Obstructions Flashcards
1
Q
Intestinal obstruction (4)
A
- small intestine or colon
- partial or complete
- mechanical: surgical adhesions, hernias, tumors
- functional: paralytic ileus, peritonitis
2
Q
Most common cause for SBO
A
adhesions
3
Q
risk factors for adhesions (6)
A
- prior GI surgery
- trauma
- dehydration
- appendix rupture
- radiation
- abdominal infections
4
Q
intestinal obstruction clinical manifestations (11)
A
- pain
- N/V
- fecal vomiting
- dehydration
- obstipation
- decreased BP
- Increased HR, RR
- absent bowel sounds
- fever
- Increased WBC
- shock
5
Q
LBO s/s (1)
A
abdominal distention
6
Q
LBO stool impaction causes _____
A
small liquid stools
7
Q
intestinal obstruction: assessment and diagnosis (3)
A
- endoscopy/ colonoscopy
- abdominal x-ray, CT: gas or fluid accumulation, possible collapsed distal bowel
- CBC, BMP: electrolytes, dehydration (BUN, Osmo Calc, possible infection)
8
Q
IO; collaborative management (goals) (3)
A
- prevent ineffective tissue perfusion (if bowel ischemia) ***
- maintain FE balance ***
- restore effective elimination ***
9
Q
IO Collaborative management priority
A
NG tube for decompression for SBO
10
Q
IO Collaborative management (4)
A
- monitor for bowel ischemia
- FE replacement
- prepare for surgical intervention: lysis of adhesions, bowel resection
- anastomosis or ostomy (if necrotic or damaged bowel): post op care ***
11
Q
ostomy surgeries: preoperative nursing management (2), post op care (6)
A
- emotional support and education
- preoperative site selection (rectus muscle)
- postop care: stoma and drainage assessment, education, pouch fitting, nutrition, FE balance, AB balance
12
Q
ostomy surgeries: postoperative nursing management
A
- stoma and drainage assessment
- Ileostomy: liquid continuous output; lack of output (more than 8 h or hospital policy) indicates obstruction, contact physicians
- colostomy (sigmoid): formed, more like regular BM
13
Q
intestinal obstruction postop management (6)
A
- NPO, NG tube, oral care
- strict I/O; notify output < 0.5 ml/kg/h
- FE balance: priority due to fast dehydration (vomiting, anorexia)
- pain management
- monitor labs: FE, AB balance, WBC, H/H
- nutritional status, focused GI assessment
14
Q
LBO
A
- severe bowel distention
- If colon perfusion if compromised: intestinal strangulation and necrosis
- dehydration occurs more slowly: colon absorbs fluid content
15
Q
most common cause of LBO
A
Adenocarcinoid tumors
16
Q
LBO clinical manifestations (3)
A
- hx of constipation
- bloody stools, weight loss, weakness, anorexia
- fecal vomiting
17
Q
Dx LBO (4)
A
- CT
- MRI
- abd xray
- no barium studies
18
Q
LBO collaborative management (4)
A
- restoration of FE balance
- NG tube, LIS (low intermittent suctioning)
- colonoscopy for decompression and untwisting
- bowel resection
