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
what nasal care should be given to a pt with NG tube (2)
- check for signs of irritaion
- clean and dry daily with application of water soluble lubricant
a nursing diagnosis r/t colostomy/ileostomy is risk for deficient fluid vol d/t insufficient fluid intake and fluid loss from ileostomy & colostomy. what nursing interventions can prevent this (7)
- monitor for S&S of dehydration
- monitor hemodynamic status
- monitor I&O
- encourage oral intake
- use IV pump for steady infusion flow rate
- monitor for abnorm electrolytes
- encourage IV solution containing electrolytes is admin at constant flow rate
a nursing diagnosis r/t colostomies is risk for impaired ski integrity d/t irritation from fecal drainage around peristomal area, irritation of appliance. what nursing interventions can prevent this (6)
- monitor stoma & surrounding tissue
- apply approp fitting ostomy device
- change/empty bag to prevent drainage onto skin
- provide & support assistance while pt develops skill in caring for stoma & surrounsing tissue
- use nonalkaline cleanser on skin to prevent irriation
- inititae consult of enterostomal therapy nurse to provide specialized teaching and care
a nursing diagnosis r/t colostomy and ileostomy is deficient knowledge. what nursing interventions can be done for this (6)
- instruct pt & fam on use of ostomy equipment and care
- have pt & caregiver demonstrate use of equipment
- instruct pt on how to monitor for comp (rash, leaks, dehydration, infection)
- instruct pt & caregiver in approp diet and expected changes in elimination
- teach pt to chew food thoroughly, avoid foods that cause digestive upset in past, add new foods one at a time, drink lots of fluids to establish normal bowel patterns
- encourage participation in support groups
a nursing diagnosis r/t colostomy & ileostomy is disturbed body image. what nursing interventions can be done for this (4)
- help pt determine extent of actual changes to body or its lvl of functioing
- monitor whether pt can look at changed body part
- assist pt to separate phys appearance from feelings of self worth
- facilitate contact w individuals w similar changes in body image
what nursing interventions r/t ostomy care can help improve pts body image perceptions (3)
- instruct on mechanisms to reduce odor
- instruct how to monitor for comp to prevent odours
- encourage pt to express feelings and concerns abt changes in body image
