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NURS 3512 - Class 1-6 > Week 5 - Bowel Obstruction > Flashcards

Week 5 - Bowel Obstruction Flashcards

1
Q

what is intestinal obstruction

A
  • partial or complete obstruction of the intestine
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2
Q

what does bowel obstruction cause

A
  • prevents intestinal contents from passing thru the GI tract
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3
Q

what are categories of causes of bowel obstruction

A
  • mechanical : something blocking

- nonmechanical = neuromuscular or vascular disorder cause

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4
Q

what are some mechanical causes of bowel obstruction (3)

A
  • adhesions
  • cancer
  • hernia
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5
Q

what are some nonmechanical causes of obstruction (2)

A
  • paralytic ileus

- emboli

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6
Q

what can cause paralytic ileus (4)

A
  • postop
  • electrolyte abnormalities
  • inflamm. disorders
  • spinal injuries
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7
Q

where can bowel obstructions occur

A
  • small or large bowel
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8
Q

what does intestinal obstruction cause

A
  • 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
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9
Q

onset is sm. vs large intestinal obstruction

A
  • small = rapid

- large = gradual

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10
Q

vomitting in small vs large intestinal obstruction

A
  • small = frequent, copious, projectile

- large = vomitting in late stages

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11
Q

describe pain in small vs large intestinal obstruction

A
  • small - colicky (sharp), cramplike, intermittent

- large = low grade, cramping, abdominal pain

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12
Q

BM in small vs large intestinal obstruction

A
  • small = feces for short time

- large = absolute constipation

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13
Q

describe abdominal distension in small vs large intestinal blockage

A
  • small = mild/mod

- large = greatly increased

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14
Q

describe dehydration and electrolyte imbalances in small vs large intestinal obstruction

A
  • small = rapid dehydration (no chance for water reabsorption)
  • large = dehydration & electrolyte imbalances do not occur early in
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15
Q

what are general symptoms of intestinal blockage (6)

A
  • NV
  • abdominal pain
  • distension
  • inability to pass gas
  • obstipation
  • high pitched BS above obstruction
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16
Q

what can be used to diagnose intestinal obstruction (6)

A
  • history
  • physical exam
  • CT scan
  • abdominal xray
  • sigmoidoscopy or colonoscopy
  • lab tests
17
Q

what does an abdominal xray show you r/t intestinal obstruction

A
  • gas & fluid in intestines
18
Q

treatment of intestinal obstruction is directed toward… (3)

A
  • decompression of the intestine thru gas & fluid removal
  • correction and maintenance of fluid & electrolyte balance
  • relief or removal of the obstruction
19
Q

what can be used to decompress the bowel in intestinal obstrucrion

A
  • NG tube
20
Q

describe nursing care for intestinal obstrucrtion (9)

A
  • 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
21
Q

what surgery may be used for treatment of intestinal obstruction (3)

A
  • resecting obstructed segment of bowel & anastomosing the remaining healthy bowel
  • partial or total colectomy if extensive or necrosis present
  • colostomy or ileostomy
22
Q

see NCP on care for pt after laparotomy for info on nursing care after surgery for an intestinal obstruction (they are v similar)

A
  • 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.

23
Q

once a NG tube is in place, what is imp to do (5)

A
  • 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
24
Q

why is oral care imp with a NG tube? what pt teaching is important for this? (3)

A

the pt must breathe thru mouth = dry mouth & lips

  • brush teeth frequently
  • use mouthwash & water to rinse mouth
  • use petroleum jelly for dry lips
25
Q

what nasal care should be given to a pt with NG tube (2)

A
  • check for signs of irritaion

- clean and dry daily with application of water soluble lubricant

26
Q

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)

A
  • 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
27
Q

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)

A
  • 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
28
Q

a nursing diagnosis r/t colostomy and ileostomy is deficient knowledge. what nursing interventions can be done for this (6)

A
  • 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
29
Q

a nursing diagnosis r/t colostomy & ileostomy is disturbed body image. what nursing interventions can be done for this (4)

A
  • 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
30
Q

what nursing interventions r/t ostomy care can help improve pts body image perceptions (3)

A
  • 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

NURS 3512 - Class 1-6 (47 decks)

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