Week 5 - Bowel Obstruction Flashcards
what is intestinal obstruction
- partial or complete obstruction of the intestine
what does bowel obstruction cause
- prevents intestinal contents from passing thru the GI tract
what are categories of causes of bowel obstruction
- mechanical : something blocking
- nonmechanical = neuromuscular or vascular disorder cause
what are some mechanical causes of bowel obstruction (3)
- adhesions
- cancer
- hernia
what are some nonmechanical causes of obstruction (2)
- paralytic ileus
- emboli
what can cause paralytic ileus (4)
- postop
- electrolyte abnormalities
- inflamm. disorders
- spinal injuries
where can bowel obstructions occur
- small or large bowel
what does intestinal obstruction cause
- accumulation of fluid, gas, and intestinal contents = distension
- distension = reduced absorption of fluids and stim of intestinal secretions
- increased P = fluids into peritoneal cavity
- fluid in peritoneal cavity = hypovolemic shock
- impaired blood supply = necrosis
- no absorption of electrolytes = imbalances
onset is sm. vs large intestinal obstruction
- small = rapid
- large = gradual
vomitting in small vs large intestinal obstruction
- small = frequent, copious, projectile
- large = vomitting in late stages
describe pain in small vs large intestinal obstruction
- small - colicky (sharp), cramplike, intermittent
- large = low grade, cramping, abdominal pain
BM in small vs large intestinal obstruction
- small = feces for short time
- large = absolute constipation
describe abdominal distension in small vs large intestinal blockage
- small = mild/mod
- large = greatly increased
describe dehydration and electrolyte imbalances in small vs large intestinal obstruction
- small = rapid dehydration (no chance for water reabsorption)
- large = dehydration & electrolyte imbalances do not occur early in
what are general symptoms of intestinal blockage (6)
- NV
- abdominal pain
- distension
- inability to pass gas
- obstipation
- high pitched BS above obstruction
what can be used to diagnose intestinal obstruction (6)
- history
- physical exam
- CT scan
- abdominal xray
- sigmoidoscopy or colonoscopy
- lab tests
what does an abdominal xray show you r/t intestinal obstruction
- gas & fluid in intestines
treatment of intestinal obstruction is directed toward… (3)
- decompression of the intestine thru gas & fluid removal
- correction and maintenance of fluid & electrolyte balance
- relief or removal of the obstruction
what can be used to decompress the bowel in intestinal obstrucrion
- NG tube
describe nursing care for intestinal obstrucrtion (9)
- decompression w NG tube & NG tube care
- IV fluids & electrolytes (esp. K+)
- abdominal assessment
- pain control
- nutrition replacement (may use TPN)
- monitor for perforation
- prep for surgery if not resolved
- I&Os (watch for dehydration)
- comfort measures
what surgery may be used for treatment of intestinal obstruction (3)
- resecting obstructed segment of bowel & anastomosing the remaining healthy bowel
- partial or total colectomy if extensive or necrosis present
- colostomy or ileostomy
see NCP on care for pt after laparotomy for info on nursing care after surgery for an intestinal obstruction (they are v similar)
- NPO until peristalsis returns
- monitor NG tube
- pain meds q 3-4 hr for first 72 hour
- splint w pillows for DB&C
- assess abdomen and BS q8h
- encourage ambulation & pstn changes to increase peristalsis
etc.
once a NG tube is in place, what is imp to do (5)
- confirm placement (thru aspiration of gastric contents)
- ensure it is secured to prevent dislodgement
- provide approp nasal and oral care
- monitor vol of NG losses
- check q4h for patency
why is oral care imp with a NG tube? what pt teaching is important for this? (3)
the pt must breathe thru mouth = dry mouth & lips
- brush teeth frequently
- use mouthwash & water to rinse mouth
- use petroleum jelly for dry lips
