DEFINITION: Partial or complete blockage of intestinal ...
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|DEFINITION: Partial or complete blockage of intestinal lumen, though which GI |RELATED DIAGNOSTIC TESTS: |
|contents cannot pass; most often occurs in the small intestine. |- X-ray - shows presence/location of excess fluid and gas |
| |- Barium enema - to locate LBO |
| |- Sigmoidoscopy or colonoscopy |
| |- hematology - may indicate inflammation/infection, hemoconcentration or |
| |bleeding |
| |- Chemistry panel - decrease in Na+, K+ and Cl- are indicators or possible |
| |small intestine obstruction; BUN may be increased from dehydration |
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|ETIOLOGY: |MEDICAL MANAGEMENT: |
|Two causes: |- nasogastric or intestinal tubes - removal of intestinal contents and relief |
|Mechanical obstruction (90 % of intestinal obstructions) |of distention |
|- adhesions (usually post-operative), hernias, tumors, fecal impaction, |- food & fluid restriction |
|inflammation (e.g.: Cohn’s disease), diverticulitis, carcinoma, volvulus |- sigmoidoscopy - removal or reduction of volvulus |
| |- colonoscopy - removal of tumors or polyps |
|Nonmechanical obstruction - neuromuscular or vascular disorder |- surgery - removal of obstruction or obstructed section; resection of bowel or|
|- paralytic (adynamic) ileus, caused by abdominal surgery, inflammatory reactions|creation of ostomy |
|(e.g.: acute pancreatitis, acute appendicitis), electrolyte abnormalities, |- IV - fluid and electrolyte management |
|thoracic or lumbar fractures |- meds - antibiotic and analgesic |
|- mesenteric thrombosis | |
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|PATHOPHYSIOLOGY: Fluid, gas and other material accumulate on proximal side of |NURSING MANAGEMENT: |
|obstruction, causing distension in that region and collapse of the distal region.|- Monitor I & O, restrict food and fluid intake, monitor weight |
|Increased pressure in the lumen yields leakage of fluid into the peritoneal |- Administer IV fluids and meds |
|cavity, which can lead to edema, congestion, necrosis from impaired blood supply |- Assess bowel sounds |
|and possible rupture of the bowel. Retention of fluid in the abdomen can |- Measure and record abdominal girth |
|decrease circulating vascular volume, resulting in hypotension and hypovolemic |- Monitor labs (see above) |
|shock. |- Maintain in semi-Fowler’s position; assist in achieving comfortable position |
|Strangulation of circulation of the obstructed intestine can lead to necrosis |- Monitor COCA of stools and vomitus |
|(gangrene). |- Maintain function, position and patency of NG or intestinal tube; provide |
| |nose and mouth care |
| |- Offer emotional support, provide information/instruction of ostomy |
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|SIGNS & SYMPTOMS: |HEALTH DEVIATION SELF-CARE REQUISITES: |
|- nausea |- Keep f/u appointments |
|- vomiting: may be orange-brown, foul-smelling, feculent |- Know meds |
|- abdominal pain/cramping |- Know s/s diverticulitis and monitor COCA of stools |
|- abdominal distention |- avoid constipating foods |
|- constipation |- perform ostomy care |
|- singultus | |
|- diminished or absent bowel sounds; may be high-pitched above area of | |
|obstruction | |
|- elevated temperature, esp. in cases of strangulation or peritonitis | |
|- weight loss | |
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|REFERENCE PAGES: | |
|- Lewis & Collier, Medical-Surgical Nursing, 4th Edition, p. 1235-1239 | |
|- Boyd & Tower, Medical-Surgical Nursing, 2nd Edition, p. 155-157 | |
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