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Introduction Definition Classification Causes of intestinal obstruction Anatomy & physiology Pathophysiology , s&s Diagnostic test Complication Treatment Nursing interventions Patients health education reference

The bowel, or intestine, is the part of the digestive tract that absorbs nutrients from foods we eat. The residue of digested food passes through the bowel and is excreted during elimination, the final stage of digestion. This process can be interrupted or halted by the presence of a bowel obstruction,

The term intestinal obstruction refers to any form of impedance to the normal passage of the bowel

contents through the small or large

intestine.

Intestinal Obstruction

Mechanical

Functional

Intraluminal Intramural IntussusceptionVolvulus Congenital (foreign bodies) (tumors and polyps) Hypodynamic state (ileus) Strangulation/ incarceration

Intramural(tumors and polyps)

Intussusception

Dynamic/Mechanical obstruction

Volvulus

Congenital

Classification

Intraluminal (foreign bodies)

Hypodynamic state (ileus)

Adynamic obstruction.
Strangulation/ incarceration

Adhesions
the most common cause of small bowel obstruction.

Intussusceptions
One part of the intestine slips into another part located below it.

 Volvulus -Bowel twists and turns on itself. Strangulated Hernia -Protrusion of intestine through a weakened area in the abdominal muscle or wall. Tumor -a tumor that exists within the wall of the intestine or a tumor outside the intestine causes pressure on the wall of the intestine. Impaction of stool Foreign bodies

paralytic /Functional obstruction: Failure of peristalsis to move intestinal contents: due to neurologic or muscular impairment. in which The intestinal muscles cannot propel(push) the contents along the bowel.

Causes;

Abdominal surgery and trauma. Spinal injuries Peritonitis Vascular insufficiency muscular dystrophy,

 H+
K+

CLK+ metabolic alkalosis.

Dehydration Ischemic bowel disease Intestinal perforation Peritonitis sepsis

:
In most cases the patient is kept NPO.
NG tube to decompressed , which relieves

symptoms and may resolve the obstruction.

I.V solution with electrolytes is initiated to

correct the fluid and electrolyte imbalance.

IV antibiotics .

The surgical treatment of intestinal obstruction

depends largely on the cause of the

obstruction.

In the most common causes of obstruction, such as

hernia and adhesions, the surgical procedure involves

repairing the hernia or dividing the adhesion to which the intestine is attached.

 In some instances, the portion of affected bowel may be removed and an anastomosis performed. A colonoscopy may be performed to untwist and decompress the bowel. A cecostomy, in which a surgical opening is made into the cecum, may be performed for patients who are poor surgical risks and urgently need relief from the obstruction. The procedure provides an outlet for releasing gas and a small amount of drainage.

 A rectal tube may be used to decompress an area that is lower in the bowel. The usual treatment, however, is surgical resection to remove the obstructing lesion. A temporary or permanent colostomy may be necessary. An ileoanal anastomosis may be performed if it is necessary to remove the entire large colon.

3. Laparotomy: inspection of intestine and removal of infracted or gangrenous tissue. 4.Removal of cause of obstruction, gangrenous portion of intestines and anastomosis or creation of colostomy depending on individual case

1. Assess the nature and location of the patient's pain, the presence or absence of distention, flatus, defecation, emesis, obstipation. 2. Listen for high-pitched bowel sounds, peristaltic rushes, or absence of bowel sounds. 3. Assess vital signs.

1. Acute Pain related to obstruction, distention, and strangulation. 2. Risk for Deficient Fluid Volume related to impaired fluid intake, vomiting, and diarrhea from intestinal obstruction. 3. Diarrhea/Constipation may be related to presence of obstruction/changes in peristalsis, possibly evidenced by changes in frequency and consistency or absence of stool, alterations in bowel sounds, presence of pain, and cramping. 4. Ineffective Breathing Pattern related to abdominal distention, interfering with normal lung expansion. 5. Risk for Injury related to complications and severity of illness. 6. Fear related to life-threatening symptoms of intestinal obstruction.

Nursing Interventions
Achieving Pain Relief: Administer prescribed analgesics. Provide supportive care during NG intubation to assist with discomfort. To relieve air-fluid lock syndrome, turn the patient from supine to prone position every 10 minutes until enough flatus is passed to decompress the abdomen. A rectal tube may be indicated.

Maintaining Electrolyte and Fluid Balance: Measure and record all intake and output. Administer I.V. fluids and parenteral nutrition as prescribed. Monitor electrolytes, urinalysis, hemoglobin, and blood cell counts, and report any abnormalities. Monitor urine output to assess renal function and to detect urine retention due to bladder compressions by the distended intestine. Monitor vital signs; a drop in BP may indicate decreased circulatory volume due to blood loss from strangulated hernia.

Maintaining Normal Bowel Elimination:

Collect stool samples to test for occult blood if ordered.

Maintain adequate fluid balance.

Record amount and consistency of stools. Maintain NG tube as prescribed to

decompress bowel.

Maintaining Proper Lung Ventilation:

Keep the patient in Fowler's position to promote ventilation and relieve abdominal

distention.
Monitor ABG levels for oxygenation levels if ordered.

Preventing Injury Due to Complications: Prevent infarction by carefully assessing the patient's status; pain that increases in intensity or becomes localized or continuous may herald strangulation. Detect early signs of peritonitis to minimize this complication. Avoid enemas, which may distort an X-ray or make a partial obstruction worse. Observe for signs of shock. Watch for signs of (metabolic alkalosis and metabolic acidosis.

 When client is to be discharged from the hospital, nursing care is still continued. With sufficient

support at home, most client recover gradually.

During home visits, the clients physical status and

progress towards recovery is assessed. The clients

understanding of therapeutic regimen is also assessed, and previous teaching is reinforced.

Instruct the significant others to take the following home medication as ordered by the physician. Explain to the significant others the drug names as well as the right route and dosage. Inform the significant others about the side effects that may occur brought by the medication. Encourage the significant others to comply and follow religiously the right timing in taking the medication. Confer with the patients family the need take precautions regarding medication therapy, activity, and dietary restriction. Discuss with the patients family ways to cope with stressful situations in positive manner.

 Instruct patients family to report for immediate occurrence of signs and symptoms to a health care professional. Reinforce and supplement patients family knowledge about diagnosis, prognosis, and expected level of function. Provide patients family with specific directions about when to call the physician and what complications require prompt attention. Peer support and psychological counseling may be helpful for some families.

Once at home, patient may resume much of the normal activity short of aggressive physical exercise. Walk short distances everyday and gradually increase activity.

No lifting of a weight greater than 20 lbs (9kg) for 6 weeks.

Exercise should be started cautiously.

Encourage to practice deep breathing exercise and range of

motion exercises up to the level of capability.

Explain the need for rest periods both before and after certain activities. Teach client the importance of stress management

through relaxation technique,

Help improve patients self-concept by providing positive feedback, emphasizing strengths and encouraging social interaction and pursuit of interests.

Explain to the significant others the need to continue drug therapy Provide patients family with a list of medications, with information on action, purpose and possible side effects. Advise significant others to always comply with the medications. Call the physician if there is a problem taking them.

Hygiene
Keep proper hygiene. Teach clients family the importance of hygiene like daily oral
care, bathing and changing clothes. Proper Wound care must be observed.

Emphasize to the clients family the importance of proper

nutrition, its need for early recovery. This can aid in

restoring body functioning.

Provide dietary instructions to help patients family identify and eliminate foods that is needed by the patient.

 Soft or low residue diet upon discharge; this should be continued at home for approximately 2 weeks (this includes breads, cereals, chicken, fish, and soup).

Avoid large quantities of raw fruits and vegetables.

After 2 weeks, gradually reintroduce your regular diet.

Encourage to drink plenty of fluids.

Take nutrition supplements

Advise to visit or have her follow up check-up with her attending physician. Advise to call and notify the attending physician for any unusual ties that may occur Routinely, follow up check up with patients within two weeks. If there are staples that require removal, postoperative problems, or wound issues, a follow-up appointment will be scheduled sooner.

Smeltzer, S.C. & Bare, B.G. Brunner and Suddarths Textbook of Medical Surgical Nursing. 12th Ed. Philadelphia: Lippincott Company, 2010. http:// www MedicinePlus.com http://nanda-nursinginterventions.blogspot.com