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Nursing Guide to Diverticulitis: Nursing Diagnosis, Interventions, & Care Plans

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Diverticulitis is an inflammatory condition that results from infection or irritation of diverticula, which are small, protruding pouches that are created in the lining of the colon. These pouches develop most frequently in the sigmoid colon and are initially asymptomatic, a condition known as diverticulosis.  

However, when infection or inflammation affects these pouches, it leads to diverticulitis, which can cause significant clinical symptoms such as lower abdominal pain, fever, gastrointestinal distress, and alterations in bowel habits. 

The severity of diverticulitis ranges from mild, self-limited cases to severe complications, including abscess formation, bowel perforation, fistulas, and generalized peritonitis. These complications may necessitate hospitalization, intravenous antibiotics, drainage procedures, or surgical intervention.  

Nurses are essential in the care of patients with diverticulitis by providing symptom monitoring, nutritional counseling, medication administration, and patient education to support both acute recovery and long-term prevention. 

Management of Diverticular Disease Course

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Etiology and epidemiology 

Understanding the etiology and epidemiology of diverticulitis is essential for identifying individuals at risk and implementing effective preventive strategies. This condition originates from the complex interplay between structural changes in the colon, dietary influences, and lifestyle factors.  

While diverticulosis, the precursor to diverticulitis, is common and often asymptomatic, only a subset of individuals will develop symptomatic inflammation. With the increasing incidence of diverticulitis, particularly in younger adults, it is crucial for healthcare providers and nurses to recognize contributing factors, monitor at-risk populations, and educate patients on modifiable lifestyle habits that can reduce risk and recurrence. 

Causes 

  • Blockage of a diverticulum by fecal matter, undigested food particles, or inflammation, leading to bacterial overgrowth and infection 
  • Increased intraluminal pressure in the colon, resulting in weakening of the intestinal wall and pouch formation 
  • Ischemia or trauma to the mucosa from mechanical stress, such as straining during defecation 

Risk factors 

  • Age over 40 years 
  • Chronic low-fiber diet and high intake of red meat 
  • Sedentary lifestyle and physical inactivity 
  • Obesity and increased body mass index 
  • Smoking and alcohol use 
  • Long-term use of NSAIDs, corticosteroids, or opioids 
  • Genetic predisposition and family history 

Epidemiology 

ICD-10 code 

  • K57.20 — Diverticulitis of large intestine with perforation and abscess without bleeding 
  • K57.30 — Diverticulitis of small intestine without perforation or abscess without bleeding 

Other relevant codes exist depending on severity, location, and presence of complications 

Diagnosis 

Early and accurate diagnosis of diverticulitis is vital for initiating appropriate treatment. This prevents complications and distinguishes it from other causes of abdominal pain.  

Because diverticulitis symptoms can mimic those of appendicitis, irritable bowel syndrome, or colitis, healthcare providers must rely on detailed history, focused physical examination, and confirmatory diagnostic imaging to guide management decisions. Nurses support this process by performing systematic assessments, monitoring for signs of deterioration, and preparing patients for diagnostic procedures. 

Clinical features 

  • Steady, progressive left lower quadrant abdominal pain (may be right-sided in some individuals of Asian descent) 
  • Fever, chills, and systemic signs of infection 
  • Nausea, vomiting, bloating, or flatulence 
  • Constipation or diarrhea 
  • Pain localized on palpation, often with rebound tenderness in advanced cases 

Diagnostic workup 

  • Physical exam assessing tenderness, bowel sounds, and abdominal distension 
  • Complete blood count (CBC) to detect leukocytosis 
  • C-reactive protein (CRP) to assess inflammatory activity 
  • Comprehensive metabolic panel (CMP) for electrolyte abnormalities or renal function 
  • Abdominal CT scan with contrast is the gold standard to identify diverticula, wall thickening, fat stranding, abscesses, or perforation 
  • Urinalysis to differentiate from urinary tract infections 
  • Stool studies if diarrhea predominates 
  • Colonoscopy is contraindicated during acute inflammation but useful after recovery to rule out malignancy 

Management 

The management of diverticulitis is multifaceted, encompassing both medical and supportive strategies tailored to the severity and complexity of the disease. The goal is to control infection, reduce inflammation, relieve symptoms, and prevent complications or recurrence.  

Uncomplicated diverticulitis can often be treated in an outpatient setting, while complicated cases involving abscesses, perforation, or sepsis may necessitate hospitalization and surgical consultation. Nurses help implement physician orders, manage symptoms, educate patients on dietary progression and medication adherence, and monitor for clinical deterioration. 

Uncomplicated diverticulitis 

  • Outpatient treatment with oral antibiotics targeting gram-negative and anaerobic bacteria (e.g., amoxicillin-clavulanate, or ciprofloxacin plus metronidazole) 
  • Short-term clear liquid diet advancing to low-fiber diet until symptoms subside, then gradually resuming high-fiber intake 
  • Acetaminophen for pain control; NSAIDs and opioids should be avoided to minimize bleeding risk and decreased bowel motility 
  • Rest, adequate hydration, and symptom monitoring 

Complicated diverticulitis 

  • Hospital admission for patients with severe symptoms, immunosuppression, or failed outpatient treatment 
  • NPO (nothing by mouth) status initially with IV fluid resuscitation and electrolyte correction 
  • Intravenous broad-spectrum antibiotics (e.g., piperacillin-tazobactam, or ceftriaxone plus metronidazole) 
  • Interventional radiology for percutaneous abscess drainage if needed 
  • Surgical consultation for bowel resection or management of complications such as perforation, fistulas, or obstruction 
  • Close monitoring for signs of systemic infection, worsening pain, or peritonitis 

Nursing care plan 

Effective nursing care planning for diverticulitis focuses on symptom control, complication prevention, and patient education. Nurses are vital in monitoring for signs of deterioration, managing pain and hydration, administering medications, and supporting dietary changes.  

A thoughtful care plan addresses both acute needs and long-term health promotion, particularly in patients at risk for recurrence. Tailoring interventions to the patient's clinical status and readiness to learn improves recovery outcomes and empowers patients to manage their health post-discharge. 

Nursing considerations 

  • Vigilantly monitor for clinical deterioration, such as rising fever, hypotension, tachycardia, or signs of sepsis. 
  • Reinforce dietary modifications across different stages of illness and recovery. 
  • Provide clear instructions for medication adherence and potential side effects. 
  • Offer supportive care for pain, nausea, and emotional distress. 

Assessment 

  • Complete frequent abdominal assessments, including pain intensity, bowel sounds, and presence of tenderness or guarding. 
  • Monitor temperature, blood pressure, heart rate, oxygen saturation, respiratory rate, and fluid balance. 
  • Review lab results and diagnostic imaging for changes in white blood cell count, CRP, or CT scan findings. 
  • Assess nutritional intake, hydration status, and bowel habits. 

Nursing diagnosis/risk for 

  • Acute pain related to colonic inflammation and distension 
  • Risk for deficient fluid volume due to vomiting, anorexia, or diarrhea 
  • Risk for infection and sepsis due to bacterial translocation or perforation 
  • Deficient knowledge regarding dietary needs, medication adherence, and follow-up care 

Interventions 

  • Administer and monitor effects of antibiotics, IV fluids, and analgesics as ordered. 
  • Maintain bowel rest protocols and guide dietary advancement based on provider recommendations. 
  • Provide emotional support, especially in cases involving hospitalization or surgery. 
  • Educate patients about avoiding triggers (low-fiber intake, dehydration) and recognizing warning signs (persistent fever, worsening pain, bleeding). 

Expected outcomes 

  • Patient reports reduced pain and stabilization of vital signs within 48 to 72 hours of treatment initiation. 
  • Gastrointestinal symptoms are resolved, and the patient tolerates oral intake without adverse effects. 
  • The patient understands disease process, recovery expectations, and follow-up recommendations. 
  • Risk of recurrence is reduced through adherence to long-term dietary and lifestyle modifications. 

Individual/caregiver education 

  • Emphasize the importance of completing antibiotics as prescribed and following up with the healthcare provider. 
  • Educate on temporary dietary restrictions during flare-ups and gradual reintroduction of fiber-rich foods during recovery. 
  • Discuss early warning signs of complications, including worsening abdominal pain, high fever, rectal bleeding, or persistent vomiting. 
  • Encourage prevention strategies such as regular physical activity, smoking cessation, stress management, and a diet high in soluble and insoluble fiber. 
  • Provide written dietary guidance, sample menus, and resources for accessing nutrition counseling if needed. 

FAQs

Resources 

References 

Erin Devine, BSN, RN

Erin Devine, BSN, RN

Erin Devine, BSN, RN, is a healthcare recruiter with a solid foundation in clinical nursing. Since earning her Bachelor of Science in Nursing in 2013, she has worked in med-surg, cardiac, progressive care, and long-term care settings. Today, she draws on that experience to match healthcare professionals with roles that align with their skills and career aspirations.