# Situation: A 63-year-old man has had steady left lower quadrant (LLQ) pain for 2 days, a temperature of 38.2 °C, and a white blood cell (WBC) count of 14,000/mm³ (normal 4,500–11,000/mm³). A computed tomography (CT) scan shows uncomplicated sigmoid diverticulitis. He is admitted for oral antibiotics and observation because he lives alone. Which diet order is BEST during the first days of this attack?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630384  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 63-year-old man has had steady left lower quadrant (LLQ) pain for 2 days, a temperature of 38.2 °C, and a white blood cell (WBC) count of 14,000/mm³ (normal 4,500–11,000/mm³). A computed tomography (CT) scan shows uncomplicated sigmoid diverticulitis. He is admitted for oral antibiotics and observation because he lives alone.

Which diet order is BEST during the first days of this attack?

## 보기

1. Bran cereal and whole-grain bread to soften the stool
2. Nothing by mouth until the antibiotic course ends
3. Fresh vegetable salad with beans for added fiber
4. Clear broth, then low-residue foods as pain settles **✔ 정답**

**정답: 4**

## 해설

During acute uncomplicated diverticulitis, the colon is rested with clear liquids or a low-residue diet, advancing as symptoms improve. A high-fiber diet is the goal after recovery to prevent future attacks.

## 심화 해설

The best diet during the acute attack
During acute uncomplicated diverticulitis, the aim is to rest the colon while the inflammation settles. The diet starts with clear liquids or a low-residue diet and advances as pain and other symptoms improve. Clear broth followed by low-residue foods as pain settles is therefore the best order. A high-fiber diet is the long-term goal, but it belongs to the period after recovery, when it helps prevent future attacks.

Why low residue first, high fiber later
Residue is the undigested material that reaches the colon and adds bulk to the stool. During inflammation, bulky stool and gas stretch the colonic wall and increase contractions against inflamed diverticula, which can worsen pain. Clear liquids and low-residue foods reduce the volume of material passing through the sigmoid colon, giving the inflamed segment time to heal while antibiotics and observation do their work. Once the attack has resolved, the logic reverses: fiber produces soft, bulky stool that moves easily, lowering intracolonic pressure and reducing the formation of new diverticula and future attacks. The same nutrient is harmful in one phase and protective in the other, which is a frequent exam theme.

| Phase | Diet | Reason |
| --- | --- | --- |
| Acute attack | Clear liquids, then low-residue foods | Rests the inflamed colon |
| Recovery and prevention | Gradually increased high-fiber diet with fluids | Softens stool and lowers colonic pressure |
| Complicated disease (severe) | May need NPO and IV fluids | Perforation, abscess, or obstruction |

Why the distractors are wrong
Bran cereal and whole-grain bread are high-fiber foods appropriate for prevention after recovery, not during acute inflammation. Nothing by mouth until the antibiotic course ends is unnecessary in uncomplicated diverticulitis; prolonged NPO status is reserved for severe or complicated disease, and he is already being managed with oral antibiotics. A vegetable salad with beans adds bulky, gas-forming fiber that can distend the colon and aggravate pain during the attack.

Nursing application
The nurse offers clear liquids, assesses tolerance, and advances to low-residue foods such as white rice, refined bread, and well-cooked foods as pain eases. The nurse continues to monitor pain, temperature, and bowel pattern and reports worsening symptoms that could signal a complication.

Exam takeaway
Watch out Fiber is the right answer for prevention questions and the wrong answer for acute-attack questions. Read the stem for timing words such as "during the first days" or "before discharge."

## 임상 시나리오

Diet in Acute DiverticulitisRest the colon first, add fiber after recovery
During the attack, clear liquids followed by low-residue foods reduce stool bulk and gas, resting the inflamed sigmoid colon. The diet advances as pain settles.

After recovery, a high-fiber diet introduced gradually with adequate fluids softens stool and lowers intracolonic pressure to prevent future attacks. Prolonged NPO status is reserved for complicated disease.

CautionBran, whole grains, beans, and raw salads are not served during the acute phase; their bulk and gas can aggravate pain in the inflamed colon.

## 핵심 개념

- **Low-residue diet** — A diet low in fiber and undigested material that reduces stool volume and bowel stimulation.
- **Clear liquid diet** — Transparent fluids such as broth, water, and clear juices that leave minimal residue in the bowel.
- **High-fiber diet** — A diet rich in fruits, vegetables, legumes, and whole grains that produces soft, bulky stool.
- **Bowel rest** — Reducing intestinal workload by limiting oral intake so that inflamed bowel can heal.

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