Medical 4-Ms61-Diverticular Disease

Front 1

What are diverticula?

(Diverticulosis are multiple diverticula...diverticulitis is the inflammation of one or more diverticula)

Back 1

congenital or acquired pouchlike herniations of mucosa through the muscular wall of small intestine or colon

Front 2

Where can diverticula occur?

Back 2

in any part of small or large intestine, but occur mostly in SIGMOID COLON

Front 3

Define etiology?

Back 3

cause of disease

Front 4

Define pathophysiology?

Back 4

the study of how normal physiological processes are altered by disease

Front 5

Describe the pathophysiology of the formation of diverticula?

it becomes herniated...so where do diverticula seem to occur?

ha! as part of the aging process

Back 5

the musculature of the colon hypertrophies, then thickens, then becomes rigid...and then what happens to the mucosa and submucosa of the colon wall?

hmmm...at points of weakness in the intestinal wall, often at areas where blood vessels interrupt muscular continuity....and how does muscle weakness develop, you in the back?

Front 6

All by themselves, diverticula cause few problems. However, if _____ or ______ become trapped in a diverticulum, however, blood supply to that area _______ and bacteria invades the diverticulum. And so how does diverticulis result from there?

PERITONITIS!

Back 6

food
bacteria

diminishes

the diverticulum perforates and a local abscess forms....and so what can form if the perforated diverticulum progresses to intra-abdominal perforation?

Front 7

What range can bleeding from diverticula occur in? (3)

Back 7

minor
localized
massive hemorrhage

Front 8

What is minor bleeding of diverticula due to?

vascular granulation...at the base of?

Back 8

localized inflammation in areas of ________ ______ tissue?

diverticulum

Front 9

Hemorrhage can result when a ______ _____ is eroded within a diverticulum

Back 9

blood vessel

Front 10

What can lead to narrowing of the bowel lumen, and resultant obstruction?

fistulas to other organs, such as bladder and vagina.

Back 10

inflammation...and so inflammation can also result in ______?

Front 11

What has been implicated in the development of diverticula?

Back 11

diets with small amounts of fiber because they cause less bulky stool and possible constipation

Front 12

What must happen for diverticulosis and diverticulitis to occur?

Back 12

there must be an increase in intraluminal pressure and muscle contractions to move fecal material through the colon

Front 13

What is the etiologic factor in diverticulitis?

Back 13

retained undigested food in diverticula, which compromises blood supply to that area and facilitates bacterial invasion of the sac

Front 14

Diverticulitis affects what percentage of adults over age 60?

Back 14

one third, more men than women...only one in 5 display symptoms

Front 15

Most clients are asymptomatic, and unless _____ or _____ develops,
the condition may go undiagnosed or found incidentally on routine ________.

Back 15

pain
bleeding

colonoscopy

Front 16

Uncomplicated diverticulosis that causes symptoms might have ________and _________ and possible rectal _____ and INTERMITTENT pain in which part of the body?

Back 16

constipation (may be due to intestinal inflammation)

fever

bleeding

left lower quadrant

Front 17

With diverticulosis, abdominal PALPATION might elicit occasional _______.
The ______ may be PALPABLE.

Back 17

tenderness

colon

Front 18

The INTERMITTENT pain in LLQ associated with onset of diverticulosis may get progressively STEADY...may be _______, or on one side.

Back 18

suprapubic

Front 19

Abdominal pain will be generalized if _______ has occurred.

Back 19

peritonitis

Front 20

Patient's temperature is elevated, ranging from low grade fever to. _______ may be secondary to fever.
Nausea and vomiting are commonly present.

Back 20

101F

Tachycardia

Front 21

When examining abdomen, observe for ________.

Back 21

distention

Front 22

What should the patient report if localized peritoneal irritation is present?

diffuse

Back 22

localized muscle spasm
guarded movement
rebound tenderness

If generalized peritonitis is present, these symptoms will be more?

Front 23

The HCP may PALPATE a tender mass during rectal exam if the perforated diverticulum is close to the?

Back 23

rectum

Front 24

Blood pressure checks may show?

Back 24

orthostatic changes

Front 25

If bleeding is massive, the patient may have ________
and _________ ?

shock....what can happen if generalized peritonitis has occurred?

Back 25

hypotension
dehydration


this may result in?

sepsis and manifestations of hypotension and septic or hypovolemic shock can occur

Front 26

With diverticulosis, WBC will?

decrease if chronic or severe bleeding is present

Back 26

increase...hematocrit and hemoglobin will?

Front 27

FOBT (fecal occult blood test) are _______ in 20% of cases

Back 27

positive

Front 28

Urinalysis may show a few ____ if the left ureter is in proximity to a perforated diverticulum

Back 28

RBCs

Front 29

X-rays (show diverticula)
upper GI series (show small
intestine diverticula)
barium enema (shows large
intestine diverticula)
okay

Back 29

okay

Front 30

A barium enema exam will usually not be performed in acute phase of diverticulitis because?

after the patient has been treated with antibiotics and inflammation has resolved.

Back 30

there's a risk of rupture of inflamed diverticulum....so when is a barium enema done?

Front 31

A CT scan may be ordered to diagnose?

Back 31

an abscess or thickening of the bowel related to diverticulitis.

Front 32

Ultrasonography, noninvasive, may reveal?

Back 32

bowel thickening or an abscess

Front 33

The doctor may perform a _________ or ________ after the ACUTE PHASE of the illness, usually to rule out presence of tumor in large intestine, particularly if patient has rectal bleeding...there is a risk for perforation.

Back 33

sigmoidoscopy
colonoscopy

Front 34

If symptoms are mild, patient may be treated outpatient. This would be done if temp is lower than _____ and WBC ranges from ______ to _________.

Monitor patient for prolonged or increased _____,
__________, or _______ in stool.

Back 34

101

13,000 to 15,000/mm3

fever
abdominal pain
blood

Front 35

Nonsurgical management is a combination of ______ and _____ therapy with rest to decrease inflammation and improve tissue perfusion.
Start antibiotics, such as?

Back 35

drug
diet

metronidazole (Flgyl) plus
trimethoprim/sulfamethox-
azole (Bactrim, Septra) or
ciprofloxacin (Cipro) and
mild analgesic for pain.

Front 36

If patient has severe pain, then admit to hospital and prescribe ____ _____ to correct ______ as well as IV
______.

meperidine hydrochloride (Demerol) or morphine sulfate.

What about laxatives?

instruct the client to remain in bed during acute phase...refrain from lifting, straining, coughing, bending to avoid increase in intra-abdominal pressure. How about diet?

if nausea, vomiting, or abdominal distention is severe....when inflammation has resolved and bowel function returns to normal, what kind of diet is started?

Back 36

IV fluids
dehydration

antibiotics (cefoxitin plus
metronidazole)

What kind of opioid analgesic might be prescribed to alleviate pain?

Laxatives are avoided because they increase intraluminal pressure. Nurse should monitor fluid and electrolytes continually.

What should the nurse instruct the patient to do to keep from perforating the diverticulum?

restrict to clear liquids...more severe cases stay NPO...when should an NG tube be inserted?

fiber-containing unless acute phase returns, then stop fiber-containing diet

Front 37

Surgical management is indicated for the following?

Back 37

rutpure of diverticulum
with subsequent peritonitis
pelvic abscess
bowel obstruction
fistula
persistent fever or pain
after 4 days of medical
treatment
uncontrolled bleeding

Front 38

Surgeon performs emergency surgery if? (3)

Back 38

peritonitis
bowel obstruction
pelvic abscess

Front 39

What is the most common surgical procedure for clients with diverticular disease?

Back 39

colon resection, with or without a colostomy

Front 40

What category of meds can be prescribed for geriatric with diverticulitis?

Back 40

antibiotics
analgesics
anticholinergics

Front 41

What are possible side effects of antibiotics,
analgesics, and anticholinergics which may be prescribed for geriatric patients with diverticulitis?

Back 41

confusion (or increased
confusion)
urinary retention
orthostatic hypotension

Front 42

Give laxatives or enemas to geriatric patient with diverticulitis?

Back 42

NO!

Front 43

Discourage geriatric patients from activities that increase ______-_______
pressure, such as straining and bending and have them rest instead.

Back 43

intra-abdominal

Front 44

In geriatric patients with active diverticulitis, provid a diet that is?

high-fiber

Back 44

low-fiber...when inflammation resolves, provid a _____ _____ diet.

Front 45

Geriatric patients with diverticulitis do not always present with typical pain or fever expected, so observe carefully for signs of active disease.
okay

Back 45

okay

Front 46

Perform frequent abdominal assessments to determine ______ and _______ on PALPATION of geriatric diverticulitis patients.

Back 46

distention
tenderness

Front 47

In geriatric patients with diverticulitis, check stools for _______ or ________ bleeding.

Back 47

occult
frank

Front 48

If the patient is NOT in the ACUTE phase of diverticulitis, a thorough bowel preparation MAY be given, consisting of laxatives daily for _____ to _____ days before surgery.

perforation...so, in the end, what is the deciding factors on whether or not to implement an aggressive bowel preparation?

Back 48

1 to 2 days...however doctor may forgo this because of the risk of?

if patient has an acutely inflamed diverticulum...OR persistent fever and abdominal pain.

Front 49

For patients without acute inflammation, what is the well-structured diet plan? (3 stages)

Back 49

4-5 days...low-fiber...then 2 days of full-liquid diet...then a romantic clear liquid diet the eve of surgery

Front 50

Preop teaching for colostomy may be indicated by an ET or office nurse if client so desires.
okay

Back 50

okay

Front 51

Define anastomosis?

Back 51

a natural communication between 2 vessels, may be direct or by means of connecting channels...the pathological connection of two tubular structures

Front 52

What is the operative procedure for a patient with diverticulitis...First of all, what part is resected?

the portion that is inflamed or diseased....how can doctor restore patency?

inflammation and infection...then what's the alternative?

colostomy closure and anastomosis

Back 52

colon...but which part?

by creating an anastomosis or tubular connection....what may keep the surgeon from creating an anastomosis?

a colostomy...what does the patient then undergo in 3 to 6 months if all goes okay?

Front 53

Immediate physical care for clients undergoing a colon resection is?

Back 53

same as clients undergoing abdominal surgery.

Front 54

Post-op, the patient has a drain in place at the abdominal incision for how many days?

it's not draining yet, so use a peteroleum gauze dressing...what alternative measure can be taken?

then monitor for color and integrity..so what color should the stoma be?

Back 54

2 to 3 days....how should nurse dress the colostomy for those 2 days?

place a colostomy bag over stoma...what if the stoma is visible?

pinkish to cherry red without retraction or prolapse into abdomen

Front 55

How is a colon resection client maintained for 2 to 3 days whether he has a colostomy or not?

when peristalsis returns...and according to HCPs orders...then the patient can have what?

Back 55

on NPO status with a possible NG tube....well, when should the NG tube be removed?

hmm...clear liquids SLOWLY and then GRADUALLY advance to solids, depending on return of peristalsis and bowel function.

Front 56

If the patient has had a successful colostomy created, when should it begin functioning?

Back 56

in 2 to 4 days

Front 57

What is the most common site for diverticulitis?

drainage will be loose, but eventually formed so be sure to get a tight seal around the stoma to avoid contact with feces and skin.

Back 57

sigmoid colon....so that's where most patients undergo surgery such as a sigmoid colostomy...and what kind of stools can we expect from this type of surgery?

Front 58

What's the average length of hospitalization for diverticulitis patients?

Back 58

3 days to longer than a week

Front 59

Home care management for patient following diverticulitis operation is?

Back 59

diet management of high-fiber
foods
incision care
possible colostomy care
activity limitations

Front 60

What does a patient with diverticulosis need to know about diet?

cellulose and hemicellulose...these materials are found in what kinds of foods?

25 to 35 g of fiber per day, found in 4 slices of 100% whole-wheat bread and a 3-ounce serving of all-bran cereal...add fruits and veges with high fiber content to add bulk to stools...so what if the patient doesn't like these foods?

then give a bulk-forming laxative such as psyllium hydrophilic mucilloid (Metamucil), which can be taken to increase fecal size and consistency...and how does fluid intake affect all of this?

foods containing seeds or indigestible material that may block a diverticulum...examples please?

30% of total daily caloric intake is sufficient

Back 60

that dietary fiber can regulate bowel function and bring about partial relief of symptoms...a diet high in what?

wheat bran
whole-grain breads
cereals

and how many grams of fiber should the patient ingest?

then introduce them gradually to avoid flatulence and abdominal cramping...and what if the symptoms are too severe to continue this diet regimen?

ample fluid intake will help prevent bloating that may accompany a high-fiber diet...and AVOID alcohol because it irritates the bowel...what should clients AVOID at all costs?

alright then...nuts, corn, popcorn, cucumbers, tomatoes, figs, strawberries, caraway seeds...and how about allowable percentage of fat?

Front 61

Patients should AVOID ALL FIBER when they have symptoms of?

because they're IRRITATING!
BUT!...as diverticulitis resolves, fiber can be gradually added until progression to a high-fiber diet is once again obtained.
This could happen even before the patient is discharged from the hospital.

Back 61

diverticulitis because why?

Front 62

What should the nurse instruct the patient to do at some point following discharge from the hospital for diverticular disease?

Back 62

1 month FU visit to HCP
repeat flexible sigmoidoscopy
or barium enema can be
performed at that time
if patient had surgery, then
give instructions on
incision care and signs
and symptoms to report to
HCP
provide instruction on
colostomy care if received

Front 63

What are the manifestations of acute diverticular disease?

Back 63

fever
abdominal pain
bloody, mahogany, or tarry
stools
avoid laxatives other than
bulk-forming ones
avoid activities that
increase intra-abdominal
pressure, such as
straining at stool,
bending, or lifting heavy
objects
can be resolved with proper
diet
doesn't commonly recur if
everything done right
discuss alteration of body
image and loss of body
function