Bowel obstruction colorectal ca


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Bowel obstruction colorectal ca

  1. 1. Managing the Client With BowelObstruction and Ostomy
  2. 2. Intestinal Obstruction Small and large Partial or complete Failure of intestinal contents to move
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 7. Example of an x ray showing a smallbowel obstruction
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. 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)
  15. 15. 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
  16. 16. 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
  17. 17. Potential Complications of Colon orRectal Cancer Intraperitoneal infection Complete large bowel obstruction GI bleeding Bowel perforation Peritonitis, abscess, and sepsis
  18. 18. Distribution Of Colon Cancer
  19. 19. Placement ofPermanent ColostomiesA. Sigmoid  Feces are solidB. Descending  Feces are semi-mushyC. Transverse  Feces are mushyD. Ascending  Feces are fluid
  20. 20. Stomas should always be beefy red
  21. 21. Ostomy Pouches and Accessories
  22. 22. Managing Nasogastric Tubes Feeding vs. Decompression Placement Verification Guidelines for Flushing Patient Positioning
  23. 23. 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
  24. 24. 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
  25. 25. 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
  26. 26. 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.
  27. 27. 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