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Diverticulitis
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Diverticulitis

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our report in MSN 132

our report in MSN 132

Published in: Education

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  • 1. Diverticulitis Presented By: Burila, John Louise Capili, Jan Bernice Engalla, Wilmar
  • 2. Diverticulitis
    • Definition:
    • Diverticulitis is out pouching of the mucosal lining of the GIT, commonly in the colon
    • Diverticula/ diverticulosis are multiple out pouchings
    • Diverticulitis is acute inflammation and infection caused by trapped fecal material and bacteria
  • 3.
    • Complication:
    • Peritonitis
    • Bowel obstruction
    • Fistula formation
    • Hemorrhage
    • Abscess formation
    •   Etiology:
    • Precipitating factors:
    • Low-fiber diet
    • Use of corticosteroids
    • Use of NSAIDS
    • Predisposing factor:
    • Age- 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     Rationale Symptoms
  • 5. Pathophysiology
  • 6.
    • Laboratory test:
    • WBC count
    • Urinalysis
    • Guiaic testing of the stool
    •  
    Diagnostic studies:
    • Barium Enema
    • Abd X-ray
    • CT scan
    • UTZ Abd
    • Flexible sigmoidoscopy or colonoscopy
    • Intravenous 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 Management
    • Impaired tissue integrity r/t gastrointestinal (colon) obstruction as evidenced by diverticula
    • Nursing Interventions
      • 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)
      • Take temperature every 4 hours. (Elevation greater than 38.3  C may indicate an increase in the severity of the disease.
      • Perform an abdominal assessment every 4 to 8 hours or more often as indicated, including measuring abdominal girth, ausculting bowel sounds and palpating the abdomen for tenderness.
      • Assess for evidence of lower intestinal bleeding by visual examination and guiaic testing of stools for occult blood.
      • Maintain IVF, TPN, and accurate intake and output records.
      • Give antibiotic as indicated.
  • 10. Nursing Management
    • Altered Comfort: Acute Pain r/t out pouching colon and stimulation of the diverticula during abdominal contraction
    • Nursing Interventions
    •       Describe the characteristics of pain, frequency, intensity, location, and duration.
    •      Provide emotional support and comfortable measures to the client.
    •       Provide pain management.
    •       Give analgesics as indicated.
    • Anxiety r/t possible surgery of the diverticula
    •    Nursing Interventions
    •       Monitor emotional reaction and anxiety level of the patient.
    •       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 complications.
    •       Provide collaborative management of the patient’s medical management.
    •       Provide comfort to the patient
  • 11. Nursing Management
    • Risk for Nutritional Imbalance: less than body requirement r/t impaired nutritional absorption secondary to disease process
    •             Nursing Interventions
    • Provide adequate nutrition to the patient such foods high in fiber.
    • Include the use of TPN in nutritional management of the patient.
    • Weight the patient to determine the deviation of the patient nutritional status.
    • Refer to dietician for appropriate plan of nutritional treatment to the patient.