DIVERTICULAR DISEASE
The home health nurse is caring for a patient who has frequent bouts of diverticulitis accompanied by increased flatulence, diarrhea, and nausea. Which of the following is the most appropriate suggestion to lessen these symptoms? a. Eat a diet high in fiber content. b. Increase dietary fat intake. c. Exercise to increase intraabdominal pressure. d. Take daily laxatives.
ANS: A The symptoms of diverticulitis can be reduced or prevented by eating a high-fiber diet, reduction of meat and fats in the diet, and avoiding activities that increase intraabdominal pressure. Although laxatives might be prescribed sparingly, daily laxatives are not recommended.
After teaching a client with diverticular disease, a nurse assesses the clients understanding. Which menu selection made by the client indicates the client correctly understood the teaching? a. Roasted chicken with rice pilaf and a cup of coffee with cream b. Spaghetti with meat sauce, a fresh fruit cup, and hot tea c. Garden salad with a cup of bean soup and a glass of low-fat milk d. Baked fish with steamed carrots and a glass of apple juice
ANS: D Clients who have diverticular disease are prescribed a low-residue diet. Whole grains (rice pilaf), uncooked fruits and vegetables (salad, fresh fruit cup), and high-fiber foods (cup of bean soup) should be avoided with a low-residue diet. Canned or cooked vegetables are appropriate. Apple juice does not contain fiber and is acceptable for a low-residue diet.
A client who is recovering from acute diverticulitis is highly motivated to prevent another exacerbation of the disease. A nurse educates the client about the need to increase the amount of dietary fiber in the diet. The nurse evaluates that teaching has been effective when the client makes which menu selection for lunch? 1. A chicken sandwich on whole wheat bread with raw carrots and celery sticks 2. Baked chicken, mashed potatoes, and herbal tea 3. Chicken noodle soup with soda crackers and chocolate pudding 4. Cooked acorn squash, fried chicken, and pasta
ANSWER: 1 Whole wheat bread and raw fruits and vegetables are foods that are high in fiber content. ➧ Test-taking Tip: Recall that cooking food will cause breakdown of the dietary fiber content. Eliminate options 2 and 4.
A client is admitted to a hospital for medical treatment of acute diverticulitis. A nurse should anticipate that this client's treatment plan will include: SELECT ALL THAT APPLY. 1. NPO (nothing per mouth) status. 2. frequent ambulation. 3. antibiotics. 4. antiemetic medication. 5. deep breathing every 2 hours.
ANSWER: 1, 3 When diverticulitis is managed medically, the goal is to promote bowel rest. Decreasing oral intake will help to achieve that goal. Antibiotics are part of the treatment regimen. Ambulation is not encouraged because resting the body also promotes bowel rest. Nausea is not a concern with diverticulitis, and, since the client did not have surgery, there is no need for deep breathing every 2 hours. ➧ Test-taking Tip: Focus on basic treatment for any inflamed body part. This would help to eliminate option 2. Thinking about the location of diverticuli should enable the elimination of option 4
A nurse is caring for a patient who has been admitted to the hospital with diverticulitis. Which of the following would be appropriate nursing diagnoses for this patient? Select all that apply. A) Acute Pain Related to Increased Peristalsis and GI Inflammation B) Activity Intolerance Related to Generalized Weakness C) Bowel Incontinence Related to Increased Intestinal Peristalsis D) Deficient Fluid Volume Related to Anorexia, Nausea, and Diarrhea E) Impaired Urinary Elimination Related to GI Pressure on the Bladder
Ans: A, B, D Feedback: Patients with diverticulitis are likely to experience pain and decreased activity levels, and are at risk of fluid volume deficit. The patient is unlikely to experience fecal incontinence and urinary function is not directly influenced.
A patient admitted with acute diverticulitis has experienced a sudden increase in temperature and complains of a sudden onset of exquisite abdominal tenderness. The nurses rapid assessment reveals that the patients abdomen is uncharacteristically rigid on palpation. What is the nurses best response? A) Administer a Fleet enema as ordered and remain with the patient. B) Contact the primary care provider promptly and report these signs of perforation. C) Position the patient supine and insert an NG tube. D) Page the primary care provider and report that the patient may be obstructed.
Ans: B Feedback: The patients change in status is suggestive of perforation, which is a surgical emergency. Obstruction does not have this presentation involving fever and abdominal rigidity. An enema would be strongly contraindicated. An order is needed for NG insertion and repositioning is not a priority.
An adult patient has been diagnosed with diverticular disease after ongoing challenges with constipation. The patient will be treated on an outpatient basis. What components of treatment should the nurse anticipate? Select all that apply. A) Anticholinergic medications B) Increased fiber intake C) Enemas on alternating days D) Reduced fat intake E) Fluid reduction
Ans: B, D Feedback: Patients whose diverticular disease does not warrant hospital treatment often benefit from a high-fiber, low-fat diet. Neither enemas nor anticholinergics are indicated, and fluid intake is encouraged.
Conservative treatment of diverticulosis includes which management? (select all that apply.) a. Eating a low-fiber diet b. Increasing fluid intake c. Taking stool softeners d. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) for discomfort e. Taking bulk laxatives
B, C, D, E A high-fiber diet is indicated for the treatment of diverticulosis. All other options would be part of a conservative, nonsurgical approach to treatment