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Alteration in elimination: Bowel disease. Alteration in elimination bowel. Inflammatory bowel disease Small bowel obstruction Cancer of the colon and ostomies. Small intestine. Made up of three parts: ileum, jejunum, and duodenum. Main function is absorption. Small intestine.

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alteration in elimination bowel
Alteration in elimination bowel
  • Inflammatory bowel disease
  • Small bowel obstruction
  • Cancer of the colon and ostomies.
small intestine
Small intestine
  • Made up of three parts: ileum, jejunum, and duodenum.
  • Main function is absorption
diarrhea
It is a symptom not a primary disorder.

It is the increase in: fluid, volume, and fluid content of the stool.

Causes:

Bacteria toxins

Parasitic infections

Malabsorption syndromes

Medication

Systemic disease

Allergies

Psychogenic

Diarrhea
constipation
Constipation
  • Two or less BM’s weekly or when defecation is excessively difficult or requires straining.
  • Most common cause: Ignoring the urge to defecate. Treat this cause with education ( a daily BM is not necessary for good health) exercise and diet modification.
nursing assessment
Nursing assessment
  • Questions ask?
    • Have you been out of the country?
    • What medications have you used?
    • When did the diarrhea start?
    • Are there any associated symptoms?
nursing assessment15
Nursing assessment
  • Observe the patient’s stool for steatorrhea, blood, pus, or mucus.
  • Monitor frequency and characteristics of bowel movement.
  • Measure abdominal girth and auscultate bowel sounds every shift.
nursing diagnosis
Nursing diagnosis
  • Fluid volume deficit
  • Risk for impaired skin integrity
  • Altered nutrition: less than body requirements related to loss of nutrients
fluid and electrolyte imbalance r t diarrhea
Fluid and electrolyte imbalance r/t diarrhea
  • The increased water content of the stool places the patient at risk for fluid deficit.
    • Record Accurate I&O
    • Weight patient QD
    • Assess the patient’s mucous membrane, skin turgor, and urine specific gravity.
    • Monitor and record vital signs including orthostatic blood pressures.
fluid and electrolyte imbalance r t diarrhea18
Fluid and electrolyte imbalance r/t diarrhea
  • Postural (orthostatic) blood pressure changes.
  • When the BP drops more than 10mmHg when changing positions (lying to sitting, sitting to standing). Orthostatic changes indicate fluid deficit. Pulse typically increases at the same time.
risk for impaired skin integrity
Risk for impaired skin integrity
  • Provide good skin care
  • Assist the client with cleaning the perianal area as needed. Use warm water and soft cloths.
  • Provide protective ointment to the perianal area
caution on pharmacological treatments
Caution on pharmacological treatments
  • Laxatives should never be administer to a patient with bowel obstruction or impaction.
  • People with abdominal pain of undetermined cause.
  • Laxatives can cause mechanical damage and perforate the bowel.
caution on pharmacological treatments21
Caution on pharmacological treatments
  • Enemas are use for chronic constipation or fecal impaction.
  • As a general rule use only for acute phase on a short time bases.
  • Excessive use of enema can lead to fluid electrolyte imbalance.
  • Never use enemas if you suspect perforation.
chronic inflammatory bowel disease
Chronic inflammatory bowel disease
  • Two inflammatory diseases(Crohn’s disease and Ulcerative colitis )similar on the following :
      • Etiology is unknown (autoimmune component involve)
      • genetic components/run families/ethnic groups
      • Affect young adults between the ages 15-35 years.
      • Diarrhea is the predominant symptom
ulcerative colitis
Ulcerative colitis
  • Affects the mucous and the submucosa of the colon and rectum.
  • Primarily affects the young (15-30)
  • More common in whites
  • Cause unknown found in families with hx. of the same, hx crohn’s, Hx certain arthritis.
pathophysiology of ulcerative colitis
Pathophysiology of ulcerative colitis
  • Inflamed crypts of Lieberkuhn in the distal large intestine and rectum
  • Pinpoint microscopic hemorrhages develop
  • Then crypt abscesses develop.
  • The abscesses penetrated the superficial submucosa an spread laterally leading to mucosal necrosis and sloughing.
pathophysiology of ulcerative colitis26
Pathophysiology of Ulcerative Colitis
  • The inflammatory process leads to further tissue damage from exudate and the release of inflammatory mediators such as prostanglandins and cytokines.
  • The mucosa becomes red because of vascular congestion, friable and edematous.
  • It bleeds easy and hemorrhage is common.
pathophysiology of ulcerative colitis27
Pathophysiology of Ulcerative Colitis
  • Edema obscure the submucosal vessels and creates a granular appearance.
  • Pseudopolyps tongue line projections are common.
  • Polypoid changes represent areas of edematous tissue between areas of ulceration ..
  • Chronic inflammation leads to shortening of the colon from fibrosis and loss of haustra.
pathophysiology of ulcerative colitis28
Pathophysiology of Ulcerative Colitis
  • The inflammatory process begins at the rectosigmoid are of the anal canal and progresses proximal.
  • May progress to involve the entire colon.
  • Blood, mucus and pus pool in he lumen of the colon (characteristic diarrhea)
  • The extent of the colon involving correlates with severity of the disease.
ulcerative colitis signs and symptoms
Ulcerative Colitis signs and symptoms
  • Insidious onset
  • Attacks last 1-3 months
  • Occur at intervals of months to years
  • Diarrhea is the predominant symptoms of all types of ulcerative colitis.
  • Typically 30-40 stools per day, with blood and mucus.
ulcerative colitis signs and symptoms32
Ulcerative Colitis signs and symptoms
  • When severe disease is present may have other manifestation such as arthritis (related to the inflammatory process going on), uveitis, thromboemboli, lesions of the liver, gallbladder, and pancreas as well as pericarditis.
  • Patients with Ulcerative Colitis have an increased risk of developing colon cancer.
complications of ulcerative colitis
Complications of Ulcerative Colitis
  • Bowel perforation most deadly
  • Hemorrhage
  • Toxic megacolon
  • Increased risk of developing colon cancer.
  • The risk is higher when there is intensive involvement of the colon with disease for >10 years.
diagnostic of ulcerative colitis
Diagnostic of Ulcerative Colitis
  • Stool for occult blood
  • Hemoglobin and hematocrit
  • Colonoscopy**not on active phase
  • Barium enema**”
  • A yearly colonoscopy is strongly recommended for anyone who has ulcerative colitis with 8-10years after the DX.
treatment of ulcerative colitis
Treatment of Ulcerative Colitis
  • Pharmacological
  • Dietary management
  • Surgical management
pharmacological treatment
Pharmacological treatment
  • Sulfasalazine (Azulfidine) anti-inflamatory
    • inhibits prostaglandin production in the bowel.
  • Mesalamine (Rowasa) & Olsalazine (Dipentum) -Same action as above.
  • Corticosteroids-anti-inflammatory effects
    • Use as a treatment during acute attacks.
pharmacological treatment37
Immunossupression

Imuran (Azathioprine)

Cyclosprine (Sandimmune)

Antidiarrheal (not used during an acute attack)

Loperamide

Diphenoxylate

Pharmacological treatment
dietary management in ulcerative colitis
Dietary management in ulcerative colitis
  • No milk products
  • No caffeine
  • No gas producing or raw fruits & vegetables
  • Bulk forming products such as psyllium or methylcellulose to decreased diarrhea and reduce symptoms.
  • TPN during acute exacerbation
surgery as a treatment for ulcerative colitis
Surgery as a treatment for ulcerative colitis.
  • Procedure of choice is a total colectomy with ileonal anastomosis.
  • The entire colon and rectum are remove
  • A pouch is formed from the terminal ileum
surgery as a treatment for ulcerative colitis40
Surgery as a treatment for ulcerative colitis.
  • The pouch is brought into the pelvis and anastomosed to the anal canal.
  • A temporary or loop ileostomy is performed and maintained for 2 to 3 months.
  • When the anastomosis sites heal the ileostomy is closed and the patient has bowel movements through the anus.
surgery as a treatment for ulcerative colitis43
Surgery as a treatment for ulcerative colitis.
  • The Kock’s ileostomy(continent)
    • an intra-abdominal reservoir is constructed from the terminal ileum.
    • Stool collects in the pouch until the patient drains it with a catheter
    • A nipple valve prevent leakage of stool.
surgery as a treatment for ulcerative colitis45
Surgery as a treatment for ulcerative colitis.
  • Total proctocolectomy with permanent ileostomy.
    • Colon, rectum, and anus are remove, and the end of the terminal ileum is exteriorized as a stoma on the right abdominal wall.
surgery as a treatment for ulcerative colitis47
Surgery as a treatment for ulcerative colitis.
  • Temporary or loop ileostomy is often used to eliminate feces and allow healing for 2-3 months after an ileoanal anastomosis.
    • A loop of the ileum is brought to the body surface and allows stool drainage into the external pouch.
    • When the stoma is not needed a second surgery is done to close the stoma and repair the bowel.
  • See Lemone text pp.826-829 for nursing care of patients with an ileostomy, for changing an ostomy pouch, and for ileostomy lavage.
nursing care in ulcerative colitis
Relieving abdominal cramping

Providing emotional support

Teaching about the illness and special needs.

Nursing diagnosis:

Fluid and electrolytes imbalance R/T diarrhea

Body image disturbance R/T disease process

Nursing care in ulcerative colitis
fluid and electrolyte imbalance
Monitor the appearance and frequency of bowel movement.

Assess and document presence of blood in the stool by testing for occult blood and BRB

Assess document Vital signs q4hrs.

Record pt. wt. qd.

Assess the pt. for signs of fluid deficit.

Maintain fluid intake by mouth or by parenteral means as indicated

Fluid and electrolyte imbalance
disturbance in body image
Encourage the patient to discuss physical changes and their consequences.

Accept patient feeling and perception of self.

Encourage discussion about concerns regarding the effects of the disease on close relationship.

Encourage pt. to make choice and decision regarding care.

Involve pt. in the teaching plans and provide instructions as needed.

Arrange for interaction with group of people with similar problems.

Teach coping strategies.

Disturbance in Body image
teaching tips for patients with ulcerative colitis
Emphasize the need to maintain an intake of 2 to 3 quarter of fluids per day to compensate for fluid losses.

Provide diet teaching refer to dietician if needed

If a surgical intervention is planned, teach about the surgery and follow up care . Contact an ET nurse.

Discuss medications , actions, side effects special consideration.

Teaching tips for patients with ulcerative colitis
teaching tips for patients with ulcerative colitis53
Teach about ileostomy care verbal and written instructions.

Discuss the use of OTC medications such as enteric coated or time release tablets and the fact that these medications might not be absorbed adequately before elimination through the ileostomy.

Refer to support groups and make community referral.

Teaching tips for patients with ulcerative colitis
crohn s disease
Crohn’s disease
  • Primarily affects young people (10-30 years)
  • Can occur anywhere in the GI tract.
  • Most frequently affects the terminal ileum and right colon.
crohn s disease55
Crohn’s disease
  • Most frequently affects the terminal ileum and the right colon
  • Full thickness (transmural) disease
  • Can lead to ulceration, strictures, fistula development.
  • Skip lesions with areas of the bowel that appear normal.
crohn s disease56
Crohn’s disease
  • Cause is unknown
  • Like ulcerative colitis can have arthritis, uveitis, thromboembolism, and vascular disorders. Also the pt can have cystitis, renal calculus, and ureteral obstruction.
pathophysiology of crohn s disease
Pathophysiology of Crohn’s disease
  • Begins with an aphthoid lesion similar to canker sore in the mucosa and submocosa of the bowel.
  • Deeper ulcerations, lesions, lumen takes on a cobblestone appearance.
  • Fibrotic changes in the bowel cause to thicken and lose of flexibility.
manifestations of crohn s disease
Manifestations of Crohn’s disease
  • Continuous or episodic diarrhea
  • Stools are liquid or semiformed and typically do not contain blood.
  • Abdominal pain and tenderness are common
  • A palpable RLQ mass is often present
  • Fever, malaise, weight loss, fatigue, and anemia are common.
complications of crohn s disease
Complications of Crohn’s Disease
  • Intestinal obstruction
  • Abscess
  • Fistula
  • No associated risk of toxic megacolon as with ulcerative colitis.
management of crohn s disease
Management of Crohn’s Disease
  • Managing symptoms
  • Controlling the disease process
  • Rest
  • Stress reduction
  • bowel rest
management of crohn s disease65
Management of Crohn’s Disease
  • Pharmacological support
      • Sulfasalazine is limited to the large bowel
      • Mesaline and olsalazine are more effective treating ileal inflammation.
    • Immunosuppressive agents
      • Corticosteroid
      • Mercaptopurine (6 MP, Purinerol)
      • Imuran (Azathioprine)
      • Cyclosporin (Sandimmune)
management of crohn s disease66
Management of Crohn’s Disease
  • Nutritional support
    • Well balance diet
    • Elimination of milk or milk products.
    • Ensure- elemental enteral feeding is helpful
    • Fiber added to diet if the Dx. Is located in the colon.
    • If a pt. shows symptoms of obstruction a low roughage is recommended
management of crohn s disease68
Management of Crohn’s Disease
  • Surgery
    • Bowel obstruction is the leading cause for surgery
    • With Crohn’s disease there is increased risk for fistula formation.
    • With Crohn’s disease, the surgery does not cure as it does with ulcerative colitis.
    • Crohn’s disease recur 50 to 75% of the time
nursing care for crohn s disease
The disease is a chronic life long illness and teaching becomes one of the nursing care priorities.

One of the most significant problems patients suffer is alteration in nutrition.

This disease significantly alter the ability of the bowel to absorb nutrients.

In addition, protein rich fluid and blood may be lost due to diarrhea.

The nutritional deficiencies can impair growth and development, healing, cause muscle wasting, bone diseases, and electrolyte imbalance.

Nursing care for Crohn’s disease
nursing care for crohn s disease70
Weight daily

Maintain accurate I &O

Monitor laboratory studies closely.

Provide a diet high in calories, protein, low fat , and restriction of milk products .

Arrange for dietary consult.

Provide parental nutrition if absorption of nutrients is highly impair.

Administer prescribe nutritional supplements.

Involve family member specially the person who prepare meal on dietary teaching.

Nursing care for Crohn’s disease
neoplastic disorders polyps and colorectal cancer
Neoplastic Disorders:Polyps and Colorectal Cancer
  • The large intestine and the rectum are the most common sites of cancer in the digestive tract.
polyps
Polyps
  • Polyps are masses of tissues that arise from the bowel wall and protrude into the lumen. Most polyps are benign but some have the potential to become malignant.
  • Familial polyposis is an uncommon disorder characterized by hundreds of adenomatous polyps throughout the large intestine. The risk of malignancy is almost 100% by the age 40.
symptoms of polyps
Symptoms of polyps
  • Most are asymptomatic
  • Intermittent painless rectal bleeding
  • Dark or bright blood
diagnostic for polyps
Barium enema

Sigmoscopy

Digital examination

Colonoscopy

Once identify polyps need to be remove because of the risk of malignancy.

They can be remove during colonoscopy using electrocautery snare or hot biopsy forceps passed through the scope

Diagnostic for polyps
nursing implications for barium enema
Nursing implications for Barium Enema
  • Liquid diet a day before procedure
  • Pt. NPO 8 hours before the procedure
  • Inform consent
  • Administer laxatives if order.
  • Laxative given after procedure
  • Stools may be white for 1 to 2 days
nursing implications for colonoscopy
Nursing implications for colonoscopy
  • Usually a liquid diet is prescribe 2 days before procedure.
  • Pt. Needs to be NPO 8 hours before procedure.
  • Administer or instruct the pt in bowel preparation procedures.
  • Conscious sedation is usually used
cathartics for bowel preparation
Cathartics for bowel preparation
  • Magnesium Citrate
    • Empty stomach follow by a full glass of water.
    • Chill the solution, Give the medication early in the evening so it does not interfere with sleep.
  • Polyethylene Glycol
    • No food should be consumed 2 to3 hrs prior nor within 2 hours of ingesting the solution.Chill,give in early evening.
nursing implications for colonoscopy81
Nursing implications for colonoscopy
  • Inform consent must be sign
  • Instruct client about procedure
    • Biopsy
    • Polyps removed
  • After the procedure
    • Report any abdominal pain, chills,fever, rectal bleeding or mucupurulent discharge.
    • If a polyp is remove avoid heavy lifting for 7 days and avoid high-fiber food for 1 to2 days.
diagnostic for polyps83
Diagnostic for polyps
  • Polyps tend to recur.
    • Need to follow-up with another colonoscopy in 3 years and then every 5 years if no further polyps are detected.
    • See the table on p. 844 of Lemone: The risk factors for colorectal cancer. Polyps are on the list.
colorectal cancer
Colorectal Cancer
  • It is a malignant tumor arising from the epithelial Tissue of the colon or rectum.
  • It is the second leading caused of cancer death in Western countries.
  • In the United states the incident is 5%
risk of colorectal cancer
Risk of colorectal cancer
  • Age >50 years
  • Polyps of the colon and or rectum
  • Cancer elsewhere in the body
  • Family Hx of colorectal cancer
  • Ulcerative Colitis Crohn’s disease
risk factors for colorectal cancer
Risk factors for colorectal cancer
  • Exposure to radiation
  • Immunodeficiency disease
  • High fat intake
  • Low calcium and fiber intake.
pathophysiology of colorectal cancer
Pathophysiology of colorectal cancer
  • Nearly all come from adenocarcinomas that develop from adenomas polyps.
  • Insidious
  • Undetected, few symptoms
  • Spread into the entire bowel, submocousa and the bowel layers, then to the liver, stomach etc...
pathophysiology of colorectal cancer89
Pathophysiology of colorectal cancer
  • Slow growth pattern
  • 5-15 years of growth before symptoms appear.
  • It spread by direct extension to involve the entire bowel circumference, the submucosa and outer bowel layers.
manifestations of bowel cancer
Manifestations of bowel cancer
  • Bleeding
  • Changes in bowel habits
  • Pain, anorexia, weight loss (late sign)
  • Palpable abdominal or rectal mass might be present.
  • Anemia caused from occult bleeding.
prognosis
Prognosis
  • Prognosis depends on the stage of the disease at the time of the diagnosis and on the initiation of treatments.
primary complications of bowel cancer
Primary complications of bowel cancer
  • Bowel obstruction (narrow lumen) cause by tumor or lesions.
  • Bowel perforation ( of the wall by the tumor)allowing contamination of the peritoneal cavity with bowel content.
  • Direct extension of the tumor to adjacent organs
laboratories and diagnostic for colorectal cancer
Colorectal cancer is a silent disease and treatment in the early stages has high cure rate.

The American cancer society recommends screening for early detection of the disease.

Annual digital rectal examination for all people over age 40.

Annual guaiac testing for occult fecal blood for people over 50.

Flexible sigmoidoscopy every 3 to 5 years for any body over the age of 50.

Laboratories and diagnostic for colorectal cancer
laboratories and diagnostic for colorectal cancer94
CBC

Barium enema

Blood chemistry

Chest x-ray

Computed topography (CT)

Endoscopy(colonos-copy, sigmoidoscopy )

Tissue biopsy

Laboratories and diagnostic for colorectal cancer
treatment of bowel cancer is surgery
Treatment of bowel cancer is surgery
  • Treatment of bowel cancer is surgery
  • Chemotherapy (adjunct) and radiation (adjunct)
treatment of bowel cancer is surgery96
Laser photocoagulation uses a very small intense light to generate heat in tissue towards it is directed.

The heat destroy small tumors and it is palliative for large tumors causing obstruction.

Incision and fulguration are performed during endoscopy eliminating the need for surgery.

Incision can be used to remove a disk of rectum containing tumor with pts. Small well differentiate polyps.

Fulguration is used to decreased the size of large tumors.

Treatment of bowel cancer is surgery
treatment of bowel cancer is surgery97
Most of the patients with colorectal cancer undergo surgical resection of the colon with anastomosis of the remaining bowel.

The distribution of the regional lymph nodes determine the extend of the resection as these may contain metastatic lesions

Most tumors of the ascending, transverse , descending and sigmoid can be resected.

Treatment of bowel cancer is surgery
surgery treatment for colorectal cancer
Surgery/treatment for colorectal cancer
  • Tumors of the rectum usually are treated as follow:
    • Abdominal perineal resection
    • The sigmoid colon, rectum, and anus are removed through both abdominal and perineal incisions.
    • A permanent sigmoid colostomy is performed.
    • See the critical pathway in(p. 849 in Lemone)
surgery treatment for colorectal cancer99
Surgery/treatment for colorectal cancer
  • Surgical resections may be accompanied by a colostomy for diversion of fecal contents.
  • A colostomy is an ostomy made in the colon.
  • It can be perform if the bowel is obstructed by the tumor, as a temporary measure to promote healing of anastomoses or permanent means of fecal evacuation when the rectum and sigmoid colon have been removed.
types of colostomies
Types of colostomies
  • Sigmoid (most common permanent): the sigmoid colon, rectum and anus are remove through abdominal and perineal incisions.
  • The anal canal is closed and a stoma formed from the proximal sigmoid colon.
  • The stoma is located in the left lower quadrant of the abdomen.
types of colostomies104
Types of colostomies
  • Double -barrel : Two separate stomas are created. The distal colon is not remove but bypassed.
  • The proximal stoma which is functional, diverts fecal flow to the abdominal wall.
  • The distal portion (mucus fistula) expel mucus from the distal colon.
  • This temporary colostomy may be temporary or permanent, being created for cases of trauma, tumor or inflammation.
types of colostomies114
Types of colostomies
  • An emergency procedure used to relieve an intestinal obstruction or perforation is a
    • Transverse loop colostomy: a loop of the transverse colon is brought out of the abdominal wall and suspended over a plastic rod or bridge which prevents it from back into abdomen. Usually temporary.
  • See your text book for nursing care of patient with a colostomy pre-and post-op.
hartmann procedure
The distal portion of the colon is left in place and is oversewn for closure.

This is a temporary colostomy usually done when bowel rest or healing is require such as tumor resection or inflammation of the bowel.

Surgical reconnection or anastomosis of the severe portions of the colon is not done immedially because of the heavy bacterial colonization of the colon would not allow the anastomosis to heal properly.

About 3 to 6 months following a temporary colostomy , the colostomy is close and the anastomosis is performed

Hartmann procedure
radiation therapy
While radiation therapy is not effective as a primary treatment for colon cancer it is recommended as adjunct therapy specially for rectal tumors.

Small rectal cancer may be treated with intracavitary, external,or implantation radiation.

Radiation reduce the recurrences of rectal and pelvic tumors

Radiation therapy
chemotherapy
Chemotherapeutic agents such as oral levamisole and intravenous Flurauracil (5-FU) are used post operative as adjunct therapy for for colorectal cancer.

When radiation and chemotherapy are used in combination after surgery it improves control and survival for patients with stage II and stage III in rectal tumors.

Chemotherapy
nursing care for colorectal cancer
Nursing care is directed at:

Providing emotional support

Teaching about specific diagnostic procedures , pre-op and post-op.

Instruct in colostomy care

Nursing diagnosis

Pain

Alteration in nutrition

Anticipatory grieving

Risk for sexual dysfunction

Nursing care for colorectal cancer
intestinal obstruction
Intestinal Obstruction
  • When the intestinal contens fail to be propelled through the lumen of the bowel.
    • Usually involves the small bowel
      • Mechanical obstruction: Scar tissue, hernia tumor
      • Functional obstruction: Peristalsis problem (paralytic ileus)
causes of intestinal obstruction
Causes of intestinal obstruction
  • Adhesions
  • Incarcerated Hernia
  • Volvulus
  • Foreign bodies
  • Stricture
  • Inflammatory bowel disease(ulcerative colitis).
paralytic ileus
Paralytic ileus
  • Paralytic ileus an impair in the propulsion or forward movement of bowel content. It can be cause by:
    • GI surgery
    • Irritation of the bowel due to inflammation, hemorrhage, peritonitis, or perforation of an organ.
    • Hypokalemia
    • Effects of narcotics or antidiarrhea medications.
what happens in a small obstruction
What happens in a small obstruction
  • Obstruction occurs
    • Gas fluid collect in the area of the bowel proximal.
    • Lumen of bowel distends
    • Swallowed air and gases contributed to further distention.
what happens in a small obstruction123
What happens in a small obstruction
  • Endotoxins and prostanglandins are released
  • Large quantities of fluid and electrolytes are drawn into the area.
  • Further distension occur
what happens in a small obstruction124
What happens in a small obstruction
  • Cycle of intestinal distention, water and sodium and potassium, further reduction in motility occurs.
  • The danger is all of this lead to pressure distention and necrosis of the bowel.
  • Large volume of fluid trapped in the bowel lead to hypovolemic and shock.
signs and symptoms of intestinal obstruction small bowel
Signs and symptoms of intestinal obstruction (small bowel)
  • Cramping or colicky abdominal pain intermittent or increasing in intensity.
  • Vomiting with both high and low obstructions. (becomes feculent with low or distal obstructions)
  • Visible peristalsis waves
signs and symptoms of intestinal obstruction small bowel126
Signs and symptoms of intestinal obstruction (small bowel)
  • Cramping or colicky abdominal pain intermittent or increasing in intensity.
  • Vomiting with both high and low obstructions. (becomes feculent with low or distal obstructions)
  • Visible peristalsis waves
signs and symptoms of intestinal obstruction small bowel127
Signs and symptoms of intestinal obstruction (small bowel)
  • Signs of fluid and electrolytes imbalance
  • Dehydration
  • Fever
  • Later the bowel becomes silent (absent bowel sounds)
laboratory and diagnostic test
Laboratory and Diagnostic Test
  • Abdominal x-ray
  • Bowel contrast x-ray studies(gastrografin)
  • WBC count is often elevated
  • Hemoglobin and hematocrit elevated
  • Serum osmolality is increased
  • Decreased K+ and CL-
management of small bowel obstruction
Management of small bowel obstruction
  • Gastrointestinal decompression
      • 90% of partial bowel obstructions are success fully treated with gastrointestinal decompression.
    • Surgery
      • NGT put in to prevent vomiting and abdominal distention and prevent aspiration of abdominal content. Fluid and electrolytes deficit need to be corrected before surgery.
goals of surgical intervention
Goals of surgical intervention
  • Relieve colonic distention
  • Prevent perforation
  • Remove obstruction
frequent complications with bowel obstructions
Frequent complications with bowel obstructions
  • Fluid electrolytes imbalance
  • Acid base imbalance
  • Hypovolemic shock
  • Perforation/peritonitis
nursing diagnosis135
Nursing diagnosis
  • Alteration in tissue perfusion/Gastrointestinal
  • Fluid volume deficit
  • Ineffective breathing pattern
alteration in tissue perfusion gastrointestinal
Alteration in tissue perfusion/gastrointestinal
  • The same obstruction of the bowel lumen may reduce or block the blood supply to the bowel wall.
    • Monitor V. S
    • Monitor I & O
    • Assess level pain frequently
    • Keep NPO until peristalsis return.
fluid volume deficit
Fluid volume deficit
  • Large collection of fluid in the bowel proximal to the obstruction, the accompanied vomiting, and Nasogastric suction the patient with bowel obstruction usually has problems in this area.
    • Monitor V.S
    • Accurate intake and output/ replace with IVF
    • Measure abdominal girth every 4 hrs.
symptoms of intestinal obstruction large bowel
Symptoms of intestinal obstruction (large bowel)
  • Less common than small bowel obstruction
  • Constipation and abdominal pain are the more common signs and symptoms.
  • Vomiting is a late signs if it happens at all
  • Abdomen is distended with high pitch bowel sounds.
large bowel obstruction
A barium enema is used to confirm a large bowel obstruction and determined its location.

Most common large bowel obstructions occur in the sigmoid segment.

Most common cause is cancer of the bowel.

Gangrene and perforation is the most common potential complications.

Large bowel obstruction
ad