Intestinal obstruction

Question 1

What is intestinal obstruction and where does it occur

Answer 1

Intestinal Obstruction occurs when intestinal contents can not pass through the GI tract.

May occur in small intestine or Colon
Can be partial or complete

Simple or strangulated

Question 2

Simple obstruction

Answer 2

Simple has an intact blood supply

Question 3

Strangulated obstruction

Answer 3

Strangulated there is no blood supply. Gangrene can set in after 6 hours: Could be a hernia causing that part of the intestine to get trapped

Question 4

Clinical manifestations of intestinal obstruction

Answer 4

Early sign-colicky (peaks and then subsides) abdominal pain, nausea, vomiting, abdominal distension
Later-constipation, decreased flatus.
Foul smelling vomitus-long standing obstruction –requires immediate surgery
High pitched bowel sounds above the area of obstruction

Question 5

Diagnostic studies

Answer 5

History and physical
Xray
CT scan
Sigmoidoscopy or colonoscopy
CBC- increased WBC in strangulation or perforation greater than greater than 11,000
Electrolytes

Question 6

Treatment

Answer 6

Emergent surgery if bowel is strangulated

Many bowel obstructions may resolve with conservative treatment

NG tube

IV fluid therapy

Electrolyte replacement, monitor renal function

Analgesics for pain control: Usually IV pain medications

In malignant bowel obstruction the goal of treatment is to regain patency and resolve obstruction
Stent placement
Corticosteroids for edema and inflammation
Venting Gastrostomy tube

Question 7

Why put a NG tube

Answer 7

for decompression: removes fluid and air to relieve pressure

Question 8

Why a venting gastrostomy tube

Answer 8

Decompresses stomach and stops nausea and vomiting. Sometimes can go home with them

Question 9

Treatment in advanced stages

Answer 9

Surgery if condition deteriorates or obstruction doesn’t improve in 24 hours

Parenteral nutrition: TPN Make sure we have a central line in these patients

bowel resection

Partial or total colectomy, colostomy or ileostomy may be required

Colostomy or ileostomy

Question 10

Colostomy is placed where? What do you need to know

Answer 10

In the colon on the left side

: In colostomy patients make sure with each round empty the bag because they fill up with gas. Check stoma-beefy red/pink. Delegate the emptying to CNA

Question 11

Ileostomy placement

Answer 11

Ileostomy is in the lower right side of abdomen

Question 12

Nursing assessment in intestinal obstruction

Answer 12

Abdominal pain assessment

Vomitus and NG output assessment:

Assess bowel function

Abdominal girth , distension

Strict intake and output

Monitor labs

Question 13

Over all goal

Answer 13

Relief of the obstruction and return to normal bowel function
Minimal to no discomfort

Fluid and electrolyte balance
Normal Acid base status

Question 14

Nursing management

Answer 14

Prevent fluid and electrolyte deficiencies

Early recognition of complications such as hypovolemic shock, bowel strangulation: What are symptoms

IV fluids, supplement electrolytes

NG tube ..oral care, tube patency

Urinary catheter for strict I & O