Please enable JavaScript.

Coggle requires JavaScript to display documents.

BOWEL MOVEMENT DISORDERS (DEFINETION OF TERMS (colostomy: surgical opening…

- - - - Pathophysiology
        
        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. With increasing distention, pressure within the intestinal lumen increases, causing a decrease in venous and arteriolar capillary pressure. This causes edema, congestion, necrosis, and eventual rupture or perforation of the intestinal wall, with resultant peritonitis. Reflux vomiting may be caused by abdominal distention. Vomiting results in a loss of hydrogen ions and potassium from the stomach, leading to a reduction of chlorides and potassium in the blood and to metabolic alkalosis. Dehydration and acidosis develop from loss of water and sodium. With acute ﬂuid losses, hypovolemic shock may occur.
      - CLINICAL MANIFESTATION
        
        The initial symptom is usually crampy pain that is wavelike and colicky. The patient may pass blood and mucus, but no fecal matter and no ﬂatus. Vomiting occurs. 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. If the obstruction is in the ileum, fecal vomiting takes place. First, the patient vomits the stomach contents, then the bile-stained contents of the duodenum and the jejunum, and ﬁnally, with each paroxysm of pain, the darker, fecal-like contents of the ileum. The unmistakable signs of dehydration become evident: intense thirst, drowsiness, generalized malaise, aching, and a parched tongue and mucous membranes. The abdomen becomes distended. The lower the obstruction is in the GI tract, the more marked the abdominal distention. If the obstruction continues uncorrected, hypovolemic shock occurs from dehydration and loss of plasma volume
      - Assessment and Diagnostic Findings
        
        Diagnosis is based on the symptoms described previously and on x-ray ﬁndings. Abdominal x-ray studies show abnormal quantities of gas, ﬂuid, or both in the bowel. Laboratory studies (ie, electrolyte studies and a complete blood cell count) reveal a picture of dehydration, loss of plasma volume, and possible infection.
      - MEDICAL AND NURSING MANAGMENT
        
        Decompression of the bowel through a nasogastric or small bowel tube (see Chap. 36) is successful in most cases. When the bowel is completely obstructed, the possibility of strangulation warrants surgical intervention. Before surgery, intravenous therapy is necessary to replace the depleted water, sodium, chloride, and potassium. 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. The complexity of the surgical procedure for intestinal obstruction depends on the duration of the obstruction and the condition of the intestine
    - - Pathophysiology
        
        As in small bowel obstruction, large bowel obstruction results in an accumulation of intestinal contents, ﬂuid, and gas proximal to the obstruction. Obstruction in the large bowel can lead to severe distention and perforation unless some gas and ﬂuid can ﬂow back through the ileal valve. Large bowel obstruction, even if complete, may be undramatic if the blood supply to the colon is not disturbed. If the blood supply is cut off, however, intestinal strangulation and necrosis (ie, tissue death) 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
      - Clinical Manifestations
        
        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 days. 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.
      - Assessment and Diagnostic Findings
        
        Diagnosis is based on symptoms and on x-ray studies. Abdominal x-ray studies (ﬂat and upright) show a distended colon. Barium studies are contraindicated
      - Nursing Management
        
        The nurse’s role is to monitor the patient for symptoms that indicate that the intestinal obstruction is worsening and to provide emotional support and comfort. The nurse administers intravenous ﬂuids and electrolytes as prescribed. If the patient’s condition does not respond to nonsurgical treatment, the nurse prepares the patient for surgery. This preparation includes preoperative teaching as the patient’s condition indicates. After surgery, general abdominal wound care and routine postoperative nursing care are provided.