NCM 116 LECTURE Medical-Surgical Nursing

LIVER BIOPSY

1. A needle is inserted through the abdominal wall to the liver to obtain a tissue sample for biopsy and
microscopic examination.
2. Pre procedure:
a. Obtained informed consent.
b. Assess results of coagulation test.
c. Administer a sedative as prescribed.
d. Note that the client is placed in a supine or left lateral position during the procedure to expose
the right side of the upper abdomen.
3. Post procedure:
a. Asses the vital signs.
b. Assess the biopsy site for bleeding.
c. Monitor for peritonitis.
d. Maintain bed rest for several hours.
e. Place client on the right side with a pillow under the costal margin to decrease the risk of
hemorrhage, and instruct the client to avoid coughing and straining.
f. Instruct the client to avoid heavy lifting and strenuous activity for 1 week.

GASTROINTESTINAL SYSTEMDISORDERS
PART ONE

STOMATITIS

Inflammation of the mucous lining of the mouth, which may involve the cheeks, gums, tongue, lips, and
roof or floor of the mouth. Usually a painful condition, associated with redness, swelling, and occasional
bleeding from the affected area.
Etiology:
1. Poor hygiene.
2. Burns from hot food or drinks
3. Conditions that affect the entire body, such as medications, allergic reactions, or infections.
4. Cheek biting, braces, or jagged teeth
5. Chronic mouth breathing due to plugged nasal airways may cause dryness of the mouth tissues

Predisposing factors:
1. Weakened immune system
2. Certain allergies may cause the lesions to appear; such as coffee, chocolate, cheese, nuts, citrus fruits and
potatoes.
3. Stress.
4. Viruses and bacteria.
5. Trauma to the mouth.
6. Poor nutrition.
7. Certain medications.
8. Usually seen in children and adolescents from the ages 10 to 19 years.

Types:
1. Herpes stomatitis
Caused by herpes virus type 1.
2. Aphthous stomatitis
Illness that causes small ulcers to appear in the mouth, usually inside the lips, on the cheeks, or on
the tongue. Also known as "canker sores." The exact cause is unknown.

Diagnostic tests:
1. Blood tests
2. Cultures of the lesions
3. Biopsy of the lesion

Clinical Manifestations:
Stomatitis is characterized by pain or discomfort in the mouth and the presence of open sores or ulcers in
the mouth.

Herpes stomatitis may cause the following symptoms:

1. Fever, sometimes as high as 101–104°F (38.3–40°C), which may precede the appearance of blisters and
ulcers by one or two days.
2. Irritability and restlessness.
3. Blisters in the mouth, often on the tongue or cheeks or roof of the mouth, which then pop and form
ulcers (These ulcers are usually small [about one to five millimeters in diameter], grayish white in the
middle, and red around the edges).
4. Swollen gums, which may be irritated and bleed.
5. Pain in the mouth.
6. Drooling.
7. Difficulty swallowing.
8. Foul-smelling breath.

Aphthous stomatitis may cause the following symptoms:

1. Burning or tingling sensation in the mouth prior to the onset of other symptoms.
 2. Skin lesions on the mucous membranes of the mouth, which begin as a red spot or bump, then develop
into an open ulcer, which is usually small (one to two millimeters to one centimeter in diameter).
3. The ulcers can be single or break out in clusters. The ulcers are painful, and the center appears white or
yellow with a fibrous texture. The border of the sore may be bright red.

Treatment
The treatment of stomatitis is based upon the problem causing it.
A. Local cleansing and good oral hygiene is fundamental.
B. Sharp-edged foods such as peanuts, tacos, and potato chips should be avoided.
C. A soft-bristled toothbrush should be used, and the teeth and gums should be brushed carefully. If tooth-
brushing is too painful, the child should rinse out his mouth with plain water after each meal.
D. Local factors, such as sharp teeth or braces, can be addressed by a dentist or orthodontist.

Herpes stomatitis treatment:

1. In herpes stomatitis, the most important part of treatment is for parents to keep their child drinking as
normally as possible.
2. Bland fluids such as apple juice, liquid flavored gelatin, or lukewarm broth are easiest to drink.
3. Sucking on a Popsicle or sherbet may be soothing.
4. Citrus juices and spicy or salty foods should be avoided.
5. In the event of severe disease, the doctor may use intravenous fluids to prevent dehydration.
6. Acetaminophen may be used for temperatures over 101°F (38.3°C) and to address pain.
7. Medicines that numb the mouth, like viscous Lidocaine or topical anesthetics only last for a brief time and
by numbing the mouth, may cause your child to further injure damaged tissues without knowing it.

Aphthous stomatitis treatment:

Alternative treatment
1. Placing a spent tea bag on a canker sore may provide comfort.
2. Sodium lauryl sulfate (SLS): a component of some tooth-pastes is a potential cause of canker sores. In
one study, most recurrent canker sores were eliminated just by avoiding SLS-containing toothpaste for
three months.

Nutritional concerns:
Some physicians may recommend a variety of dietary measures to treat stomatitis. These may include
eating cottage cheese, buttermilk, and yogurt, as well as foods high in B vitamins. Some doctors may recommend
supplementation with folic acid, iron, or vitamin B 12.

ESOPHAGITIS

Esophagitis is an inflammation of the esophagus. Causes include chemical irritants, physical irritants such
as smoking, alcohol, and temperature extremes of food and fluids.

Clinical Manifestations:
1. Achalasia.
2. Pyrosis.

Management:
1. Instruct the client to eliminate the cause and prevent reflux of gastric acid.
2. Instruct the client to take medications as ordered even after the clinical manifestations subside.
 GASTROESOPHAGEAL REFLUX DISEASE

GERD is the backflow of gastric and duodenal contents into the esophagus.

Causes:
1. Incompetent lower esophageal sphincter
2. Pyloric stenosis
3. Motility disorder

Clinical manifestations:
1. Pyrosis
2. Dyspepsia
3. Regurgitation
4. Pain and difficulty swallowing
5. Hypersalivation

Nursing and Medical management:

1. Eat a low fat, high fiber diet.
2. Avoid:
a. Caffeine
b. Tobacco
c. Carbonated beverages
d. Eating and drinking 2 hours before bedtime
e. Wearing tight clothes
3. Elevate the head of the bed.
4. Avoid the use of anticholinergics which delay gastric emptying.
5. Instruct the client regarding prescribed medications such as:
a. Antacids
b. Histamine receptor antagonist
c. Gastric acid pump inhibitors
d. Prokinetic medication

HIATAL HERNIA

It is also known as esophageal or diaphragmatic hernia.A portion of the stomach herniates through the
diaphragm and into the thorax.Herniation results from weakening of the muscles of the diaphragm.

Aggrevating factors:
1. Pregnancy
2. Ascites
3. Obesity
4. Tumors
5. Heavy lifting

Clinical manifestations:
1. Heartburn
2. Regurgitation or vomiting
3. Dysphagia
4. Feeling of fullness

Nursing and Medical management:

 1. Similar to GERD.
2. Provide small frequent meals and minimize the amount of liquids.
3. Advise the client not to recline for 1 hour after eating.
4. Avoid anticholinergic which delays gastric emptying.

GASTRITIS

Inflammation of the stomach or gastric mucosa.

Risk factors:
1. Eating highly seasoned food.
2. Overuse of aspirin.
3. NSAID
4. Excessive alcohol intake.
5. Bile reflux
6. Radiation therapy.

Clinical manifestations:
1. Acute
a. Abdominal discomfort
b. Anorexia, nausea and vomiting
c. Hiccupping
2. Chronic
a. Anorexia, nausea and vomiting
b. Belching
c. Heartburn after eating
d. Sour taste in the mouth
e. Vitamin B12 deficiency

Nursing Management:
1. Acute gastritis: food and fluid may be withheld until symptoms subside; afterward, ice chips followed by
clear liquids, and then solid food is introduced.
2. Monitor for signs of hemorrhagic gastritis such as hematemesis, tachycardia, and hypotension and notify
the physician if this occurs.
3. Avoid irritating foods and fluid.
4. Vitamin B12 injection.
 PEPTIC ULCER DISEASE

PUD refers to an erosion of the gastrointestinal mucosa by hydrochloric acid and pepsin. Locations of
ulcers include the lower esophagus, stomach, pyloric channel, and duodenum, as well as postoperative
ulcers near sites of surgical anastomosis. When the ulcer is located in the duodenum, it is also known as
duodenal ulcer.

A. Types of peptic ulcers:

1. Duodenal (most common).
2. Gastric.
3. Stress-induced ulcers.
B. Histamine release occurs with the erosion of the gastric mucosa in both duodenal and gastric ulcers. This
stimulates further secretion of gastric acid and formation of mucosal edema. The continued erosion will
eventually damage the blood vessels leading to hemorrhage or erosion through gastric mucosa.

C. Characteristics.
1. Risk factors:
a. Helicobacter pylori (causes two thirds of ulcers).
b. NSAIDs.
c. Medications that alter gastric mucosa and secretions.
d. Increased physical stress (trauma, surgery).
e. Psychosocial stress (duodenal ulcers).
f. Smoking, alcohol.
g. Type A personality
h. Type O blood- high pepsinogen level.

2. Aggravating factors:
a. Stress: emotional or physical.
b. Smoking.
c. Alcohol.
d. Increased incidence if family member has ulcers.
 3. Clinical manifestations:
a. Pain: the pain associated with ulcers may be confusing, and symptoms may overlap from one type of
ulcer to another. Be careful to avoid confusing ulcer pain to angina.
b. Significant weight change.
c. Nausea and vomiting.
d. Bleeding when ulcer erodes through a vessel.

DIAGNOSTICS
A. Acid-base studies may indicate metabolic alkalosis caused by overuse of antacids.
B. Barium swallow (X-ray films of upper GI system).
C. Fecal occult blood test.
D. Gastric sampling may be positive for Helicobacter pylori.
E. Hematologic study.
F. Esophagogastroduodenoscopy.

TREATMENT
A. Medications
1. Antacids.
2. Histamine receptor antagonist.
3. Anticholinergic medications for duodenal ulcers.
4. Prostaglandin analogs and acid-pump inhibitors.
5. Medications to eliminate H. pylori bacteria.
a. Metronidazole (Flagyl).
b. Omeprazole (Prilosec).
c. Clarithromycin (Biaxin) or Tetracycline.
B. Lifestyle modifications
1. Avoid foods that cause discomfort.
2. Decrease or stop smoking.
3. Decrease activity and psychosocial stress.

C. Surgical interventions for intractable ulcers

1. Partial gastrectomy: removal of majority of stomach (antrum and pylorus) with anastomosis to either
the duodenum or the jejunum (preffered).
2. Vagotomy: denervation of a portion of the stomach to decrease acid-secreting stimulus to gastric
cells.

3. Pyloroplasty (pyloric stenosis repair): method for relieving a narrowed pyloric sphincter to allow the
stomach contents to pass more easily into the duodenum; may be done in combination with
vagotomy.

4. Antrectomies: removal of 50% of the lower part of the stomach.

a. Billroth I (Gastroduodenostomy) - remaining segment anastomosed to the jejunum.
 b. Billroth II (Gastrojejunostomy) – remaining segment anastomosed to the jejunum.

COMPLICATIONS
A. Hemorrhage
1. Hematemesis, melena, or both.
2. Hypovolemic shock.

B. Perforation of ulcer into the peritoneal cavity.

1. Sudden, severe, diffuse upper abdominal pain.
2. Abdominal muscles contract as abdomen becomes rigid.
3. Bowel sounds are absent.
4. Respirations become shallow and rapid.
5. Severity of peritonitis is proportional to size of perforation and amount of gastric spillage.

C. Pyloric obstruction.
1. Clients with a long history of ulcer disease have a greater risk.
2. Progression of pain from epigastric to generalized upper abdominal pain.
3. Increasing abdominal discomfort.
4. Relief may be obtained by vomiting.
5. Increased bowel sounds.

D. Dumping syndrome: affects up to half of clients who have undergone gastrectomy.

DUMPING SYNDROME

Condition occurs when a large bolus of gastric chyme and hypertonic fluid enter the intestine.

Assessment
 Weakness, dizziness, tachycardia.
 Epigastric fullness and abdominal cramping.
 Diaphoresis.
 Generally occurs within 30 minutes of eating.
 Condition is usually self-limiting and resolves in about 6 to 12 months.

Prevention
 Decrease amount of food eaten at one meal.
 Decrease carbohydrates, decrease salt intake and roughage,
increase proteins and fats as tolerated.
 No added fluid with meal or for 1 hour after meal.
 No milk, sweets, or sugars.
 Position client in semi-recumbent position during meals;
client should lie down on the left side for 20 to 30 minutes after meals
 to delay stomach emptying.
 Hypoglycemia may occur 2 to 3 hours after eating,
caused by rapid entry of carbohydrates into jejunum.

NURSING INTERVENTIONS
 Goal: to promote health in clients with peptic ulcer disease.
A. Identify factors in lifestyle contributing to development of ulcer.
B. Identify factors that precipitate pain and discomfort.
C. Do not take OTC medications, especially aspirin compounds and NSAIDs.
D. Identify stress factors in lifestyle. Counseling may be indicated to help client improve ability to cope with
stress.

 Goal: to relieve pain and promote healing.

A. Dietary modifications.
1. Encourage small, frequent meals.
2. Non-stimulating bland foods are generally tolerated better during healing of acute episodes.
3. Assist client to identify specific dietary habits that exacerbate or precipitate pain.
4. Avoid the following foods:
a. Fatty foods.
b. Coffee, tea, cola drink, chocolate
c. Spices, red/black pepper
d. Alcohol
e. Bedtime snacks
f. Binge eating
g. Large quantities of milk
5. Promote good nutritional habits.

B. Identify characteristics of pain and activities that increase/decrease pain.

 Goal: to assess for complications of hemorrhage.

A. Assess for symptoms indicating hemorrhage.
1. Evaluate hemoglobin and hematocrit levels.
2. Assess for distension, increase in pain, and tenderness.
3. Correlate vital signs with changes in client’s overall condition.
4. Assess stools and nasogastric drainage for presence of blood.
B. If hemorrhage occurs:
1. Establish peripheral infusion line, preferably with large-gauge needle for blood infusion.
2. Insert indwelling urinary catheter to monitor urinary output.
3. Insert nasogastric tube for removal of gastric contents and maintain gastric suction.
4. May implement iced saline solution lavage.
5. Prepare to administer whole blood transfusion and IV fluids.
C. Position client in supine with legs slightly elevated.
D. Begin oxygen administration.
E. Initiate preoperative preparation.

 Goal: Assess for complications of gastric obstruction, perforation and peritonitis.

 Goal: to assist client to return to homeostasis after gastric resection.

A. Provide general postoperative care as indicated.
B. Maintain nasogastric suction until peristalsis returns.
C. After removal of nasogastric tube, assess for:
1. Increasing abdominal distension.
2. Nausea and vomiting.
 3. Changes in bowel sounds.
D. No oral fluid until client is able to tolerate removal of nasogastric tube.
E. Begin oral fluids slowly: clear liquids, then progress to bland, soft diet.
F. Based on client’s condition, total parenteral nutrition may be necessary to maintain adequate nutrition.
G. Encourage ambulation to promote peristalsis.

ANTIULCERS
MEDICATIONS SIDE EFFECTS NURSING IMPLICATIONS
ANTACID: An alkaline substance that will neutralize gastric acid secretions; nonsystemic. Some combination
antacids also relieve gas and some work as laxatives. Several antacids form a protective coating on the stomach
and upper GI tract.
Aluminum hydroxide Constipation, phosphorus 1. Avoid administration within 1 to 2 hours
(Amphogel) depletion with long-term of other oral medications. Medications
use, should be taken frequently, before and
after meals and at bedtime.
2. Instruct clients to take medication even if
Aluminum hydroxide and they do not experience discomfort.
magnesium salt combinations Constipation or diarrhea, 3. Clients on low-sodium diets should
(Gelusil, Maalox, Gaviscon) hypercalcemia, renal calculi. elevate sodium contents of various
antacids.
4. Administer with caution to the client with
cardiac disease, because GI symptoms
may be indicative of cardiac problems.
Sodium preparation: Sodium Rebound acid production, 1. Discourage use of sodium bicarbonate
bicarbonate, (Rolaids, Tums): alkalosis. because of occurrence of metabolic
PO alkalosis.

HISTAMINE H2 RECEPTOR ANTAGONISTS: Reduce volume and concentration of gastric acid secretion.
Cimetidine (Tagamet): PO, IV, Rash, confusion, lethargy, 1. Take with or after meals.
IM diarrhea, dysrhythmias. 2. May be used prophylactically or for
treatment of PUD.
3. Do not take with oral antacids.
Ranitidine (Zantac): PO, IM, IV Headache, GI discomfort, 1. Use with caution in clients with liver and
jaundice, hepatitis. renal disorders.
2. Do not take with aspirin products.
3. Wait 1 hour after administration of
antacids.
Nizatidine(Axid): PO Anemia, dizziness 1. Use with caution in clients with renal or
hepatic problems.
Famotidine (Pepcid): PO, IV 2. Dosing may be done with meals or
Headache, dizziness, without regard to meal time.
constipation, diarrhea. 3. Caution clients to avoid aspirin and other
NSAIDs.
PROTON PUMP INHIBITORS: Inhibit the enzyme that produces gastric acid.
Omeprazole (Prilosec), Headache, diarrhea, 1. Administer before meals.
Lansoprazole(Prevacid): PO dizziness. 2. Do not crush or chew; do not open
capsules.
3. Sprinkle granules of Prevacidover food;
do not chew granules.
4. The combination of omeprazole (Prilosec)
with clarithromycin (Biaxin) effectively
treats clients with Helicobacter pylori
 infection in duodenal ulcer.
CYTOPROTECTIVE AGENT: Binds to diseased tissue; provides a protective barrier to acid.
Sucralfate(Carafate): PO Constipation, GI discomfort. 1. Avoid antacids.
2. Use: prevention and treatment of stress
ulcers, gastric ulceration, and PUD.
3. May impede the absorption of
medications that require an acid medium.

PROSTAGLANDIN ANALOGUE: Suppresses gastric acid secretion; increases protective mucus and mucosal blood
flow.
Misoprostol (Cytotec) GI problems, headache. 1. Contraindicated in pregnancy.
2. Indicated for prevention of NSAID-
induced ulcers.
ANTICHOLINERGICS (ANTISPASMODICS): Inhibit secretion of gastric acids.
Dicyclomine hydrochloride Drowsiness, dry mouth, 1. Use with caution in clients with glaucoma.
(Bentyl): PO urinary retension, blurred 2. Evaluate for anticholinergic side effects.
vision, constipation, 3. Do not administer at same time as
Hyoscyamine(Levsin): PO orthostatic hypotension. antacids.

Propantheline
(Pro-Banthine): PO, IM

APPENDICITIS

Appendicitis is an inflammation of the vermiform appendix. Although the appendix has no known
function, it regularly fills with and empties itself with food. Appendicitis occurs when the appendix
becomes inflamed from ulceration of the mucosa or from obstruction of the lumen.
If appendicitis is not treated, the appendix can become gangrenous and burst causing peritonitis,
septicemia, and potential death. It is the most common reason for emergency abdominal surgery in
children.
ASSESSMENT

A. Risk factors/etiology
1. Age: peak at 20 to 30 years old; rare in children younger than 2 years.
2. Diet: low-fiber and refined carbohydrate diets.
3. Viral infection: coxsackievirus B, adenovirus.
4. Fecal mass.
5. Stricture.
6. Barium ingestion.
7. Mumps.
8. Amoebiasis.

B. Clinical Manifestations
1. Abdominal cramping and pain, beginning near navel then migrating toward McBurney’s point (right lower
quadrant). Pain worsens with time.
2. Anorexia, nausea and vomiting, constipation.
3. Elevated temperature and heart rate.
4. Side-lying, fetal position for comfort.
5. Client complains of pain when asked to cough: asking client to cough is better assessment method than
palpating for rebound tenderness.
6. Sudden relief from pain may indicate rupture of appendix.

C. Diagnostic evaluations
1. Clinical manifestations.
2. Urinalysis to rule out urinary tract infection.
3. Ultrasonography to identify inflamed appendix.
4. White blood cell count revealing leukocytosis.

D. Complication
Peritonitis

TREATMENT

A. Laparoscopic appendectomy is the only effective treatment.

B. Abdominal laparotomy and peritoneal lavage if appendix has ruptured (less desirable).
C. Broad spectrum antibiotic therapy.
D. Early ambulation after surgery.

NURSING INTERVENTIONS

 Goal: to assess clinical manifestations and to prepare for surgery as indicated.

A. Careful nursing assessment for clinical manifestations.
B. Maintain NPO status until otherwise indicated.
C. Maintain bed rest in position of comfort.
D. Do not apply heat to the abdomen; cold applications may provide some relief or comfort.
 E. Do not administer enemas.
F. Avoid unnecessary palpation of the abdomen.

UNDIAGNOSED ABDOMINAL PAIN

DON’T: DO:
1. Give anything by mouth. 1. Maintain bed rest.
2. Put any heat on the abdomen 2. Place in a position of comfort
3. Give an enema 3. Assess hydration
4.Give strong narcotics 4. Assess abdominal status
5. Give a laxative

 Goal: to prevent abdominal distension and to assess bowel function after abdominal laparotomy.
A. Maintain NPO status.
B. Gastric decompression by nasogastric tube; maintain patency and suction.
C. Monitor abdomen for distension.
D. Assess peristaltic activity.
E. Evaluate and record character of bowel movements.

 Goal: to decrease infection and promote healing after abdominal laparotomy.

A. Place client in semi-Fowler’s position to localize infection and prevent spread of infection or development
of subdiaphragmatic abscess.
B. Antibiotics are usually administered via IV infusion; monitor response to antibiotics and status of IV
infusion site.
C. Monitor vital signs frequently (every 2 to 4 hours) and evaluate for infectious process.
D. Provide appropriate wound care.

 Goal: to maintain adequate hydration and nutrition to promote comfort after abdominal laparotomy.
A. Maintain adequate hydration via infusion.
B. Begin oral administration of clear liquids when peristalsis returns.
C. Progress diet as tolerated.
D. Administer analgesics as indicated.

PERITONITIS

It refers to the generalized inflammation of the peritoneal cavity, leading to intra-abdominal infection.

Risk factors:

1. Chemical peritonitis- may result from gastric ulcer perforation or a ruptured ectopic pregnancy.
2. Bacterial peritonitis- ruptured appendix.
3. Postoperative dehiscence

Diagnostics:
 1. Elevated WBC.
2. Paracentesis to evaluate abdominal fluid.
3. X-ray film of the abdomen.

Nursing and Medical management:

1. To maintain fluid and electrolyte balances and reduce gastric distention;

a. Maintain nasogastric suction.
b. IV fluid usually NSS or PLR.
c. Evaluate peristalsis and return of bowel sound function.
d. Maintain intake and output record.
2. Encourage activities to facilitate return of bowel function:
a. Encourage ambulation.
b. Maintain adequate hydration.
3. To reduce infectious process:
a. Administer antibiotic via IV; assess client’s tolerance of antibiotics and status of the site.
b. Maintain in semi Fowler’s position.

DIVERTICULAR DISEASE

When a diverticulum (a pouch-like herniation of superficial layers of the colon through weakened bowel
wall) becomes inflamed, it is known as diverticulitis. In diverticulosis, there are asymptomatic diverticula.
Meckel’s diverticulum is diverticular disease of the ileum in children. It is the most common congenital
anomaly of the GI tract in children.
A. Diverticulum: dilatation or out-pouching of a weakened area in the intestinal wall.
B. Diverticulitis: inflammation of the diverticulum.

ASSESSMENT

A. Risk factors/Etiology:
1. Low-fiber diet; high intake of processed foods.
2. Age:
a. May be due to constipation and low-fiber diet.
b. Indigestible fibers (corn, seeds, etc.) will precipitate diverticulitis.
3. The edema that accompanies the inflammation results in increased swelling and bowel irritation.

B. Clinical Manifestations:
1. Diverticulum, including Meckel’s diverticulum, is usually asymptomatic; symptoms vary with degree
of inflammation.
2. Intermittent left lower quadrant tenderness, abdominal cramping.
3. Inflammatory changes may precipitate perforation or abscess formation.
4. Diverticulitis:
a. Fever.
b. Left lower quadrant pain, usually accompanied by nausea and vomiting.
c. Abdominal distention.
d. Frequently constipated.
e. May progress to intestinalobstruction.
 C. Diagnostics (Diverticulosis).
1. Barium enema to visualize colon.
2. Sigmoidoscopy or colonoscopy.
3. Ultrasonography and/or computed tomography scan.
4. Stool examination.
5. Barium enema and colonoscopy are done after the acute phase.

Treatment

A. Management of uncomplicated diverticulum.

1. High-residue diet and fiber supplements.
2. Avoid laxatives and enemas.
B. Diverticulosis with pain.
1. Liquid or bland diet.
2. Stool softeners or mineral oil.
C. Diverticulitis without perforation.
1. Oral antibiotics when symptoms are mild.
2. Antispasmodic medications.
3. Liquid or low-fiber foods for acute diverticulitis.
D. Severe diverticulitis.
1. Hospitalized with IV antibiotic management.
2. NPO status.
3. Surgery for obstruction, abscess, hemorrhage, or perforation.

Nursing Interventions

 Goal: to assist client to understand dietary implications and maintain prescribed therapy to prevent
exacerbations.
A. Understand high-fiber diet.
B. Avoid indigestible roughage such as nuts, popcorn, raw celery, corn and seeds.
C. Maintain high fluid intake.
D. Avoid large meals.
E. Avoid alcohol.
F. Weight reduction if indicated.
G. Avoid activities that increase intraabdominal pressure. (e.g., straining at stool, bending, lifting); avoid
wearing tight restrictive clothing.

 Goal: to decrease colon activity in client with diverticulitis.

A. Maintain clear liquids or NPO status.
B. Bed rest.
C. Adequate hydration via parenteral fluids.
D. As attack subsides, introduce oral fluids gradually.

Self-Care

A. High-fiber diet that is low in indigestible fibers.

 B. If client has any abdominal distress, then all fiber should be avoided until tenderness resolves.
C. Report fevers; consistent abdominal pain; and dark, tarry stools.

Prepared by:

Renee Jessee Anthony E.Lopez, RN, HAAD-RN, LPT, MAN

Asst. Professor I/ Clinical Coordinator