Intestinal obstruction

Assess

-fam HX CRC -change in bowel pattern -blood in stool -passage of flatus -last BM

When obstruction is suspected

-keep the pt NPO and contact Dr immediately

No major fluid and electrolyte imbalances

-large - bowel obstruction

Intermittent lower abdominal cramping

-large-bowel obstructin

Minimal or no V

-large-bowel obstructio

Lower abdominal distention

-large-bowel obstruction

Obstipation or ribbon-like stools

-large-bowel obstruction

metabolic acidosis (not always present)

-large-bowel obstruction

Partial obstruction

-lower abdominal distention -obstipation -ribbon-like stools -diarrhea

️Severe pain that then stops and changes to tenderness on palpation

-may indicate perforation and should be reported to Dr

Obstruction caused by intestinal infarction

-embolectomy, thrombectomy, or resection of gangrenous small or large bowel may be necessary

Nonmechanical obstruction

-(paralytic ileus or adynamic ileus) does not involve physical obstruction in or outside the intestine -peristalsis is ⬇️ or absent as a result of neuromuscular disturbance, resulting in a slowing of the movement or a backup of intestinal contents

All pts with obstruction

-IV fluids -2-4L NS or LR with K added (careful with older adult susceptible to ️fluid overload) -lung sounds, wt, I/o -frequent mouth care

Mechanical obstruction can result from

-adhesions(scar tissue surgery or pathology) -benign or malignant tumor -complications of appendicitis -hernias -fecal impactions -strictures due to Crohn's disease or prev. radiation therapy -intussusception (telescoping of a segment of the intestine within itself ) -volvulus(twisting of the intestine ) -fibrosis due to disorders such as endometriosis -vascular disorders ex. emboli arteriosclerotic narrowing of mess enteric vessels

Bacteria in the intestine

-blood flow in the intestinal contents lie stagnant and this is not a problem unless the blood flow to the intestine is compromised -bacteria w/o blood supply can form and release an endotoxin into peritoneal or systemic circulation circulation and cause septic shock

Mechanical obstruction

-bowel is physically blocked by problems outside the intestine (adhesions), in the bowel wall (Crohn's disease), or in the intestinal lumen (tumors)

Most common place for obstruction

-can occur anywhere in the intestinal tract -ileum in the small intestine is the most common site

Mechanical colonic obstruction

-causes a milder, more intermittent colicky abdominal pain, seen with a SBO

Obstruction at the end of the small intestine and lower in the intestinal tract

-causes loss of alkaline fluids, which can lead to metabolic acidosis

Obstruction caused by tumor or diverticulitis

-colon resection with primary anastomosis or temporary or permanent colostomy

Hiccups (singultus)

-common w/ all types of bowel obstruction

Surgery

-complete mechanical obstruction -strangulated obstruction

Placement

-confirmed with X-ray -irrigate w/30mL NS -q4h

A temp ⬆️than 100 and a sustained elevation in pulse

-could indicate a strangulated obstruction or peritonitis

Most common cause for elderly

-diverticulitis -tumors -decal impactions

Paralytic ileus or nonmechanical obstruction

-most commonly caused by handling of the intestines during abdominal surgery -electrolyte disturbance especially hypokalemia predispose the pt to this problem -can also be a consequence of peritonitis -vascular insufficiency to the bowel

NGT

-most pts with an obstruction have an NGT unless the obstruction is mild -assess for flatus, BM, and nausea

If strangulation is present

-pain becomes more localized and steady

Severe hypovolemia complications

-renal insufficiency -death -bacterial peritonitis w/ or w/o actual perforation

Loss of gastric hydrochloride

-results from an obstruction high in the small intestine, which can lead to ️metabolic alkalosis

Hypovolemia

-results from distention -bowel is edematous➡️ ⬆️cap permeability -️fluid leaking into peritoneal cavity and fluid trapped in intestinal lumen ⬇️the absorption of fluid and electrolytes in vasc. space

Distention

-results from the intestine's inability to absorb the contents and move them down the intestinal tract -to compensate for the lag, peristalsis ⬆️in an effort to move the intestinal contents forward -⬆️secretions, which then leads to additional distention

Obstruction below the duodenum but above large bowel

-results in loss of both acids and bases -acid-base balance is usually not compromised

Fever, tachycardia , hypotension, ⬆️abdominal pain, abdominal rigidity, or change in color of skin overlying the abdomen

-should be reported to the Dr immediately

N and early, profuse V(may contain feels material) May contain bile and mucous or be orange-brown and foul smelling

-small-bowed obstruction

Abdominal discomfort or pain possibly accompanied by visible peristaltic wave sin upper and middle abdomen

-small-bowel obstruction

Obstipation

-small-bowel obstruction

Upper or epigastric abdominal distention

-small-bowel obstruction

️severe fluid and electrolyte imbalances

-small-bowel obstruction

Closed-loop obstruction(blacked in 2 areas) or strangulated obstruction

-the risk for peritonitis is greatly increased

️metabolic alkalosis

-️small-bowel obstruction