What are the discharge instructions for a patient with diverticulitis, bleeding, and altered stool?

Discharge Instructions for Diverticulitis with Bleeding and Altered Stool

Patients with diverticulitis who are discharged from the emergency department without antibiotics should receive clear instructions on self-monitoring of signs and symptoms and when to re-seek medical attention. 1

Monitoring Instructions

Signs and Symptoms to Monitor

• Worsening abdominal pain - especially if becoming more severe or diffuse
• Persistent or high fever (>101°F/38.3°C)
• Changes in bowel movements:
  • Increased frequency of bloody stools
  • Severe diarrhea or constipation
  • Black, tarry stools (melena)
• Nausea or vomiting that prevents adequate oral intake
• Increasing abdominal distension
• Worsening weakness or dizziness

When to Seek Immediate Medical Attention

• Severe, worsening, or persistent abdominal pain
• High fever with chills
• Significant rectal bleeding or blood in stool
• Inability to tolerate oral intake for >24 hours
• Signs of dehydration (dizziness, dry mouth, decreased urination)
• Development of new symptoms such as shortness of breath or chest pain

Dietary Recommendations

Initial Diet (First 2-3 days)

• Start with clear liquids until symptoms improve 2
• Gradually advance to low-residue diet as tolerated

Long-term Diet (After symptoms resolve)

• High-fiber diet (gradually increase to 25-35g daily) 2
• Focus on fruits, vegetables, whole grains, and legumes
• Drink plenty of fluids (at least 8-10 glasses of water daily)
• Contrary to old beliefs, there is no need to avoid seeds, nuts, corn, or popcorn 3

Medication Instructions

For Uncomplicated Diverticulitis

• Pain management: Acetaminophen as needed for pain 4
• Avoid NSAIDs, opiates, and corticosteroids as they may increase risk of complications 2

For Complicated Diverticulitis (with bleeding)

• Complete full course of prescribed antibiotics if provided
• Common regimens include:
  • Oral: amoxicillin-clavulanate or cefalexin with metronidazole 2, 4
  • IV (if started in hospital): ceftriaxone plus metronidazole or piperacillin-tazobactam 2

Activity Guidelines

• Rest as needed during acute phase
• Gradually return to normal activities as symptoms improve
• Regular physical activity is recommended for prevention of recurrence 2
• Avoid heavy lifting (>10 pounds) until cleared by healthcare provider

Follow-up Care

Medical Follow-up

• Schedule follow-up appointment within 1-2 weeks
• Colonoscopy recommended 4-6 weeks after resolution of symptoms to rule out malignancy (especially for first episode or complicated diverticulitis) 2

Prevention Strategies

• Maintain high-fiber diet
• Regular physical activity
• Smoking cessation
• Weight management if overweight
• Avoid regular use of NSAIDs, opiates, and corticosteroids 2

Special Considerations for Bleeding

• Monitor amount and frequency of blood in stool
• If bleeding is significant or persistent, seek immediate medical attention
• Keep track of bowel movements (frequency, consistency, presence of blood)
• Ensure adequate fluid intake to prevent dehydration
• Consider iron supplementation if recommended by healthcare provider for blood loss

Documentation

• Keep a symptom diary to track:
  • Pain levels (scale 1-10)
  • Temperature readings
  • Bowel movement characteristics
  • Medication intake
  • Dietary intake

This comprehensive approach to discharge instructions ensures patients understand how to monitor their condition, when to seek additional care, and how to prevent recurrence of diverticulitis episodes.