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Nursing 172 > Week 12: Chp 58: Diverticulitis > Flashcards

Week 12: Chp 58: Diverticulitis Flashcards

1
Q

Diverticulum

A

a small, pouch-like protrusion or herniation, most often occurring in the gastrointestinal tract, particularly in the colon
-occurs most frequently in the left colon, most commonly sigmoid colon

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2
Q

A diverticulum is thought to be related to what?

A

a lack of fiber in the diet, obesity, and lack of physical acitivity

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3
Q

Risk Factors

A
  • increasing age
  • obesity
  • smoking
  • low-fiber diet
  • heredity
  • some medications (NSAIDs, acetaminophen, oral corticosteroids, and opiates)
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4
Q

Patients with diverticulitis should not comsume what?

A

whole pieces of fiber such as seeds, corn, and nuts

-these undigested fragments can become lodged in the diverticulum and induce an episode of diverticulitis

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5
Q

Where is Diverticulitis generally located?

A

extraluminal, occurring on the outside of the colon (outpouching)

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6
Q

Diverticulosis

A

the presence of diverticula that are not inflamed

-are asymptomatic and may not even know they have this condition

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7
Q

What is diverticulitis

A

inflammation and/or infection of diverticula

  • most often occurs in the colon, most commonly sigmoid colon
  • acute or chronic
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8
Q

Pathophysiology of Diverticulitis

A

when a patient has diverticula, the colon wall thickens and becomes rigid; without adequate fiber intake, more water is absorbed from the stool; this slows transit time and makes it more difficult for the stool to pass through the colon; this then cause increased intraluminal pressure from constipation and straining, which is thought to lead to the formation of diverticula

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9
Q

What does dietary fiber do?

A

thought to act by producing a larger, bulkier stool that results in a wider-bore colon, which is less likely to develop diverticula

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10
Q

Diverticula seem to occur at points of what in the intestinal wall?

A

points of weakness in the intestinal wall

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11
Q

Fecalith

A

mass or dried, hard, concrete-like stool

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12
Q

How does Fecalith develop?

A

food can become entrapped in the diverticula, and when it mixes with normal bacterial flora, this leads to decreased blood supply forming fecalith

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13
Q

What happens to the diverticular wall from fecalith?

A

the diverticular wall is eroded by increased intraluminal pressure or hard, dried food particles
-this process leads to inflammation and/or infection; the inflammation can spread to other areas of the intestine

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14
Q

Why is the sigmoid colon more frequent to herniation?

A

because it is the segment with the smallest diameter, and increased intraluminal pressure may predispose the area to more frequent herniation

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15
Q

Chronic Diverticulitis

A

the bowel can become scarred, leading to narrowing of the lumen, and the patient may develop an intestinal obstruction

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16
Q

Clinical Manifestations

A
  • complain of abdominal pain over the area that is involved, usually sigmoid colon (LLQ)
  • may experience fever or leukocytosis (WBC above normal range), and often a palpable mass felt over involved areas
  • complain of increased flatus, anorexia, abdominal bloating/ distension, and diarrhea or constipation
  • stools may contain mucus and blood
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17
Q

Why would you have bloody stool?

A

bleeding occurs because of inflammation near areas of blood vessels and may range from minor to severe

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18
Q

Older adult patients and clinical manifestations

A

may present afebrile with normal WBC count and minimal abdominal tenderness

  • first sign may be a change in mental status
  • increased confusion, falling, and anorexia
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19
Q

If perforation has occurred, the patient may present with?

A

clinical manifestations of sepsis

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20
Q

If peritonitis (inflammation of the peritoneum) has occurred, what will the patient display?

A

profound guarding with widespread rebound tenderness

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21
Q

Most Common diagnostic Tests

A
  • plain flat-plate abdominal x-rays
  • usually confirmed with a CT scan
  • elevated WBC
  • urinalysis may show a few RBCs if ureter is near a perforated diverticulum
22
Q

Uncomplicated Diverticulitis Treatment

A

uncomplicated diverticulitis may be treated on an outpatient basis with broad-spectrum antibiotics for 7-10 days but should be reassessed after 2-3 days of therapy
-consume a clear liquid diet until symptoms subside, then advanced slowly

23
Q

Common antibiotics used to treat diverticulitis

A
  • Ciprofloxacin and metronidazole
  • trimethoprim-sulfamethoxazole and metronidazole
  • amoxicillin-clavulanate
  • Augmentin
  • Moxifloxacin
24
Q

When should the patient be admitted to the hospital?

A
  • fever higher than 102.5 F
  • microperforation (few air bubbles outside the colon or confined to the pelvis)
  • immunosuppression
  • significant leukocytosis
  • severe abdominal pain or diffuse peritonitis
  • advanced age
  • significant comorbidities
  • intolerance of oral intake
  • noncompliance or failed outpatient treatment
25
Q

Dietary restrictions for acute uncomplicated diverticulitis?

A

no restrictions

-although, limiting to clear liquid diet for 2 to 3 days is common

26
Q

What happens when a person is being admitted to the hospital with diverticulitis?

A
  • IV fluids are started and is NPO to allow the bowel to rest
  • may have a nasogastric (NG) tube for bowel decompression and will receive parenteral antibiotics
  • pain medications PRN and opiates are frequently needed
27
Q

What should be avoided in a patient with diverticulitis?

A

laxatives and enemas because they increase intestinal motility

28
Q

When is an inpatient discharged?

A

as clinical manifestations resolve and they should complete a course of 10 to 14 days of antibiotics, then have a follow up examination
-after manifestations completely resolve, patient is recommended to have a colonoscopy to assess extent of the diverticular disease

29
Q

When is surgical Management needed?

A

failure of medial management

30
Q

Indications for surgery

A

perforation, obstruction, abscess formation which is not responding to antibiotic treatment, or fistula formation between the colon and another pelvic organ
-if patients develop complications, they may require surgery to remove the diseased portion of the colon; may have a temporary colostomy because re-anastomosis 3 to 6 months later is usually successful

31
Q

Complications of Diverticulitis

A

perforation, microperforation, abscess and fistula formation, bowel obstruction, and bleeding
-inflammation can also result in fistulas to other organs

32
Q

Nursing Management: Assessment and Analysis (what the patient presents with)

A
  • Fever ranging from low-grade (101 F) due to inflammation
  • tachycardia often accompanies increased temperature
  • pain in LLQ or midabdomen depending on what area of colon is involved; if abdominal pain is generalized, the diverticula may have ruptured, and peritonitis should be suspected
  • altered bowel habits (constipation, diarrhea, or both)
  • increased flatus and anorexia
  • elevated WBC
33
Q

Peritonitis

A

Peritonitis is inflammation of the peritoneum — a silk-like membrane that lines your inner abdominal wall and covers the organs within your abdomen — that is usually due to a bacterial or fungal infection.

34
Q

Nursing Diagnoses

A
  • acute pain r/t inflammation and distension of the colon

- knowledge deficit r/t the need to consume adequate fiber in the diet

35
Q

Nursing Interventions: Assessment

A
  • vital signs
  • serum potassium levels
  • intake and output
  • pain
  • mental status in older adults
36
Q

Assessment: Vital Signs

A
  • fever accompanies diverticulitis, ranging from a low-grade fever (101 F) because of inflammation
  • Tachycardia accompanies increased temperature secondary to an increase in insensible fluid loss due to fever
37
Q

Assessment: Serum Potassium levels

A

if the patient has intermittent NG suction, potassium loss increases and requires monitoring and replacement if levels are below 3.5 mEq/L

38
Q

Assessment: Intake and Output

A

fluid volume status may be impacted by NG suction and decreased intake
-important to monitor urine output to determine renal perfusion

39
Q

Assessment: Pain

A

pain accompanies diverticulitis, usually in the LLQ or midabdomen depending on what area of the colon is involved

  • if abdominal pain is generalized, the diverticula may have ruptured, and peritonitis should be suspected
  • opioid analgesics are frequently required but should be used with caution in older adults because of the mental status change that may occur
40
Q

Assessment: Mental Status in Older Adults

A

older adults do not always show classic signs of infection

-the first changes observed may be changes in mental status

41
Q

Nursing Actions

A
  • administer IV fluids
  • administer ordered antibiotics
  • nasogastric tube to low intermittent suction
  • provide oral care
42
Q

Actions: administer IV fluids

A

patients are often NPO during the acute phase to allow the bowel to rest, and fluid balance must be maintained

43
Q

Actions: administer ordered antibiotics

A

diverticulitis is a localized infection

-antibiotics are administered until pain, inflammation, infection, and fever subside

44
Q

Action: Nasogastric tube to low intermittent suction

A

gastric decompression decreases gastric motility and allows the bowel to rest until inflammation decreases

45
Q

Action: provide oral care

A

oral cavity may be dry due to insensible fluid loss, as well as increased mouth breathing in a patient with an NG tube
-apply lip balm to dry cracked lips

46
Q

Nursing Teachings

A
  • dietary recommendation
  • avoid straining, bending, and lifting
  • weight reduction
  • complete antibiotic therapy as prescribed
47
Q

Teaching: Dietary recommendation

A

increase fiber from raw fruits and vegetables in their diet; without adequate fiber intake, more water is absorbed from the stool; this slows transit time and makes it more difficult for the stool to pass through the colon; this then causes increased intraluminal pressure from constipation and straining, which is thought to lead to the formation of diverticula
-important to note that patients should not increase their fiber during acute phases, and the diverticulitis should be resolved

48
Q

Teaching: Avoid straining, bending, and lifting

A

increase intra-abdominal pressure, which can lead to further outpouching of the diverticula

49
Q

Teaching: weight reduction

A

obesity has been linked to increase intra-abdominal pressure, which is a risk factor for diverticulitis

50
Q

Teaching: Complete antibiotic therapy as prescribed

A

adherence to antibiotic therapy is crucial, and the nurse should stress to the patient who is being treated in an outpatient setting about the importance of taking all the medication as prescribed
-rebound infection can occur when the prescribed dose of antibiotics is not taken

51
Q

Evaluating Care Outcomes

A
  • may be hospitalized for antibiotic therapy and bowel rest
  • will be free of abdominal pain and fever prior to discharge
  • maintaining adequate fiber in the diet may decrease recurrence or the severity of bouts of diverticulitis
52
Q

Intervention appropriate for the patient admitted to the hospital with Diverticulitis?

A

antibiotics, IV fluids, NPO, NG tube, pain medications

Nursing 172 (120 decks)

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