bowel obstruction Flashcards
what is bowel obstruction?
an obstruction, constrictor or occlusion in GI tract
passage of nutrients and secretion in the gI system is blocked and impairs motility
may be partial or complete at one or more locations
congenital or acquired
what is motility?
contraction of the muscles that mix and propel contents in the gi tract
how do you classify bowel obstruction? (causes)
1) mechanical
- adhesions: fibrous tissue that develops after
abdominal surgery
- tumor within the intestine
- intussusception: telescoping or pushing one
segment of intestine into another
- hernia: portion of intestine protrudes into
another part of the body
- volvulus: twisting of intestines
- gallstones
- swallowed objects
- inflammatory bowel disease: crohns
- strictures
- diverticulitis
- impacted stool/meconium plug
2) non mechanical
- paralytic ileus: msk or nerves within small or
large intestine dont work
- Hirschsprungs disease
what are your nursing assessments?
- assess bb’s first stool (should be within 24-36h)
- determine if bb is bottle or breast fed (constipations
is rare in BF bb) - rectal temp to determine patency of anal catheter
what is pyloric stenosis?
obstruction of pylori sphincter by hypertrophy and hyperplasia of circular muscle of pylorus
leads to narrowing of pylorus
develops in the first wks of life (1-10wks)
what are the clinical manifestations of pyloric stenosis?
asymptomatic => firs few wks of like
regurgitation or non-projectile vomiting => wk 2-4
projectile vomiting (blood tinged) => wk 4-6
failure to thrive (wt loss)
dehydration
hunger
distended abdomen
palpable olive shaped tumor in epigastric region
What the diagnostic tests for pyloric stenosis?
- U/S
- radiological studies (Reveal delayed gastric emptying +
elongated threadlike pyloric channels) - labs: low Na+ and K+, high hematocrit (dehydration)
- metabolic alkalosis (loss of gastric acid d/t excessive
vomiting) - barium swallow: an imaging test that checks for problems in your upper GI tract
- barium enema: X-ray exam that can detect changes or abnormalities in the large intestine (colon)
- abdominal x ray: presence of gas and fluids
- sigmoidoscopy
- colonoscopy
** lower GI series then upper GI series
what is the surgical management for pyloric stenosis?
pyloromyotomy
what is a pyloromyotomy? how is it done? any complications?
longitudinal incision through circular msk fibers of the pylorus till the submucosa
laparoscopic
complication: persistent pyloric obstruction, wound infection, dehiscence
what is the post op care for pyloromyotomy?
- 24-48h hospitalization
- NGT to low wall suction
- iv fluid until child is retaining fluids
- feeding begin 4-6 h post op => w small frq feed of 15-30 cc clear fluid (pedialyte or glucose water)
- after 24hr, advance to formula or breast milk
- if N/V more than 2-3 time = npo for short period
- iv therapy
- elevate HOB
- daily wt
- position on side
- pain control
- I and O
- drgs change
- daily labs
- dc teaching
hydrostatic reduction considerations?
hydrostatic pressure of barium flowing into the colon will push the telescoping portion of the bowel back into it’s original position
Now using water soluble contrast and air pressure
Fluid resuscitation, NG and antibiotic therapy may be given before attempting hydrostatic reduction
contraindicated: perforation and shock
what is hirschsprung disease?
congenital mechanical obstruction caused by inadequate motility of part of the large intestine (aganglionic mega colon)
theres an absence of ganglion cells in the rectum and a proximal portion of the large intestine
resulting in absent or poor peristalsis
causes accumulation of feces + dilated colon (mega colon) and internal anal sphincter fails to relax preventing evacuation of solid liquids or gas
leads to intestinal distention and ischemia leading to inflammed colon
clinical manifestation of hirschsprung disease in a new born?
failure to pass meconium within 24-36h
reluctant to ingest fluids
bile stained vomitus
irritable/fussy infant
anemia
clinical manifestation of hirschsprung disease in infancy?
1) ftt/ retarted g and d
2) constipation
3) abdo distention
5) diarrhea
6) vomiting
7) enterocolitis (explosive diarrhea, fever)
clinical manifestation of hirschsprung disease in a childhood?
more chronic symptoms
- constipation
- ribonlike, foul smelling stools !!
- abdo distention
- visible peristalsis
- fecal mass easily palpable
- malnourished, anemic
what is the surgical intervention for hirschsprung disease?
2 steps
1) anaganglionic portion of bowel removed. function of internal anal sphincter repaired (hemicolectomy) + ostomy created (colostomy)
2) endorectum pull through + ostomy closed
occurs when child wt more than 9kg
what is gastrografin?
used in newborns to help remove a hard first stool
causes water to be pulled into the intestine, and the extra water softens the stool.
dx test for hirschsprung disease?
gastrografin
manometry: small balloon inflated inside the rectum. Normally, the anal muscle will relax.
biopsy: looks for missing nerve cells
rectal exam
complications to look out for in obstructions?
- enterocolitis
- toxic megacolon
- F and E imbalances
- perforation
- strangulation
- necrosis
how do you bowel prep?
- not needed in newborns
- pull through procedure => repeated saline enemas
- decreasing bowel flora w antibiotics
nursing care/consideration for abdominal distention?
- analgesia witheld => mask s and s and decreases intestinal motility
- NGT for decompression (remove gas and fluids)
- measure type and amount of drainage - colon decompression though colonoscopy (decompress bowel before surgery0
- measure abdominal girth
what is important teaching related to homecare?
-Provide parents how to complete irrigations and allow time for return demonstration (if patient goes home with no colostomy, so rectal irrigation)
- Low fiber, high calorie, high protein diet
- TPN
- Atraumatic care and childlife
- Ostomy teaching
what are signs of necrosis?
(fever, increase abdo distention, tender++, dyspnea, irritable, cyanosis)
what are pre op interventions/teachings rt hirschsprungs?
pre op:
- Assess bowel function, characteristics of stool
- Abdominal circumference
- Vomiting
- Respiratory distress
- Hydration status
- Enema
- consent
- NPO
- Pre-anesthetic sedation
-labs
- ostomy teaching (reassure that its usually temp)
