NCLEX Examination.
Practice Question # 632.
nclex
Diverticulitis Review
Diverticulitis is the inflammation of one or more diverticula that occurs from penetration of fecal matter through the thin-walled diverticula; it can result in local abscess formation and perforation.
- A perforated diverticulum can progress to intra-abdominal perforation with generalized peritonitis.
Assessment
- Left lower quadrant abdominal pain that increases with coughing, straining, or lifting
- Elevated temperature
- Nausea and vomiting
- Flatulence
- Cramp-like pain
- Abdominal distention and tenderness
- Palpable, tender rectal mass may be present.
- Blood in the stools
Interventions
- Provide bedrest during the acute phase.
- Maintain NPO status or provide clear liquids during the acute phase as prescribed.
- Introduce a fiber-containing diet gradually, when the inflammation has resolved.
- Administer antibiotics, analgesics, and anticholinergics to reduce bowel spasms as prescribed.
- Instruct the client to refrain from lifting, straining, coughing, or bending to avoid increased intra-abdominal pressure.
- Monitor for perforation (see Box 56-3), hemorrhage, fistulas, and abscesses.
- Instruct the client to increase fluid intake to 2500 to 3000 mL daily, unless contraindicated.
- Instruct the client to eat soft high-fiber foods, such as whole grains; the client should avoid high-fiber foods when inflammation occurs because these foods will irritate the mucosa further.
- Instruct the client to avoid gas-forming foods or foods containing indigestible roughage, seeds, or nuts because these food substances become trapped in diverticula and cause inflammation.
- Instruct the client to consume a small amount of bran daily and to take bulk-forming laxatives as prescribed to increase stool mass.
Surgical interventions
- Colon resection with primary anastomosis may be an option.
- Temporary or permanent colostomy may be required for increased bowel inflammation.
