Exam 3 - Large and Small Bowel Obstructions

Question 1

Manifestations of small bowel obstruction

Answer 1

Crampy pain – mid-abd colicky pain that subsides then increases
Passing of blood and/or mucous without fecal matter or gas
Bowel sounds initially loud, may be high-pitched, may correspond with abd pain and then later, be infrequent or absent
Vomiting – fecal with ileum blockage
Peristaltic waves may come strong and reverse directions
Dehydration
Abdominal distention

Question 2

Manifestations of large bowel obstruction

Answer 2

Progresses slowly and usually occurs in sigmoid
Causes: oth etio volvulus, diverticular disease, inflammatory disorders, fecal impaction
Constipation may be first complication noticed
Ribbon stool
Colicky abd pain – often deep and cramping, severe, continuous pain may signal bowel ischemia and possibly perforation
Abdominal distention with bowel visibly outlined through abdominal wall
High pitched tinkling bowel sounds with rushes and gurgles
Palpable localized tenderness and mass may be noted

Question 3

Treatment for small bowel obstruction

Answer 3

Decompression of bowel via NG tube to relieve vomiting and abdominal distention and to prevent aspiration of intestinal contents
Laparoscopic surgery to remove or lyse the scar tissue
Laparotomy to inspect small intestine and remove infarct or gangrenous tissue
Obstructing tumors are resected
Foreign bodies removed

Question 4

Treatment for large bowel obstruction

Answer 4

Fluid and electrolyte balance restoration
Decompression of bowel via NG tube
Colonoscopy – to untwist bowel or decompress bowel
Cecostomy – for poor surgical risk pt that needs relief from obstruction. Allows release of gas and small amount of fecal matter.
Rectal tube – for lower bowel obstruction for decompression
Surgical resection

Question 5

Nursing interventions for small bowel obstruction

Answer 5

Manage NG tube
Assess and manage fluid and electrolyte imbalance
Monitor nutritional status
Monitor bowel status

Question 6

Nursing interventions for large bowel obstruction

Answer 6

Management of NG tube
Assess and manage fluid and electrolyte balance
Prepare for surgery
Monitor bowel status
Emotional support