INTESTINAL

OBSTRUCTION

A REPORT BY C2
 INTESTINAL OBSTRUCTION

INTESTINAL OBSTRUCTION EXISTS WHEN BLOCKAGE

PREVENTS THE NORMAL FLOW OF INTESTINAL
CONTENTS THROUGH THE INTESTINAL TRACT.
TWO TYPES OF PROCESSES CAN IMPEDE THIS FLOW:
 TWO TYPES OF PROCESSES CAN IMPEDE
THE FLOW
MECHANICAL OBSTRUCTION:
AN INTRALUMINAL OBSTRUCTION OR A MURAL OBSTRUCTION FROM PRESSURE ON THE
INTESTINAL WALL OCCURS. EXAMPLES ARE INTUSSUSCEPTION, POLYPOID TUMORS
AND NEOPLASMS, STENOSIS, STRICTURES, ADHESIONS, HERNIAS, AND ABSCESSES.

FUNCTIONAL OBSTRUCTION:
THE INTESTINAL MUSCULATURE CANNOT PROPEL THE CONTENTS ALONG THE BOWEL.
EXAMPLES ARE AMYLOIDOSIS, MUSCULAR DYSTROPHY, ENDOCRINE DISORDERS SUCH
AS DIABETES MELLITUS, OR NEUROLOGIC DISORDERS SUCH AS PARKINSONS DISEASE.
THE BLOCKAGE ALSO CAN BE TEMPORARY AND THE RESULT OF THE MANIPULATION OF
THE BOWEL DURING SURGERY.
 CAUSES

THE OBSTRUCTION CAN BE PARTIAL OR COMPLETE. ITS

SEVERITY DEPENDS ON THE REGION OF BOWEL
AFFECTED, THE DEGREE TO WHICH THE LUMEN IS
OCCLUDED, AND ESPECIALLY THE DEGREE TO WHICH
THE VASCULAR SUPPLY TO THE BOWEL WALL IS
DISTURBED. MOST BOWEL OBSTRUCTIONS OCCUR IN
THE SMALL INTESTINE. ADHESIONS ARE THE MOST
COMMON CAUSE OF SMALL BOWEL OBSTRUCTION,
FOLLOWED BY HERNIAS AND NEOPLASMS.
 TYPES ON BASED ON LOCATION
SMALL BOWEL OBSTRUCTION
INTESTINAL CONTENTS, FLUID, AND GAS ACCUMULATE ABOVE THE
INTESTINAL OBSTRUCTION. > THE ABDOMINAL DISTENTION AND RETENTION
OF FLUID REDUCE THE ABSORPTION OF FLUIDS AND STIMULATE MORE
GASTRIC SECRETION > INCREASING DISTENTION > PRESSURE WITHIN THE
INTESTINAL LUMEN INCREASES > DECREASE IN VENOUS AND ARTERIOLAR
CAPILLARY PRESSURE >EDEMA,CONGESTION, NECROSIS, > RUPTURE OR
PERFORATION OF THE INTESTINAL WALL, WITH RESULTANT PERITONITIS > IF
THE OBSTRUCTION CONTINUES UNCORRECTED, HYPOVOLEMIC SHOCK
OCCURS FROM DEHYDRATION AND LOSS OF PLASMA VOLUME.
 TYPES ON BASED ON LOCATION
LARGE BOWEL OBSTRUCTION
AS IN SMALL BOWEL OBSTRUCTION, LARGE BOWEL OBSTRUCTION RESULTS IN AN
ACCUMULATION OF INTESTINAL CONTENTS, FLUID, AND GAS PROXIMAL TO THE
OBSTRUCTION. > SEVERE DISTENTION AND PERFORATION > (LARGE BOWEL
OBSTRUCTION, EVEN IF COMPLETE, MAY BE UNDRAMATIC IF THE BLOOD SUPPLY TO THE
COLON IS NOT DISTURBED) HOWEVER, IF THE BLOOD SUPPLY IS CUT OFF, INTESTINAL
STRANGULATION AND NECROSIS OCCUR > THIS CONDITION IS LIFE-THREATENING.
IN THE LARGE INTESTINE, DEHYDRATION OCCURS MORE SLOWLY THAN IN THE SMALL
INTESTINE BECAUSE THE COLON CAN ABSORB ITS FLUID CONTENTS AND CAN DISTEND
TO A SIZE CONSIDERABLY BEYOND ITS NORMAL FULL CAPACITY.
 SIGNS AND SYMPTOMS
CRAMPY PAIN THAT IS WAVE LIKE AND COLICKY
PATIENT MAY PASS BLOOD AND MUCUS BUT NO FECAL MATTER AND NO FLATUS
IF THE OBSTRUCTION IS COMPLETE, THE PERISTALTIC WAVES INITIALLY BECOME EXTREMELY
VIGOROUS AND EVENTUALLY ASSUME A REVERSE DIRECTION, WITH THE INTESTINAL
CONTENTS PROPELLED TOWARD THE MOUTH INSTEAD OF TOWARD THE RECTUM.
ILEUM: FECAL VOMITING TAKES PLACE. FIRST, THE PATIENT VOMITS THE STOMACH
CONTENTS, THEN THE BILESTAINED CONTENTS OF THE DUODENUM AND THE JEJUNUM, AND
FINALLY, WITH EACH PAROXYSM OF PAIN, THE DARKER, FECAL-LIKE CONTENTS OF THE ILEUM.
SIGNS OF DEHYDRATION: INTENSE THIRST, DROWSINESS, GENERALIZED MALAISE, ACHING
PARCHED TONGE
 SIGNS AND SYMPTOMS

LARGE BOWEL OBSTRUCTION DIFFERS CLINICALLY FROM SMALL BOWEL OBSTRUCTION

IN THAT THE SYMPTOMS DEVELOP AND PROGRESS RELATIVELY SLOWLY. IN PATIENTS
WITH OBSTRUCTION IN THE SIGMOID COLON OR THE RECTUM, CONSTIPATION MAY BE
THE ONLY SYMPTOM FOR MONTHS. THE SHAPE OF THE STOOL IS ALTERED AS IT
PASSES THE OBSTRUCTION THAT IS GRADUALLY INCREASING IN SIZE. BLOOD LOSS IN
THE STOOL MAY RESULT IN IRON DEFICIENCY ANEMIA. THE PATIENT MAY EXPERIENCE
WEAKNESS, WEIGHT LOSS, AND ANOREXIA. EVENTUALLY, THE ABDOMEN BECOMES
MARKEDLY DISTENDED, LOOPS OF LARGE BOWEL BECOME VISIBLY OUTLINED
THROUGH THE ABDOMINAL WALL, AND THE PATIENT HAS CRAMPY LOWER ABDOMINAL
PAIN. FINALLY, FECAL VOMITING DEVELOPS. SYMPTOMS OF SHOCK MAY OCCUR.
 DIAGNOSTIC TESTS
DIAGNOSIS IS BASED ON THE SYMPTOMS DESCRIBED PREVIOUSLY AND ON
IMAGING STUDIES.
ABDOMINAL X-RAY AND CT FINDINGS INCLUDE ABNORMAL QUANTITIES OF
GAS, FLUID, OR BOTH IN THE INTESTINES.
LABORATORY STUDIES (IE, ELECTROLYTE STUDIES AND A COMPLETE BLOOD
CELL COUNT) REVEAL A PICTURE OF DEHYDRATION, LOSS OF PLASMA
VOLUME, AND POSSIBLE INFECTION.
 NURSING DIAGNOSIS

SMALL BOWEL OBSTRUCTION:

VOMITING: FLUID AND ELECTROLYTE IMBALANCE
DEHYDRATION: RISK FOR DEFICIENT FLUID VOLUME
PAIN: ACUTE PAIN
LARGE BOWEL OBSTRUCTION
CONSTIPATION
PAIN
FECAL VOMITING -> RISK FOR INFECTION
FATIGUE
IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS
COLOSTOMY
IMPAIRED SKIN INTEGRITY
DISTURBED BODY IMAGE
RISK FOR INFECTION
INEFFECTIVE SEXUAL PATTERNS R/T PRESENCE OF OSTOMY
 MEDICAL AND SURGICAL MANAGEMENT
2. NGT INSERTION (DECOMPRESS BOWEL)

3. SURGICAL INTERVENTIONS

-HERNIOPLASTY (REPAIR OF HERNIA)(HERNIA AND ADHESIONS)

-COLECTOMY (REMOVAL)

-ANASTAMOSIS (CREATION OF STOMA)

4. IVF TO REPLACE DEPLETED WATER, NA, CL, K

RESTORATION OF INTRAVASCULAR VOLUME

CORRECT ELECTROLYTE IMBALANCES

NASOGASTRIC ASPIRATION AND DECOMPRESSION

COLONOSCOPY (TO UNTWIST AND DECOMPRESSS THE BOWEL)

CECOSTOMY (SURGICAL OPENING ON CECUM) PROVIDES OUTLET FOR RELEASING GAS AND
SMALL AMOUNT OF DRAINAGE
 NURSING MANAGEMENT

NUTRITIONAL MANAGEMENT
-ASSESS & MEASURE NGT OUTPUT,
- ASSESS F & E IMBALANCE,
-MONITOR NUTRITIONAL STATUS
-ASSESS IMPROVEMENT (BOWEL SOUNDS, DECREASED ABDOMINAL DISTENTION, IMPROVEMENT OF ABDOMINAL PAIN
AND TENDERNESS, PASSAGE OF FLATUS OR STOOL)
MONITOR FOR SYMPTOMS OF INTESTINAL OBSTRUCTION IS WORSENING
PROVIDE EMOTIONAL SUPPORT AND COMFORT
ADMINISTER IV FLUID AND ELECTROLYTES AS PRESCRIBED
PREOPERATIVE TEACHING
POSTOPERATIVE (ABDOMINAL WOUND CARE
 QUESTIONS

1. HOW LONG AFTER A SMALL BOWEL OBSTRUCTION DOES SOMEONE HAVE

TO STAY ON A LOW RESIDUE DIET?
2. CAN A PARTIAL BOWEL OBSTRUCTION CAUSE STOMACH GURGLE AND
DIARRHEA?
3. WHY ASSESS THE LOCATION OF THE STOMA AND THE TYPE OF
COLOSTOMY PERFORMED?
COLOSTOMY CARE
 COLOSTOMYIS THE OPENING OF SOME PORTION OF THE COLON ONTO THE ABDOMINAL FACE
REASONS FOR PERFORMING A COLOSTOMY
WHEN FECES CANNOT PROGRESS NATURALLY FROM THE COLON TO THE ANUS
WHEN IT IS MORE DESIRABLE OR MANAGEABLE TO DIVERT THE FECES, AS FOR PARAPLEGICS
IN ANY CONDITION WHERE THE RECTUM OR ANUS IS NONFUNCTIONAL BECAUSE OF DISEASE, A BIRTH DEFECT OR A TRAUMATIC
CONDITION.
IT IS PERFORMED TO DIVERT THE FECAL FLOW AWAY FROM AN AREA OF INFLAMMATION OR AROUND AN OPERATIVE AREA
GENERAL PROCEDURE FOR CHANGING AN OSTOMY POUCH
ASSESSMENT
IDENTIFY THE TYPE OF OSTOMY THE PATIENT HAS AND ITS LOCATION (BOWEL URINARY DIVERSION)
ASSESS THE SKIN INTEGRITY AROUND THE STOMA AND AS GENERAL APPEARANCE
NOTE THE AMOUNT AND CHARACTER OF ANY FECAL MATERIAL OR URINE IN THE POUCH
DETERMINE WHETHER THE PATIENT IS BEING TAUGHT SELF-CARE AT THE MOMENT
 IMPLEMENTATION
IDENTIFY THE PATIENT
EXPLAIN THE PROCEDURE TO THE PATIENT
PUT ON CLEAN GLOVES FOR INFECTION
ASSIST THE PATIENT TO THE BATHROOM OR PROVIDE PRIVACY
REMOVE THE SOILED DRESSING
USING WARM WATER AND A MILD SOAP, CLEANSE THE SKIN AROUND THE STOMA THOROUGHLY. INSPECT THE SKIN FOR REDNESS OR IRRITATION.
COVER THE STOMA WITH A TISSUE TO PREVENT FECES OR URINE FROM CONTACTING. CHANGE TISSUES AS NECESSARY DURING THE PROCEDURE
DRY THE SKIN AROUND THE STOMA CAREFULLY, PATTING GENTLY
APPLY A SKIN PROTECTIVE SPRAY IF NEEDED
ALLOW THE SKIN TO DRY THOROUGHLY SO THE POUCH WILL ADHERE FIRMLY (A HAIR DRYER ON A LOW SETTING AT LEAST 18 INCHES FROM THE SKIN
MAY BE USED)
REMOVE THE TISSUE FROM THE STOMA AND APPLY THE CLEAN POUCH OR DRESSING
REMOVE GLOVES AND WASH HANDS
EVALUATION
EVALUATE USING THE FOLLOWING CRITERIA
POUCH OR DRESSING SECURE
AREA CLEAN
ODOR FREE
PATIENT COMFORTABLE
IF THE PATIENT IS BEING TAUGHT THE PROCEDURE, ADD THE FOLLOWING CRITERIA:
PATIENT IS ABLE TO CHANGE POUCH USING CORRECT TECHNIQUE
PATIENT VERBALIZES UNDERSTANDING OF KEY POINTS IN CARE
DOCUMENTATION
RECORD THE FOLLOWING INFORMATION:
THE AMOUNT, COLOR, AND CONSISTENCY OF THE FECAL MATERIAL OR URINE IN THE POUCH
THE APPLICATION OF THE CLEAN POUCH AND DRESSING CHANGE
THE KNOWLEDGE AND ABILITY OF THE PATIENT T PARTICIPATE IN THE PROCEDURE OR ABILITY TO CHANGE INDEPENDENTLY.
 PLANNING
WASH YOUR HANDS
GATHER THE EQUIPMENT NEEDED IN CHANGING A POUCH OR DRESSING
CLEANSING SUPPLIES INCLUDING TISSUES, WARM WATER, MILD SOAP, WASH CLOTH AND A TOWEL
CLEAN POUCH OF THE TYPE CURRENTLY BEING USED
SEAL OR USE TAPE TO PREVENT LEAKAGE
CLEAN BELT
DRESSING MATERIALS
RECEPTACLE FOR THE SOILED POUCH OR DRESSING (BEDPAN, PAPER BAG/NEWSPAPER FOR WRAPPING)
PROTECTIVE SPRAY
CLEAN GLOVES
DETERMINE WHETHER THE PATIENT IS TO PARTICIPATE ACTIVELY
CHOOSE THE APPROPRIATE LOCATION IN PERFORMING THE PROCEDURE (BATHROOM/ BEDSIDE)
COLOSTOMY CARE