Intestinal Obstructions and Colon Cancer

Signs and Symptoms: Large bowel obstruction

-minor fluid and electrolyte imbalance -metabolic acidosis -small, frequent liquid stool -diarrhea or ribbon like stools around an impaction -infrequent vomiting

Colorectal Cancer: Risk Factors

-Age>50 year -Colorectal polyps -Chronic, inflammatory bowel disease -family history -previous history of colorectal cancer

Anemia or Metastasis Suspected

-CBC -Clotting Studies -Liver Function tests -CT scan -Ultrasound

Colostomy--Nursing Care

-Psychological Preparation important -Bowel preparation before surgery -Assessment of HEALTHY stoma (SHINY BRIGHT RED) -protecting skin -selecting the pouch -ENGAGE the client -ACKNOWLEDGE reluctance

Colorectal Cancer: Surgical Interventions

-Right or left hemicolectomy

Radiation Therapy

-adjuvant therapy after colon resection and chemotherapy -palliative measure for clients with advanced lesions

Chemotherapy

-adjuvant therapy following colon resection -primary treatment for positive lymph nodes or metastatic disease

Signs and Symptoms

-constipation -abdominal distention -high pitched bowel sounds above obstruction -low pitched bowel sounds below obstruction

Diagnostic Testing: Colorectal Cancer

-digital rectal exam -fecal occult blood -sigmoidoscopy every 5 years -colonoscopy if at risk--MODERATE SEDATION -repeat colonoscopy every 7-10 years (if polyps, shorter intervals)

Hernias

A hernia that cannot be moved back into place with gentle palpation is considered irreducible and requires immediate surgical evaluation. In a hernia that is strangulated, blood supply is cut off to a portion of the bowel, increasing the risk for obstruction, necrosis, and perforation. findings include abdominal distention, tachycardia, vomiting, and abdominal pain. Surgical intervention is necessary.

Client with obstruction in large intestine is being assessed by the nurse. Which symptom is most indicative of this obstruction? A. Pain B. Abdominal distention C. Vomiting D. Low-grade fever

Abdominal distention

A nurse is completing discharge teaching with a client who has irritable bowel syndrome (IBS). Which of the following instructions should the nurse include in the teaching? A. avoid foods that trigger exacerbation B. Consume 15-20 grams of fiber daily C. Plan three moderate to large meals per day D. Limit fluid intake to 1L each day

Avoid foods that trigger exacerbation

Intestinal Obstruction Mechanical

Blocked by something inside or outside intestines -surgical adhesions is the most common cause -hernias -tumors -Crohn's disease -diverticulitis Treat complete obstruction with surgery

Intestinal Obstruction, Non-mechanical

Diminished peristalsis Paralytic ileus, causing decreased GI motility -(post op abdominal surgery, hypokalemia, pancreatitis, appendicitis, and lumbar spinal fractures) Vascular obstructions -rare but is the result of interference with blood supply

A nurse is planning care for a client who has a small bowel instruction and a nasogastric tube in place. which of the following interventions should the nurse include in the plan of care? (select all that apply) A. Document the NG drainage with the client's output B. Irrigate the NG tube every 8 hours C. Assess bowel sounds D. Provide oral hygiene every 2 hours E. Monitor NG tube placement

Document the NG drainage with the client's output assess bowel sounds provide oral hygiene every 2 hours monitor NG tube placement

A nurse is caring for a client who has a small bowel obstruction form adhesions. Which of the following findings are consistent with this diagnosis? (select all that apply) A. Emesis greater than 500mL with a fecal odor B. Report of spasmodic abdominal pain C. High pitched bowel sounds D. Abdomen flat with rebound tenderness to palpation E. Lab findings indicating metabolic acidosis

Emesis is greater than 500ml with a fecal odor report of spasmodic abdominal pain high pitched bowel sounds

Surgical Intervention

Exploratory Laparotomy -lysis of adhesions, colon resection, embolectomy Ensure patient understands surgical procedure Monitor hemodynamic instability (vital signs) Give IV fluids (dehydration) Monitor bowel sounds Assess NG tube patency Advance diet as tolerated

Surgical Interventions

Lower anterior resection (LAR) -anal sphincters left intact Abdominal-perineal resection (APR) -Colostomy

Nursing Care

NPO--oral hygiene NASOGASTRIC TUBE Assess bowel sounds Monitor fluid/electrolytes -administer IV fluids -replace potassium Manage pain Semi-fowler's position broad-spectrum antibiotics antiemetic

Risk Factors of nontechnical obstructions

Nonmechanical obstructions (paralytic ileus) result from decreased peristalsis secondary to the following. -neurogenic disorders (manipulation of the bowel during major surgery and spinal fracture) -vascular disorders (vascular insufficiency and mesentric emboli) -electrolyte imbalances (hypokalemia) -inflammatory responses (peritonitis or sepsis) manifestations of nonmechanical obstructions include diffuse, constant pain; significant abdominal distention; and frequent vomiting.

Signs and Symptoms: Small Bowel obstruction

Severe fluid and electrolyte imbalance Metabolic alkalosis -vomiting, loss of gastric hydrochloride abdominal pain projectile vomiting--dehydration, with fecal odor

A nurse is assessing an older adult client in an extended care facility. The nurse should recognize which of the following findings is a manifestation of an obstruction of the large intestine due to fecal impaction? A. The client reports he had a bowel movement yesterday B. The client is having small, frequent liquid stools C. The client is flatulent D. The client indicates he vomited once this morning

The client is having small, frequent liquid stools.

Symptoms

THERE MAY BE NONE -rectal bleeding -alternating constipation and diarrhea -change in stool caliber (narrow, ribbonlike) -sensation of incomplete evacuation

Staging of Colorectal Cancer

Tumor-Node-Metastasis (TNM) Classification -primary tumor -regional lymph node involvement -distant metastasis

Risk Factors for MECHANICAL

encirclement or compression of intestine by adhesions, tumors, fibrosis (endometriosis), or strictures (Crohn's disease, radiation) -postsurgical adhesions are often the cause of small bowel obstructions -carcinomas are often the cause of large intestine obstructions -hernia -volvulus (twisting) or intussusception (telescoping) of bowel segments.

Intestinal Obstruction

intestinal obstruction can result from mechanical or nontechnical causes. Manifestations vary according to type. Mechanical: occurs when the bowel is blocked by something outside or inside the intestines. Complete mechanical obstructions should be addressed surgically. Non-mechanical: are caused by diminished peristalsis within the bowel (paralytic ileum). This can occur postoperatively due to the handling of the intestines during surgery. Treatment focuses on fluid and electrolyte balance, decompressing the bowel, and relief/removal of the obstruction.

Both small and large bowel obstructions

obstipation: the inability to pass a stool and/or flatus for more than 8 hours despite feeling the urge to defecate abdominal distention high pitched bowel sounds above the site of obstruction (borborygmi) with hypoactive bowel sounds below, or overall hypoactive; absent bowel sounds later in process

A nures is completing an admission assessment for a client who has a small bowel obstruction. Which of the following findings should the nurse report to the provider? (select all that apply) A. emesis prior to insertion of the NG tube B. urine specific gravity 1.040 C. Hematocrit 60% D. Serum potassium 3.0 mEq/L E.WBC 10,000/uL

urine specific gravity hematocrit of 60% serum potassium 3.0mEq/L