What is the nursing intervention for verticulitis

Diverticulitis (diverticular disease)

description

Diverticula are protrusions of the intestinal wall, preferably in the left-hand colon (sigmoid diverticulosis), but also on the right-hand side or affecting the entire colon. The frequency of diverticula increases with age. More than 70% of people over the age of 70 have diverticula, but young people can also have diverticula.

Symptoms / complaints

The cause is a combination of increased intestinal pressure, constipation, a low-fiber diet and weak connective tissue. Diverticulosis in itself has no disease value. Only the inflammation of the diverticula with the following symptoms make the diverticulum carrier a diverticulitis patient (sigmoid diverticulitis):

  • Pain in the (left) lower abdomen
  • fever
  • pressure-sensitive "roller"
  • increased signs of inflammation

Complications

Inflamed diverticula can burst (perforation). If this happens in the free abdominal cavity, a potentially dangerous peritonitis develops, otherwise an abscess develops. If the episodes of inflammation are repeated, the intestine can become constricted (stenosis) with the risk of intestinal obstruction (ileus). Furthermore, connections (fistulas) to the urinary bladder or vagina can develop or bleeding from the intestine can also occur.

Diagnosis

With a computed tomography of the abdomen, it is very likely that diverticulitis can be differentiated from other diseases and targeted treatment can be initiated. In addition, a colonoscopy should be performed to assess the intestinal mucosa and to rule out an intestinal tumor. Even after the acute inflammation has subsided, this examination is necessary for planning the further course of action.

therapy

Mild inflammation, especially during the first attack, is treated conservatively (non-surgically) with antibiotics. This is followed by diagnostics and, if necessary, measures to regulate the stool.

More severe inflammations lead to inpatient hospital treatment. If a perforation can be ruled out, non-surgical antibiotic treatment with infusion therapy takes place here as well.

In the case of recurrent attacks or severe inflammation, the risk of complications increases, so that a planned operation is indicated here.

surgery

The planned operation can often be performed minimally invasively with a laparoscopy (laparoscopic resection).

The diseased part of the large intestine is removed with the help of a video camera using 4 - 5 small incisions, which is then recovered from the abdominal cavity via a small incision in the pubic area. The intestine is reunited (anastomosis) with a stapler inserted through the anus. In individual cases, it may be necessary to create a protective outlet from the small intestine (protective ileostomy). This stoma can usually be resolved after 4 - 6 weeks with a small operation.

There may be reasons for an open operation (previous operations, adhesions, pronounced diverticulitis). This is then performed via a straight or transverse abdominal incision in the middle (conventional surgery).

Aftercare

As a rule, a rapid, gradual increase in diet is carried out after the operation. Depending on the severity of the operation and any previous illnesses, a stay in the intensive care unit may be necessary, but this is not the rule. Once the diet and wound healing have been completed after the laparoscopic operation, the patient can often leave the hospital after 4 - 8 days. Due to the small incisions, physical restraint is not necessary for a long time.

In the case of open surgery or emergency procedures, the recovery process naturally takes longer. A further diet is generally not necessary; attention should be paid to a healthy diet, sufficient exercise and fluid intake, and if necessary also to measures to soften or regulate the stool.