# A client with diverticulitis is admitted for an acute flare-up with left lower quadrant pain, abdominal distension, and high-pitched bowel sounds. Which nursing intervention is the highest priority for this client?

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## 문제

A client with diverticulitis is admitted for an acute flare-up with left lower quadrant pain, abdominal distension, and high-pitched bowel sounds. Which nursing intervention is the highest priority for this client?

## 보기

1. Encourage a high-fiber diet to promote bowel regularity
2. Monitor for signs of complications **✔ 정답**
3. Administer bulk-forming laxatives to prevent constipation
4. Increase fluid intake to 3000 mL per day to prevent dehydration

**정답: 2**

## 해설

During an acute exacerbation of diverticulitis, monitoring for complications such as intestinal obstruction, perforation, or abscess formation is the priority nursing intervention due to the life-threatening nature of these complications. Other options are less appropriate: (1) High-fiber diet can exacerbate symptoms during acute flare-ups; (3) Laxatives are contraindicated in acute diverticulitis; (4) Increased fluid intake alone does not address the risk of obstruction or perforation.

## 심화 해설

Clinical Reasoning & Priority Setting

When a client with a known history of diverticulitis presents with an acute flare-up characterized by left lower quadrant pain, abdominal distension, and high-pitched bowel sounds, the nurse must differentiate between the chronic management of the disease and the immediate dangers of an acute episode. High-pitched bowel sounds in the setting of distension and pain are a significant clinical red flag; they indicate intestinal hyperperistalsis proximal to an obstruction or severe inflammation, which can be a precursor to mechanical ileus or perforation.

The highest priority during this acute inflammatory phase is not to stimulate the bowel, but to assess for life-threatening progression. Diverticulitis involves inflammation and micro-perforation of diverticula. If the inflammation worsens, it can lead to macro-perforation and fecal peritonitis, a surgical emergency with high mortality. According to a case series on colonic perforation, early recognition of such deterioration is critical because the spectrum of perforation ranges from contained inflammation to free perforation requiring urgent surgical intervention to prevent fatal outcomes [1]. Therefore, vigilant monitoring for signs of peritonitis (rigid, board-like abdomen, rebound tenderness, fever, and hemodynamic instability) is the cornerstone of nursing care at this stage.

Analysis of Incorrect Options

The other options represent interventions that are appropriate for uncomplicated diverticular disease or the recovery phase, but are contraindicated or lower priority during an acute flare-up.

- Option 1 (High-fiber diet): A high-fiber diet is a preventive strategy for diverticulosis to reduce intraluminal pressure. During an acute flare of diverticulitis, the bowel needs rest. Fiber increases bulk and mechanical workload, which can exacerbate inflammation and increase the risk of perforation. The standard acute management is NPO (nothing by mouth) or clear liquids to rest the bowel.

- Option 3 (Bulk-forming laxatives): This is dangerous in the context of acute inflammation and potential narrowing. Increasing bulk proximal to an inflamed, narrowed segment can increase intraluminal pressure dramatically, precipitating perforation. Stercoral colitis, an inflammatory condition caused by severe fecal impaction, demonstrates how increased intraluminal pressure from solid stool can lead to inflammation and life-threatening perforation, reinforcing the principle that adding bulk in an inflamed colon is hazardous .

- Option 4 (Increase fluid intake to 3000 mL/day): While hydration is important to prevent constipation and support overall health, it is not the highest priority in the acute setting. Aggressive fluid intake does not address the immediate risk of perforation or obstruction. Fluid management is supportive, whereas monitoring for complications is a direct safety action.

Pathophysiology & Clinical Correlation

The high-pitched bowel sounds are a key clinical cue. In the early stages of a localized inflammatory process like diverticulitis, the inflamed segment can cause a functional or mechanical narrowing. The bowel proximal to this narrowing attempts to push content through, resulting in hyperactive, high-pitched sounds. If the process is not closely monitored, it can progress to a complete obstruction or perforation. The rarity and diagnostic difficulty of complicated diverticular presentations, such as giant Meckel's diverticulum, highlight how non-specific symptoms can mask a surgical abdomen, making systematic monitoring essential . Furthermore, severe inflammatory or ischemic complications following initial hemorrhage or inflammation can lead to persistent ileus, underscoring the need for the nurse to continuously reassess bowel sounds, distension, and pain patterns to detect deterioration early .

References (research sources)

- [1]A Case Series Characterizing the Spectrum of Colonic Perforation: A Retrospective Study From a Tertiary Care Center in Central India.Case reportGoli A, Anand K, Yadav A, Kushwah PS. (2025) · DOI: 10.7759/cureus.92986

## 임상 시나리오

Acute Diverticulitis: Priority AssessmentRecognizing the shift from chronic management to emergent monitoring
In an acute flare-up with high-pitched bowel sounds and distension, the primary concern is progression to bowel obstruction or perforation. The nurse must immediately place the patient on NPO status and initiate bowel rest.

Perform frequent abdominal assessments, focusing on a change from high-pitched to absent bowel sounds, and palpating for rebound tenderness or a rigid, board-like abdomen, which signals peritonitis.

CautionDo not administer fiber, bulk-forming laxatives, or enemas during the acute phase. These interventions increase intraluminal pressure and bowel stimulation, drastically raising the risk of macro-perforation and fecal peritonitis.

## 핵심 개념

- **Diverticulitis** — Inflammation or infection of small pouches (diverticula) that form in the lining of the digestive system, often causing acute abdominal pain.
- **High-pitched bowel sounds** — Hyperactive bowel sounds indicating intestinal hyperperistalsis, often a sign of early mechanical bowel obstruction or severe inflammation.
- **Peritonitis** — Inflammation of the peritoneum, the tissue lining the inner abdominal wall, often caused by bacterial infection from a perforated organ, presenting as a rigid, board-like abdomen.
- **Bowel rest** — A period of NPO (nothing by mouth) status allowing the gastrointestinal tract to rest and inflammation to subside, standard initial treatment for acute diverticulitis.
- **Perforation** — A hole that develops through the wall of a body organ, such as the colon, leading to leakage of contents into the sterile abdominal cavity.

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