Intestinal Obstructions Flashcards
What is an intestinal obstruction?
This disorder occurs when the intestinal contents are unable to pass through the GI system due to a blockage. It can occur in the small or large intestine. It can be a complete or partial blockage.
What are some types of intestinal obstructions?
- Mechanical Obstructions
- Non-Mechanical Obstructions
Mechanical Obstructions
There is a detectable obstruction such as a tumor, an adhesion, or a twisting of the intestine
Non-mechanical obstruction
Results from neuromuscular or vascular deficiency. Peristalsis has ceased to move intestinal contents along the tract or portion of the intestine has lost adequate blood supply to maintain the tissue integrity and function
Diagnostic testing for intestinal obstructions
- Colonoscopy
- Barium Enema
- Upper or lower barium swallow or series
- Plain film x-rays or CT scan may be used
Causes of Intestinal Obstructions
- Adhesions and strangulated hernias
- Volvulus (twisting of intestine)
- Instussusception (telescoping of intestine strictures)
- Fecal or barium impaction
- Hirshsprung Disease
- Paralytic Ileus (nonmechanical)
- Pseudoobstruction (nonmechanical)
Hirshsprung Disease
Inadequate motility of part of the intestine Megacolon due to failure of development of myentericplexus of rectosigmoid area of large intestine
Volvulus
twisting of intestine
Intussusception
telescoping of intestine strictures
Paralytic Ileus
paralysis of intestines, occurs to some degree after abdominal surgery
Pseudoobstruction
idiopathic
Assessment of Intestinal Obstructions in the Small Intestine
- Rapid Onset
- Frequent and copious vomiting
- Cramp like, intermittent pain
- Feces for a short time
- Abdominal distention greatly increased
Assessment of Large Intestine
- Gradual onset
- Rarely vomits
- Low grade and crampy pain
- Constipation
- Increased abdominal distention
Dianostic Testing for intestinal obstructions
- Physical Exam
- x-ray, CT scan
Nursing Diagnoses for Intestinal Obstructions
- Acute Pain r/t abdominal distention and increased peristalsis
- Deficient Fluid Volume r/t decrease in intestinal reabsorption and loss of fluid
- Imbalanced nutrition: less than body requirments r/t intestinal obstruction and vomiting
Nursing Interventions for Intestinal Obstructions
Assess:
- VS
- Pain and treatment
- Monitor for dehydration and electrolyte imbalance
- Monitor NG tube patency q4h
- Strict I&O
- IV fluids as ordered
Surgical Management of Intestinal Obstructions
- Most obstructions treated surgically may involve simple resection of obstructed segment of bowel
- Partial or total colectomy, colostomy, or ileostomy required with extensive obstruction or necrosis
Post-operative for intestinal obstruction abdominal surgery
- VS
- Pain
- Incision care and teaching
- TCDB
- Splinting
- Teach progression of activities
- Instruct patients on signs and symptoms of complications that should be reported
- Ostomy teaching as needed
Intestinal Obstruction Important Information
- Obstruction in the intestine can be a surgical emergency
- Can cause abdominal pain and distention, the absence of fecal excretion, and sometimes vomiting and dehydration
- Can be confirmed by x-rays
- treatment usually includes the administration of IV fluids and the use of a NG or nasintestinal tube to suction fluid from the intestinal tract
General Information Hirschsprung Disease
- Caused by inadequate motility of part of intestine
- 1/4 of all cases of neonatal obstructions
- Most cases require surgery: temporary ostomy
General Information Intussusception
- One of the most frequent causes of obstruction in children between 3 months and 3 years of age
- Proximal segment of bowel telescopes inito a distal segment
- Can result in lymphatic, venous and nervous compression
- Venous engorgement leads to leaking of blood into intestine forming classic currant jelly like stools
- Treatment of choice is hyrostatic reduction with barium or air enema
- If enema unscuccessful, will require surgery
General Information Volvulus
- Intestine twisting around itself
- Can compromise blood flow to intestine leading to necrosis, peritonitis, perforation, and death
- Occurs in children usually secondary to being born with malrotation in which the intestines are not in the anatomically correct position and are twisting upon themselves
- Requires surgical Correction
