Intestinal Obstruction

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Mechanical intestinal obstruction:
causes:
- volvulus (twisting of the intestine)
- intussusceptions (telescoping of
a segment of the intestine within
itself)
- inflammatory bowel disease,
foreign bodies, strictures,
neoplasms, fecal impaction
Non Mechanical intestinal
obstruction:
“paralytic”, “neurogenic” or
“adynamic ileus” (Infection)
brought about by interference
with the nerve supply to the
Diagnostic tests:
intestine resulting in decreased or
● Flat-plate & upright abdominal
absent peristalsis
x-rays reveals the presence of
causes:
gas and fluid
● handling of the intestine during
● 🡩 Hgb/Hct, BUN & Creatinine
abdominal surgery
(indicative of dehydration)
● Thoracic diseases (rib fracture, MI,
● 🡫 serum Na+, Cl-, K+
pneumonia)
● sigmoidoscopy, colonoscopy,
● Hypokalemia
barium enema, CT scan
● Peritonitis
● Shock
● Vascular obstructions Nursing interventions:
● interference with the blood supply - Monitor F&E balance, prevent
to a portion of the intestine, further imbalance; keep client
resulting in intestinal ischemia NPO and administer IV fluids as
and gangrene of the bowel; ordered
caused by an embolus, - Most clients w/ an obstruction
atherosclerosis have at least an NGT. Accurately
Assessment findings: measure the drainage from
NG/intestinal tube
- high-pitched bowel sounds
- Put in fowler’s position (alleviate
above the level of the obstruction
pressure on diaphragm)
decreased or absent bowel sound
- Encourage nasal breathing to
below the obstruction
minimize swallowing of air and
further abdominal distension
- Institute comfort measures
associated with NG intubation
and intestinal decompression
Prevent complications ASSESSMENT findings:
● Measure abdominal girth daily to - cobblestone
assess for increasing abdominal - Abdominal distention, masses,
distension visible peristalsis
● Assess for S/Sx of peritonitis - Diarrhea (steatorrhea is common
● Monitor urinary output & sometimes bloody)
- constant abdominal pain
CHRONIC INFLAMMATORY BOWEL - low-grade fever
DISORDERS - weight loss (80% of clients)
Be aware NURSE!!! to detect clinical
manifestations of peritonitis, bowel
obstruction & nutritional & fluid
imbalances!!!

2. Ulcerative Colitis (start

rectumm)
Ulcerative and inflammatory condition of
affecting the mucosal lining of the colon
or rectum
cause: UNKNOWN

1. Crohn’s Disease
● an idiopathic inflammatory
disease of the small intestine
(60%), the colon (20%), or both
terminal ileum: the site most
often affected
Causes
Unknown, thought to be autoimmune ASSESSMENT findings
M. paratuberculosis - Board like abdomen
● Genetic predisposition (1st degree Anorexia
& identical twins) Weight loss
Pathology: Fever,
● Deep fissures & ulceration SEVERE diarrhea with Rectal bleeding
develops 🡪 bowel FISTULAS 🡪 Anemia
diarrhea & malabsorption Dehydration
● Chronic pathologic changes Abdominal pain and cramping
include thickening of the bowel
wall 🡪 narrowed lumen &
strictures 🡪 obstruction
 Appendicitis
- Inflammation of the vermiform
appendix that prevents mucus
from passing into the cecum; if
untreated, ischemia, gangrene,
rupture, and peritonitis occur
- Occurs in about 7% of the
population and affects males
more often than females
Causes:
mechanical obstruction (fecaliths,
calcium-phosphate rich mucus &
inorganic salts, worms, tumors, viral
infection, inflammation) may be related
to decreased fiber in the diet and high
intake of refined carbohydrates
kinking of appendix

Crohn’s Disease & Ulcerative

PATHOPHYSIOLOGY:
Colitis Obstruction of the appendix lumen
Nursing interventions: (Crohn’s & UC) (mucosa continues to secrete fluids until
● Maintain NPO during the active pressure w/in the lumen exceeds venous
phase pressure)
● Monitor for complications like 🡫
severe bleeding, dehydration, blood flow to appendix, mucosal
electrolyte imbalance Inflammation and bacterial proliferation
● Monitor bowel sounds, stool and 🡫
blood studies gangrene develops w/in 24-36° due to
● Restrict activities hypoxia
● Administer IVF, electrolytes and 🡫
TPN if prescribed Abscess
● Instruct the patient to AVOID 🡫
gas-forming foods, MILK products Peritonitis
and foods such as whole grains,
nuts, RAW fruits and vegetables
(SPINACH), pepper, alcohol and
caffeine
Diet progression- clear liquid🡪 LOW
residue, high protein diet
Administer drugs
- anti-inflammatory, antibiotics,
steroids, bulk-forming agents and
vitamin/iron supplements
ASSESSMENT FINDINGS Diverticulitis
● Pain starts at the epigastric or Acute inflammation and infection
umbilical region & becomes caused by trapped fecal material and
localized in the “Mc Burney’s bacteria
point” (midway between the - Diverticulum is outpouching of the
umbilicus and the anterior iliac mucosal lining of the GI tract
crest) commonly in the colon
“Blumberg sign” = Rebound tenderness - Diverticula/ Diverticulosis are
“Psoas sign” = lateral position with right multiple outpouchings
hip flexion Causes: Low fiber diet, chronic
“Rovsing’s sign” = right quadrant pain constipation, obesity
when the left is palpated Assessment
“Obturator sign” = pain on external - Dull, steady, cramp-like lower left
rotation of the right thigh quadrant abdominal PAIN
- Nausea & Vomiting worsens with movement,
- ANOREXIA coughing or straining
- Decreased bowel sounds - Low – grade fever
- Fever, low grade (38 – 38.5°C) - Chronic constipation with
- High grade fever = Ruptured!!! episodes of diarrhea
- Nausea and vomitingAbdominal
Diagnostic tests: - distention and tenderness
● 🡩 WBC (above 10,000/cu.mm.) - Occult bleeding, rectal bleeding,
● Elevated acetone in urine change in bowel movement
● Ultrasound & Abdominal x-ray - Signs and symptoms of peritonitis
(detection of fecalith) due to development of abscess or
perforation
Nursing interventions: Diagnostic test:
● Administer ● Colonoscopy, sigmoidoscopy
antibiotics/antipyretics as visualization of diverticula
ordered ● CBC may reveal increased WBC
● Prevent perforation of the ● Barium enema is NOT usually
appendix; don’t give enemas or ordered in cases of acute
cathartics or use heating pad inflammation because of
possibility of perforation
In addition to routine pre-op care for Nursing Management:
appendectomy High fiber diet
- Give support to parents if seeking - Liberal fluid intake of 2,500 to
treatment was delayed 3,000 ml/day.
- Explain necessity of obtaining lab - Avoid nuts and seeds which can
work prior to surgery be trapped in the diverticula.
- Bulk – forming laxatives are
ordered to restore normal bowel
pattern
- IVF and medications
During an acute episode: Nursing Management
- Bed rest High fiber diet
- NPO, then clear liquids to rest the liberal fluid intake
bowel Bulk laxatives
- Avoid high fiber foods to prevent Hot Sitz bath, warm compress, witch
further irritation of the mucosa hazel cream can be applied to decrease
- Gradually increase the fiber when size
the infection/ inflammation Local anesthetic application –
subsides Nupercaine
Pre-op Care
Hemorrhoids - Low residue diet to reduce the
bulk of stool
- These are dilated blood vessels
- Stool softeners
beneath the lining of the skin in
the anal canal Post-op Care
Promotion of comfort
Types
- Analgesics as prescribed
External hemorrhoids – occur below the
- Position: Side – lying position or
anal sphincter
prone position
Internal hemorrhoids – occur above the
- Hot sitz bath 12 to 24 hrs. post-op
anal sphincter
to promote comfort and hasten
healing
Causes
Promotion of elimination
Chronic constipation
- Stool softeners are given as
Pregnancy
prescribed
Obesity
- Analgesic before initial defecation
Prolonged sitting or standing
- Encourage the client to defecate
Wearing constricting clothing
as soon as the urge occurs
Disease conditions like liver cirrhosis,
- Enema as prescribed, using a
RSCHF
small – bore rectal tube
Patient Teaching
Assessment
- Clean rectal area thoroughly after
- Constipation in an effort to
each defecation
prevent pain or bleeding
- Sitz bath at home especially after
associated with defecation
defecation
- Anal PAIN
Avoid constipation by adhering to these
- Rectal bleeding (usually bright
practice :
red- hematochezia)
- High – fiber diet, High fluid intake,
- Anal itchiness
Regular exercise
● Mucous secretion from the anus
- Regular time for defecation, Use
Sensation of incomplete
stool softener until healing is
evacuation of the rectum
complete
Internal hemorrhoids may prolapse,
Notify physician for the following:
usually painless.
- Rectal bleeding, Suppurative
External hemorrhoids are usually painful
drainage, Continued pain on
defecation, Continued
constipation.