Diverticulosis Nursing Diagnosis & Care Plans – RNlessons (2022)

Contents:

  • Overview of Diverticlar disease
  • Nursing diagnoses for diverticulosis and diverticulaitis
  • 5 Nursing Care plans for diverticulosis and diverticulitis

Terms:

Diverticular disease: umbrella term for diverticulosis and diverticulitis

Diverticulosis: a gastrointestinal disorder of having diverticula

Diverticulitis: acute inflammation of diverticula

Diverticulum(a): outpouching(s) of the large intestine or colon

Pathophysiology:

  • Diverticular disease is an outpouching of the intestinal mucosa through the colon wall. This clinical manifestation can occur in any part of the intestine but most commonly occurs in the Sigmoid colon – the descending part of the colon.
  • These herniations occur at weak spots of the intestinal wall where blood vessels interrupt the muscle layer. If the pressure builds up in the intestinal lumen, an outpouching forms only the mucosal layers and not the muscle wall.
  • Diverticulitis occurs when fecal matter blocks the diverticula and causes ischemia, initiating inflammation. Also, gut bacteria may cause an inflammatory process.

Risk Factors/ Causes

  • Age
  • Male
  • Obesity
  • Low-fiber diet
  • Medications such as NSAIDs and corticosteroids
  • Smoking
  • Sedentary lifestyle

Signs & Symptoms:

  • Majority is asymptomatic
  • Symptomatic diverticulosis
    • Constant abdominal pain in the left lower quadrant (in western countries); may be right lower quadrant in Asian countries because diverticulosis occurs more frequently in the ascending part of the colon.
      • Rebound tenderness
      • Cramp-like pain
    • Blood in the stool from rupture of submucosal blood vessel surrounding an area of outpouching
    • Changes in bowel habits: Diarrhea or Constipation
    • Hyperactive bowel sounds
    • Abdominal distention
    • Urinary symptoms that are consistent with those of UTI
    • Diverticulitis (inflammation of diverticula)
      • Nausea
      • Fever
      • Tachycardia
      • Loose stool
      • Acute left iliac fossa pain (in western countries)

Diagnosis:

  • Abdominal x-ray – may help visualize possible perforation
  • CT scan – may reveal abscess or thickening of the intestinal wall
  • Barium enema – x-ray films with radiocontrast; may not be used during acute diverticulitis
  • Colonoscopy – visualization of the colon; may find other malignancies

Laboratory studies:

  • WBC
  • Hematocrit and Hemoglobin
  • Occult stool sample
  • C-reactive protein (CRP)
  • Urinalysis

Treatment:

  • Medical treatment
    • IV fluids if not contraindicated
    • IV antibiotics
    • pain control
  • Surgical treatment (Indication for surgery: perforation, inflammation unresponsive to medical therapy, an abscess that cannot be drained, fistula)
    • Colon resection with primary anastomosis
    • Temporary or permanent colostomy

Possible Complications:

  • Diverticulitis
  • Local abscess formation
  • Perforation > Sepsis
    • Peritonitis
    • Fistula (Colovesicular fistula) may cause UTI
  • Obstruction (rare)
  • Hemorrhage from diverticulum rupture

Nursing Diagnoses for Diverticulosis and Diverticulitis

  • Acute Pain r/t bowel inflammation
  • Deficient Knowledge r/t diet regimen and medication regimen
  • Imbalanced Nutrition: Less than body requirements r/t loss of appetite
  • Ineffective tissue perfusion r/t blockage of diverticula
  • Risk for Deficient Fluid Volume
  • Constipation r/t insufficient fiber
  • Diarrhea r/t inflammation of intestine
  • Disturbed Body Image r/t ostomy; incision
  • Anemia r/t acute blood loss due to disease process

5 Nursing Care Plans for Diverticulosis and Diverticulitis

Acute Pain r/t bowel inflammation

Expected Outcome:

  • The patient reports an acceptable pain level of less than 3 on a pain scale of 0 to 10.
  • The patient’s comfort level is improved, as evidenced by stable vital signs within normal limits and a relaxed posture and affect.
  • The patient will use a combination of pharmacological and non-pharmacological treatment for pain.
Assess the patient’s pain level using a universal pain assessment tool such as a numeric pain scale, the Wong-Baker grimace tool, or the activity tolerance scale.

Patients with diverticulosis may be completely pain-free. However, exacerbations of this condition may be painful.
Note the following characteristics of pain.

Onset
Location
Duration
Characteristics
Aggravating factors
Alleviating factors
Treatments

Detailed documentation about different aspects of pain helps guide diagnosis and treatment.

Perform a comprehensive abdominal assessment palpating the most painful area last.

In western countries, the left lower quadrant is the most common area of pain associated with diverticulosis, whereas, in Asian countries, patients may report pain in the right lower quadrant. As mentioned previously, in Asian countries, diverticula may form in the cecum area of the intestine.

Assess for changes in bowel habits.

Patients with diverticular disease may have a history of constipation and diarrhea.

Obtain a complete set of vital signs.

Blood pressure, heart rate, and respirations reveal information about the patient’s physiological condition, stress level, and pain. For example, elevated blood pressure, tachycardia, and tachypnea may be the reason for an acute change in health status or uncontrolled pain.

Obtain information about the strategies the patient has tried for pain control.

This information provides a baseline for adequate pain management.

Provide analgesia medication as ordered.

Acetaminophen (Tylenol) and antispasmodics are the first-line analgesic treatment. The use of NSAIDs and narcotic agents should be avoided, for there is an increased risk of complications associated with Diverticulitis. However, narcotic agents are still being used in cases of severe pain.

Administer broad-spectrum antibiotics as ordered.

The pain the patient experiences derives from an inflammatory response triggered by an infectious process. Antimicrobials help treat the infection that can occur from Diverticulitis.

Offer non-pharmacological pain management techniques.

Frequent position changes, meditation, and warm compresses may help alleviate pain in addition to analgesic medication.

Monitor for sudden changes in severity and nature of abdominal pain.

A sudden increase in pain sensations may indicate a gastrointestinal perforation, which is a life-threatening condition.

Deficient Knowledge r/t diet regimen and medication regimen

Expected Outcome: The patient will verbalize an understanding of the disease process and the importance of complying with diet and medication regimen.

Assess the patient’s knowledge base about the disease and evaluate the diet and medication regimens compliance history.

This gives a baseline and offers a starting point for developing a teaching plan. For example, newly diagnosed patients need further education than patients living with the disease for years undergoing surgery.

During non-acute phases (diverticulosis), encourage a high-fiber diet.

A high-fiber diet is high in cellulose, such as wheat bread, whole-grain bread, and cereal. In addition, fresh fruits and vegetables with high fiber content are encouraged to add bulk to stool and ensure consistency.

Encourage fluid intake of at least 2500 to 3000 ml per day, if not contraindicated.

High fluid intake prevents bloating that can occur with a high-fiber diet.

Tell the patient to avoid alcohol.

Alcohol may irritate the gastrointestinal tract.

During acute phases (diverticulitis), teach the patient to avoid fiber.

Foods high in fiber stimulate bowel motility and only irritate the gastrointestinal mucosa further. Once the exacerbation subsides, the patient may gradually add fiber back into the diet.

Encourage clear liquids as tolerated.

Clear liquids may help maintain adequate fluid balance if the patient is stable enough to recover at home. During hospitalizations, the patient may even be kept NPO or have a nasogastric tube inserted to promote gut rest.

Encourage rest during acute phases and teach the patient to avoid lifting, straining, coughing, or bending.

Activities such as above may increase intraabdominal pressure and may result in the perforation of a diverticulum.

Teach about medications and their indications.

Antibiotics such as metronidazole (Flagyl) or ciprofloxacin (Cipro).

It is important for the patient to take antibiotics on time even if he or she feels better.Each course of antibiotics should be finished to ensure all bacteria are killed and prevented from multiplying.

Analgesics such as acetaminophen (Tylenol) or opiate narcotics for severe/complicated cases.

Opioid analgesics may affect gut motility and can contribute to constipation.

Antispasmodics/ anticholinergics

These medications help to control diarrhea and cramping.

Teach the patient and family to avoid laxatives and enemas.

Bowel stimulating medications may irritate the intestines and exacerbate symptoms.

Discuss possible surgical interventions with the patient and family.

Diverticular disease may require surgical intervention. Colon resection may be indicated in some cases.

For the patient that had surgical intervention, teach incision care and ostomy care if needed.

Proper care will keep the site clean and reduce the risk of infection.

Imbalanced Nutrition: Less than body requirements r/t loss of appetite, nausea, vomiting

Expected Outcome: The patient will exhibit an improved nutritional status as evidenced by weight maintenance, absence of nausea and vomiting, and stable electrolytes.

Obtain the patient’s weight. Use a standing scale if possible.

Compared to weighing the patient in the bed, a weight obtained from a standing scale may be more accurate.

Collaborate with a dietitian to assist with appropriate food selection for each phase of diverticular disease.

Diet for diverticulitis:
During acute exacerbations, patients should avoid sources of fiber and eat light meals.

No fiber foods:
WaterBroth
Jell-O
Popsicles
Clear juices such as apple, cranberry, or grape

Diet for recovery phase:
While the patient is recovering, slowly introduce low-fiber foods to the diet.

Low-fiber foods:
Canned and well-cooked vegetables without seeds such as apple sauce
Dairy products such as cheese, milk, and yogurt
Eggs
Pasta, white bread, and white rice
Ground meat or well-cooked meat
Low-fiber cereal

Diet for maintenance phase:
While the patient does not experience any symptoms, a high-fiber diet is recommended. Fiber helps keep the digestive system active and prevents constipation. Constipation can contribute to building up pressure in the colon and lead to flare-ups.

High fiber foods:
Beans and legumes
Bran and whole wheat bread
Brown and wild rice instead of white rice
Fresh fruit and vegetables instead of juices – fiber gets lost during the juicing process
Fruits and vegetables with peels and skin

Eliminate offending odors and other factors in the environment that might affect appetite.

A pleasant environment may help make food more appetizing and increase food intake.

Monitor electrolyte, vitamin, and mineral profile closely and replete as ordered.

Decreased food intake, vomiting, and diarrhea can lead to deficiencies.

Anticipate the need for total parenteral nutrition (TPN) as ordered.

Some patients may not tolerate oral intake during exacerbations.

Anticipate the need for a nasogastric tube (NGT) if the patient experiences severe nausea, vomiting, or abdominal distention.

A nasogastric tube helps with decompression and promotes gut rest.

Ineffective Tissue Perfusion r/t fecal blockage of diverticula

Expected Outcome: The patient will exhibit adequate tissue perfusion of the gastrointestinal tract as evidenced by the absence of compilations of diverticular disease, absence of pain, and containment of acute phases of diverticular disease through necessary and appropriate interventions.

Perform an abdominal assessment considering pain location, characteristics, and intensity level.

Abdominal pain usually presents as cramp-like discomfort during an acute episode of diverticular disease. However, a sudden increase in pain may be an indication of rupture or perforation. This would be a medical emergency and require surgical intervention.

Monitor lab studies pertinent to diverticulosis.

Hemoglobin and Hematocrit
The blood vessels that supply the diverticula may rupture and cause bleeding.

WBC
Patients with acute diverticulitis often present with an elevated white blood cell count.

BMP
A basic metabolic panel should be obtained to assess electrolytes and renal function. Sometimes diverticular disease may cause nausea, vomiting, and diarrhea. This can cause electrolyte imbalances.

Urinalysis
Urine sample to rule out urinary tract infection (UTI)

Occult stool sample
A stool sample should be obtained to rule out occult bleeding.

Anticipate the need for surgical intervention.

Several options include a colon resection with primary anastomosis or a temporary or permanent colostomy.

Risk for Deficient Fluid Volume

Risk factors:

  • Diarrhea
  • Vomiting
  • Bleeding from diverticula

Expected Outcome: The patient will remain euvolemic as evidenced by good skin turgor, moist mucous membranes, and adequate urine output of at least 30 mL/hr.

Assess the patient’s hydration status. Note

Skin turgor
Mucous membranes
Fluid intakeoutput
Weight
Blood pressure
Heart rate

Signs of dehydration are tenting skin turgor, dry mucous membranes, decreased urine output, tachycardia, decreased blood pressure, and weight loss.

Monitor stools for the presence of frank blood and obtain an occult stool sample as ordered.

Blood loss may contribute to low circulatory volume, which may lead to low blood pressure.

Monitor hemoglobin and hematocrit.

These values decrease with bleeding.

Encourage oral fluid intake of at least 8 to 10 glasses of fluid per day if not contraindicated.

Oral fluid is the primary way to maintain an adequate fluid status.

Anticipate the need for IV fluids.

If the patient cannot maintain an adequate fluid status via oral intake, IV fluids may be necessary.

Anticipate the need for blood transfusions as ordered.

If the patient has decreased hematocrit and hemoglobin levels during an exacerbation, blood transfusions may be needed.

More Care Plans:

Gastritis

GI bleed

Deficient Fluid Volume

Acute Pain

Ineffective Tissue Perfusion

References:

Swanson, S. M. (2018, March 1). In the Clinic: Acute Colonic Diverticulitis. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430566/.

Diagnosis and Management of Acute Diverticulitis. (n.d.). Retrieved from https://www.aafp.org/afp/2013/0501/p612.html.

What Is Diverticulitis? (n.d.). Retrieved from https://www.healthline.com/health/diverticulitis

Discharge Instructions for Diverticulitis. (n.d.). Retrieved from https://www.fairview.org/Patient-Education/Articles/English/d/i/s/c/h/Discharge_Instructions_for_Diverticulitis_86329.

Diverticular Disease and Diet. (n.d.). Retrieved from https://www.ucsfhealth.org/Education/Diverticular%20Disease%20and%20Diet.

Diverticulitis. (2019, June 3). Retrieved from https://www.eatright.org/health/wellness/digestive-health/diverticulitis.

Matrana, M. R. (2009, June 5). Epidemiology and Pathophysiology of Diverticular Disease. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2780269/.

Gulanick, M., & Myers, J. L. (2013). Nursing Care Plans (8th ed.). Elsevier Health Sciences.

Ignatavicius, D. D., & Workman, M. L. (2012). Medical-surgical Nursing (8th ed.). Elsevier Health Sciences.

FAQs

What are some nursing interventions for diverticulitis? ›

Interventions include eating a diet high in fiber, taking products to soften the stool, reducing intra-abdominal pressure, and exercising. In severe instances, bowel resection may be necessary to remove the affected portion of the intestine. Initially, patients will be NPO or on a clear liquid diet.

What are 5 nursing diagnosis? ›

The following are nursing diagnoses arising from the nursing literature with varying degrees of authentication by ICNP or NANDA-I standards.
  • Anxiety.
  • Constipation.
  • Pain.
  • Activity Intolerance.
  • Impaired Gas Exchange.
  • Excessive Fluid Volume.
  • Caregiver Role Strain.
  • Ineffective Coping.

What is a nursing diagnosis in nursing care plan? ›

The nursing diagnosis is the nurse's clinical judgment about the client's response to actual or potential health conditions or needs.

What is the nursing diagnosis of a patient? ›

“A nursing diagnosis is a clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group or community.

What is the best way to diagnose diverticulosis? ›

Colonoscopy. Doctors may recommend a colonoscopy to confirm a diagnosis of diverticular disease and rule out other conditions, such as cancer link. Doctors may also order a colonoscopy to see and treat diverticular bleeding.

What should the nurse teach the patient with diverticulosis to do? ›

Instruct patients to avoid the use of laxatives or enemas as these agents increase pressure in the colon and therefore increase the risk of recurrent symptoms. Physical activity reduces the occurrences of painful episodes and as a result, nurses can encourage the patient to exercise regularly.

How do you care for someone with diverticulosis? ›

How can you care for yourself at home?
  1. Drink plenty of fluids. ...
  2. Stay with liquids or a bland diet (plain rice, bananas, dry toast or crackers, applesauce) until you are feeling better. ...
  3. Use a heating pad set on low on your belly to relieve mild cramps and pain.
  4. Get extra rest until you are feeling better.

What are the possible complications of diverticulosis? ›

Diverticulosis may lead to several complications including inflammation, infection, bleeding or intestinal blockage. Fortunately, diverticulosis does not lead to cancer. Diverticulitis occurs when the pouches become infected or inflamed.

How do you write a nursing diagnosis examples? ›

A nursing diagnosis has typically three components: (1) the problem and its definition, (2) the etiology, and (3) the defining characteristics or risk factors (for risk diagnosis). BUILDING BLOCKS OF A DIAGNOSTIC STATEMENT. Components of an NDx may include problem, etiology, risk factors, and defining characteristics.

What are the types of nursing diagnosis with examples? ›

There are 4 types of nursing diagnoses: risk-focused, problem-focused, health promotion-focused, or syndrome-focused.

What is the most important nursing diagnosis? ›

Any nursing diagnoses that directly relate to survival or a threat to the patient's mortality should be prioritized first. This may be related to the patient's access to air, water, or food, defined as the necessities of survival.

How do you write a good care plan? ›

Every care plan should include:
  1. Personal details.
  2. A discussion around health and well being goals and aspirations.
  3. A discussion about information needs.
  4. A discussion about self care and support for self care.
  5. Any relevant medical information such as test results, summary of diagnosis, medication details and clinical notes.
Feb 14, 2022

What should a nursing care plan include? ›

A nursing care plan contains relevant information about a patient's diagnosis, the goals of treatment, the specific nursing orders (including what observations are needed and what actions must be performed), and an evaluation plan.

What are the 3 types of diagnosis? ›

Sub-types of diagnoses include: Clinical diagnosis. A diagnosis made on the basis of medical signs and reported symptoms, rather than diagnostic tests. Laboratory diagnosis.

Do nurses explain diagnosis? ›

Most nurses don't have the authority or scope of practice to perform a diagnosis. For example, CNAs, LPNs, and registered nurses do not diagnose their patient's conditions. Moreover, they don't prescribe medications, perform invasive surgical procedures (independently) or act as primary care providers.

What is a 2 part nursing diagnosis? ›

TWO-PART NURSING DIAGNOSIS: Risk Nursing Diagnosis are written in the two-part format. The first part indicates the diagnostic label and the second part indicates the presence of risk factors or confirmation for a risk nursing diagnosis. Example: 'Risk for infection related to compromised immune system''.

What is the main cause of diverticulosis? ›

Diverticular disease is caused by small bulges in the large intestine (diverticula) developing and becoming inflamed. If any of the diverticula become infected, this leads to symptoms of diverticulitis. The exact reason why diverticula develop is not known, but they are associated with not eating enough fibre.

What is the most common site for diverticulosis? ›

Diverticulosis is a clinical condition in which multiple sac-like protrusions (diverticula) develop along the gastrointestinal tract. Though diverticula may form at weak points in the walls of either the small or large intestines, the majority occur in the large intestine (most commonly the sigmoid colon).

What can you teach a patient with diverticulosis? ›

Drink at least 8 cups of fluid daily. Fluid will help soften your stool. Exercise also promotes bowel movement and helps prevent constipation. When the colon is not inflamed, eat popcorn, nuts and seeds as tolerated.

What foods should be avoided with diverticulosis? ›

Actually, no specific foods are known to trigger diverticulitis attacks. And no special diet has been proved to prevent attacks. In the past, people with small pouches (diverticula) in the lining of the colon were told to avoid nuts, seeds and popcorn.

What should I avoid with diverticulosis? ›

Most people with diverticulosis or diverticular disease do not need to avoid specific foods. In the past, doctors used to recommend avoiding nuts, popcorn, and seeds. However, more recent research suggests that these foods are not harmful to people with diverticulosis or diverticular disease.

What is the best treatment for diverticulosis pain? ›

Rest, taking over-the-counter medications for pain and following a low-fiber diet or a liquid diet may be recommended until your symptoms improve. Once your symptoms improve, you can slowly return to soft foods, then a more normal diet, which should be one that includes many high-fiber foods.

What type of diet is recommended for a patient with diverticulosis? ›

Stages of Diverticulosis

Early on, a diet consisting of clear liquids is often prescribed to ensure maximum bowel rest. As recovery proceeds, the diet is advanced to a Low Fiber Diet, progressing gradually to a High Fiber Diet when recovery is complete.

What part of the body does diverticulosis affect? ›

Diverticulosis is a condition that occurs when small pouches, or sacs, form and push outward through weak spots in the wall of your colon. These pouches form mostly in the lower part of your colon, called the sigmoid colon. One pouch is called a diverticulum.

What is the difference between diverticulitis and diverticulosis? ›

Diverticulosis occurs when small, bulging pouches (diverticula) develop in your digestive tract. When one or more of these pouches become inflamed or infected, the condition is called diverticulitis.

What are four complications of diverticulitis? ›

Complications of diverticulitis
  • Perforation. Perforation of diverticulitis occurs secondary to severe inflammation of bowel wall layers with subsequent necrosis and loss of intestinal wall integrity. ...
  • Abscess. Diverticulitis may result in phlegmon and abscess formation. ...
  • Pylephlebitis. ...
  • Bowel obstruction. ...
  • Bleeding. ...
  • Fistula.

What are the 4 types of nursing diagnosis? ›

The four types of nursing diagnosis are Actual (Problem-Focused), Risk, Health Promotion, and Syndrome.

What are the 4 types of nursing diagnosis select all that applies? ›

Nursing diagnoses are written with a problem or potential problem related to a medical condition, as evidenced by any presenting symptoms. There are 4 types of nursing diagnoses: risk-focused, problem-focused, health promotion-focused, or syndrome-focused.

Which nursing diagnosis is common with inflammatory bowel disorders? ›

Here are seven (7) nursing care plans (NCP) and nursing diagnosis for patients with inflammatory bowel diseases: ulcerative colitis, Crohn's disease, and ileocolitis: Diarrhea. Risk for Deficient Fluid Volume. Anxiety.

What is the gold standard for diagnosing diverticulitis? ›

Abdominal computerized tomography (CT) scan is still the gold standard in diagnosing acute diverticulitis and its complications.

What is the most important nursing diagnosis? ›

Any nursing diagnoses that directly relate to survival or a threat to the patient's mortality should be prioritized first. This may be related to the patient's access to air, water, or food, defined as the necessities of survival.

What are the 3 steps in diagnosis? ›

physical examination. generating a provisional and differential diagnosis. testing (ordering, reviewing, and acting on test results) reaching a final diagnosis.

What are the 3 types of diagnosis? ›

Sub-types of diagnoses include: Clinical diagnosis. A diagnosis made on the basis of medical signs and reported symptoms, rather than diagnostic tests. Laboratory diagnosis.

What are the two most common types of inflammatory bowel disease? ›

Types of IBD include: Ulcerative colitis. This condition involves inflammation and sores (ulcers) along the lining of your large intestine (colon) and rectum. Crohn's disease.

What are the two most common inflammatory bowel disease? ›

Inflammatory Bowel Disease (IBD) is a broad term that describes conditions characterized by chronic inflammation of the gastrointestinal tract. The two most common inflammatory bowel diseases are Crohn's disease and ulcerative colitis.

What is the diagnosis of inflammatory bowel disease? ›

How is IBD diagnosed? A combination of endoscopy (for Crohn's disease) or colonoscopy (for ulcerative colitis) and imaging studies, such as: Contrast radiography. Magnetic resonance imaging (MRI).

Is diverticulosis the same as diverticulitis? ›

Diverticulosis occurs when small, bulging pouches (diverticula) develop in your digestive tract. When one or more of these pouches become inflamed or infected, the condition is called diverticulitis.

What is the standard treatment for diverticulitis? ›

Diverticulitis is treated using diet modifications, antibiotics, and possibly surgery. Mild diverticulitis infection may be treated with bed rest, stool softeners, a liquid diet, antibiotics to fight the infection, and possibly antispasmodic drugs.

What is the most common site for the presence of diverticulitis? ›

The most common location for diverticulitis is the sigmoid colon, which is the S-shaped near end portion of your colon. Although this is the most common location, it's possible for diverticula to form in other areas of your colon.

Top Articles

Latest Posts

Article information

Author: Frankie Dare

Last Updated: 11/10/2022

Views: 5726

Rating: 4.2 / 5 (73 voted)

Reviews: 80% of readers found this page helpful

Author information

Name: Frankie Dare

Birthday: 2000-01-27

Address: Suite 313 45115 Caridad Freeway, Port Barabaraville, MS 66713

Phone: +3769542039359

Job: Sales Manager

Hobby: Baton twirling, Stand-up comedy, Leather crafting, Rugby, tabletop games, Jigsaw puzzles, Air sports

Introduction: My name is Frankie Dare, I am a funny, beautiful, proud, fair, pleasant, cheerful, enthusiastic person who loves writing and wants to share my knowledge and understanding with you.