Diverticulitis Flashcards
Role of RN for inflammation
collaborate for decrease/elimination of inflammation and maintenance/improvement of function
What is diverticula?
saclike herniation of lining of bowels
What is the most common place for diverticulosis to occur?
sigmoid colon; may occur in the entire colon and small bowel
What is diverticulitis?
inflammation of the diverticula.
symptoms of diverticulosis
mostly asymptomatic, history of chronic constipation (irregularity, bloating, distention)
Clinical manifestations of diverticulitis (5)
- left lower quadrant pain/cramps
- bowel irregularity, intervals of diarrhea, nausea, constipation
- narrow stools
- abdominal distension, fatigue, anorexia
- fever, chills
Clinical manifestations of diverticulitis in the elderly
may be asymptomatic, delay for care of fear, overlook blood in the stool
Diverticulitis diagnosis (6)
- colonoscopy (NOT FOR ACUTE DIVERITICULITIS)
- CT w/ contrast
- AXR with free peritoneal air
- elevated WBC, ESR, CRP
- Hg if blood in stool
- urinalysis IF colovesicular fistulas
When is a colonoscopy contraindicated?
acute diverticulitis
What is the test of choice to diagnose diverticulitis?
CT w/ contrast
Complications of diverticulitis (6)
- peritonitis
- abscesses
- fistula formation
- palpable mass
- fever, leukocytosis, abd pain
- bleeding
diverticulitis nursing dx (5)
- acute pain
- activity intolerance
- deficient fluid volume (anorexia, n/v)
- risk for dysfunctional gastrointestinal motility
- risk for infection
Hinchey stage (I), how is it treated
- localized pericolic or mesenteric abscess
- outpatient treatment
Hinchey stage (II), how is it treated
- walled-off pelvic, intra-abdominal, or retroperitoneal abscess
- may need admission
Hinchey stage (III), how is it treated
- generalized purulent peritonitis
- Admission and surgery
Hinchey stage (IV), how is it treated
- generalized fecal peritonitis
- admission and surgery
Conservative therapy for diverticulitis to decrease inflammation and address risk factors (6)
- bedrest
- clear liquid diet –> high fiber low-fat diet
- antibiotics 7-10 days (acute diverticulitis)
- stool softeners, bulk laxatives
- weight reduction, exercise program
- Increased fluid intake
Acute treatment for severe exacerbation of diverticulitis (6)
- Bedrest
- NPO with NG tube suctioning or clear liquid diet
- IV fluids
- broad spectrum IV antibiotics
- pain management with opioids
- low fiber diet until signs of infection decrease
Surgical management for diverticulitis (2 surgeries, post op care, ___ care if present)
- intestinal resection (pre-op antibiotics)
- colostomy
- post op nursing care: similar to GI surgery: IV fluids, antibiotics, NPO to evolving diet, monitor GI, F&R, I&O
- stoma care if preset
Stoma after surgery
-bright red, may be shiny, some blood drainage expected
colostomy care (Pt ed) (4)
- dietary changes
- skin care
- FE balance
- colostomy care
What does secondary peritonitis result from?
it results from the primary disease (ex: diverticulitis)
Peritonitis is caused by _____
a leakage of abdominal organs’ contents
Peritonitis is the leakage of abdominal organ contents possibly from …. (5)
- inflammation
- Infection
- Ischemia
- trauma
- perforation
Assessment and diagnosis of secondary peritonitis (5)
- AXR: free air or fluid, distended bowel loops
- CT, MRI for abcesses
- Increased WBC
- may present decreased H/H
- electrolyte imbalance
complications of secondary peritonitis (4)
- sepsis
- hypovolemia
- Intestinal obstruction
- bowel adhesions
Peritonitis: interventions to decrease inflammation (5)
- pain management and infection control (ABX)
- NPO: NG tube suctioning
- Monitor VS; prevention of shock, infection/sepsis
- FE; acid-base balance; treat nausea
- surgical excision (appendix)/ resection (intestine), repair (perforation), and drainage (abscess)
As peritonitis subsides …. (3)
- softening of abdominal wall
- VSS and toward WNL
- diet advancement
