Intestinal obstruction occurs when the lumen of the small or large intestine becomes partially or completely blocked, interrupting the normal flow of intestinal contents. It can be caused by mechanical factors like adhesions, tumors, or hernias obstructing the intestinal walls or lumen, or functional issues where the intestinal musculature cannot propel contents. Symptoms include colicky pain, nausea, vomiting, and constipation. Diagnosis involves abdominal exams, imaging, and lab tests. Treatment focuses on decompressing the bowel, correcting fluid and electrolyte imbalances, and potentially surgically removing the obstruction. Complications can include dehydration, peritonitis, shock, and death if not properly managed.

1. INTESTINAL OBSTRUCTION
The partial or complete blockage of the lumen of the small or large intestine causing an interruption in the normal flow of intestinal contents along the intestinal tract. The
block may be complete or incomplete, may be mechanical or paralytic, and may or may not compromise the vascular supply.
Ø Mechanical obstruction: An intraluminal obstruction or a mural obstruction from pressure on the intestinal walls occurs. (e.g.: intussusception, polypoid tumors and neoplasms,
stenosis, strictures, adhesions, hernias, abscesses)
Ø Functional obstruction: The intestinal musculature cannot propel the contents along the bowel. (e.g.: amyloidosis, muscular dystrophy, endocrine disorders such as diabetes
mellitus, or neurologic disorders such as Parkinson’s disease) The blockage also can be temporary and the result of the manipulation of the bowel during surgery.
Ø 90% - small bowel obstruction, ileum
Ø 10% - large bowel obstruction, sigmoid colon
Risk Factors/ Nursing
Pathophysiology Assessment Interventions
Etiology Diagnoses
Modifiable Ø Hiccups are a common 1. Ineffective Nursing Management
Ø GI tract, Adhesions- produce kinking of an Ø SCI, vertebral complaint in all types of Tissue
abdominal intestinal loop fractures bowel obstruction Perfusion: GI Primary Prevention
surgery – risk Ø Abdominal related to Ø Encourage well balanced
for adhesions, Intussusception- intestinal lumen surgery Mechanical Obstruction of the interruption of and high-fiber diet.
stricture; may becomes narrowed Ø Peritonitis Small Intestine arterial and Ø Encourage regular exercise.
cause postop Ø Wound Subjective Findings: venous flow Ø Encourage elderly for regular
neurogenic Volvulus- intestinal lumen dehiscence Ø Complain of colicky pain, check-up.
bladder becomes obstructed; gas and Ø GI tract surgery nausea, vomiting, and 2. Acute Pain
Ø Hernia – fluid accumulate in the trapped Ø Thrombosis, constipation related to Secondary Prevention
may be bowel embolism Ø If obstruction is complete, obstruction, Ø Insert an NG tube to
strangulated may report vomiting of distention, and decompress the bowel as
Ø Inflammator fecal contents. Results strangulation ordered.
y dse Hernia- intestinal flow may be from vigorous peristaltic Ø Maintain the function of the
of intestinal
(Crohn’s, completely obstructed; blood flow waves that propel bowel nasogastric tube
tissue
diverticulitis, to the area may be obstructed contents toward the Ø Assess and measure the
ulcerative mouth instead of the nasogastric output
Tumor- intestinal lumen becomes 3.
colitis) – may rectum Ø Maintain fluid and electrolyte
partially or completely obstructed Constipation
cause Ø Vomitus: related to balance by monitoring
intussusceptio 1. stomach contents presence of electrolyte, blood urea
n 2. bile-stained contents obstruction nitrogen, and creatinine
FUNCTIONAL
Ø Cancer – ADYNAMIC
of the duodenum and changes levels.
causes MECHANICAL and jejunum Ø Begin and maintain I.V.
OBSTRUCTION NEUROGENIC in peristalsis
mechanical 3. darker, fecal-like therapy as ordered.
PARALYTIC ILEUS
obstruction contents of ileum Ø Monitor nutritional status
Ø Foreign 4. Risk for Ø Continually assess his pain.
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2. bodies (fruit Objective Findings: Deficient Fluid Colicky pain that suddenly
pits, Ø Inspection - distended Volume becomes constant could
gallstones, abdomen, hallmark of all related to signal perforation.
worms) – may types of mechanical impaired fluid Ø Assess improvement (return
cause obstruction intake, of normal bowel sounds,
mechanical Ø Auscultation - bowel vomiting, and decreased abdominal
obstruction sounds, borborygmi, and diarrhea from distention, subjective
Ø Chronic, Gases and fluids rushes (occasionally intestinal improvement in abdominal
severe Borborygmi accumulate proximal loud enough to be heard obstruction pain and tenderness,
constipation – to the obstruction without a stethoscope) passage of flatus or stool).
may cause Ø Palpation - abdominal 5. Risk for Ø Look for signs of dehydration
impaction and tenderness. Rebound Injury related (thick, swollen tongue; dry,
mechanical tenderness may be to cracked lips; dry oral
obstruction Distension of noted in patients with complications mucous membranes).
Ø SCI, intestine & retention obstruction that results and severity of Ø Watch for signs of metabolic
Inc contractions of
vertebral of fluid from strangulation with illness alkalosis (changes in
proximal intestine
fractures – ischemia sensorium; slow, shallow
causes 6. Fear related respirations; hypertonic
adynamic Mechanical Obstruction of the to life- muscles; tetany) or acidosis
obstruction Large Intestine threatening (shortness of breath on
Ø Thrombosis, Subjective Findings:
symptoms of exertion; disorientation; and
embolism – Inc intraluminal Ø History of constipation with later, deep, rapid breathing,
pressure Persistent intestinal
may cause a more gradual onset of weakness, and malaise).
vomiting obstruction
dec arterial Severe signs and symptoms Ø Report discrepancies in
blood supply colicky than in small-bowel intake and output,
to the intestine abdominal obstruction worsening of pain or
Inc gastric
pain Ø Several days after abdominal distention, and
secretions Loss of hydrogen
Non- constipation begins, may increased nasogastric
modifiable ions, potassium
report the sudden onset output.
Ø Age: of colicky abdominal Ø Watch for signs and
young – Compression of pain, producing spasms symptoms of secondary
congenital veins that last less than 1 infection, such as fever and
bowel Metabolic minute and recur every chills.
deformities alkalosis few minutes Ø Administer analgesics,
(atresia, Ø History reveal constant broad-spectrum antibiotics,
imperforate Inc venous hypogastric pain, nausea and other medications as
anus) pressure and, in the later stages, ordered.
Ø Old age – vomiting Ø Keep the patient in semi-
inc risk for Fowler's or Fowler's position
colorectal Objective Findings: as much as possible. These
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3. cancer Ø Vomitus - orange-brown positions help to promote
Ø Family and foul smelling, pulmonary ventilation and
history of characteristic of large- ease respiratory distress
colorectal bowel obstruction from abdominal distention.
Dec absorption
cancer – inc Ø Inspection - abdomen may Ø Monitor urine output carefully
risk for appear dramatically to assess renal function,
mechanical distended, with visible circulating blood volume,
obstruction loops of large bowel and possible urine retention
Edema of the
Ø Auscultation - loud, high- due to bladder compression
intestine
pitched borborygmi by the distended intestine.
Ø Partial obstruction usually Ø If the patient’s condition does
causes similar signs and not improve, prepare pt for
symptoms, in a milder surgery.
Dec arterial Compression of form
blood supply terminal branches of Ø Leakage of liquid stools Tertiary Prevention
mesenteric artery around the partial Ø After surgery, provide all
obstruction is common necessary postoperative
care. Care for the surgical
Nonmechanical Obstruction site, maintain fluid and
Perforation of
Necrosis Subjective Findings: electrolyte balance, relieve
necrotic segments
Ø Describes diffuse pain and discomfort,
abdominal discomfort maintain respiratory status,
instead of colicky pain and monitor intake and
Bacteria or toxins Ø Reports frequent vomiting, output.
Gangrenous leak into: which may consist of Ø Advice patient to progress
intestinal wall gastric and bile contents diet slowly as tolerated once
but, rarely, fecal home.
contents Ø Advice plenty of rest and
Ø Complain of constipation slow progression of activity
Dec Cessation of and hiccups as directed by surgeon or
bowel peristalsis Ø If obstruction results from other health care provider.
sounds Peritoneal Blood vascular insufficiency or Ø Teach wound care if
cavity supply infarction, the patient indicated.
may complain of severe Ø Encourage patient to follow-
abdominal pain. up as directed and to call
surgeon or health care
Objective Findings: provider if increasing
Peritonitis Bacteremia Ø Inspection - abdomen is abdominal pain, vomiting, or
Septicemia distended fever occur prior to follow-
Ø Auscultation discloses up.
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4. decreased bowel sounds
early in the disease; this
sign disappears as the Medical Management
COMPLICATIONS disorder progresses Ø Correction of fluid and
electrolyte imbalances with
normal saline or Ringer's
Laboratory and Diagnostic solution with potassium as
Tests: required.
Ø NG suction to decompress
• Fecal material aspiration bowel.
from NG tube Ø Colonoscopy to untwist and
• Abdominal X-ray, CT scan, decompress the bowel.
MRI Ø Treatment of shock and
• Dehydration due to loss of peritonitis.
o May show presence and
water, sodium, and chloride Ø TPN may be necessary to
location of small or
• Peritonitis correct protein deficiency
large intestinal
• Shock due to loss of distention, gas or fluid from chronic obstruction,
electrolytes and dehydration o “Bird beak” lesion in paralytic ileus, or infection.
• Death due to shock colonic volvulus Ø Analgesics and sedatives,
o Foreign body avoiding opiates due to GI
visualization motility inhibition.
• Contrast studies Ø Antibiotics to prevent or treat
o Ileus may be identified infection.
by oral barium or Ø Ambulation for patients with
Gastrografin. paralytic ileus to encourage
return of peristalsis.
• Laboratory tests
o May show decreased
Surgical Management
sodium, potassium,
Consists of relieving
and chloride levels due
obstruction.
to vomiting
Ø Closed bowel procedures:
o Elevated WBC counts
lysis of adhesions,
due to inflammation;
reduction of volvulus,
marked increase with
intussusception, or
necrosis, strangulation,
incarcerated hernia
or peritonitis
Ø Enterotomy for removal of
o Serum amylase may be
foreign bodies or bezoars
elevated from irritation
Ø Resection of bowel for
of the pancreas by the
obstructing lesions, or
bowel loop
strangulated bowel with
• Flexible sigmoidoscopy or
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5. colonoscopy may identify end-to-end anastomosis
the source of the Ø Intestinal bypass around
obstruction such as obstruction
tumor or stricture Ø Temporary ostomy may be
indicated
CARE OF THE PATIENT
WITH AN OSTOMY
Pre-operative Nursing
Responsibilities
Ø Prepare patient by explaining
the surgical procedure,
stoma characteristics, and
ostomy management with a
pouching system.
Post-operative Nursing
Responsibilities
Ø Monitor the stoma color and
amount and color of stomal
output every shift;
document, and report any
abnormalities.
Ø Periodically change a
properly fitting pouching
system over the ostomy to
avoid leakage and protect
the peristomal skin. Use this
time as an opportunity for
teaching.
Ø Assess peristomal skin with
each pouching system
change, document findings,
and treat any abnormalities
(skin breakdown due to
leakage, allergy, or
infection) as indicated.
Ø Teach the patient and/or
caregiver self-care skills of
routine pouch emptying,
cleansing skin and stoma,
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6. and changing of the
pouching system until
independence is achieved.
Ø Instruct the patient and
family in lifestyle
adjustments regarding gas
and odor control;
procurement of ostomy
supplies; and bathing,
clothing, and travel tips.
Ø Encourage patient to
verbalize feelings regarding
the ostomy, body image
changes, and sexual issues.
References:
rd
Ø Gould, Barbara E. Pathophysiology for the Health Professions 3 Ed. Elsevier Pte Ltd.: 2007
th
Ø McCann, J. A., et al. Diseases: A Nursing Process Approach to Excellent Care, 4 Edition. Lippincott Williams & Wilkins: 2006.
th
Ø Nettina, Sandra M., Mills, Elizabeth Jacqueline. Lippincott Manual of Nursing Practice, 8 Edition. Lippincott Williams & Wilkins: 2006.
th
Ø Smeltzer, C.S., Bare, B.G., Hinkle, J.L., Cheever, K.H., Brunner and Suddarth’s Textbook of Medical-Surgical Nursing 11 Ed. United States of America: Lippincott
Williams and Wilkins, 2008.
Ø Smith, Graeme, Watson, Roger. Gastrointestinal Nursing. Oxford, UK: Blackwell Publishing Co., 2005.
rd
Ø Sommers, M. S., Johnson, S. A., Beery, T. A. Diseases and Disorders: A Nursing Therapeutics Manual, 3 Edition. F. A. Davis Company: 2007.
Reynel Dan L. Galicinao
BSN-IV 2010, CCC MSU-IIT
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