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