Question

The patient's labs are grossly normal aside from a WBC count of 12,400. Results of the CT scan confirm a diagnosis of diverticulitis.

1. What medical management does the nurse expect to implement for this client?
2. The prescriber orders the following for the client: NPO except medications, bisacodyl 10 mg PO Q12 hours PRN, metronidazole 500 mg IV, increase fiber in diet, dietary consult, and case manager consult.
   1. Which order(s) should be questioned? Provide a rationale.
   2. For the correct orders for the client, provide a rationale for its use with diverticulitis.

The nurse initiates the appropriate orders for the client.

1. What nursing interventions should be completed for this client, and why?
2. What client education should be completed for this client and why?

Answer 1

a) The order bisacodyl 10 mg PO Q12 hours PRN is questionable

Because the patient is already receiving high fiber diet again a laxative like bisacodyl is not advisable

B) The correct orders is the other orders

the patient with diverculitis develop constipation

Until the patients infection is subside the patient should be NIL per oral..

Infection must be present in diverculitis, so for the purpose of infection treatment metronidazole 500 mg IV is prescribed as per the protocol.

dietary consult can be a best option for the purpose of providing advice regarding the type of high fiber diet can be taken and also type of dietary modifications need to be followed in rest of his life.

Case management consult is used for the purpose of  ensure that patient are admitted and transitioned to the appropriate level of care, have an effective plan of care and are receiving prescribed treatment, and have an advocate for services and plans needed during and after their stay.

Nursing interventions and its rationale

• Monitor vital signs

Fever / chills are signs of infection and possibly early peritonitis

• Provide Bowel Rest

Maintain NPO status during initial phase of antibiotic treatment to kill infection and help bowel rest

As symptoms decrease, advance diet to clear liquids and then increase fiber slowly.

• Assess abdominal pain

Detailed abdominal assessments will indicate if inflammation or infection may be developing. For example, a rigid abdomen may indicate peritonitis.

• Monitor hydration status

Maintain optimal hydration for improved intestinal motility to prevent constipation

Administer medications

• Antibiotics – for infection
• Analgesics – for pain
• IV Fluids – for hydration and bowel motility
• Psyllium – (bulk-forming laxative) absorbs water from the intestine and makes stool easier to pass
• Provide nutrition education
• Hydrate (2-3 L fluids daily, unless contraindicated for renal or cardiac disease) to avoid constipation
• Probiotics – to help regulate the intestinal bacteria
• Avoid foods that trigger flare up (low-fiber foods)

Client education with the patient with diverculitis

Eat a high-fiber diet when you have diverticulosis. Fiber softens the stool and helps prevent constipation.

High-fiber foods include:

• Beans and legumes
• Bran, whole wheat bread and whole grain cereals such as oatmeal
• Brown and wild rice

• Consider using a fibre supplement (such as psyllium) Psyllium works by absorbing water from the intestine which in turns makes stool easier to pass (softer and bulker)
• Drink plenty of fluids to ensure your stools are soft, moist and easy to pass
• Exercise regularly(Increases the peristaltic movement.
• Avoid any foods that make the symptoms worse, such as carbonated drinks and gas-forming foods like beans, cabbage, and cauliflower.