed by the health care provider.. The nurse should observe the patient for increasing or decreasing distress and for any adverse reactions to the therapy. Stools should be inspected for mucus, blood, and consistency; the frequency of bowel movements is noted. The patient is assessed for fever, increasing abdominal pain, blood in the stools, and leukocytosis, and for indications of perforation, such as rebound tenderness. The nurse should be aware of signs and symptoms of infection. Rest is prescribed, and the patient is instructed not to lift, strain, bend, cough, or perform other actions that increase intra-abdominal pressure. When the patient resumes a normal diet, stool softeners may be employed. ( F.A. Davis, 1993 Print).
In the nursing in the maintenance of diverticulosis and prevention of diverticulitis, the nurse should encourage a fluid/electrolyte intake of 2 to 3 liters a day and foods that are soft but have increased fiber to promote defecation. An individual exercise program should be encouraged to improve abdominal muscle tone. The nurse should educate the patient to understand the nature of the condition and to recognize signs of on-coming problems. A patient diagnosed with diverticulitis related to diverticulosis should be aware that pain or rigidity in the lower left quadrant, anterior or posterior, may indicate perforation or peritonitis, and should be reported immediately to their health care provider. ( Lippincott Williams & Wilkins, 2013. Print. ).
In summary, patient should be made aware of the advantages of a high fiber diet, appropriate fluid intake and exercise. The patient should be made aware of ways to control internal pressure of the intestines and lower bowels. Because of the potential for developing complex problems, prevention of diverticulosis, which can lead to diverticulitis should be emphasized.
References
White, Lois, Gena Duncan, Wendy Baumle, and Shawn White. Procedures Checklist to Accompany Foundations of Basic Nursing Third Edition Lois White, Gena Duncan, Wendy Baumle. United States: Delmar, 2011. Print.
Thomas, Clayton L., M.D., M.P.H. (1993). Taber's Cyclopedic Medical Dictionary, Edition 18. F.A. Davis, 1993 Print. ISBN 0-8036-0194-8.
Brunner and Suddarth's Textbook of Medical Surgical Nursing, 12th Ed. Fundamentals of Nursing, 7th Ed. Clinical Nursing Skills Video Guide, 2nd Ed. Taylor's Clinical Nursing Skills, 3rd Ed. LWW DocuCare One Year Access North American Edition. N.p.: Lippincott Williams & Wilkins, 2013. Print.
"CRS | Colon Rectal Specialists | Diverticulitis." CRS | Colon Rectal Specialists | Diverticulitis. N.p., n.d. Web. 28 Jan. 2014. .
