Diverticulitis is an inflammation and infection of small pouches called diverticula that form in the lining of the intestines, usually in the colon. It is commonly caused by trapped fecal material and bacteria. Symptoms include crampy lower abdominal pain, fever, and changes in bowel habits. Treatment involves rest, clear liquids, antibiotics, and analgesics. A high fiber diet and fluid intake are recommended for prevention and management of diverticulitis. Nursing care focuses on monitoring for complications, managing pain and nutrition, and health education.

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.