Report sudden severe abdominal pain with a rigid board-like abdomen, rebound tenderness, fever, and tachycardia (perforation/peritonitis).
Before you read
Test yourself first: 2 questions
Question 1 of 2
A client with acute diverticulitis is admitted. Which intervention does the nurse anticipate during the acute phase?
Answer: A. During acute diverticulitis the bowel is rested with NPO status or clear liquids and antibiotics. A high-fiber diet is introduced only after the inflammation resolves, not during the acute flare.
Question 2 of 2
A client reports that abdominal pain consistently worsens after eating fried or fatty foods. The nurse recognizes this pattern is most characteristic of:
Answer: A. Fatty foods stimulate cholecystokinin release, causing gallbladder contraction. In cholelithiasis or cholecystitis, this contraction against an obstructed or inflamed gallbladder produces biliary colic, so pain typically intensifies after fatty meals. This dietary trigger pattern is a hallmark of gallbladder disease rather than peptic ulcer, appendicitis, or diverticulitis.
Keep the streak going with more questions like these, each with a full rationale.
What is diverticulitis?
It classically causes left lower quadrant pain, fever, and altered bowel habits. A low-fiber diet and chronic constipation are major contributors.
Key points to remember
- Hallmark presentation is left lower quadrant abdominal pain, fever, leukocytosis, and often a palpable LLQ mass.
- Acute diverticulitis is managed with bowel rest (NPO or clear liquids), IV antibiotics, and IV fluids; the bowel is rested then advanced slowly.
- Long-term prevention uses a HIGH-fiber diet and adequate fluids once the acute episode resolves.
- Complications include perforation, peritonitis, abscess, fistula, and bowel obstruction.
- Barium enema and colonoscopy are AVOIDED during the acute phase because of perforation risk and are deferred 4-6 weeks until inflammation subsides.
- Older adults and patients on corticosteroids may have blunted symptoms, masking a serious infection or perforation.
Signs & symptoms
- LLQ pain, fever, ↑WBC
- N/V, bloating, altered bowels
Nursing priorities
- Keep the patient NPO or on clear liquids during the acute attack to rest the bowel, then advance the diet gradually as ordered.
- Administer prescribed IV antibiotics and IV fluids and monitor temperature and WBC trend.
- Assess pain and abdomen frequently for rigidity, rebound tenderness, or distention signaling perforation.
- Monitor for signs of peritonitis or sepsis (rising fever, tachycardia, hypotension, board-like abdomen).
- Teach a high-fiber, high-fluid lifestyle for prevention once recovered.
Labs & values
Patient teaching
- Eat a high-fiber diet (20-35 g/day) with plenty of fluids to keep stool soft and prevent recurrence, but only after the acute attack resolves.
- Older 'avoid nuts and seeds' advice is no longer broadly required; follow your provider's guidance.
- Avoid increasing intra-abdominal pressure with straining; prevent constipation.
- Return for fever, worsening pain, or rectal bleeding.
Red flags: report now
- Report sudden severe abdominal pain with a rigid board-like abdomen, rebound tenderness, fever, and tachycardia (perforation/peritonitis).
- Never give laxatives, enemas, or perform a colonoscopy/barium study during the acute inflamed phase due to perforation risk.
- Report bright red rectal bleeding or signs of shock.
References
Clinical references for this topic
