Nursing Diagnosis Care Plans for Diverticulitis

Diverticular disease encompasses a spectrum of conditions related to diverticula, which are bulging pouches that can form in the lining of the colon. Diverticulosis refers to the presence of these pouches and often presents without noticeable symptoms. However, when these diverticula become inflamed or infected, the condition progresses to diverticulitis, characterized by a range of symptoms. While diverticula can develop anywhere in the digestive tract, they are most frequently found in the sigmoid colon, particularly where the intestinal walls are weaker.

This article will explore the essential aspects of nursing care for patients with diverticulitis, focusing on nursing assessments, interventions, and care plans to effectively manage this condition.

Nursing Process in Diverticulitis Care

The primary goal in treating diverticulitis is to allow the colon to heal by reducing inflammation. Treatment strategies vary based on the severity of the condition. Some patients with mild diverticulitis can be effectively managed at home with oral antibiotics, pain relievers, rest, and a clear liquid diet. However, more severe cases necessitate hospitalization.

Surgical intervention becomes necessary for patients experiencing recurrent diverticulitis or complications. Surgery typically involves removing the affected segment of the colon followed by reconnecting the healthy sections (primary anastomosis). In situations where primary anastomosis is not feasible, a temporary diverting colostomy might be created. This allows the colon to heal, and subsequently, the colostomy is reversed to restore normal bowel continuity.

Patient education plays a crucial role in managing diverticulitis. Nurses are responsible for providing patients with comprehensive information about their condition, dietary guidelines, and fluid intake recommendations. A thorough understanding of the disease process and diligent adherence to the treatment plan are essential for preventing complications and future flare-ups.

Comprehensive Nursing Assessment for Diverticulitis

The initial step in providing nursing care is a thorough nursing assessment. This involves gathering comprehensive data encompassing the patient’s physical, psychosocial, emotional, and diagnostic aspects. This section will detail the subjective and objective data relevant to patients with diverticulitis.

Reviewing Patient Health History

1. Inquire about General Symptoms:
Diverticulosis is often asymptomatic. However, some individuals might report symptoms that overlap with other gastrointestinal issues, such as:

• Abdominal cramps
• Tenderness in the affected area
• Abdominal swelling or bloating
• Difficulty with bowel movements (constipation)

Diverticulitis symptoms are more pronounced and may include:

• Acute abdominal pain
• Abdominal distention
• Reduced or absent bowel sounds
• Nausea and vomiting
• Chills
• Constipation or diarrhea
• Rectal bleeding

2. Investigate Changes in Bowel Habits:
Changes in bowel habits, such as frequency or consistency, are significant indicators. Patients may experience nausea and vomiting, potentially due to bowel obstruction.

3. Identify Risk Factors:

• Non-modifiable Risk Factors:

  • Ethnicity: Diverticulosis is highly prevalent in Western populations.
  • Age: The incidence of diverticular disease increases significantly after age 40.

• Modifiable Risk Factors:

  • Smoking: Smoking elevates diverticulitis risk by reducing mucus production in the colon.
  • Physical Inactivity: Regular physical activity is associated with a lower risk of diverticular disease and its complications.
  • Diet: A low-fiber, high-fat diet contributes to bowel strain and constipation, increasing the risk of diverticulosis and diverticulitis.
  • Obesity: Obesity is linked to chronic inflammation and changes in gut bacteria, increasing diverticulitis risk.

4. Assess NSAID Use: Regular use of aspirin or NSAIDs has been linked to a higher risk of diverticulitis and diverticular bleeding.

Physical Examination

1. Monitor Body Temperature: Fever, typically 100.4°F (38.0°C) or higher, is common in diverticulitis due to infection.

2. Abdominal Palpation: Inflammation of the peritoneum causes tenderness upon palpation, especially in the left lower quadrant, the common site of diverticulitis pain. The presence of an abscess might be felt as a mass. In cases of bowel wall perforation, symptoms like rigidity, guarding, and rebound tenderness may be present.

3. Auscultate Bowel Sounds: Bowel sounds may be normal or hypoactive.

4. Rectal Examination: This helps assess the rectal mucosa and check for rectal bleeding, a potential sign of diverticulitis.

Diagnostic Procedures

1. Incidental Discovery of Diverticulosis: Diverticulosis is often found incidentally during routine colonoscopies or abdominal scans as it’s usually asymptomatic.

2. Stool Sample Analysis: Stool samples are analyzed to rule out bacterial or parasitic infections as causes of symptoms like abdominal pain, bloody stools, or diarrhea.

3. Laboratory Blood Tests:

• Complete Blood Count (CBC): Evaluates for infection (elevated white blood cell count – leukocytosis) or bleeding (low hemoglobin).
• C-Reactive Protein (CRP): Elevated CRP indicates inflammation.

4. Imaging Studies: Imaging techniques visualize the bowel for inflammation and complications.

• Computed Tomography (CT) Scans: Highly effective in identifying inflamed diverticula and assessing disease severity.

Alt text: CT scan image revealing inflamed diverticula in the colon, a key diagnostic tool for diverticulitis.

• Barium Enema: Involves barium contrast to enhance X-ray visibility of the colon.
• Ultrasonography: Less sensitive than CT scans but can still diagnose diverticulitis, although it might miss larger abscesses.

5. Colon Visualization:

• Colonoscopy: Confirms diverticulitis by directly visualizing inflammation within the colon. Recommended 6-8 weeks post-symptom resolution to rule out other conditions like cancer or colitis.
• Sigmoidoscopy: Visualizes the sigmoid colon and rectum, the most common sites for diverticula.

Nursing Interventions for Diverticulitis

Nursing interventions are critical for patient recovery. The following sections outline key nursing interventions for patients with diverticulitis.

Managing Inflammation

1. No Specific Treatment for Diverticulosis: Asymptomatic diverticulosis typically requires no specific treatment. Current guidelines suggest that mild diverticulitis may be managed at home with bowel rest.

2. Preventative Measures for Inflammation: A high-fiber diet is crucial for preventing diverticulitis by promoting regular bowel movements and reducing strain on the colon. Encourage consumption of fruits, vegetables, and whole grains.

3. Bowel Rest: For uncomplicated diverticulitis, bowel rest is often prescribed. This involves a clear liquid diet for a few days, with a gradual transition back to solid foods as symptoms improve.

Supporting Medical Treatment

1. NPO Status: Complicated diverticulitis often requires complete bowel rest (NPO). Total parenteral nutrition (TPN) may be necessary to provide nutritional support.

2. Antibiotic Administration: Oral antibiotics are prescribed to treat bacterial infections, typically targeting gram-negative and anaerobic bacteria. Common regimens include quinolones (ciprofloxacin) or sulfa drugs (trimethoprim/sulfamethoxazole) combined with metronidazole or amoxicillin-clavulanate, usually for 7-10 days. Hospitalization and intravenous antibiotics are required for complicated cases like bowel perforation.

3. Surgical Preparation: Complicated diverticulitis may lead to peritonitis, fistulas, or bowel perforation, necessitating surgery. Bowel resection is often performed laparoscopically; however, severe inflammation may require a temporary colostomy.

4. Abscess Drainage Assistance: Abscesses may form in the intestines due to diverticulitis. Percutaneous drainage, involving a catheter inserted into the abscess to drain pus, may be required.

Preventing Recurrence

1. Dietary Modifications: A high-fiber diet is essential for maintaining soft stools and preventing constipation. Recommend foods like fresh fruits and vegetables, whole grains, and beans. Limit red meat intake.

2. Hydration: Adequate water and fluid intake is crucial as fiber absorbs water, helping to soften stools.

3. Exercise and Weight Management: Overweight and obese individuals have a higher risk of recurrent and complicated diverticulitis. Encourage regular exercise to help patients achieve and maintain a healthy body weight.

4. Smoking Cessation: Smoking increases the risk of complicated diverticulitis and worsens outcomes.

5. Re-evaluation of Nut and Seed Avoidance: Current research suggests that avoiding nuts, seeds, and popcorn is not necessary for reducing recurrence risk, contrary to previous beliefs.

6. Fiber and Probiotic Supplements: Fiber supplements like psyllium (Metamucil) can help increase fiber intake. Probiotic supplements may also be beneficial in preventing recurrences.

Nursing Care Plans for Diverticulitis

Once nursing diagnoses are identified, nursing care plans guide the prioritization of assessments and interventions to achieve both short-term and long-term care goals. Here are examples of nursing care plans for diverticulitis, focusing on common nursing diagnoses.

Nursing Care Plan for Acute Pain

Acute pain in diverticulitis can be severe and sudden or develop gradually. It’s typically located in the left lower abdomen, often described as sharp and constant, and may radiate to the back, side, groin, and legs.

Nursing Diagnosis: Acute Pain related to disease process and inflammatory process.

Defining Characteristics:

• Diaphoresis
• Distraction behavior
• Reports of abdominal pain/tenderness
• Facial grimacing
• Guarding behavior
• Positioning to ease pain
• Protective behavior

Desired Outcomes:

• Patient will report a significant reduction in pain, evidenced by stable vital signs and absence of restlessness and guarding.

Nursing Assessment:

1. Assess Pain Characteristics: Evaluate pain intensity, location, and characteristics (sharp, constant). Ask the patient to rate their pain on a pain scale and identify aggravating or relieving factors.
2. Review Diagnostic Results: Assess laboratory results (WBC, ESR, CRP) and imaging (CT scan) to understand the extent of inflammation and infection.

Nursing Interventions:

1. Administer Medications: Provide prescribed antibiotics for infection and analgesics for pain relief.
2. Dietary Management: If not NPO, provide a clear liquid or soft diet to reduce bowel stimulation and inflammation.
3. Promote Rest: Encourage bed rest to reduce intra-abdominal pressure and pain. Advise against activities that increase intra-abdominal pressure, such as heavy lifting or straining during bowel movements.
4. Non-pharmacological Pain Relief: Implement non-pharmacological methods like distraction, music therapy, guided imagery, and relaxation techniques to complement medication.
5. Prepare for Surgery: If surgical intervention is needed, provide preoperative education and preparation.

Nursing Care Plan for Constipation

Constipation is a frequent symptom in diverticulitis, often stemming from low fiber intake, which leads to increased pressure in the colon and diverticula formation.

Nursing Diagnosis: Constipation related to insufficient fiber intake, insufficient fluid intake, and decreased physical activity.

Defining Characteristics:

• Straining with defecation
• Sensation of anorectal obstruction
• Sensation of incomplete evacuation
• Hard stools
• Need for manual stool evacuation
• Infrequent bowel movements
• Rectal bleeding

Desired Outcomes:

• Patient will report passing stool without straining.
• Patient will achieve bowel movements at least every three days.

Nursing Assessment:

1. Assess Fiber and Fluid Intake: Evaluate dietary habits to identify deficiencies in fiber and fluid intake.
2. Assess Bowel Habits: Determine the patient’s typical bowel patterns, frequency, and consistency of stools.

Nursing Interventions:

1. Bowel Habit Diary: Encourage the patient to keep a diary to track bowel movements, including time, frequency, consistency, and any straining.
2. Promote High-Fiber Diet: Educate and encourage the consumption of high-fiber foods, such as fruits, vegetables, whole grains, and legumes.

Alt text: Image displaying a variety of high-fiber foods recommended for patients with diverticulitis to promote bowel regularity.

3. Increase Fluid Intake: Encourage a daily intake of at least 1.5 liters of fluids, unless contraindicated.
4. Encourage Physical Activity: Promote physical activity as tolerated to stimulate bowel peristalsis.
5. Bowel Training Education: Educate on proper bowel habits, emphasizing not suppressing the urge to defecate and ensuring adequate time and privacy for bowel movements.
6. Stool Softeners/Laxatives: Consider the use of stool softeners or laxatives as needed to manage chronic constipation.

Nursing Care Plan for Diarrhea

Diarrhea can also occur in diverticulitis due to the inflammatory and infectious processes, leading to changes in bowel habits.

Nursing Diagnosis: Diarrhea related to disease process, infectious process, and inflammatory process.

Defining Characteristics:

• Abdominal pain and cramping
• Bowel urgency
• Hyperactive bowel sounds
• Dehydration

Desired Outcomes:

• Patient will exhibit formed stools without bowel urgency.
• Patient will verbalize strategies to prevent dehydration during episodes of diarrhea.

Nursing Assessment:

1. Assess Defecation Pattern and Stool Characteristics: Evaluate the frequency, consistency, and characteristics of stools. Investigate any changes in bowel habits, rectal bleeding, and abdominal discomfort.
2. Evaluate Stool Tests: Review stool test results to identify potential infections or other causes of diarrhea.
3. Review CT Scan Results: Assess CT scan findings to confirm diverticulitis and evaluate severity.
4. Monitor for Dehydration: Assess for signs of dehydration, such as tachycardia, hypotension, dry mucous membranes, and poor skin turgor.

Nursing Interventions:

1. Administer Medications: Provide prescribed antidiarrheals and antibiotics as indicated.
2. Liquid Diet: Implement a liquid diet initially to allow bowel rest and healing, gradually reintroducing solid foods as symptoms improve.
3. Dietary Instructions: Advise on adjusting fiber intake; reducing fiber intake during diarrhea episodes and resuming a high-fiber diet once resolved.
4. Monitor Fluid and Electrolytes: Closely monitor fluid intake and output, hydration status, and electrolyte levels to prevent imbalances.
5. Fluid Replacement: Encourage oral fluid intake or administer IV fluids as prescribed to maintain hydration.

Nursing Care Plan for Imbalanced Nutrition: Less Than Body Requirements

Nutritional management is crucial in diverticulitis, particularly addressing the common issue of low fiber intake.

Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to inability to absorb nutrients due to inflammatory response, abdominal pain, and altered bowel habits.

Defining Characteristics:

• Difficulty swallowing (if related to general malaise)
• Insufficient dietary intake
• Inadequate fluid intake
• Poor appetite
• Knowledge deficit regarding nutritional needs

Desired Outcomes:

• Patient will maintain stable weight and identify appropriate food choices for diverticulitis management.

Nursing Assessment:

1. Assess Nutritional Habits: Evaluate dietary intake, preferences, and habits to identify nutritional deficiencies.
2. Review Laboratory Values: Monitor prealbumin and albumin levels as indicators of nutritional status and inflammatory response.
3. Identify Barriers to Adequate Nutrition: Assess for factors hindering adequate nutrition, such as financial constraints, lack of appetite, or insufficient nutritional knowledge.

Nursing Interventions:

1. Parenteral Nutrition: Provide parenteral nutrition as indicated for patients who are NPO or severely malnourished.
2. Medication Administration: Administer antiemetics and pain medications before meals to improve appetite and reduce discomfort.
3. Food Preference Identification: Incorporate patient food preferences when planning dietary changes to enhance adherence.
4. Nutritional Education: Educate the patient about the importance of a high-fiber diet and appropriate food choices for diverticulitis.
5. Fiber Supplements: Consider fiber supplements like Metamucil to augment dietary fiber intake, avoiding use during acute flares.

Nursing Care Plan for Ineffective Tissue Perfusion

Inflammation in diverticulitis can lead to complications that compromise tissue perfusion, such as obstruction or perforation.

Nursing Diagnosis: Ineffective Tissue Perfusion related to disease process, inflammatory process, and potential complications like obstruction and abscess formation.

Defining Characteristics:

• Abdominal tenderness and cramping
• Abdominal distension or bloating
• Constipation
• Decreased or absent bowel sounds
• Nausea and vomiting

Desired Outcomes:

• Patient will not experience severe abdominal pain or swelling.
• Patient will remain free from gastrointestinal tissue perfusion complications such as intestinal perforation, obstruction, and peritonitis.

Nursing Assessment:

1. Assess Elimination Patterns and Bowel Sounds: Monitor bowel sounds for hypoactivity or absence, and assess for constipation.
2. Monitor Signs and Symptoms: Closely monitor for worsening symptoms, especially chills, fever, nausea, and vomiting, which may indicate complications.
3. Abdominal Assessment: Assess for abdominal distension and tenderness, noting any signs of peritoneal irritation like muscle spasm, rebound tenderness, or guarding.

Nursing Interventions:

1. Monitor Laboratory Studies: Track WBC count, CRP levels, hemoglobin, and hematocrit to assess infection, inflammation, and bleeding.
2. Monitor Vital Signs: Regularly monitor vital signs for indicators of complications like bleeding, perforation, peritonitis, or shock.
3. Administer Medications: Provide antibiotics, analgesics, and IV fluids as prescribed to manage infection, pain, and maintain hemodynamic stability.
4. Educate on Bowel Rest: Emphasize the importance of bowel rest in reducing intestinal inflammation.
5. Prepare for Surgery: Prepare the patient for potential surgical interventions if serious complications like peritonitis, perforation, or obstruction occur.

References

References from the original article would be listed here.