NURSING PROCESS:THE PATIENT WITH DIVERTICULITIS
During the health history, the nurse asks the patient about the onset and duration of pain and about past and present elimina-tion patterns. The nurse reviews dietary habits to determine fiber intake and asks the patient about straining at stool, history of con-stipation with periods of diarrhea, tenesmus (ie, spasms of the anal sphincter with pain and persistent urge to defecate), ab-dominal bloating, and distention.
Assessment includes auscultation for the presence and charac-ter of bowel sounds and palpation for lower left quadrant pain, tenderness, or firm mass. The stool is inspected for pus, mucus, or blood. It is important to monitor temperature, pulse, and blood pressure for abnormal variations.
Based on the assessment data, the nursing diagnoses may include the following:
• Constipation related to narrowing of the colon from thick-ened muscular segments and strictures
• Acute pain related to inflammation and infection
Potential complications that may develop include the following:
• Abscess formation
The major goals for the patient may include attainment and maintenance of normal elimination patterns, pain relief, and ab-sence of complications.
The nurse recommends a fluid intake of 2 L per day (within limits of the patient’s cardiac and renal reserve) and suggests foods that are soft but have increased fiber to increase the bulk of the stool and facilitate peristalsis, thereby promoting defecation. An individual-ized exercise program is encouraged to improve abdominal muscle tone. It is important to review the patient’s daily routine to estab-lish a schedule for meals and a set time for defecation and to assist in identifying habits that may have suppressed the urge to defecate. The nurse encourages daily intake of bulk laxatives such as Meta-mucil, which helps to propel feces through the colon. Stool soft-eners are administered as prescribed to decrease straining at stool, which decreases intestinal pressure. Oil retention enemas may be prescribed to soften the stool, making it easier to pass.
Analgesics (eg, meperidine) to relieve the pain of diverticulitis and antispasmodic agents to decrease intestinal spasm are adminis-tered as prescribed. The nurse records the intensity, duration, and location of pain to determine if the inflammatory process wors-ens or subsides.
The major nursing focus is to prevent complications by identify-ing patients at risk and managing their symptoms as needed. The nurse assesses for the following signs of perforation:
• Increased abdominal pain and tenderness accompanied by abdominal rigidity
• Elevated white blood cell count
• Elevated sedimentation rate
• Increased temperature
Perforation is a surgical emergency. The clinical manifesta-tions of perforation and peritonitis and the care of the patient with peritonitis are presented in the next section. The nurse mon-itors vital signs and urine output and administers intravenous flu-ids to replace volume loss as needed.
Because patients and their family members and health care providers tend to focus on the most obvious needs and issues, the nurse reminds the patient and family about the importance of continuing health promotion and screening practices. The nurse educates patients who have not been involved in these practices in the past about their importance and refers the patients to ap-propriate health care providers.
Expected patient outcomes may include the following:
1) Attains a normal pattern of elimination
a. Reports less abdominal cramping and pain
b. Reports the passage of soft, formed stool without pain
c. Adds unprocessed bran to foods
d. Drinks at least 10 glasses of fluid each day (if fluid in-take is tolerated)
e. Exercises daily
2) Reports decreased pain
a. Requests analgesics as needed
b. Adheres to a low-fiber diet during acute episodes
3) Recovers without complications
a. Is afebrile
b. Has normal blood pressure
c. Has a soft, nontender abdomen with normal bowel sounds
d. Maintains adequate urine output
e. Has no blood in the stool
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