Diverticular disease (diverticulosis and diverticulitis) is a group of conditions associated with the presence of diverticula (bulging pouches) in the colon. Diverticulosis is the presence of multiple pouches in the colon and is often asymptomatic. Diverticulitis is when these diverticula become inflamed or infected, causing symptoms.
While diverticula may occur anywhere in the gastrointestinal tract, it is most common in the descending sigmoid colon where there are weak points in the intestinal walls. This condition is common in people over age 40 and the rate increases with age.
Diverticulitis is caused by genetic and environmental factors including constipation, lack of dietary fiber, obesity, smoking, inactivity, excessive alcohol consumption, and NSAID use.
The clinical manifestations of diverticulitis include the following:
- Acute abdominal pain
- Distention
- Fever
- Decreased or absent bowel sounds
- Nausea and vomiting
- Chills
- Constipation
- Rectal bleeding
Diverticulitis can cause erosion of the walls of the bowel, leading to perforation. Other complications can occur such as abscess formation, peritonitis, and bowel obstruction.
Diverticulitis can be discovered during a routine colonoscopy or sigmoidoscopy. CT scans confirm suspected diverticulitis and its severity.
The Nursing Process
The goal of treatment in diverticulitis is to let the colon rest until the inflammation resolves. While some patients can be managed at home with oral antibiotics, analgesics, bed rest, and a clear liquid diet, hospitalization is required for those with severe symptoms.
Surgery may be indicated for those patients with recurring diverticulitis or complications. Surgical intervention often involves the resection of the involved colon with a primary anastomosis. If this is not possible, the patient will have a temporary diverting colostomy. Once the colon heals, the colostomy will be removed and the colons will be reconnected.
Patient education is important for the management of diverticulitis. Nurses should provide patients with accurate information about their condition as well as dietary and fluid requirements. Proper understanding of the disease process and adherence to the treatment plan will prevent complications and exacerbation.
Nursing Care Plans Related to Diverticulitis
Acute Pain Care Plan
Acute pain in diverticulitis is typically severe and occurs suddenly. However, it may be mild and worsen over several days. It usually occurs on the lower left side of the abdomen and is described as sharp and constant, radiating to the back, side, groin, and legs.
Nursing Diagnosis: Acute Pain
Related to:
- Disease process
- Inflammatory process
As evidenced by:
- Diaphoresis
- Distraction behavior
- Reports of abdominal pain/tenderness
- Facial grimacing
- Guarding behavior
- Positioning to ease pain
- Protective behavior
Expected Outcomes:
- The patient will verbalize a significant reduction of pain as evidenced by stable vital signs and absence of restlessness and guarding behavior
Acute Pain Assessment
1. Assess pain characteristics, intensity, and location.
Pain in diverticulitis is described as sharp, constant, and sudden, usually to the lower left quadrant of the abdomen. Ask the patient to rate their pain and identify any precipitating or relieving factors.
2. Assess results of diagnostic imaging and laboratory studies.
Patients with diverticulitis will have elevated white blood cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in their laboratory results. CT scan of the abdomen and pelvis with oral contrast will identify diverticulitis.
Acute Pain Interventions
1. Administer medications as needed.
Antibiotics are prescribed for an infectious process while pain medications will treat the acute pain symptoms.
2. Provide a clear liquid or soft diet as indicated.
If the patient is not NPO, provide a clear liquid diet or soft diet to enable the bowels to rest and reduce inflammation.
3. Encourage bed rest.
Increased intraabdominal pressure can aggravate pain. Avoid activities that can increase intraabdominal pressure like vomiting, bending, wearing tight clothing, heavy lifting, and straining with bowel movements.
4. Provide nonpharmacological pain relief.
Nonpharmacologic pain relief includes distraction, music therapy, imagery, and relaxation. Such techniques can be used to complement the pharmacological treatment of pain.
5. Prepare for surgical intervention as indicated.
Surgical intervention may be indicated to improve the symptoms of diverticulitis. Prepare the patient preoperatively by providing patient education.
Imbalanced Nutrition: Less Than Body Requirements Care Plan
Nutrition is a priority consideration in the treatment and prevention of diverticulitis. Diverticulitis is associated with low fiber intake. Addressing poor nutritional intake in patients with diverticulosis will improve outcomes.
Nursing Diagnosis: Imbalanced Nutrition
Related to:
- Inability to absorb nutrients due to inflammatory response
- Inability to digest food
- Abdominal cramping
- Abdominal pain
- Constipation
- Diarrhea
- Food intake less than recommended daily allowance (RDA)
As evidenced by:
- Difficulty swallowing
- Insufficient dietary intake
- Inadequate fluid intake
- Poor appetite
- Inadequate knowledge of nutrient requirements
Expected Outcomes:
- The patient will maintain an average weight and identify food choices appropriate for diverticulitis
Imbalanced Nutrition: Less Than Body Requirements Assessment
1. Assess the patient’s nutritional habits.
Assessing the patient’s nutritional intake can help to identify causative factors and develop an appropriate approach to the management of the condition.
2. Assess laboratory values.
A decrease in prealbumin and albumin may indicate an inflammatory response and acute malnutrition.
3. Assess for barriers to acquiring adequate nutrition.
Barriers to acquiring adequate nutrition may include financial barriers, lack of interest, or inadequate knowledge. Assessing these factors can help determine the best approach to provide adequate nutrition to the patient.
Imbalanced Nutrition: Less Than Body Requirements Interventions
1. Provide parenteral nutrition as indicated.
Patients with severe diverticulitis are often placed on NPO status. To ensure adequate nutrition, parenteral nutrition is provided.
2. Administer antiemetics and pain medications as indicated.
Diverticulitis occurs with pain and nausea resulting in a decrease in appetite. Providing medications before meals can help improve the patient’s appetite.
3. Identify food preferences.
It’s important when educating on dietary changes to first discuss which foods the patient prefers and will eat to increase adherence.
4. Educate the patient about proper nutrition.
Diverticulitis is associated with low fiber intake. It is important to educate the patient about the importance of following a high-fiber diet by including foods the patient has identified they will eat.
5. Consider fiber supplements.
Fiber supplements such as metamucil can supplement diets. Fiber supplements should not be consumed during a flare of diverticulitis as it could worsen symptoms.
Constipation Care Plan
Constipation is one of the symptoms of diverticulitis. Low fiber intake causes the buildup of waste in the colon leading to constipation. Constipation places extra strain and pressure on the colon, creating small pouches, or diverticula, in weakened areas. Infection and inflammation in these small pockets occur when stool or bacteria gets caught in these diverticula.
Nursing Diagnosis: Constipation
Related to:
- Blockage of the colon
- Insufficient fiber intake
- Insufficient fluid intake
- Inadequate toileting habits
- Altered routine
- Decreased physical activity
- Habitually suppresses the urge to defecate
As evidenced by:
- Straining with defecation
- A sensation of anorectal obstruction
- A sensation of incomplete evacuation
- Hard stools
- Need for manual stool evacuation
- Inability to defecate
- Rectal bleeding
Expected Outcomes:
- The patient will report passing stool without straining
- The patient will report at least one bowel movement every 3 days
Constipation Assessment
1. Assess the patient’s fiber and fluid intake.
Inadequate nutritional intake can contribute to the development of constipation. Understanding the patient’s normal nutritional intake can help address the patient’s nutritional needs.
2. Assess the patient’s bowel habits.
Assessing the patient’s defecation patterns will help determine the extent of the problem. This will help the nurse plan appropriate interventions and monitor outcomes.
Constipation Interventions
1. Encourage the patient to keep a diary of their bowel habits.
A diary of bowel habits should include time, length of time in the toilet, consistency, amount and frequency of stool, and straining. This information can help the patient and healthcare team monitor progress.
2. Encourage the patient to eat a high-fiber diet.
Provide patients with high-fiber foods to prevent constipation: apples, pears, peas, beans, potatoes, whole grains, bran cereal, and nuts.
3. Encourage adequate fluid intake.
Encourage the patient to drink at least 1.5 liters per day (unless contraindicated). Water intake promotes the formation of soft stools and makes them easier to pass.
4. Encourage physical activity as tolerated.
Physical activity stimulates peristalsis in the colon and encourages the movement of feces for elimination.
5. Educate on bowel training.
Poor bathroom habits can cause constipation. Ensure the patient is not suppressing the urge to defecate. The patient should be provided with adequate time and privacy to complete defecation.
6. Consider stool softeners or laxatives.
Chronic constipation may require the use of stool softeners or laxatives to prevent worsening diverticulitis.
References and Sources
- Acute Diverticulitis. Linzay CD, Pandit S. Acute Diverticulitis. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459316/
- Diverticulitis. Mayo Clinic. April 19, 2022. https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758
- Diverticular Disease and Diverticulitis. NHS. September 29, 2020. https://www.nhs.uk/conditions/diverticular-disease-and-diverticulitis/
- Diverticulitis. WebMD. Neha Pathak, MD. September 16, 2021. https://www.webmd.com/digestive-disorders/understanding-diverticulitis-basics
- Intestinal Perforation. Hafner J, Tuma F, Hoilat GJ, et al. Intestinal Perforation. [Updated 2021 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538191/
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
