intestinal obstruction

which bowel obstruction is less common? large or small

large and isnt usually as dramatic.

if the obstruction is nonmechanical what kind of bowel sounds are heard

absence

intussusception occurs when

peristalsis causes the intestine to telescope into isteself

therapeutic measures for small bowel obstruction

NPO, NG tube, (rarely a tungsten weighted intestinal tube), IV electrolytes, sometimes IV antibiotics, surgery if complete mechanical (removal of tumors, release of adhesions, or bowel resection with anastomosis)

nursing dx of r/f deficient fluid volume r/t vomiting whats your interventions

accurately monitor intake and output, maintain fluid replacement as ordered

nonmechanical obstruction occurs when

peristalsis is impaired and the intestinal contents cannot be propelled through the bowel.

large bowel obstructions if not dx and treated, can lead to what

gangrene, perforation, and peritonitis

mechanical obstruction occurs when

a blockage occurs within the intestine from conditions causing pressure on the intestinal walls such as adhesions, twisting of the bowel, or strangulated hernia.

the lower in the gastrointestinal tract the obstruction is, the greater the what

abdominal distention

causes of nonmechanical obstruction

abdominal surgery and trauma, pneumonia, spinal injuries, hypokalemia, MI, peritonitis, vascular insufficiency

nursing dx of acute pain r/t abdominal distention whats the nursing intervention

assess pain level, give meds, position pt in semi fowlers, frequent oral care

how do you identify th location of the obstruction during assessment

ausculated for bowel sounds in each quadrant, abdomen is palpate for distention, firmness, and tenderness.

why does dehydration occur more slowly with large bowel obstruction

because the colon can absorb fluid and distend well beyond its normal full capacity

what data collection is needed for the pt with a bowel obstruction

bowel sounds, pain level, palpation for distention, amount and character of stool, vs (for infection or shock), daily wt. i and o, skin turgor, amount color and character of ng drainage

most large bowel obstructions occur in the sigmoid colon and are caused by what

carcinoma, inflammatory bowel disease, diverticulitis, or benign tumors. impaction of stools

if the large bowel obstruction is in the rectum or sigmoid, the only symptom may be what

constipation

in large bowel obstruction as the loops of bowel distend (swell from inside), the pt may report what

crampy lower abdominal pain and abd distention.

what therapeutic measures are done for large bowel obstruction

enamas, manual disimpaction, surgical resection, temporary colostomy, ileoanal anastomosis. cecostomy

if impaction is present what may be effective

enemas and manual disimpaction

nonmechanical obstruction is seen when

following abdominal surgeries, trauma, mesenteric ischemia, or infection

the adhesions or bands of scar tissue from loops of intestine adhering to areas in the abdomen that arent healed after surgery are the most common cause of small bowel obstruction, whats the next most common cause?

hernias and neoplasms, followed by inflammatory bowel disease, foreign bodies, strictures, volvulus, and intussusception

in mechanical obstructions what kind of bowel sounds are heard and where

high pitched, tinkling bowel sounds heard proximal to the obstruction and absent distal to it

are peristaltic waves visible

in a thin person

most large bowel obstructions occur where

in the sigmoid colon

initial s/s of small bowel obstruction

initially wavelike abd pain and vomiting, flatus and feces that are low in bowel and blood and mucus may be passed, but stops as obstuction worsens

when obstruction occurs in the small bowel a collection of what occurs proximal to the obstruction

intestinal contents, gas, and fluid

as distention worsens in a small bowel obstruction, what happens

intraluminal pressure causes a decrease in venous and arterial capillary pressure, resulting in edema, necrosis, and eventually perforation of the intestinal wall

volvulus and intussusception considtions are what kind of obstructions

mechanical

the two types of intestinal obstruction

mechanical and nonmechanical both of which can be either partial or complete

risk for electrolyte imbalance r/t suctioning whats the interventions

monitor electrolyte values, monitor vs, five ice chips sparingly if ordered.

paralytic or adynamic, ileus are what kind of obstructions

nonmechanical

if the blood supply to the colon is cut off, the pts life is in jeopardy because

of bowel strangulation and necrosis

as the small bowel obstruction becomes more extreme what happens

peristaltic waves reverse, propelling the intestinal contents toward the mouth, eventually leading to fecal vomiting with pain and abd distention

risk for dysfunctional gastrointestinal motility whats the goal

pt will maintain passage of flatus and stoll

nursing dx of r/f deficient fluid volume r/t vomiting whats the goal

pt will maintain vs and urine output WNL

nursing dx of acute pain r/t abdominal distention whats the expected outcome

pt will state pain is relieved or at an acceptable level within 30 mins

dx tests for small bowel obstruction

radiographic studies and CT scans. leukocytosis evident with strangulation or perforation. hemoglobin and hematocrit levels elevated if pt is dehydrated and serum electrolyte levels decreased

what reveals a distended colon

radiological exams

what kind of pain might indicate perforaiton

sharp and sustained

an uncorrected obstuction can lead to what

shock and death

how do the symptoms of large bowel obstruction develop and what do they depend on

slowly and depend on the location of the obstruction

the distention that results form an obstruction in the small bowel stimulates what but decreases what

stimulates gastric secretion but decreases the absorption of fluids

what is the most common cause of small bowel obstruction

the adhesions or bands of scar tissue from loops of intestine adhering to areas in the abdomen that arent healed after surgery

the severity of the obstruction depends on what

the area of bowel affected the amount of occlusion within the lumen and the amount of disturbance in the blood flow to the bowel

a volvulus occures when

the bowel twists, occluding the lumen of the intesting

intestinal obstructoins occur when

the flow of intestinal contents is blocked.

paralytic or adynamic, ilues are nonmechanical obstructions that occurs when

the intestinal peristalsis decreases or stops because of a vascular or neuromuscular pathological condition.

nursing dx risk for electrolyte imbalance r/t suctioning whats the goal

the pt will maintain vs and urine output WNL at all times

whats a late sign of bowel distention

vomiting and may be fecal

pt with large bowel obstruction has developed distention of the loops of bowels, what are some s/s

vomiting, may be fecal, high pitched tinkling bowel sounds, localized tender area and mass may be felt