Intestinal Obstructions (Sherpath)

The nurse is caring for a patient with intestinal obstruction who reports severe abdominal pain, nausea, and vomiting. The nurse notes 36 ml of urine output in 3 hours and an elevated BUN. Which action is most important for the nurse to take?

Administer a bolus of IV fluids

The nurse is caring for a patient with an intestinal obstruction and severe vomiting who reports palpitations and fatigue. The nurse notes a potassium level of 2.2 mEq/L and a thready pulse. Which action would the nurse take first?

Administer an IV piggyback with potassium

The nurse is caring for a patient admitted with nausea, vomiting, and abdominal pain. Which additional finding indicates the possibility of intestinal obstruction?

Last bowel movement a week ago Constipation, as indicated by the lack of a bowel movement in a week, is a sign of an intestinal obstruction.

The nurse is caring for a patient with an intestinal obstruction caused by strictures. For which procedure would the nurse anticipate to prepare the patient?

Stent placement via endoscopy An endoscopy can be done to insert stents and repair strictures.

Stent Placement

Stents can be placed via endoscopic or fluoroscopic procedures for palliative purposes or until surgery can be performed. Corticosteroids may be given in conjunction with stent placement, because they can decrease nausea, vomiting, edema, and inflammation.

Surgery is performed to relieve the obstruction if:

The obstruction does not resolve within 24 hours. The patient's condition deteriorates. The patient shows signs of peritonitis or perforation, such as increased WBC count or a rigid, board-like abdomen.

The nurse is caring for a patient with intestinal obstruction. Which laboratory finding would be most concerning?

White blood cell (WBC) count of 18.0 cells/mcL An elevated WBC may indicate that the intestine has become strangulated or that the patient has developed peritonitis.

Match the location of the intestinal obstruction to the corresponding patient report of symptoms.

"I have been vomiting every few hours for 3 days."Proximal small intestine "The pain in my belly just will not go away."Large intestine "I have gradually become more constipated."Distal small intestine

Which patient is at an increased risk for a nonmechanical obstruction?

A patient who underwent an open cholecystectomy

Which patients are at an increased risk for developing a mechanical obstruction? Select all that apply.

A patient with a 10-year history of Crohn's disease A patient with Crohn's disease is at a higher risk for developing a mechanical intestinal obstruction due to the formation of strictures. A patient who has undergone multiple abdominal surgeries. Adhesions form every time a patient undergoes surgery. A patient who has had multiple abdominal surgeries will have many abdominal adhesions, which can cause mechanical intestinal obstructions.

Colonoscopy

Occasionally obstructions can be removed via colonoscopy without the need for surgery. A colonoscopy can remove polyps, dilate strictures, or remove and destroy tumors (with a laser).

A patient presents with colicky abdominal pain, nausea, vomiting, and abdominal distention. The health care provider has prescribed diagnostic tests to determine if the patient has an intestinal obstruction. Which physical assessment finding would indicate that the condition has worsened?

A rigid, board-like abdomen

During assessment of a patient with reports of nausea, vomiting, and severe abdominal pain, the nurse notes increased abdominal girth and tenderness. Which additional symptoms indicate the presence of an intestinal obstruction?

Abdominal rigidity Hypoactive bowel sounds

Complications of Bowel Obstruction complications can occur by the following process:

Bowel tissue becomes ischemic, possibly causing necrosis and perforation. If this continues, blood flow stops, causing cyanosis, edema, and gangrene (intestinal strangulation/intestinal infarction). The bowel can then become necrotic and rupture, resulting in infection, septic shock, and death.

Diagnostic Imaging Studies

CT scans and abdominal x-rays, including an obstructive series. Sigmoidoscopy or colonoscopy may provide direct visualization of an obstruction in the colon.

Patients with obstructions in the proximal small intestine rapidly develop nausea and vomiting. Vomiting

Can be projectile Contains bile Can relieve abdominal pain in higher intestinal obstructions Has a more gradual onset and is fecal and foul-smelling when it is due to obstructions that occur past the small intestine

Blood Testing

Complete blood count (CBC)An elevated white blood cell (WBC) count may indicate strangulation or perforation. Hemoglobin and hematocrit Elevated hematocrit (Hct) values may reflect hemoconcentration. Decreased hemoglobin (Hgb) and Hct values may indicate bleeding from a neoplasm or strangulation with necrosis. Serum electrolytes May be decreased due to prolonged nausea and vomiting, and must be monitored frequently. Blood urea nitrogen (BUN) and serum creatinine Must be monitored frequently. Arterial blood gases Metabolic alkalosis may result from vomiting/NG suction.

A patient with an intestinal obstruction recently had surgery to create an ileostomy. In the immediate postoperative period, the nurse who is caring for the patient anticipates assessing for which frequent complication of this surgery?

Electrolyte imbalances Fluid and electrolyte imbalances are a common complication seen immediately after the creation of an ileostomy.

A patient with intestinal obstruction receives stent placement under endoscopy prior to surgical intervention. Which assessment finding indicates that the stent has been effective?

Flatus The patient is passing gas, so there is evidence that normal bowel function is returning.

The nurse is caring for a patient who presents with nausea and vomiting. X-ray results reveal a lower intestinal obstruction. Which provider order would the nurse implement first?

Insert a nasogastric (NG) tube

The nurse is caring for a patient with an intestinal obstruction with severe nausea and vomiting. The health care provider orders insertion of a nasogastric (NG) tube, administration of a bolus of IV fluids, hydromorphone 2 mg IVP every 3 hours PRN, and a urinalysis. Which intervention is most important for the nurse to implement first?

Insert the nasogastric (NG) tube

The nurse is caring for a patient with nausea, vomiting, and severe pain. For which health care provider order would the nurse anticipate to prepare the patient?

Obstructive series An obstructive series is a radiographic procedure used to determine the presence of intestinal obstructions.

The nurse is caring for a patient with intestinal obstruction. The patient has an NG tube in place and is receiving IV fluid therapy. The nurse understands that which assessment findings indicate that treatment has been effective?

Normoactive bowel sounds Decrease in nausea and vomiting Serum potassium level of 3.8 mEq/L

Nursing assessment

Obtain routine vital signs Record the onset, frequency, color, odor, and amount of vomitus Assess bowel function Auscultate bowel sounds Inspect the abdomen for scars, visible masses, and distention Assess for tenderness and rigidity Measure the abdominal girth Observe for signs of peritonitis Assess for drainage from the nasogastric tube, including the amount, color, and consistency, and provide meticulous oral care Monitor for signs of dehydration/electrolyte imbalances Administer IV fluids and watch for fluid overload Monitor labs closely, especially electrolytes (potassium) Monitor and manage pain

During care for the patient with intestinal obstruction the nurse will:

Provide pain management and comfort measures as needed Address fluid, electrolyte, and acid-base status to detect early imbalances, such as:Common complication with Ileostomy creationHigh obstruction—metabolic alkalosisLow obstruction—metabolic acidosis Assess the abdominal incision for signs of infection and treat any infection with medications or other ordered interventions Provide care of the stoma and change abdominal dressing daily Provide NG tube care, check around the nasal area for pressure ulcers from the NG tube, and provide meticulous oral care Apply supplemental oxygen as needed Promote lung expansion after surgery by having the patient:Turn, cough, and take a deep breathUse the incentive spirometerAmbulate

The nurse is providing postoperative care for a patient with an intestinal obstruction. The nurse takes the patient's vital signs and notes a HR of 105, RR 12, SpO2 92%, and a temperature of 102.3° F. Which nursing interventions should be implemented?

Provide stoma care Administer antibiotic Administer an antipyretic Assess abdominal incision

The goals of nursing care for patients with bowel obstruction include:

Resolving the obstruction Ensuring the patient returns to normal bowel function Ensuring the patient has minimal to no discomfort Ensuring the patient returns to normal fluid, electrolyte, and acid-base status

The nurse is caring for a patient with intestinal obstruction who has been vomiting for 4 days. The nurse notes pallor, dry mucosa, and poor skin turgor. Which diagnostic tests are most important for the nurse to obtain?

Serum electrolytes

The location of the obstruction determines the amount of fluid, electrolyte, and acid-base imbalances.

With a high obstruction (e.g., upper duodenum), metabolic alkalosis may result (loss of HCl acid). When the obstruction is in the small intestine, dehydration occurs rapidly. If the obstruction is below the proximal colon, solid fecal material accumulates until the patient experiences discomfort. In large bowel obstruction, dehydration and electrolyte imbalances do not occur, which can be helpful in differentiating the possible location of the obstruction.