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Intestinal Obstruction
blockage of the intestines - Coggle Diagram
Intestinal Obstruction
- blockage of the intestines
Contributing factors:
5 main causes:
- Volvulus (Twisted)
- Intussuseption (Slipt in)
- Hernia (Protrude)
- Adhesion
- Tumor
Non-mechanical obstruction:
Pseudo-obstruction / paralytic ileus, where the peristalsis process of the bowel unable to function well
- Ogilvie's syndrome
- Colonic ileus, dilation of the large intestine.
- Hirschsprung's disease
- A congenital condition where nerve cells are missing at the end of the bowel.
- Nerve & muscle disorders, such Parkinson's disease
- Cause absence of smooth muscles & peristaltic contraction.
- Abdominal surgery
- Disturbs the peristaltic process
-
Health education:
- Change intake diet by:
- eat low fat diet with plenty of vegetables & fruits.
- cutting down caffeine, which can irritate the bowel.
- eat high protein food such as fish.
- Change lifestyle to help boost digestive system by:
- exercise
- keeping hydrated
- avoiding/quitting smoking
- consuming less alcohol
- Avoid heavy lifting** after undergoing surgery**.
- For sudden abdominal pain:
- Avoid carbonated beverages to reduce stomach acidity
- Avoid chewing gum/sucking candies to reduce stomach acidity
- Avoid drinking through straw/sipping hot beverages to allow stomach to rest.
- For irritable bowel syndrome:
- Decreased emotional stress
- Increase dietary fiber
- Go for check-ups often.
- Demonstrate proper ostomy care if colostomy was done.
- Maintain proper hygiene at all times even when at home.
- Consult the doctor if you are present with the history/symptoms of intestinal obstruction.
Clinical manifestations:
- Colicky abdominal pain
- Loss of appetite
- Constipation
- Vomiting
- Nausea
- Diarrhea
- Bloating
- Inability to have a bowel movement / pass gas (Obstipation)
- Swelling of the abdomen
-
Pharmacotherapeutics:
Antibiotics (to treat infections):
- Meropenem - Meronem, Monem
- Synthetic carbapenem B-lactam antibiotic that inhibit bacteria cell wall synthesis in gm+ve & gm-ve bacteria.
- Given intravenously & used to treat intra-abdominal infections.
- SE: Diarrhea, n + v, hypersensitivity rx
- Nsg resp:
- Observe pt's cond after administering the med.
- If there is any sign of hypersensitivity, stop administration & inform the doctor.
Analgesics (to relieve pain):
- Morphine sulfate - Roxanol
- Given by injection & helps to relieve severe pain by interacting with the brain.
- SE: Decrease gastrointestinal motility, n + v, drowsiness, respiratory & CNS depression, hypersensitivity rx.
- Nsg resp:
- Assess pt's lvl of pain.
- Ensure adequate airway protection in pt with decrease lvl of consciousness.
- Observe pt's cond after administering the med.
- If there is any sign of hypersensitivity, stop administration & inform the doctor.
Anti-emetics (to prevent n + v):
- Ondansetron - Zofran, Ondavell.
- A drug class of serotonin (5HT3) antagonists & used for preventing n+v associated with chemotherapy/surgery.
- SE: Diarrhea, n+v, chest pain, bradycardia, hypersensitivity rx.
- Nsg resp:
- Assess pt's lvl of pain.
- Ensure adequate airway protection in pt with decrease lvl of consciousness.
- Observe pt's cond after administering the med.
- If there is any sign of hypersensitivity, stop administration & inform the doctor.
Medical tx:
Fluid replacement therapy:
- Insert intravenous line into the vein so that fluids can be given & able to compensate for the normal amount of fluid in the body.
Electrolyte correction:
- Fluids with electrolyte such as sodium, potassium & chloride given through infusion to maintain the number of electrolytes in the body.
Nasogastric suction:
- Insert NG tube to aspirate excess gas inside the stomach & intestines thus relieve abdominal swelling.
Placing a thin, flexible tube (catheter) into the bladder:
- to drain urine & collect it for laboratory test.
-
For pt with intussusception:
- A barium/air enema is used as both diagnostic procedure & a tx for children with intussusception.
For partial obstruction:
- Doctor may recommend a special low-fiber diet that is easier for the partially blocked intestine to process as some food & fluid can still get through.
For non-mechanical obstruction (pseudo-obstruction):
- Paralytic ileus get better on its own.
- Food will be given thru nasal tube/IV to prevent malnutrition.
- If paralytic ileus doesnt improve on its own, doctor may prescribe med that causes muscle contractions, help move food & fluids thru intestines.
- If paralytic ileus is caused by an illness/med, doctor will treat the underlying illnesses/stop the med.
- Surgery may be needed to remove part of the intestine, but rare.
Surgical intervention:
- Surgical resection
- removal of the obstruction is necessary when there is a mass such as tumor.
2. Removal of adhesion
- careful incision to cut the scar tissue that squeezing the intestines from the outside.
- Metal stent placement
- a flexible tube will be placed inside the obstructed intestine to allow passage of food & stool & to prevent another blockage.
- may be necessary when a bowel obstruction is recurrent or when the intestines are severely damaged.
- stent usually used to treat pt with colon cancer/to provide temporary relief for people with risky emergency surgery.
- Colostomy/Ileostomy
- if the intestines are damaged/inflamed, a permanent/temporary artificial opening will be created at the abdomen for waste/stool evacuation.
- sometimes needed to prevent severe gastrointestinal infection from spreading throughout the body.
- Revascularization
- ischemic colitis may require revascularization to repair the blocked blood vessels taht supply the blood to intestines.
Priority Nsg Care:
Related nsg diagnosis:
- Fluid & electrolyte imbalance related to decrease in intestinal fluid absorption as evidenced by decreased bowel sounds & vomiting.
- Imbalanced nutrition: Less that body requirements related to impaired nutrition absorption as evidenced by clinical manifestations (loss of weight, decreased appetite & etc).
- Acute pain related to contractions of proximal intestines & smooth muscle spasms as evidenced by pt's verbalization.
Prioritized nsg care plan:
Fluid & electrolyte imbalance related to decrease in intestinal fluid absorption as evidenced by decreased bowel sounds & vomiting.
Goals:
Pt's fluid & electrolyte will maintain at a normal lvl, as indicated in lab tests (BUSE/CREAT).
Nsg interventions:
- Assess pt's vital signs (blood presure, temp, & pulse) to look for indications of fluid loss (Hypotension, tachycardia, dehydration & fever).
- Assess pt's fluid intake & output record to establish baseline data for continuous assessment of the effectiveness of tx.
- Maintain strict intake & output charting to ensure the pt does not bcme dehydrated.
- Restrict oral intake to allow intestines to rest & reduce intestinal contractions.
- Provide fluid intravenously as ordered by the doctor/allow the pt to get water parenterally.
- Administer medications as prescribed by the doctor to facilitate healing.
Complications:
If not treated:
- Tissue death
- venous compression & affect the O2 supply into the intestinal wall thus lead to tissue necrosis.
- Infection (peritonitis)
- an infection in the abdominal cavity that may arise from the perforation of the bowel.
- Sepsis
- a potentially fatal blood infection as bacteria enters the circulation.
- Dehydration
- due to loss of water, sodium & chloride.
- Electrolyte imbalance
- Abscess within the abdomen
After surgery:
- Bowel paralysis
- Adhesions
- Nerve damage
- Short bowel syndrome, in which part of the bowel is lost/does not work properly.
- Wound reopening.