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
