Intestinal obstruction

• Intestinal obstruction is a significant mechanical
impairment or complete arrest of the passage of
contents through the intestine. Intestinal
obstructions account for 20% of all acute
surgical admissions. Mortality and morbidity are
dependent on the early recognition and correct
diagnosis of obstruction. If untreated,
strangulated obstructions cause death in 100%
of patients. However, the mortality rate
decreases to 8% with prompt surgical
intervention (Vicky P. Kent, RN, PhD, CNE,
2009).

• Nanay Ganda, 84 years old, was admitted last
December 8, 2010 at General Santos Doctors’
Hospital under the care of Dr. Albano, had
complaints of inability to defecate by about 4
days. A background of one year history of
intermittent abdominal pain with bloating was
claimed by the patient.

• The impression to the result of the ultrasound of
her whole abdomen is to consider ileus; partial
obstruction and fecal stasis. Dr. Albano believed
that the symptoms being manifested were results
of a disorder she has in a long time. Since they
weren’t able to have that checked and it wasn’t
figured out earlier, the signs become more evident
now. It’s also because these manifestations
develop and progresses relatively slowly. It was
then that the physician decided to let the patient
undergo exploratory lap to detect what really had
cause the obstruction.

• It was December 13, 2010 when the surgeon
discovered a tumor at the site of the obstruction
particularly at the descending colon and
immediately removed it. The found tumor was
then subjected for biopsy.

Intestinal obstruction is a significant mechanical
impairment or complete arrest of the passage of
contents through the intestine. Overall, the most
common causes of mechanical obstruction are
adhesions, hernias, and tumors. Other general
causes are diverticulitis, foreign bodies (including
gallstones), intussusceptions (bowel folding into
itself), and volvulus (twisting of the colon).

The symptoms usually include
cramping pain, vomiting,
constipation, and lack of flatus.
Diagnosis is clinical which is
confirmed by abdominal x-rays.
Treatment is fluid resuscitation,
nasogastric suction, and, in most
cases, surgery.

Intestinal obstructions account for 20% of all
acute surgical admissions. Mortality and
morbidity are dependent on the early
recognition and correct diagnosis of
obstruction. If untreated, strangulated
obstructions cause death in 100% of
patients. However, the mortality rate
decreases to 8% with prompt surgical
intervention (Vicky P. Kent, RN, PhD, CNE,
2009).

In the course of this study, 84 year-old, Nanay
Ganda, admitted last December 8, 2010 at
General Santos Doctors’ Hospital under the care
of Dr. Albano, had complaints of inability to
defecate by about 4 days. A background of one
year history of intermittent abdominal pain with
bloating was claimed by the patient

Because of this, Dr. Albano believed that the
disorder had a gradual onset and its
symptoms were experienced timely yet later
with age. The patient recently claimed that
pain usually starts at the right upper quadrant
and radiates all throughout the abdomen.
Abdominal distention was also observed with
rounded asymmetric contour of the abdomen.
The bowel sounds were normal at first and
becomes quiet later on. She also had
episodes of vomiting.

Last December 13, 2010, the patient had
undergone exploratory laparotomy and the
surgeon found out that there was a
presence of tumor and immediately
removed it. However, the result of the biopsy
has not been seen. She also had a
colostomy to eliminate waste products until
such time the colon heals.

The study focuses on the nature and
possible causes which may lead people to
experience this obstruction. The patient is in
her older age and same with other elders
who have the same case as Nanay Ganda,
it is difficult in their part to deal with the
disorder. Since they are older, they need
more attention and care from the medical
team, and particularly, from their significant
others.

It is for this reason why the student
nurses decided to have the case. To
give awareness and knowledge of what
is the disorder all about and how can
somebody be of help to manage
patients with this case especially the
older ones.

This will be a big implication in the medical
and nursing care since it is a challenge to
diagnose a bowel obstruction. The keys to
successful management are to identify
signs and symptoms that may present very
subtly at first, followed by a commitment to
help the patient before the condition
becomes aggravated. Whatever the
treatment, participation in management and
postoperative care is vital. Staying current
with new findings and methods is the best
course.

General Objectives:
Comprehend and recognize salient
points that are important to remember when
dealing with patients who manifested
intestinal obstruction; its nature, causes,
clinical manifestations, management, and
prognosis This is to enhance the students’
and other health care providers’ awareness,
knowledge, and understanding of it in order
to promote health, prevent the disease and
help manage patients with this kind of
disorder to recover.

Specific Objectives:
Present the introduction of the studied
disease;
State the purpose of the study;
Present the obtained initial database of
the patient;
Present the nursing history including the
past and present illness of the patient, as
well as his activities of daily living;

 Present the patient’s cephalocaudal
assessment;
 Identify the anatomy and physiology of
the system involved (Gastrointestinal
System);
 Trace the pathophysiology of the disorder
process through an illustration and
explanation;
 Compare the clinical manifestations of
the disorder based on the theories and
actual observations;
 Explain the assessment and diagnostic
findings;

 Interpret the laboratory results and the
nursing responsibilities;
 Discuss the medical and nursing
management for the said condition.
 Outline the drug study from the patient’s
medication;
 State the discharge planning of the
patient;
 List the health teachings given to the
patient;

 State the prognosis of the disease;
 Enumerate the problem list;
 Present the Gordon’s Functional Pattern
of the patient; and
 Present the nursing care plan made for
the patient.

Name: Nanay Ganda
Age: 84 years old
Sex: Female
Address: Block 17 Lot 14
Gensanville Subd.,
Bula, GSC
Religion: Roman Catholic

Civil Status: Married
Birthdate: September 12, 1926
Birthplace: Bajada, Davao City
Room: 242 A and 242 B
Date of Admission: December 8, 2010
Attending Physician: Dr. Albano

Chief Complaints: Generalized Abdominal
Pain; Inability to defecate;
Abdominal distention
Admitting Diagnosis: T/C Ileus Partial
Obstruction; Fecal Stasis
Occupation/Source of Income : Housewife

A. History of Present Illness
4 days before the admission, Nanay
Ganda experienced inability of defecating.
She also recalled and claimed that it’s
approximately a year that she has been
suffering from intermittent pain in the
abdominal area. She cited that pain starts
at the right upper quadrant and radiates
all throughout the abdomen.

Nanay Ganda and her children then
decided to let her be seen by a physician.
They scheduled the check-up last
December 8, 2010. According to them,
the physician advised Nanay Ganda to be
admitted on that same day, after doing
assessment and series of laboratory tests
such as complete blood count and fluid
serum. After 5 days being at the hospital,
she had episodes of vomiting.

The impression to the result of the ultrasound
of her whole abdomen is to consider ileus;
partial obstruction and fecal stasis. Dr. Albano
believed that the symptoms being manifested
were results of a disorder she has in a long
time. Since they weren’t able to have that
checked and it wasn’t figured out earlier, the
signs become more evident now. It’s also
because these manifestations develop and
progresses relatively slowly.

It was then that the physician decided to let
the patient undergo exploratory lap to detect
what really had cause the obstruction. It was
December 13, 2010 when the surgeon
discovered a tumor at the site of the
obstruction particularly at the descending
colon and immediately removed it. The found
tumor was then subjected for biopsy.

B. Past Medical History
•Immunization and Childhood Illness
The patient can only recall being
immunized with BCG and OPV. She had a
history of having chicken pox infection when
she was on her 1st
year high school. She also
experienced cough and colds, fever, diarrhea,
constipation, sore throat, rashes, and nausea
and vomiting.

• Compliance to Health Management
Nanay Ganda rarely visits a doctor to have
a check-up. However, she is using herbal
medicines since her childhood days
depending on what condition she has such
as oregano, guava, bitter gourd, and
ginger.
She also takes over the counter drugs and
what she mentioned were Solmux,
Neozep, Biogesic, Mefenamic acid,
Bentyl, and Loperamide. She said that
when she was still on her 30’s to 40’s, she
is taking multivitamins which is Enervon

• Menarche
Her menarche started when she was in
her 6th
grade. She was 11 years old
back then on the year 1938.
C. Family History
There is no known inherited condition
present in her both paternal and
maternal family. She’s the first in their
family to be experience intestinal
obstruction.

D. Activities of Daily Living
•Personal Hygiene
The patient is able to bathe herself.
She takes a bath everyday. According to
her, before and after eating her meals, she
only washes her hands with the use of
water though sometimes, she can be able
to use soap.

• Nutrition
Since she believes that eating fruits
and vegetables is good for her and will
be able to maintain her health, she
doesn’t seek for medical assistance
that much.
She eats her meals three times a day
with snacks in between. She admitted
that she only drinks 4-5 glasses of
water a day which approximately is
equal to 1.5L. She drinks coffee in the
morning and afternoon. She claimed
that she has allergies on food

• Elimination
She voids 4-5 times a day. Her urine
color is yellow which is dark most of
the times. There is no burning
sensation/ pain felt during urination.
She usually moves her bowel every
morning with brown and formed
stools. But recently, she is having
difficulty in defecating.

• Rest and Sleep
She can sleep for 7-9 hours per
night. Her earliest time in going to
sleep is at 9:30 PM while the latest
time in waking up is at 6:30 AM. She
sometimes takes a nap at noon for
about 1-3 hours. She said that she
doesn’t experience any difficulties in
going to sleep and doesn’t take any
sedatives.

• Exercise
The patient ambulates within the
house and does household chores.
She also takes a walk at their
subdivision in visiting their neighbors
or buying at the store. She does
simple exercises on the upper and
lower extremities by means of shaking
and stretching.

• Religion
She is a Roman Catholic who has a
strong faith in God. She goes to the
church with her youngest child and her
grandchildren to attend the mass
every Sunday. She always brings with
her the rosary and always prays at
night.

• Sexuality
The patient is married and has 4
children. She has no history of
Sexually Transmitted Disease or any
disease affecting her sexual organ. Her
menarche was on the year 1938 when
she was still 11 years old and she is
now on her menopausal stage.

E. Hospitalization
This was her first hospitalization.
She never experienced being
hospitalized before because her
parents would just bring her to
manghihilot in their place.

Date Conducted: December 13 – 14, 2010
a.General Appearance
Pre-operative Phase
IVF of D5NM 1L x 160
hooked at her left cephalic
vein

Vital Signs
12-13-10
8 AM 12PM Normal
T 360
C 360
C 36.5-37.50
C
PR 93 bpm 94 bpm 60-100 bpm
RR 30 cpm 24 cpm 12-20 cpm
BP 110/80mmHg 110/80mmHg 90/60-120/90 mmHg

 Thin
 Clean and well-groomed
 Conscious and coherent
 Tries to be calm and relaxed
 Facial grimacing at times
 Oriented to people, time, and place
 Frequent sighing

Post-operative Phase
IVF of PLR 1L x 8 hours as main line
hooked at her left cephalic vein with a
side drip of PNSS 500mL + 2 ampules
Voltaren at 20cc/hr and an IVF of PNSS
1L x KVO hooked at her right cephalic
vein with a side drip of 2units PRBC

Vital Signs
12-14-10
8 AM 12PM Normal
T 360
C 36.50
C 36.5-37.50
C
PR 70 bpm 84 bpm 60-100 bpm
RR 18 cpm 18 cpm 12-20 cpm
BP 120/70 mmHg 100/60mmHg 90/60-120/90 mmHg

 Uses oxygen via face mask at 3 LPM
 She has a nasogastric tube attached to a
drainage bottle
 Calm but shows evidence of weakness
 A colostomy is being attached to
colostomy bag at the left upper quadrant
of her abdomen
 A vertical surgical incision is present on
the abdomen with clean and intact
dressing
 Foley catheter is attached to uro bag
draining well with dark yellow urine

Skin, Hair, Nails
Light brown in color same all
throughout the body
Senile skin turgor
Wrinkles present on the face and
neck
Dry and flaky prominent over the
extremities
Brown-colored macules on the face
and upper extremities
No edema

 Unblemished skin
 No masses noted
 No lesions found
 Warm to touch
 Evenly distributed short, thin, white
hair
 Short and thick fingernails and
toenails

Head
Normocephalic
Oblong-shaped
Symmetric facial features
Symmetric facial movements
Without lesions, lumps, or masses
noted

Eyes
Eyebrows are unevenly distributed and
aligned
Eyelashes are short and curl outwards
Sunken eyeballs
White sclera
Pale conjunctiva
Pupils appear smaller in size and both
react to light and accommodation
Bilateral blinking

Ears
Color is same as facial skin
Symmetrical
Mobile and firm pinna that recoils
after it is fold
Pinna aligned with the outer canthus
of the eye
No unnecessary foul discharges
Can hear sounds in both ears

Nose
Color is same as facial skin
Symmetric
Greenish discharges present after
operation
No lesions

Mouth
Symmetric
Dark colored dry lips
Able to purse lips
No lesions noted
Dark colored gums
No swelling
Uses dentures
Tongue is moist and pink in color which is in
central position
Tongue moves freely

Neck
Color is same with the head
Wrinkles present
Not enlarged
Head centered
Coordinated movement

Spine and Back
Spinal curvature is accentuated
Before operation, patient can turn to
sides with slight discomfort
After operation, patient is flat on bed

Thorax and Lungs
Decrease in depth of respiration during
inspiration
Use of accessory organs during expiration
Before operation, respiration rate is 24 cpm
After operation, respiration rate is 18 cpm
Vibrations present and can be felt on the
chest
Clear breath sounds

Breast
Color is same all throughout the abdomen
Slightly unequal in size
Generally symmetric
Appears flaccid
Lacks firmness
No masses and lesions found
Areola and nipples are darker in
pigmentation
No discharges noted

Heart
Present and audible heartbeats
Beats with regular rhythm
Before operation, cardiac rate is 90
bpm
After operation, cardiac rate is 73
bpm

Abdomen
Pre-operative Phase
Uniform color
Unblemished skin
Round with asymmetric contour
Rises with inspiration and falls with
expirations
Umbilicus centrally positioned
Hypoactive bowel sounds auscultated

 Abdominal distention
 Claimed that pain starts at the right
upper quadrant and radiates all
throughout the abdomen
 The impression to the result of the
ultrasound of her whole abdomen is
to consider ileus; partial obstruction
and fecal stasis

Post-operative Phase
Symmetric contour
A colostomy is being attached to
colostomy bag at the left upper quadrant of
her abdomen
A vertical surgical incision is present on
the abdomen with clean and intact dressing
No tenderness

Upper Extremities
 Both arms are in the same size and length
 Movement is limited
 No lesions noted
 No masses noted
 No rashes found
 Dry and flaky skin
 Brown-colored macules noted
 Senile skin turgor

Lower Extremities
 Both legs are in the same size and
length
 No lesions and masses noted
 Dry and flaky skin
 Fissures noted
 With lesser hair distributed in the
legs

Musculoskeletal
 Muscles are equal in size on both
sides of the body
 Flaccid muscles
 No tremors found and no presence
of tenderness or swelling
 Limited range of motion; decreased
strength; becomes weak in
prolonged activities

Neurologic
 Has poor posture but is able to walk
and maintain balance; but aided
during ambulation
 Reaction to stimuli are slower
 Has reduced speed of movement

Genitourinary
 On menopausal stage
 No history of disease affecting
genitals
 After operation, a foley catheter is
attached to uro bag draining well with
dark yellow urine; no pain during
urination

Abdominal CT scan - combines special x-
ray equipment with sophisticated computers
to produce multiple images or pictures of
the inside of the body. These cross-
sectional images of the area being studied
can then be examined on a computer
monitor, printed or transferred to a CD.

Abdominal X-Ray - An abdominal X-ray is
a picture of structures and organs in the
belly (abdomen). This includes the
stomach, liver, spleen, large and small
intestines, and the diaphragm, which is the
muscle that separates the chest and belly
areas. Often two X-rays will be taken from
different positions. An abdominal X-ray
may be one of the first tests done to find a
cause of belly pain, swelling, nausea, or
vomiting.

Abdominal Ultrasonography - An ideal
clinical tool for determining the source
of abdominal pain. It can simplify the
differential diagnosis of abdominal
pain, especially when pain and
tenderness are present over the site of
disease.

Barium Enema - X-ray examination of
the large intestine (colon and rectum).
The test is used to help diagnose
diseases and other problems that
affect the large intestine. To make the
intestine visible on an X-ray picture,
the colon is filled with a contrast
material containing barium. This is
done by pouring the contrast material
through a tube inserted into the anus.

Laboratory studies (e.g.,
electrolyte studies and a
complete blood cell count)
reveal a picture of dehydration,
loss of plasma volume, and
possible infection.

Decompression of the bowel through a
nasogastric or small bowel tube 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.

A colonoscopy may be performed to
untwist and decompress the bowel. A
cecostomy, in which a surgical
opening is made into the cecum, may
be performed for patients who are
poor surgical risks and urgently need
relief from the obstruction. The
procedure provides an outlet for
releasing gas and a small amount of
drainage.

A rectal tube may be used to
decompress an area that is lower in
the bowel. The usual treatment,
however, is surgical resection to
remove the obstructing lesion.
A temporary or permanent colostomy
may be necessary. An ileoanal
anastomosis may be performed if it is
necessary to remove the entire large
colon.

Nursing management of the nonsurgical
patient with a small bowel obstruction
includes maintaining the function of the
nasogastric tube, assessing and measuring
the nasogastric output, assessing for fluid
and electrolyte imbalance, monitoring
nutritional status, and assessing
improvement (eg, return of normal bowel
sounds, decreased abdominal distention,
subjective improvement in abdominal pain
and tenderness, passage of flatus or stool).

The nurse reports discrepancies in
intake and output, worsening of pain or
abdominal distention, and increased
nasogastric output. If the patient’s
condition does not improve, the nurse
prepares him or her for surgery. The
exact nature of the surgery depends on
the cause of the obstruction. Nursing
care of the patient after surgical repair
of a small bowel obstruction is similar to
that for other abdominal surgeries

Fluid Serum
December 8, 2010
Electrolytes exist in the blood as acids, bases, and salts (such
as sodium, calcium, potassium, chloride, magnesium, and
bicarbonate). They control such things as cardiac function
and muscle contraction and are routinely measured by
laboratory studies of the serum.
Fluid Serum is the cell-free fluid of the bloodstream. It
appears in a test tube after the blood clots and is often used
in expressions relating to the levels of certain compounds in
the blood stream.
A Blood chemistry test is a procedure to examine the general
health of a patient especially to assess the functioning of
certain organs.

Test Result Reference
value
Interpretation
Creatinine 0.8 mg/dl 0.7-1.2 Normal
Sodium 137 mmol/L 137-145 Normal
Potassium 3.4 mmol/L 3.5-5.0 Low
Amylase 37 u/L 30-110 Normal
Interpretation:
The table shows that Potassium is slightly
decreased. This decrease in potassium may
be due to patient’s vomiting, deficient
potassium intake, or dehydration.

Nursing Responsibilities:
•define and explain the test
•state the specific purpose of the test
•explain the procedure
•discuss test preparation, procedure,
and posttest care
•some blood chemistry tests will have
specific requirements such as dietary
restrictions or medication restrictions.

Complete Blood Count
December 8, 2010
The complete blood count (CBC) is one of the
most commonly ordered blood tests. The complete
blood count is the calculation of the cellular
(formed elements) of blood. These calculations are
generally determined by special machines that
analyze the different components of blood in less
than a minute.
This test may be a part of a routine check-up or
screening, or as a follow-up test to monitor certain
treatments. It can also be done as a part of an
evaluation based on a patient's symptoms.

Interpretation:
CBC is a combination report of a series of test of the
peripheral blood. White blood cells (leukocytes) are
body’s defense against infective organisms and foreign
substances. The table shows that there is elevated
number of WBC which indicates that there is possible
infection or immunosuppression happening inside.
Test Results Reference
Value
Interpretation
WBC 12.1 5-10 x 10^
9/L High
Segmenters 0.76 0.55-0.65 High
Lymphocyte 0.15 0.25-0.35 Low
Monocyte 0.08 0.03-0.06 High
Eosinophil 0.01 0.02-0.04 Low
Hemoglobin 96 140-170 9/L Low
Hematocrit 0.29 0.40-0.50
volume
Low
Platelet 291 150-350x10^
9/L Normal

Segmenters are above the normal range
which indicates infection.
Low Lymphocyte, Eosinophil and
Monocyte count indicates that the body's
resistance to fight infection has been
substantially lost and one may become more
susceptible to certain types of infection,
namely cancer and tumor. As lymphocyte
cells make up fifteen to forty percent of the
total white blood cells that circulate in the
bloodstream, a low count can cause damage
to organs.

Hemoglobin is the oxygen carrying protein within
the RBC’s. The table shows that there is
decreased hemoglobin concentration in the blood,
which indicates that there is less oxygen being
transported throughout the body, because of the
less oxygen being transported. With this, the
patient is likely experiencing difficulty of breathing
that leads patient to have impaired gas
exchange.
Hematocrit is the percentage of RBC mass to
original blood volume. The table shows that
hematocrit volume is decreased which indicates
that there is over expansion of extra cellular fluid
volume, since the patient has a decreased RBC
she also have a decreased hematocrit level..

•Explain that the tests are done to detect any
hematologic disorders as well as infection and
inflammation.
•Tell the patient that a blood sample will be taken
and that she may feel slight discomfort from the
tourniquet and needle puncture.
•Use gloves when collecting and handling all
specimens.
•Transport the specimen to the laboratory as soon
as possible after the collection.
•Do not allow the blood sample to clot, of the
results will be invalid. Place the specimen in a
biohazard bag.

Abdomen Supine and Upright
December 8, 2010
Abdominal x-rays may be performed to
diagnose causes of abdominal pain, such as
masses, perforations, or obstruction.
Abdominal x-rays may be performed prior to
other procedures that evaluate the
gastrointestinal (GI) tract or urinary tract,
such as an abdominal CT scan and renal
procedures.

Result:
Lung bases are clear. Free subphrenic air is noted.
There are gas containing loops of small and large
bowel in all quadrants with no definite pattern. An
ovoid soft tissue density is seen in the right lower
quadrant area overlying pattern of the right superior
iliac crest. This is seen in the supine view only and
may be in the soft tissues. Reacted gas is present.
There are advance degenerative changes in lumbar
spine characterized by osteophytes/ spurs
formation. Asymmetrical narrowing of L4-L5
intervertebral joint space, left is seen with linear
lucencies within. Mild levoseoliosis is noted.
Impression:
Essentially (-) study of the abdomen save for
degenerative changed of the lumbar spine.

Abdomen Supine and upright
December 9, 2010
Re-examination no longer shows the
ovoid soft tissue density in the right lower
quadrant area or seen in the abdominal
supine view. Gas containing loops of
predominantly small bowel segments are
still seen in all quadrants with no definite
pattern. Rectal gas is present. Pro-
peritoneal flank stripes are intact,
abdomen are not displaced laterally.

•Remove any clothing, jewelry, or other objects that
might interfere with the procedure.
•Given a gown to wear.
•Position in a manner that carefully places the part
of the abdomen that is to be observed. The patient
may be asked to stand erect, to lie flat on a table,
or to lie on the side on a table, depending on the x-
ray view the physician has requested.
•Body parts not being imaged may be covered with
a lead apron (shield) to avoid exposure to the x-
rays.

•Once positioned, ask the patient to hold still for a
few moments while the x-ray exposure is made.
Also, ask the patient to hold his/her breath at
various times during the procedure.
•It is extremely important to remain completely still
while the exposure is made, as any movement may
distort the image and even require another x-ray to
be done to obtain a clear image of the body part in
question.
•The x-ray beam is then focused on the area to be
photographed.

Urinalysis
December 9, 2010
Routine urinalysis is performed for
general health screening to detect
renal and metabolic diseases; to
diagnose diseases or disorders of the
kidneys or urinary tract. In addition, it
is performed to help diagnose specific
disorders such as endocrine diseases.

Interpretation:
The physical and chemical properties of the
patient’s urine show normal results. Normally, blood must
be absent in the urine. Presence of blood may indicate
acute kidney infections, chronic infections, and stone
formation in the kidneys.
Color Reaction Transparency Specific gravity
Light yellow 6.0 Clear 1.003
Sugar Albumin
Negative Negative
Pus cell RBC
0.1/ HPF 0.1/ HPF

•Explain how to collect a clean catch
specimen of at least 15 mL.
•Explain that there is no food or fluids
restriction.
•Obtain a first voided morning specimen if
possible.
•Medications may be restricted for it may
affect laboratory results.

Fecalysis
December 9, 2010
It refers to a series of laboratory tests
done on fecal samples to analyze the
condition of a person's digestive tract
in general. Among other things, a
fecalysis is performed to check for the
presence of any reducing substances
such as white blood cells (WBCs),
sugars, or bile and signs of poor
absorption as well as screen for colon
cancer.

Interpretation:
Black stool may be a result of possible
internal bleeding, particularly somewhere in the
digestive tract.
Color Chemical and
occult blood
Result
Black Positive No intestinal
parasite seen

•Discourage patient from taking aspirin, alcohol,
vitamin C, ibuprofen, and certain types of food if
fecal sample will be checked for any sign of blood.
•The patient must urinate first to prevent any urine
from mixing with feces.
•The patient must wear gloves when it's time to
handle stool and transfer it to a safer container.
This will prevent any possibilities of being
contaminated or infected by bacteria found within
the stool.
•Solid and liquid fecal samples are both acceptable
as long as they do not have urine or other foreign
substances like soap, water, and toilet paper mixed
in them.

•If the patient is suffering from diarrhea, placing
a plastic wrap and securing it under the toilet
seat could facilitate the collection process.
•Collected samples must be brought to the
doctor's office or laboratory as soon as
possible. Delays could compromise the quality
of the sample.
• Volume or amount is also important so the
patient must be sure he has collected an
adequate amount of stool.

Potassium Test
December 10, 2010
This test measures the amount of potassium in the blood.
Potassium (K+) helps nerves and muscles communicate. It
also helps move nutrients into cells and waste products
out of cells.
Test Result Reference
value
Interpretation
Potassium 4.1 3.6-5.0 mmol/L Normal
Interpretation:
The potassium level of the patient is normal.

Ultrasound in the Whole Abdomen
December 10, 2010
It is an ideal clinical tool for
determining the source of abdominal
pain. It can simplify the differential
diagnosis of abdominal pain,
especially when pain and tenderness
are present over the site of disease.

Result:
Liver is normal in size and contour. It
shows normal homogenous echo
pattern. No mass lesion is noted.
Intrahepatic bile ducts and CBD are
not dilated. Hepatic vessels are
unremarkable. Gallbladder is
physiologically distended. It shows
normal wall thickness. No internal
echoes are noted. No pevicholecystic
fluid collection is seen.

Pancreas and spleen are normal. Right
kidney measures 9.6 x 4.2 cm with
cortical thickness of 1.2 cm. Left kidney
measures 9.5 x 4.0 cm with cortical
thickness of 1.5 cm. Both are normal in
size showing homogenous
corticomedullary parenchymal
echogenecity. No echogenic focus or
mass lesion is noted. There is no
separation of the central echo complexes.
Proximal uterus is not dilated. Uterus is
atrophic and is compatible with the age of
the patient. No abnormal masses are
seen in both advexac.

Moderately dilated, fecal-filled segment of
large bowel are noted in both paracolic
gutters, iliac regions and pelvis. No
evident mass lesion is appreciated.
Impression:

•Before procedure, instruct patient to be
on NPO 8-12 hrs since air or gas car
reduce quality of image
•Assess abdominal distention because it
may affect quality of image
•During procedure, keep the patient in a
supine position

An exploratory laparotomy is done
especially when a person
complains of abdominal pain. The
operation allowed the surgeon to
examine the internal organs.
Disease or damage can be
uncovered. In some cases, the
problem can be corrected during
the surgery.

A colostomy is when the colon is cut in half and
the end leading to the stomach is brought
through the wall of the abdomen and attached
to the skin. The end of the colon that leads to
the rectum is closed off and becomes dormant.
Usually a colostomy is performed for infection,
blockage, or in rare instances, severe trauma of
the colon. This is not an operation to be taken
lightly. It is truly quite serious and demands the
close attention of both patient and doctor. A
colostomy is often performed so that an
infection can be stopped and/or the affected
colon tissues can heal.

•Assess and measure the nasogastric output
•Assess fluid and electrolyte balance and
administer IV as prescribed
•Monitor nutritional status
•Assess improvement such as return of normal
bowel sounds, decreased abdominal distention,
abdominal pain and tenderness, passage of
flatus or stool
•Prepare patient for surgery which includes
preoperative teaching

•After surgery, provide wound care and
post-operative nursing care
•Place ice chips on the same day of
surgery to ease the patient’s thirst. By the
next day, the patient may be allowed to
drink clear liquids.
•Slowly add thicker fluids and then soft
foods as the bowels begin to work again.
•Patient may eat normally within 2 days
after the surgery.

•The colostomy drains stool
(feces) from the colon into the
colostomy bag. Most colostomy
stool is softer and more liquid than
stool that is passed normally. The
texture of stool depends on the
location of the segment of
intestine used to form the
colostomy.

When client is to be discharged from
the hospital, nursing care is still
continued. With sufficient support at
home, most client recover gradually.
During home visits, the client’s physical
status and progress towards recovery is
assessed. The client’s understanding of
therapeutic regimen is also assessed,
and previous teaching is reinforced.

Method
•Instruct the significant others to take the following home
medication as ordered by the physician.
•Explain to the significant others the drug names as well as
the right route and dosage.
•Inform the significant others about the side effects that
may occur brought by the medication.
•Encourage the significant others to comply and follow
religiously the right timing in taking the medication.
•Confer with the patient’s family the need take precautions
regarding medication therapy, activity, and dietary
restriction.
•Discuss with the patient’s family ways to cope with
stressful situations in positive manner.

Method
•Instruct patient’s family to report for immediate occurrence
of signs and symptoms to a health care professional.
•Reinforce and supplement patient’s family knowledge
about diagnosis, prognosis, and expected level of function.
•Provide patient’s family with specific directions about when
to call the physician and what complications require prompt
attention.
•Peer support and psychological counseling may be helpful
for some families.

Exercise/ Environment
•Once at home, patient may resume much of the
normal activity short of aggressive physical
exercise.
•Walk short distances everyday and gradually
increase activity.
•No lifting of a weight greater than 20 lbs (9kg) for
6 weeks. Exercise should be started cautiously.
•Encourage to practice deep breathing exercise
and range of motion exercises up to the level of
capability.

Exercise/ Environment
•Explain the need for rest periods both before and
after certain activities.
•Teach client the importance of stress
management through relaxation technique,
•Help improve patient’s self-concept by providing
positive feedback, emphasizing strengths and
encouraging social interaction and pursuit of
interests.

Treatment
•Explain to the significant others the
need to continue drug therapy
•Provide patient’s family with a list of
medications, with information on
action, purpose and possible side
effects.
•Advise significant others to always
comply with the medications. Call the
physician if there is a problem taking
them.

Hygiene
•Keep proper hygiene. Teach client’s
family the importance of hygiene like
daily oral care, bathing and changing
clothes.
•Proper Wound care must be
observed.

Outpatient
•Advise to visit or have her follow up
check-up with her attending physician.
•Advise to call and notify the attending
physician for any unusualities that may
occur
•Routinely, follow up check – up with
patients within two weeks. If there are
staples that require removal,
postoperative problems, or wound
issues, a follow-up appointment will be
scheduled sooner.

Diet
•Emphasize to the client’s family the importance of proper
nutrition, its need for early recovery. This can aid in
restoring body functioning.
•Provide dietary instructions to help patient’s family
identify and eliminate foods that is needed by the patient.
•Soft or low residue diet upon discharge; this should be
continued at home for approximately 2 weeks (this
includes breads, cereals, chicken, fish, and soup).
•Avoid large quantities of raw fruits and vegetables.
•After 2 weeks, gradually reintroduce your regular diet.
•Encourage to drink plenty of fluids.
•Take nutrition supplements

Intestinal obstruction

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