Bowel obstruction colorectal ca
Upcoming SlideShare
Loading in...5
×
 

Bowel obstruction colorectal ca

on

  • 1,238 views

 

Statistics

Views

Total Views
1,238
Views on SlideShare
1,238
Embed Views
0

Actions

Likes
0
Downloads
56
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

Bowel obstruction colorectal ca Bowel obstruction colorectal ca Presentation Transcript

  • Managing the Client With BowelObstruction and Ostomy
  • Intestinal Obstruction Small and large Partial or complete Failure of intestinal contents to move
  • Mechanical Causes of Intestinal ObstructionA. Intussusceptions: The prolapse of the intestine into the lumen of the immediate adjacent partB. Volvulus: Torsion of a loop of intestine causing an obstruction (may also have strangulation)C. Hernia: An abnormal protrusion through the abdominal wall
  • Functional Causes of BowelObstruction Ileus, paralytic ileus, adynamic)  musculature can’t propel bowel contents usually accompanied by peritonitis Symptoms include abdominal pain and distention, vomiting and constipation. Potential complications include dehydration and shock. Treatment : Decompression with a tube at the site of the obstruction
  • Small Bowell Obstruction Pathophysiology  Obstruction  Effluent and flatus collect above  abdominal distention  Distention and fluid retention  absorp & stimulate prod of more fluids   distention   intraluminal press   venous and art cap press   edema, congestion, necrosis, rupture
  • Signs and SXs of Small BowelObstruction Crampy abdominal pain that is wavelike and colicky Pass blood and mucus but no feces or flatus Vomiting In severe cases reverse peristalsis
  • Example of an x ray showing a smallbowel obstruction
  • Large Bowel Obstruction Pathophysiology  Obstruction  build up of effluent & gas above site   severe distention and perforation  Often undramatic (unlike sbo)  Strangulation and necrosis are life threatening Adenocarcinoid tumors account for the majority of large bowel obstructions
  • Signs & SXs of Large BowelObstruction Constipation (may be the only sx for months) Alteration in the shape of stool Weakness, anorexia and weight loss May develop iron deficiency anemia Distended abdomen showing the outline of the large bowel
  • Treatment Options for LBO Monitor symptoms, provide sx relief Surgical resection of bowel and formation of ostomy (temp or permanent) if condition worsens Nursing Care  Monitor for improvement, deterioration  Fluid and electrolyte balance  Pre- & post-op care
  • Bowel ObstructionClinical Signs & SXs Small Intestine Large IntestineOnset Rapid GradualVomiting Frequent & Copious RarePain Colicky, cramp like, Low grade, crampy intermittentBowel Movements Feces for a short duration Absolute constipationAbdominal Distention Minimally increased Greatly increased
  • Colorectal Cancer Risk Factors (cause unknown):  Over 40  Blood in stool  History of rectal polyps  Family history  History of inflammatory bowel disease  High fat, protein, beef diet; low fiber The third most common cause of U.S. cancer deaths Risk factors: see Chart 38-8 Importance of screening procedures Manifestations include change in bowel habits; blood in stool—occult, tarry, bleeding; tenesmus; symptoms of obstruction; pain, either abdominal or rectal; feeling of incomplete evacuation Treatment depends upon the stage of the disease
  • Patho-physiology of ColorectalCancer Predominantly adenocarcinoma (arising from the epithelial cells of the intestine Symptoms •Rectal  Right side •Tenesmus •Pain  Dull pain •Felling of  Melena incomplete  Left side evacuation •Bloody stools  Pain/cramping  Narrowing stools  Constipation  Bright blood
  • Colon Cancer Diagnosis  Abdominal and rectal exam  Fecal occult blood testing  Barium enema  Colonoscopy / sigmoidoscopy with biopsy & cytology smears  Carcinoembryonic antigen (CEA) (dx and recurrence)
  • Nursing Process—Assessment of the PatientWith Cancer of the Colon or Rectum Health history Fatigue and weakness Abdominal or rectal pain Nutritional status and dietary habits Elimination patterns Abdominal assessment Characteristics of stool
  • Nursing Diagnosis Anxiety Pain Altered nutrition, less than High risk for fluid volume deficit High risk for infection Knowledge deficit Impaired skin integrity Disturbed body image Ineffective sexuality patterns
  • Potential Complications of Colon orRectal Cancer Intraperitoneal infection Complete large bowel obstruction GI bleeding Bowel perforation Peritonitis, abscess, and sepsis
  • Distribution Of Colon Cancer
  • Placement ofPermanent ColostomiesA. Sigmoid  Feces are solidB. Descending  Feces are semi-mushyC. Transverse  Feces are mushyD. Ascending  Feces are fluid
  • Stomas should always be beefy red
  • Ostomy Pouches and Accessories
  • Managing Nasogastric Tubes Feeding vs. Decompression Placement Verification Guidelines for Flushing Patient Positioning
  • Nasogastric Tubes Decompress Lavage Diagnose GI motility and other disorders Administer medications and feedings Treat an obstruction Compress a bleeding site Aspirate gastric contents for analysis
  • Care of the Patient with a G-Tube Check institution’s policy for management Monitor GI function and tube insertion site at least once per shift Assess gastric drainage for amount and characteristics each shift
  • Care of the Patient with an NG orG-Tube Irrigate q 4 hours. Flush a tube used for feeding with 30ml Replace irrigation equipment per protocol. Reposition as needed Clean nares, apply water soluble lubricant and retape daily or prn. Oral hygiene Clean new abdominal tube site
  • Medication Administration by NGor G-Tube Assess for placement and flush with 30 ml water. When gastric suction prescribed, clamp tube for 20 minutes after instillation of medications to allow for absorption. Avoid crushing sustained release, enteric coated products, or drugs in a chewable or sublingual form. Administer crushed medications separately; do not mix together in water. Flush with about 15 ml between each medication. Some medications, for example Dilantin, are rendered less potent when given with tube feedings. For these medications, it is important to turn the feeding off for 30-45 minutes following medication administration. Check your institution’s policy for specifics.
  • Enteral Feeding Verify placement Verify formula, amount, and method of administration upon initiation of feeding and minimally once per shift there after Confirm placement Monitor for vomiting, diarrhea, changes in aspirates, abdominal characteristics, change in bowel sounds, onset of respiratory distress, hypotension, fever or significant change in UO. Monitor labs (especially glucose levels). Assess weight. Elevate HOB 30 degrees – when and why? Aspirate for residual