Week 10- Bowel Obstruction Flashcards
A nurse is assessing a client who has been admitted with a diagnosis of an obstruction in the small intestine. The nurse should assess the client for? Select all that apply.
1. Projectile vomiting.
2. Significant abdominal distention.
3. Copious diarrhea.
4. Rapid onset of dehydration.
5. Increased bowel sounds.
A nurse is assessing a client who has been admitted with a diagnosis of an obstruction in the small intestine. The nurse should assess the client for? Select all that apply.
1. Projectile vomiting.
2. Significant abdominal distention.
3. Copious diarrhea.
4. Rapid onset of dehydration.
5. Increased bowel sounds.
1, 4, 5.
Signs and symptoms of intestinal obstructions in the small intestine may include projectile vomiting and rapidly developing dehydration and electrolyte imbalances. The client will also have increased bowel sounds, usually high-pitched and tinkling. The client would not normally have diarrhea and would have minimal abdominal distention. Pain is intermittent, being relieved by vomiting. Intestinal obstructions in the large intestine usually evolve slowly, produce persistent pain, and vomiting is less common. Clients with a large-intestine obstruction may develop obstipation and significant abdominal distention.
Define obstipation
severe or complete constipation with inability to pass gas or stool
Can lead to colon perforation
A client is admitted with a bowel obstruction. The client has nausea, vomiting, and crampy abdominal pain. The physician has written orders for the client to be up ad lib, to have narcotics for pain, to have a nasogastric tube inserted if needed, and for I.V. Ringer’s Lactate and hyperalimentation fluids. The nurse should do the following in order of priority from first to last:
1. Assist with ambulation to promote peristalsis
2. Administer Ringer’s Lactate
3. Insert a nasogastric tube.
4. Start and infusion of hyperalimentation fluids.
1,2,3,4
The nurse should first help the client ambulate to try to induce peristalsis; this may be effective and require the least amount of invasive procedures. I.V. fluid therapy can be done to correct fluid and electrolyte imbalances (sodium and potassium), and normal saline or Ringer’s Lactate to correct interstitial fluid deficit. Nasogastric (NG) decompression of G.I. tract to reduce gastric secretions and nasointestinal tubes may also be used. Hyperalimentation can be used to correct protein deficiency from chronic obstruction, paralytic ileus, or infection.
After insertion of a nasoenteric tube, the nurse should place the client in which position?
1. Supine.
2. Right side-lying.
3. Semi-Fowler’s.
4. Upright in a bedside chair.
- The client is placed in a right side-lying position to facilitate movement of the mercury-weighted tube through the pyloric sphincter. After the tube is in the intestine, the client is turned from side to side or encouraged to ambulate to facilitate tube movement through the intestinal loops. Placing the client in the supine or semi-Fowler’s position, or having the client sitting out of bed in a chair will not facilitate tube progression.
The nurse is caring for a 68-year-old patient admitted with abdominal pain, nausea, and vomiting. The patient has an abdominal mass, and a bowel obstruction is suspected. The nurse auscultating the abdomen listens for which type of bowel sounds that are consistent with the patient’s clinical picture?
a. Low-pitched and rumbling above the area of obstruction
b. High-pitched and hypoactive below the area of obstruction
c. Low-pitched and hyperactive below the area of obstruction
d. High-pitched and hyperactive above the area of obstruction
d. High-pitched and hyperactive above the area of obstruction
Early in intestinal obstruction, the patient’s bowel sounds are hyperactive and high pitched, sometimes referred to as “tinkling” above the level of the obstruction. This occurs because peristaltic action increases to “push past” the area of obstruction. As the obstruction becomes complete, bowel sounds decrease and finally become absent.
The nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first?
a. Administering pain medication
b. Obtaining a blood sample for laboratory studies
c. Preparing to insert a nasogastric (NG) tube
d. Administering I.V. fluids
he nurse caring for a client with small-bowel obstruction would plan to implement which nursing intervention first?
a. Administering pain medication
b. Obtaining a blood sample for laboratory studies
c. Preparing to insert a nasogastric (NG) tube
d. Administering I.V. fluids
a. Administering I.V. fluids
I.V. infusions containing normal saline solution and potassium should be given first to maintain fluid and electrolyte balance.
A client develops peritonitis and sepsis after the surgical repair of a ruptured diverticulum. What signs should the nurse expect when assessing the client? (Select all that apply.)
- Fever
2 Tachypnea - Hypertension
- Abdominal rigidity
- Increased bowel sounds
A client develops peritonitis and sepsis after the surgical repair of a ruptured diverticulum. What signs should the nurse expect when assessing the client? (Select all that apply.)
- Fever
2 Tachypnea - Hypertension
- Abdominal rigidity
- Increased bowel sounds
- Fever
2 Tachypnea - Abdominal rigidity
1 The metabolic rate will be increased and the temperature-regulating center in the hypothalamus resets to a higher than usual body temperature because of the influence of pyrogenic substances related to the peritonitis.
2 Tachypnea results as the metabolic rate increases and the body attempts to meet cellular oxygen needs.
4. With increased intra-abdominal pressure, the abdominal wall will become rigid and tender.
The nurse is preparing to insert a nasogastric (NG) tube into a 68-year-old female patient who is nauseated and vomiting. The patient has an abdominal mass and suspected small intestinal obstruction. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate?
- “The tube will help to drain the stomach contents and prevent further vomiting.”
- “The tube will push past the area that is blocked and thus help to stop the vomiting.”
- “The tube is just a standard procedure before many types of surgery to the abdomen.”
- “The tube will let us measure your stomach contents so that we can plan what type of intravenous (IV) fluid replacement would be best.”
The nurse is preparing to insert a nasogastric (NG) tube into a 68-year-old female patient who is nauseated and vomiting. The patient has an abdominal mass and suspected small intestinal obstruction. The patient asks the nurse why this procedure is necessary. What response by the nurse is most appropriate?
- “The tube will help to drain the stomach contents and prevent further vomiting.”
- “The tube will push past the area that is blocked and thus help to stop the vomiting.”
- “The tube is just a standard procedure before many types of surgery to the abdomen.”
- “The tube will let us measure your stomach contents so that we can plan what type of intravenous (IV) fluid replacement would be best.”
- “The tube will help to drain the stomach contents and prevent further vomiting.”
The NG tube is used to decompress the stomach by draining stomach contents, and thereby prevent further vomiting
A client is being evaluated in the emergency department for a possible small bowel obstruction. Which signs and/or symptoms does the nurse expect to assess?
a. Cramping intermittently, metabolic acidosis, and minimal vomiting
b. Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis
c. Metabolic acidosis, upper abdominal distention, and intermittent cramping
d. Upper abdominal distention, metabolic alkalosis, and great amount of vomiting
A client is being evaluated in the emergency department for a possible small bowel obstruction. Which signs and/or symptoms does the nurse expect to assess?
a. Cramping intermittently, metabolic acidosis, and minimal vomiting
b. Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis
c. Metabolic acidosis, upper abdominal distention, and intermittent cramping
d. Upper abdominal distention, metabolic alkalosis, and great amount of vomiting
d. Upper abdominal distention, metabolic alkalosis, and great amount of vomiting
What are the most common causes of intestinal blockage?
Adhesions
Hernias
Tumor
Volvulus
Intussusception (in newborns)
What are the S&S of an intestinal obstruction?
Abdominal pain with bloating/distention, N&V, fever
hypo or hyperactive bowel sounds (bowel sounds above obstruction are hyperactive and high pitched tinkling)
Constipation, obstination (complete constipation with absence of flatus)
What are possible complications of a bowel obstruction?
Ischemia, perforation, sepsis
What interventions should the nurse implement for management of an intestinal obstruction?
NPO, IV fluids, fluid + electrolyte replacement
NG tube insertion
Pain management, antiemetics (laxative contraindicated)
How is placement of an NG tube confirmed?
X-ray
