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  1. 1. Diverticulitis Presented By: Burila, John Louise Capili, Jan Bernice Engalla, Wilmar
  2. 2. Diverticulitis <ul><li>Definition: </li></ul><ul><li>Diverticulitis is out pouching of the mucosal lining of the GIT, commonly in the colon </li></ul><ul><li>Diverticula/ diverticulosis are multiple out pouchings </li></ul><ul><li>Diverticulitis is acute inflammation and infection caused by trapped fecal material and bacteria </li></ul>
  3. 3. <ul><li>Complication: </li></ul><ul><li>Peritonitis </li></ul><ul><li>Bowel obstruction </li></ul><ul><li>Fistula formation </li></ul><ul><li>Hemorrhage </li></ul><ul><li>Abscess formation </li></ul><ul><li>  Etiology: </li></ul><ul><li>Precipitating factors: </li></ul><ul><li>Low-fiber diet </li></ul><ul><li>Use of corticosteroids </li></ul><ul><li>Use of NSAIDS </li></ul><ul><li>Predisposing factor: </li></ul><ul><li>Age- most common in older adults (60 up) </li></ul>
  4. 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. 5. Pathophysiology
  6. 6. <ul><li>Laboratory test: </li></ul><ul><li>WBC count </li></ul><ul><li>Urinalysis </li></ul><ul><li>Guiaic testing of the stool </li></ul><ul><li>  </li></ul>Diagnostic studies: <ul><li>Barium Enema </li></ul><ul><li>Abd X-ray </li></ul><ul><li>CT scan </li></ul><ul><li>UTZ Abd </li></ul><ul><li>Flexible sigmoidoscopy or colonoscopy </li></ul><ul><li>Intravenous Pyelogram </li></ul><ul><li>Surgical procedure: </li></ul><ul><li>Two-stage Hartmann procedure </li></ul>
  7. 7. <ul><li>Collaborative Management </li></ul><ul><li>high fiber diet </li></ul><ul><li>liberal fluid intake of 2500 - 3000 mL/day </li></ul><ul><li>avoid nuts and seeds which can become trapped in the diverticula </li></ul><ul><li>bulk - forming laxatives </li></ul><ul><li>curing an acute episode:     </li></ul><ul><li>          bed rest </li></ul><ul><li>        NPO, then clear liquid to rest the bowel </li></ul><ul><li>        avoid high fiver foods to prevent irritation of the mucosa </li></ul><ul><li>        IVF's, antibiotics, analgesics, anticholinergics (Pro - Banthine) </li></ul><ul><li>        NGT insertion to relieve distention </li></ul><ul><li>weight loss to reduce intraabdominal pressure </li></ul>
  8. 8. <ul><li>Patients with mild symptoms abdominal pain due to muscular spasm in the area of the diverticula may benefit from anti-spasmodic drugs such as: </li></ul><ul><li>chlordiazepoxide (Librax) </li></ul><ul><li>dicyclomine (Bentyl), </li></ul><ul><li>atropine, scopolamine, phenobarbital (Donnatal), and hyoscyamine (Levsin). </li></ul><ul><li>Oral antibiotics are sufficient when symptoms are mild. Some examples of commonly prescribed antibiotics include: </li></ul><ul><li>  ciprofloxacin (Cipro) </li></ul><ul><li>metronidazole (Flagyl) </li></ul><ul><li>cephalexine (Keflex) </li></ul><ul><li>Doxycycline (Vibramycin). </li></ul><ul><li>  </li></ul>
  9. 9. Nursing Management <ul><li>Impaired tissue integrity r/t gastrointestinal (colon) obstruction as evidenced by diverticula </li></ul><ul><li>Nursing Interventions </li></ul><ul><ul><li>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) </li></ul></ul><ul><ul><li>Take temperature every 4 hours. (Elevation greater than 38.3  C may indicate an increase in the severity of the disease. </li></ul></ul><ul><ul><li>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. </li></ul></ul><ul><ul><li>Assess for evidence of lower intestinal bleeding by visual examination and guiaic testing of stools for occult blood. </li></ul></ul><ul><ul><li>Maintain IVF, TPN, and accurate intake and output records. </li></ul></ul><ul><ul><li>Give antibiotic as indicated. </li></ul></ul>
  10. 10. Nursing Management <ul><li>Altered Comfort: Acute Pain r/t out pouching colon and stimulation of the diverticula during abdominal contraction </li></ul><ul><li>Nursing Interventions </li></ul><ul><li>      Describe the characteristics of pain, frequency, intensity, location, and duration. </li></ul><ul><li>     Provide emotional support and comfortable measures to the client. </li></ul><ul><li>      Provide pain management. </li></ul><ul><li>      Give analgesics as indicated. </li></ul><ul><li>Anxiety r/t possible surgery of the diverticula </li></ul><ul><li>   Nursing Interventions </li></ul><ul><li>      Monitor emotional reaction and anxiety level of the patient. </li></ul><ul><li>      Explain the treatment regimen and plan of care to the patient/SO. </li></ul><ul><li>      Discuss to the patient and SO the need for surgery of the patient’s condition and its possible complications. </li></ul><ul><li>      Provide collaborative management of the patient’s medical management. </li></ul><ul><li>      Provide comfort to the patient </li></ul>
  11. 11. Nursing Management <ul><li>Risk for Nutritional Imbalance: less than body requirement r/t impaired nutritional absorption secondary to disease process </li></ul><ul><li>            Nursing Interventions </li></ul><ul><li>Provide adequate nutrition to the patient such foods high in fiber. </li></ul><ul><li>Include the use of TPN in nutritional management of the patient. </li></ul><ul><li>Weight the patient to determine the deviation of the patient nutritional status. </li></ul><ul><li>Refer to dietician for appropriate plan of nutritional treatment to the patient. </li></ul>