Diverticulitis PAINT Model

What is the difference between diverticulosis and diverticulitis?

• Diverticulosis: Presence of diverticula (pouch-like herniations) in the intestinal wall, usually in the sigmoid colon.

  • Often asymptomatic

  • Caused by chronic pressure from low-fiber diet, constipation, or aging

  • No active inflammation

• Diverticulitis: Inflammation and infection of one or more diverticula.

  • Caused by trapped food particles or bacteria

  • Symptoms: LLQ pain, fever, possible abscess, perforation, or peritonitis

  • Active, symptomatic disease

Memory Tip:
-osis = just the pouches (no inflammation)
-itis = inflamed pouches (infection present)

What is the pathophysiology of diverticulitis?

Diverticulitis occurs when diverticula—small pouch-like herniations in the intestinal lining—become inflamed due to trapped food or bacteria. This can lead to localized infection, abscess formation, or perforation. Symptoms appear during active inflammation.

What is the difference between the diet for diverticulosis and the diet for diverticulitis?

• Diverticulosis (inactive phase):

  • High-fiber diet (30–40 g/day) to prevent constipation and reduce pressure in the colon

  • Includes whole grains, fruits, vegetables, legumes

  • Adequate fluid intake (8–10 glasses water/day)

  • Avoid nuts, seeds, and GI stimulants if advised by provider

• Diverticulitis (active/inflamed phase):

  • Low-fiber diet or clear liquids to rest the bowel and decrease motility

  • Avoid raw fruits/vegetables, nuts, seeds, popcorn

  • Gradually return to high-fiber diet once inflammation resolves

Memory Tip:
High fiber when Healthy (diverticulosis)
Low fiber when inflamed (diverticulitis)

What are key risk factors for diverticulitis?

• Aging

• High-fat, low-fiber diet

• Obesity

• Smoking
  Rationale: Low fiber increases constipation and pressure in the colon, contributing to diverticula formation and inflammation.

What assessment findings should the nurse anticipate in diverticulitis?

• History: Constipation alternating with diarrhea, low-fiber diet

• Physical Exam:

  • LLQ pain

  • Low-grade fever

  • Abdominal distention

  • Rebound tenderness

  • Bloody stool
    Rationale: LLQ pain is typical because most diverticula form in the sigmoid colon.

What vital signs would concern the nurse in diverticulitis?

• Fever above low-grade range

• Tachycardia

• Hypotension (possible perforation or sepsis)

What labs and diagnostic results support diverticulitis or complications?

• CBC: ↑ WBC, ↓ H & H (bleeding)

• Occult stool: Positive for blood

• Abdominal X-ray: Free air = perforation

• CT scan: Abscess, thickening, perforation
  Rationale: Imaging identifies complications; labs indicate infection or bleeding.

What non-pharmacologic interventions are used in active diverticulitis?

• Keep patient NPO

• Avoid strenuous activity

• Monitor for orthostatic hypotension (dehydration, blood loss, or sepsis from diverticulitis can lower blood volume, causing BP to drop when standing)

• Assess stool for bleeding

• Avoid laxatives and enemas (increase motility)

• Provide low-fiber diet during acute phase

• Palpate abdomen for distention/tenderness

What pharmacologic treatments are used for diverticulitis?

• Antibiotics: Metronidazole + trimethoprim/sulfamethoxazole (TMP-SMX) or ciprofloxacin

• Analgesics: As prescribed
  Rationale: Targets anaerobic and gram-negative bacteria common in diverticulitis.

What surgical intervention may be needed for severe diverticulitis?

Bowel resection with or without colostomy

What patient teaching helps prevent recurrence during remission (diverticulosis phase)?

• Increase fiber to 30–40 g/day

• Avoid nuts, seeds, GI stimulants

• Drink 8–10 glasses of water/day

• Chew food slowly

• Exercise regularly

• Avoid smoking

A nurse is teaching a client with diverticulitis about diet during the acute phase. Which statement shows correct understanding?
A. “I will eat a high-fiber diet to keep my bowels moving.”
B. “I will follow a low-fiber diet until my symptoms improve.”
C. “I will include nuts and seeds for extra nutrition.”
D. “I can resume caffeine to help relieve constipation.”

Correct answer: B
Rationale: During acute diverticulitis, a low-fiber diet decreases bowel motility and irritation. High-fiber diets are recommended only during remission (diverticulosis). Nuts, seeds, and caffeine can worsen symptoms.

A nurse reviews the labs of a client with suspected diverticulitis. Which finding requires immediate provider notification?
A. WBC of 12,000/mm³
B. Positive occult stool test
C. Hemoglobin 8.2 g/dL
D. Mildly elevated ESR

Correct answer: C
Rationale: Normal hemoglobin ranges are:

• Male: ~13.5–17.5 g/dL

• Female: ~12–16 g/dL
  A hemoglobin of 8.2 g/dL indicates significant anemia, likely from GI bleeding, and requires urgent evaluation and intervention. WBC of 12,000/mm³, positive occult stool, and mildly elevated ESR are consistent with diverticulitis but are not as immediately life-threatening as severe anemia.

Which order for a patient admitted with diverticulitis should the nurse question?
A. Keep NPO
B. Start IV fluids
C. Administer metronidazole and ciprofloxacin
D. Give a warm tap water enema

Correct answer: D
Rationale: Enemas and laxatives are avoided during diverticulitis because they increase bowel motility, pressure, and risk of perforation.

A client with diverticulitis reports sudden worsening LLQ pain, fever of 102.8°F, and guarding. What is the nurse’s priority action?
A. Administer PRN analgesics
B. Notify the provider immediately
C. Apply a warm compress
D. Encourage oral fluids

A:
Correct answer: B
Rationale: Worsening pain with high fever and guarding may indicate perforation and peritonitis, a surgical emergency. Heat can worsen inflammation; oral fluids are contraindicated if surgery is possible.

The nurse is reinforcing dietary teaching for a client with a history of diverticulosis who is now hospitalized with active diverticulitis. Which foods are appropriate during the acute phase? Select all that apply.

A. Steamed white rice
B. Applesauce
C. Whole grain bread
D. Baked chicken
E. Raw carrots
F. Mashed potatoes

Correct answers: A, B, D, F
Rationale:

• A. Steamed white rice → Low fiber, gentle on bowel. ✅

• B. Applesauce → Low fiber, easy to digest. ✅

• C. Whole grain bread → High fiber; avoided during active diverticulitis. ❌

• D. Baked chicken → Low fiber, protein source. ✅

• E. Raw carrots → High fiber and rough texture; avoided during acute inflammation. ❌

• F. Mashed potatoes → Low fiber, tolerated during bowel rest. ✅

NCLEX Tip:
Think low fiber = low work for bowel during active diverticulitis; high fiber = prevention for diverticulosis. (AVOID SEEDS THEY GET STUCK IN THE POCKET)

The nurse is teaching a client with diverticulosis about foods that help prevent flare-ups. Which foods should the nurse recommend including in the diet? Select all that apply.

A. Whole grain bread
B. Brown rice
C. Fresh raspberries
D. Baked chicken
E. Raw broccoli
F. Applesauce

Correct answers: A, B, C, E
Rationale:

• A. Whole grain bread → High fiber, promotes bowel regularity. ✅

• B. Brown rice → High fiber, supports colon health. ✅

• C. Fresh raspberries → High fiber fruit, aids in preventing constipation. ✅

• D. Baked chicken → Low fiber, doesn’t help with prevention. ❌

• E. Raw broccoli → High fiber vegetable, beneficial for diverticulosis. ✅

• F. Applesauce → Low fiber, not harmful but doesn’t help prevent constipation. ❌

NCLEX Tip:
High fiber when Healthy (diverticulosis) → think whole grains, fresh fruits, and vegetables with skins.