1. DIVERTICULOSIS AND DIVERTICULITIS
Kim Eastman RN, MSN, CNS

2. DIVERTICULAR DISEASE
NORMAL ANATOMY
LARGE INTESTINE

3. Diverticula

4. Difference between Diverticulosis and Diverticulitis

5. 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

6. 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.

7. 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

8. 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

9. DIVERTICULAR DISEASE
INTERVENTIONS
PRIMARY
ENCOURAGE A HIGH FIBER DIET

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

11. 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

12. 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

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

14. DIVERTICULAR DISEASE TERTIARY INTERVENTIONS
DIETS HIGH IN FIBER, 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