DIVERTICULOSIS AND DIVERTICULITIS Kim Eastman RN, MSN, CNS

DIVERTICULAR DISEASE NORMAL ANATOMY LARGE INTESTINE

Diverticula

Difference between Diverticulosis and Diverticulitis

DIVERTICULAR DISEASE OVERVIEW PATHOPHYSIOLOGY STRESSORS MUCOSA HERNIATES THROUGH THE MUSCLE WALL AT WEAK POINTS FOOD AND BACTERIA BECOME TRAPPED AND FORM A HARD MASS CALLED A FECALITH STRESSORS AGE REFINED FOODS

DIVERTICULAR DISEASE ASSESSMENT HISTORY MOST PATIENTS ARE ASYMPTOMATIC DIVERTICULITIS OR DIVERTICULUM HEMORRHAGE PAIN LEFT LOWER QUADRANT PAIN FEVER N & V DIARRHEA OR CONSTIPATION PHYSICAL ASSESSMENT ABDOMINAL DISTENTION TENDERNESS OVER THE LEFT LOWER QUADRANT.

DIVERTICULAR DISEASE ENDOSCOPIC ASSESSMENT LABORATORY ASSESSMENT ROUTINE COLONOSCOPY LABORATORY ASSESSMENT CBC H&H AND WBC STOOL FOR OCCULT BLOOD X RAY ASSESSMENT CT SCAN ABDOMINAL FILMS ABDOMINAL ULTRASOUND

DIVERTICULAR DISEASE ANALYSIS/NURSING DIAGNOSIS TISSUE INTEGRITY, IMPAIRED R/T ACUTE INFLAMMATORY PROCESS EXPECTED OUTCOMES: NORMAL INTESTINAL TISSUE WITHOUT SIGNS OF BLEEDING PAIN, ACUTE R/T DIVERTICULITIS AND POSSIBLE RUPTURED DIVERTICULUM EXPECTED OUTCOME: MAINTAIN COMFORT BETWEEN 0-2 ON THE STANDARD PAIN SCALE; NO PAIN BEHAVIORS EVIDENT, NO PAIN OR TENDERNESS ON PALPATION OF THE ABDOMEN

DIVERTICULAR DISEASE INTERVENTIONS PRIMARY ENCOURAGE A HIGH FIBER DIET

DIVERTICULAR DISEASE SECONDARY INTERVENTIONS MILD DISEASE REST DRUG THERAPY DIETARY MODIFICATIONS CLEAR LIQUIDS LOW FIBER DIET ACUTE DISEASE HOSPITAL ADMISSION NPO IV NG TUBE

DIVERTICULAR DISEASE SECONDARY INTERVENTIONS DRUG THERAPY BROAD SPECTRUM ANTIBIOTICS MILD ATTACKS – PO MEDS FLAGYL (METRONIDAZOLE) & CIPRO (CIPROFLOXACIN) BACTRIM (TRIMETHOPRIM-SULFAMETHOXAZOLE) HOSPITALIZED PATIENTS –IV MEDICATIONS PAIN MEDICATIONS – PO OR IV OPIOID MEDICATIONS TALWIN BULK FORMING AGENTS METAMUCIL STOOL SOFTENERS LAXATIVES AND ENEMAS ARE AVOIDED

DIVERTICULAR DISEASE SECONDARY INTERVENTIONS SURGICAL MANAGEMENT APPROXIMATELY 20-30% OF PATIENTS REQUIRE SURGICAL INTERVENTION RUPTURE OF THE DIVERTICULUM WITH PERITONITIS PELVIC ABSCESS BOWEL OBSTRUCTION FISTULA PERSISTENT FEVER OR PAIN UNCONTROLLED BLEEDING

DIVERTICULAR DISEASE SECONDARY INTERVENTIONS SURGICAL MANAGEMENT MOST COMMON COLON RESECTION, WITH OR WITHOUT A COLOSTOMY

DIVERTICULAR DISEASE TERTIARY INTERVENTIONS DIETS HIGH IN FIBER, 25-30 GM / DAY LOW FIBER DIET DURING ACUTE ILLNESS AND HIGH FIBER WHEN SYMPTOMS HAVE SUBSIDED METAMUCIL INCREASE FLUID INTAKE TEACH PATIENTS OSTOMY CARE AS NEEDED REFER TO COMMUNITY VOLUNTEERS