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 stoolForeign 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,
Intestinal obstruction can be: partial complete/ acute
the severity of obstruction depends on; the region of bowel affected the degree to which the lumen is occluded.
Most bowel obstructions occur in the small intestine.About 15% of intestinal obstructions occur in the large bowel; most of these are found in the sigmoid colon.
Pathophysiology Intestinal contents, fluid, and gas accumulate above the obstruction. Resulting in abdominal distention and retention of fluid. With increasing distention, pressure within the lumen increases, causing a decrease in venous and arteriolar capillary pressure. This causes edema, congestion, necrosis, and perforation of the intestinal wall.
vomiting may be caused by abdominal distention. Vomiting results in a loss of H+ and K+ from the stomach, leading to a reduction of CL- and K+ in the blood, resulting in metabolic alkalosis. With acute fluid losses, hypovolemic shock may occur.
Complications Hypovolemia and hypovolemic shock can result in multiple organ dysfunction. Strangulated bowel can result in;-Perforation peritonitis septic shock
Clinical Manifestations:- depend on level & type of obstruction.The patient initially complains of wavelike abdominal painabdominal distention.vomiting.The patient may pass blood and mucus, but no fecal no flatus.Signs of dehydration
in complete obstruction , peristaltic waves reverse, propelling the intestinal contents toward the mouth, leading to fecal vomiting.
Peristaltic waves may be visible in a thin person. In mechanical obstructions, high- pitched, bowel sounds are heard proximal to the obstruction and are absent distal to it. If the obstruction is nonmechanical, there is an absence of bowel sounds.
Large Bowel Obstruction;a. Only accounts for 15% of obstructionsb. Causes include cancer of bowel, volvulus, diverticular disease, inflammatory disorders, fecal impaction.c. c.Manifestations: deep, cramping pain; localized tenderness or palpable mass may be noted.
Assessment and Diagnostic Findings; Diagnosis is based on the history. Physical examination x-ray; show abnormal quantities of gas, fluid, or both in the bowel. Laboratory studies (ie, electrolyte studies).
Medical Treatment 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. Sometimes IV antibiotics are begun.
Surgical treatment; Required in Complete mechanical obstruction. Preoperative care;1.Insertion of NG tube to relieve vomiting, abdominal distention, and to prevent aspiration of intestinal contents.2.Restore fluid and electrolyte balance; correct acid and alkaline imbalances..
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
Nursing ProcessASSESSMENT. Assess pain assessment of Abdomen by auscultation of bowel for 5 minutes . Palpation for distention, firmness, and tenderness. assess the vomiting . Assess S/S of dehydration. Vital signs are assessed.
NURSING DIAGNOSIS: acutepain R/T abdominal distention and ineffective tissue perfusion Goals; to reduce or relive pain.
IMPL; NGT is maintained on low intermittent suction to relieve discomfort from distention. NPO to rest the bowel The patient is placed in semi-Fowler’s position to reduce tension on the abdomen. pain killers as ordered. Opioids are given cautiously because they may mask symptoms of perforation and decrease intestinal motility.
deficient fluid volume R/T collection of fluid in the intestine and vomiting.Goal ; prevention of dehydration and electrolyte imbalance.IMPL; - assess fluid status Ineffective Breathing Pattern R/T abdominal distention. Knowledge deficit about disease, surgery
Choose the best answer:The nurse is listening to a patient’s abdomen and determines that bowel sounds are absent. To make this determination, the nurse would listen for which of the following time frames?a. 2 minutes in each quadrantb. 5 minutes in each quadrantc. 7 minutes in each quadrantd. 10 minutes in each quadrant